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There have been no previous meta-analytic studies that have looked at the prevalence of insomnia symptoms in different COVID-19 groups using a single assessment instrument to evaluate insomnia symptoms while maintaining data homogeneity. The current review's associated goal is to undertake an individual participant data (IPD) analysis to further investigate past meta-analyses, a method that has been shown to be more robust than standard meta-analyses.Only studies that used the Insomnia Severity Index (ISI) to assess insomnia are used in this analysis. The IPDMA was performed and registered in PROSPERO in compliance with the PRISMA IPD Statement (CRD42021275817). From November 2019 to August 2021, researchers explored seventeen databases and six preprint services for relevant studies.The pooled estimate of insomnia symptoms (subthreshold and clinically significant) was 52.57%. An estimated 16.66% of the population suffered from clinically significant insomnia, of which 13.75% suffered from moderate insomnia, and 2.50% suffered from severe insomnia. The different populations' grouping had no statistically significant differences in the prevalence of insomnia symptoms. Insomnia symptoms did not appear to be associated with age or sex.Our findings imply that the COVID-19 pandemic is linked to a significant rise in subthreshold insomnia symptoms, but not to moderate or severe insomnia. Educating people from all walks of life about the importance of sleep and the risk of acquiring insomnia symptoms during this or future pandemics should be a top concern.

Data from the Global Burden of Disease Study 2019 were used to report the burden of migraine in 204 countries and territories during the period 1990 to 2019, through a systematic analysis of point prevalence, annual incidence, and years lived with disability (YLD). In 2019, the global age-standardised point prevalence and annual incidence rate of migraine were 14,107.3 (95% Uncertainty Interval [UI] 12,270.3-16,239) and 1142.5 (95% UI 995.9-1289.4) per 100,000, an increase of 1.7% (95% UI 0.7%-2.8%) and 2.1% (95% UI 1.1%-2.8%) since 1990, respectively. Moreover, the global age-standardised YLD rate in 2019 was 525.5 (95% UI 78.8-1194), an increase of 1.5% (95% UI -4.4% to 3.3%) since 1990. The global point prevalence of migraine in 2019 was higher in females and increased by age up to the 40 to 44 age group, then decreased with increased age. Belgium (22,400.6 [95% UI: 19,305.2-26,215.8]), Italy (20,337.7 [95% UI: 17,724.7-23,405.8]), and Germany (19,436.4 [95% UI: 16,806.2-22,810.3]) had the 3 highest age-standardised point prevalence rates for migraine in 2019. In conclusion, there were large intercountry differences in the burden of migraine, and this burden increased significantly across the measurement period. These findings suggest that migraine care needs to be included within the health system to increase population awareness regarding the probable risk factors and treatment strategies especially among young adults and middle-aged women, as well as to increase the data on migraines.

Aims To provide the first systematic analysis of the burden and underlying causes of heart failure (HF) in 195 countries and territories from 1990 to 2017. Methods and results We collected detailed information on prevalence, years lived with disability (YLDs), and underlying causes of HF from the Global Burden of Disease study 2017. Numbers and age-standardized rates of HF prevalence and YLDs were compared by age, sex, socio-demographic index (SDI), and location. The proportions of HF age-standardized prevalence rates due to 23 underlying causes were also presented. Globally, the age-standardized prevalence and YLD rates of HF in 2017 were 831.0 and 128.2 per 100 000 people, a decrease of −7.2% and −0.9% from 1990, respectively. Nevertheless, the absolute numbers of HF prevalent cases and YLDs have increased by 91.9% and 106.0% from 1990, respectively. There is significant geographic and socio-demographic variation in the levels and trends of HF burden from 1990 to 2017. Among all causes of HF, ischaemic heart disease accounted for the highest proportion (26.5%) of age-standardized prevalence rate of HF in 2017, followed by hypertensive heart disease (26.2%), chronic obstructive pulmonary disease (23.4%). Conclusion HF remains a serious public health problem worldwide, with increasing age-standardized prevalence and YLD rates in countries with relatively low SDI. More geo-specific strategies aimed at preventing underlying causes and improving medical care for HF are warranted to reduce the future burden of this condition.

Aims The aim of this study was to estimate the burden and risk factors for ischaemic heart disease (IHD) in 195 countries and territories from 1990 to 2017. Methods and results Data from the Global Burden of Disease Study 2017 were used. Prevalence, incidence, deaths, years lived with disability (YLDs), and years of life lost (YLLs) were metrics used to measure IHD burden. Population attributable fraction was used to estimate the proportion of IHD deaths attributable to potentially modifiable risk factors. Globally, in 2017, 126.5 million [95% uncertainty interval (UI) 118.6 to 134.7] people lived with IHD and 10.6 million (95% UI 9.6 to 11.8) new IHD cases occurred, resulting in 8.9 million (95% UI 8.8 to 9.1) deaths, 5.3 million (95% UI 3.7 to 7.2) YLDs, and 165.0 million (95% UI 162.2 to 168.6) YLLs. Between 1990 and 2017, despite the decrease in age-standardized rates, the global numbers of these burden metrics of IHD have significantly increased. The burden of IHD in 2017 and its temporal trends from 1990 to 2017 varied widely by geographic location. Among all potentially modifiable risk factors, age-standardized IHD deaths worldwide were primarily attributable to dietary risks, high systolic blood pressure, high LDL cholesterol, high fasting plasma glucose, tobacco use, and high body mass index in 2017. Conclusion Our results suggested that IHD remains a major public health challenge worldwide. More effective and targeted strategies aimed at implementing cost-effective interventions and addressing modifiable risk factors are urgently needed, particularly in geographies with high or increasing burden.

Examine the associations of sleep problems with health-risk behaviors and psychological well-being in a representative sample of Canadian adults.Cross-sectional.The 2011-2012 Canadian Community Health Survey (CCHS, conducted by Statistics Canada).Of all individuals taking part in the 2011-2012 CCHS, 42,600 participants aged ≥18 years from five provinces/territories (Nova Scotia, Quebec, Manitoba, Alberta, and Yukon) who participated in the sleep survey module were selected for this study.Health conditions were self-reported. Sleep problems referred to extreme sleep durations (either5 or ≥10 hours) and insomnia symptom. Health-risk behaviors included physical inactivity, daily smoking, highly sedentary behavior, and insufficient fruit and vegetable consumption. Worse psychological well-being included having worse self-rated general health, worse self-rated mental health, and worse sense of belonging, and being dissatisfied with life.The participants represented 10,614,600 Canadian adults aged ≥18 years from the five abovementioned provinces/territories. A significantly higher prevalence of all health-risk behaviors and worse psychological well-being was found among participants with extreme sleep durations (than those with 7 to8 hours) and insomnia symptom (than those without insomnia symptom). After multivariate adjustment, extreme sleep durations and insomnia symptom were still independently associated with increased odds of all health-risk behaviors and worse psychological well-being.Both extreme sleep durations and insomnia symptom were independently associated with health-risk behaviors and worse psychological well-being among Canadian adults.

Aims To estimate the prevalence, incidence, mortality, and risk factors for atrial fibrillation (AF) in 195 countries and territories from 1990 to 2017. Methods and results Following the methodologies used in the Global Burden of Disease Study 2017, the prevalence, incidence, and mortality of AF were analysed by age, sex, year, socio-demographic index (SDI), and location. The percentage contributions of major risk factors to age-standardized AF deaths were measured by population attributable fractions. In 2017, there were 37.57 million [95% uncertainty interval (UI) 32.55–42.59] prevalent cases and 3.05 million (95% UI 2.61–3.51) incident cases of AF globally, contributing to 287 241 (95% UI 276 355–304 759) deaths. The age-standardized rates of prevalent cases, incident cases, and deaths of AF in 2017 and their temporal trends from 1990 to 2017 varied significantly by SDI quintile and location. High systolic blood pressure was the leading risk factor for AF age-standardized deaths [34.3% (95% UI 27.4–41.5)] in 2017, followed by high body mass index [20.7% (95% UI 11.5–32.2)] and alcohol use [9.4% (95% UI 7.0–12.2)]. Conclusion Our study has systematically and globally assessed the temporal trends of AF, which remains a major public heath challenge. Although AF mainly occurred in developed countries, the unfavourable trend in countries with lower SDI also deserves particular attention. More effective prevention and treatment strategies aimed at counteracting the increase in AF burden should be established in some countries.

Previous studies revealed that high serum uric acid (SUA) levels correlated with increased triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio. However, evidence is lacking regarding whether TG/HDL-C is an independent risk factor or just a simple marker of hyperuricemia. We aimed to investigate the relationship between TG/HDL-C and the risk of hyperuricemia in Chinese population. This retrospective cohort study involved 15,198 subjects (43.14 ± 13.13 years, 54.9% men) who were free of hyperuricemia at baseline. The association between TG/HDL-C and the risk of hyperuricemia, in the total sample and stratified by subgroups, was examined by multiple logistic regression analyses. During 4 years follow-up, hyperuricemia occurred in 2365 (15.6%) participants. The cumulative incidence of hyperuricemia was significantly elevated with increasing TG/HDL-C quartiles (5.9, 10.8, 18.4, and 27.5%, respectively). After multivariate adjustment, the odds ratio for hyperuricemia in the highest compared with the lowest quartile of TG/HDL-C was 1.80 (95% confidence interval [CI] 1.49, 2.18), and each SD increment of TG/HDL-C ratio caused a 10% additional risk for hyperuricemia. Moreover, subgroup analyses showed that the association between TG/HDL-C and the risk of hyperuricemia was more pronounced in women and normal-weight adults. The results were consistent when analyses were restricted to participants without metabolic syndrome. TG/HDL-C ratio was positively related to the risk of hyperuricemia in Chinese population, particularly in women and normal-weight individuals. These findings suggested the potential of TG/HDL-C ratio to serve as an independent risk indicator in the prevention of hyperuricemia.

Background This article presents the first detailed analysis of the prevalence and disability burden of Guillain–Barré syndrome (GBS) from 1990 to 2019 by cause, age, sex, and Socio-demographic Index (SDI) in 204 countries and territories. Methods Data from the Global Burden of Diseases Study (GBD) 2019 were used. GBD 2019 modelled the prevalence of GBS using hospital and claims data. Years lived with disability (YLDs) were estimated as the product of the GBS prevalence and the disability weight. This article also reported proportions in the age-standardised prevalence rate that were due to six underlying causes of GBS. Results In 2019, there were 150,095 [95% uncertainty intervals (UI) 119,924 to 188,309] total cases of GBS worldwide, which resulted in 44,407 (95% UI 28,016 to 64,777) YLDs. Globally, there was a 6.4% (95% UI 3.6 to 9.5) increase in the age-standardised prevalence of GBS per 100,000 population between 1990 and 2019. High-income Asia Pacific [1.9 (95% UI: 1.5 to 2.4)] and East Asia [0.8 (95% UI: 0.6 to 1.0)] had the highest and lowest age-standardised prevalence rates (per 100,000), respectively, in 2019. Nationally, Japan [6.4 (95% UI: 5.3 to 7.7)] and China [0.8 (95% UI: 0.6 to 1.0)] had the highest and lowest age-standardised prevalence rates (per 100,000). The age-standardised burden of GBS increased with increasing age and was higher in males in all age groups. Furthermore, the age-standardised prevalence of GBS (per 100,000) had a positive association with the level of development, as measured by SDI, although this association was not strong. Upper respiratory infections and unknown causes accounted for the highest proportions of underlying causes. Conclusions Globally, the prevalence of GBS continues to increase. Geographical differences and strategies aimed at preventing infectious diseases should be considered in future health policy planning and decision-making processes. This study had several limitations, such as using the same disability weight for all causes and a reliance on hospital- and self-reported data, which should be addressed in future research.

IntroductionThe objective of this study is to examine the temporal trends and patterns of regional and socioeconomic disparities in cardiovascular disease (CVD) in Canada during 2005–2016.MethodsA total of 670 000 adults aged ≥20 years who participated in the Canadian Community Health Surveys between 2005 and 2016 were enrolled for this study. CVD referred to heart disease and stroke in this study. Equivalised household income was used as a proxy of socioeconomic status. Absolute and relative socioeconomic inequalities were measured by slope index of inequality (SII) and relative index of inequality (RII), respectively.ResultsIn 2015/2016, the overall age-adjusted and sex-adjusted prevalence of heart disease and stroke was 4.80% (95% CI 4.61% to 4.98%) and 1.25% (95% CI 1.13% to 1.36%), respectively. Trend analyses suggested a significant decline in the age-adjusted and sex-adjusted prevalence of heart disease (P for trend ConclusionGeographical and socioeconomic disparities should be taken into account during the further efforts to strengthen preventive measures and optimise healthcare resources for heart disease and stroke in Canada.

This study aimed to explore the association between sleep problems and health-related quality of life (HRQoL) in Canadian adults with chronic diseases, and whether mental illness can mediate the association.Data were drawn from the Canadian Community Health Survey, 2015. A total of 10,900 participants aged ≥18 years and diagnosed with chronic diseases were enrolled in this study.Of these participants, 23.6% (95% CI 22.1, 25.2) suffered from severe impairment of HRQoL. Extreme sleep durations, including both short (5, 5 to6, and 6 to7 h) and long (9 to10, and ≥10 h) sleep durations, were significantly associated with severe impairment of HRQoL (compared to 7 to8 h). Insomnia was also independently associated with severe impairment of HRQoL when compared to those without insomnia. In the mediation analyses, mental illness was shown to partly mediate the associations of extreme sleep durations and insomnia with severe impairment of HRQoL.In conclusion, both extreme sleep durations and insomnia were independently associated with severe impairment of HRQoL in adults with chronic diseases, and mental illness partly mediated the association.

Hypertensive heart disease (HHD) is a major cause of global morbidity and mortality. Understanding its current burden among various countries and populations is crucial for formulating effective strategies for preventing and managing HHD. This study aimed to use the estimates from the Global Burden of Disease Study 2017 to describe the prevalence, mortality, and disability-adjusted life years for HHD for 195 countries and territories from 1990 to 2017. Worldwide, the age-standardized prevalence rate of HHD in 2017 was 217.9 (95% uncertainty interval [UI], 184.1–254.1) per 100 000 people, an increase of 7.4% (95% UI, 5.0–9.7) from 1990. The global age-standardized mortality and disability-adjusted life year rates of HHD were 12.3 (95% UI, 9.0–13.2) and 209.4 (95% UI, 160.5–226.3) per 100 000 people, a decrease of −19.3% (95% UI, −29.7 to −8.1) and −24.0% (95% UI, −31.0 to −13.7) from 1990, respectively. The global age-standardized prevalence rate of HHD was higher in females and increased with age. Between 1990 and 2017, Bolivia (51.3% [95% UI, 29.6–84.5]) and Maldives (32.3% [95% UI, 22.9–43.8]) showed the greatest increases in age-standardized prevalence rates. Generally, a negative association was found between the age-standardized disability-adjusted life year rates and Sociodemographic index at the regional and national levels. Our results suggest that HHD is a major public health challenge worldwide with an increasing prevalence rate over the past decades. Efforts to improve public awareness and management of high blood pressure and HHD, especially for vulnerable populations, were necessary.

Background: Dupilumab (Dupixent®) is a monoclonal antibody that inhibits IL-4 and IL-13 signaling used for the treatment of allergic diseases. Whilst biological therapy is generally associated with an increased risk of infectious disease, prior studies have suggested Dupilumab may be protective. Objective: We investigated the link between Dupilumab therapy and SARS-CoV-2 infection. Methods: We carryied out a comprehensive data-mining and disproportionality analysis of the WHO global pharmacovigilance database. One asymptomatic COVID-19 case, 106 cases of symptomatic COVID-19, and 2 cases of severe COVID-19 pneumonia were found. Results: Dupilumab treated patients were at higher risk of COVID-19 (with an IC0.25 of 3.05), even though infections were less severe (IC0.25 of -1.71). The risk of developing COVID-19 was significant both among males and females (with an IC0.25 of 0.24 and 0.58, respectively). The risk of developing COVID-19 was significant in the age-group of 45-64 years (with an IC0.25 of 0.17). Limitations: Limitations include: the heterogeneous nature of the database sources. Furthermore, a direct causal relationship cannot be inferred from the current investigation. Conclusion: Dupilumab use was found to reduce COVID-19 related severity. Further studies are needed to better understand the immunological mechanisms and clinical implications of these findings.

BackgroundTo estimate the burden of myocarditis (MC) and cardiomyopathy for 195 countries and territories from 1990 to 2017.MethodsWe collected detailed information on MC and cardiomyopathy between 1990 and 2017 from the Global Burden of Disease study (GBD) 2017. Cardiomyopathy was divided into two types in GBD 2017, including alcoholic cardiomyopathy (AC) and other cardiomyopathy (OC). All estimates were presented as counts, age-standardised rates per 100 000 people and percentage change, with 95% uncertainty intervals (UIs).ResultsWorldwide, there were 1.80 million (95% UI 1.64 to 1.98) cases of MC, 1.62 million (95% UI 1.37 to 1.90) cases of AC and 4.21 million (95% UI 3.63 to 4.87) cases of OC, contributing to 46 486 (95% UI 39 709 to 51 824), 88 890 (95% UI 80 935 to 96 290) and 233 159 (95% UI 213 677 to 248 289) deaths in 2017, respectively. At the national level, the age-standardised prevalence rates varied by 10.4 times for MC, 252.6 times for AC and 38.1 times for OC; and the age-standardised death rates varied by 43.9 times for MC, 531.0 times for AC and 43.3 times for OC. Between 1990 and 2017, despite the decreases in age-standardised rates, the global numbers of prevalent cases and deaths have significantly increased for all the diseases. Females had greater decreases in age-standardised prevalence and death rates than males for all the diseases.ConclusionsMC, AC and OC remain important global public health problems, and there are significant geographic variations in the burden for all these diseases. More effective and geo-specific strategies are necessary to counteract and mitigate the future burden of these diseases.Key questionsWhat is already known?➢Myocarditis (MC), alcoholic cardiomyopathy (AC) and other cardiomyopathy (OC) impose a substantial economic burden on healthcare systems. Studies that have systematically assessed the global, regional, and national burden of these diseases are still scarce.What are the new findings?➢Globally, there were an estimated 1.80 million (95% uncertainty interval (UI) 1.64 to 1.98) cases of MC, 1.62 million (95% UI 1.37 to 1.90) cases of AC and 4.21 million (95% UI 3.63 to 4.87) cases of OC in 2017.➢The global numbers of deaths due to MC, AC, and OC in 2017 were 46 486 (95% UI 39 709 to 51 824), 88 890 (95% UI 80 935 to 96 290) and 233 159 (95% UI 213 677 to 248 289), respectively.➢Across 21 world regions, the highest age-standardised prevalence rates of MC, AC and OC were seen in High-income Asia Pacific, Eastern Europe and Southern Sub-Saharan Africa, respectively. While the highest age-standardised death rates of MC, AC and OC were seen in Oceania, Eastern Europe and Central Europe, respectively.➢Despite the decreases in age-standardised rates, the global numbers of prevalent cases and deaths of MC, AC and OC have significantly increased between 1990 and 2017.What do the new findings imply?➢Our findings suggested that total numbers of prevalent cases and deaths of MC, AC and OC are increasing worldwide. More effective and geo-specific strategies aimed at counteracting and mitigating the future burden of these diseases are warranted.

Nonalcoholic fatty liver disease (NAFLD) is an increasingly prevalent liver pathology marked by hepatic steatosis and commonly accompanied by systematic inflammation and metabolic disorder. Despite an accumulating number of studies, no pharmacological strategy is available to treat this condition in the clinic. The current work applied extensive gain- and loss-of-function approaches to identify the key immune factor leukocyte immunoglobulin-like receptor B4 (LILRB4) as a negative regulator of NAFLD. The hepatocyte-specific knockout of LILRB4 (LILRB4-HKO) significantly exacerbated high-fat diet (HFD)-induced insulin resistance, glucose metabolic imbalance, hepatic lipid accumulation, and systematic inflammation in mice, whereas LILRB4 overexpression in hepatocytes showed a completely opposite phenotype relative to that of LILRB4-HKO mice when compared to their corresponding controls. Further investigations on molecular mechanism demonstrated that LILRB4 recruit SHP1 for inhibiting TRAF6 ubiquitination and subsequently inactivating NF-κB and MAPK cascades. From a therapeutic perspective, the overexpression of LILRB4 in a genetic model of NAFLD, ob/ob mice, largely reversed the inherent hepatic steatosis, inflammation, and metabolic disorder. Conclusions: Targeting hepatic LILRB4 to improve its expression or activation might represent a promising strategy for the treatment of NAFLD as well as related liver and metabolic diseases. This article is protected by copyright. All rights reserved.

Background and Purpose The gut-liver axis is associated with the progression of non-alcoholic fatty liver disease (NAFLD). Targeting the gut-liver axis and bile acid-based pharmaceuticals are potential therapies for NAFLD. The effect of tauroursodeoxycholic acid (TUDCA), a candidate medicine for NAFLD, on intestinal barrier function, intestinal inflammation, gut lipid transport and microbiota composition in a murine NAFLD model were analysed. Experimental Approaches An NAFLD mouse model was established by feeding mice with a high-fat diet (HFD) for 16 weeks. TUDCA was orally administered during the last 4 weeks. The expression levels of intestinal tight junction genes, lipid metabolic and inflammatory genes were determined by q-PCR. Tissue inflammation was evaluated by haematoxylin and eosin (H&E) staining. The gut microbiota was analysed by 16S rRNA gene sequencing. Key Results TUDCA administration attenuated HFD-induced hepatic steatosis, inflammatory responses, obesity and insulin resistance in mice. Moreover, TUDCA attenuated gut inflammatory responses as manifested by decreased intestinal histopathology scores and inflammatory cytokines. In addition, TUDCA improved intestinal barrier function involving increased levels of tight junction molecules and a solid chemical barrier. The components involved in ileum lipid transport were also reduced by TUDCA administration in HFD-fed mice. Finally, TUDCA administration in mice showed different gut microbiota composition compared with that in HFD-fed mice and a similar composition to that in normal chow diet (NCD)-fed mice. Conclusion and Implications TUDCA attenuates the progression of HFD-induced NAFLD in mice by ameliorating gut inflammation, improving intestinal barrier function, decreasing intestinal fat transport and modulating intestinal microbiota composition.

Key Points Question What are the trends and patterns of regional and socioeconomic disparities in cardiovascular risk factors in Canada from 2005 to 2016? Findings This survey study of 670 000 adults found a significant increase in the prevalence of hypertension, diabetes, and obesity but a significant decrease in the prevalence of current smoking, with prevalence rates varying widely across health regions. In addition to obesity among men, persistent absolute and relative socioeconomic inequalities were observed for all risk factors. Meaning These findings suggest that geographic and socioeconomic gaps should be considered and addressed in future cardiovascular health strategies in Canada., This survey study investigates the temporal trends, regional variations, and socioeconomic disparities in major cardiovascular risk factors in Canada from 2005 to 2016., Importance Cardiovascular disease remains the second leading cause of death in Canada. Monitoring and tracking the trends and disparities in major cardiovascular risk factors could provide benchmarks for future cardiovascular health strategies. Objective To investigate the temporal trends, regional variations, and socioeconomic disparities in major cardiovascular risk factors in Canada from 2005 to 2016. Design, Setting, and Participants This repeated cross-sectional survey study included adults aged 20 years and older from 6 Canadian Community Health Survey cycles between 2005 and 2016. Cardiovascular risk factors included hypertension, diabetes, obesity, and current smoking. Socioeconomic status was measured using equivalized household income. Data analysis was performed from September 2019 to April 2020. Exposures A total of 112 health regions and socioeconomic status. Main Outcomes and Measures Age- and sex-adjusted prevalence of hypertension, diabetes, obesity, and current smoking by year; health regions; and socioeconomic status. Absolute numbers were rounded to base 100 for confidentiality purposes, and percentages were based on weighted numbers. Slope index of inequality (SII) and relative index of inequality (RII) were calculated to assess absolute and relative socioeconomic inequalities, respectively. Results A total of 670 000 respondents (329 000 [49.1%] men; 341 000 [50.9%] women) aged 20 years and older from 6 survey cycles were enrolled for this study. The largest age group was those aged 40 to 59 years (eg, 2005 cycle: 40.2% [95% CI, 39.9%-40.6%]). In the 2015/2016 cycle, the overall age- and sex-adjusted prevalence rates of hypertension, diabetes, obesity, and current smoking were 20.7% (95% CI, 20.4%-21.1%), 7.2% (95% CI, 7.0%-7.5%), 20.1% (95% CI, 19.7%-20.6%), and 17.8% (95% CI, 17.4%-18.2%), respectively. From 2005 to 2016, there was a significant increase in the prevalence of hypertension, diabetes, and obesity (eg, prevalence of diabetes in both sexes, 2005: 5.8% [95% CI, 5.6%-6.0%]; 2015/2016: 7.2% [95% CI, 7.0%-7.5%]; P

Background Non-alcoholic fatty liver disease (NAFLD), recognized as the liver manifestation of metabolic syndrome, is highly prevalent in the general population. Recent studies suggest that lipid accumulation product is significantly associated with metabolic abnormalities. The aim of this study was to assess the accuracy of lipid accumulation product (LAP) as an effective screening tool for diagnosing NAFLD in the general population. Methods A total of 40,459 subjects aged ≥18 years were enrolled in this cross-sectional study. LAP was calculated as [waist circumference (cm) – 65] × triglyceride concentration (mmol//L) in men and [waist circumference (cm) – 58] × triglyceride concentration (mmol/L) in women. Multiple logistic regression and receiver operating characteristic (ROC) analyses were performed. Results According to multiple logistic regression analyses, LAP was significantly associated with a higher prevalence and severity of NAFLD in both men and women. When assessed using ROC curve analyses, LAP exhibited high diagnostic accuracy for identifying NAFLD, and the areas under the curves (AUC) in men and women were 0.843 (95% CI 0.837, 0.849) and 0.887 (95% CI 0.882, 0.892), respectively. After further analyzed in different age groups, the diagnostic accuracy of LAP was found to be significantly better in younger age groups (aged 18-34 for men; aged 18-34 and 35-44 years for women) for both sexes. Conclusions LAP is significantly associated with the presence and severity of NAFLD, and has a high diagnostic accuracy for identifying NAFLD in the general population. The diagnostic accuracy of LAP was especially high among younger age groups. Electronic supplementary material The online version of this article (doi:10.1186/s12986-017-0206-2) contains supplementary material, which is available to authorized users.

Background The substantial burden of physical and mental comorbidity is increasingly gaining attention, but a comprehensive evaluation of this is limited in Canada. This study aimed to investigate the prevalence of physical and mental comorbidity and its implications in Canada. Methods We used nationally representative data from Canadian Community Health Survey, 2014. We included individuals who were aged ≥18 years and excluded those who had missing information on physical or mental disorders. Chronic diseases referred to both physical and mental disorders. Results Respondents included in our analysis represented 27,221,856 Canadians aged ≥18 years. Of these, 53.9% (95% CI 53.1–54.6) had one or more chronic diseases, 11.5% (95% CI 11.0–12.0) had mental disorder, and 8.4% (95% CI 8.0–8.8) had physical and mental comorbidity. Compared with those without chronic diseases, people with one or more chronic diseases had higher sex- and age-adjusted prevalence of severe impairment of health-related quality of life (HRQoL), suicidal ideation, and healthcare utilization; and the risks increased consistently with the number of chronic diseases. However, among those with the same number of chronic diseases, people with mental disorder or physical and mental comorbidity were more likely to have these adverse consequences than people with only physical disorders. Limitations Our study was based on self-reported data, and included only major chronic diseases rather than all probable chronic diseases. Conclusions Physical and mental comorbidity is prevalent in Canada and should be addressed with appropriate interventions considering its excessive adverse impact on HRQoL, suicidal ideation and healthcare utilization.

Background Regulator of G protein signaling 6 ( RGS 6) is an important member of the RGS family and produces pleiotropic regulatory effects on cardiac pathophysiology. However, the role of RGS 6 protein in cardiomyocytes during angiotensin II – and pressure overload–induced cardiac hypertrophy remain unknown. Methods and Results Here, we used a genetic approach to study the regulatory role of RGS 6 in cardiomyocytes during pathological cardiac hypertrophy. RGS 6 expression was significantly increased in failing human hearts and in hypertrophic murine hearts. The extent of aortic banding–induced cardiac hypertrophy, dysfunction, and fibrosis in cardiac‐specific RGS 6 knockout mice was alleviated, whereas the hearts of transgenic mice with cardiac‐specific RGS 6 overexpression exhibited exacerbated responses to pressure overload. Consistent with these findings, RGS 6 also facilitated an angiotensin II –induced hypertrophic response in isolated cardiomyocytes. According to the mechanistic studies, RGS 6 mediated cardiac hypertrophy by directly interacting with apoptosis signal–regulating kinase 1, which further activates the P38‐c‐ JUN N‐terminal kinase 1/2 signaling pathway. Conclusions Based on our findings, RGS 6 aggravates cardiac hypertrophy, and the RGS 6‐apoptosis signal–regulating kinase 1 pathway represents a potential therapeutic target to attenuate pressure overload–driven cardiac remodeling.

PURPOSE To determine whether preoperative renin-angiotensin system (RAS) inhibitor use within 7 days of noncardiac surgery is associated with a lower incidence of postoperative acute kidney injury (AKI) in hypertensive patients. MATERIALS AND METHODS We retrospectively analyzed 12,545 hypertensive patients undergoing noncardiac surgery at the Third Xiangya Hospital of Central South University from February 2007 to November 2015. According to the use of RAS inhibitors within 7 days of surgery, the patients were divided into a RASI group and a non-RASI group. We used a multivariable logistic regression model and propensity score matching (PSM) analysis to examine the association between preoperative RAS inhibitor use and postoperative AKI incidence. RESULTS Among the 12,545 hypertensive patients undergoing noncardiac surgery who met the inclusion/exclusion criteria, 18.74% received preoperative RAS inhibitor treatment within 7 days of surgery. After PSM, 2,192 patients in each group were matched successfully. The incidence of postoperative AKI in the RASI group was significantly lower than that in the non-RASI group (7.39% vs. 12.32%, p

The aim of this study was to assess the correlation between blood lead levels and both serum uric acid and hyperuricemia in adult residents living within an area of China with lead pollution. We conducted a cross-sectional analysis of 2120 subjects (1180 of whom were male) between the ages of 20 and 75 years who had undergone health examinations at the Centers for Disease Control and Prevention (CDC) in a lead-polluted area of China between June 2013 and September 2014. Blood lead was positively correlated with serum uric acid in both males (r = 0.095, p = 0.001) and females (r = 0.134, p &lt, 0.001). Multivariate linear regression analysis demonstrated that for males, blood lead (p = 0.006), age (p = 0.001), current smoking (p = 0.012), education (p = 0.001), triglycerides (TG) (p &lt, 0.001), and serum creatinine (p &lt, 0.001) were independently associated with serum uric acid. For females, blood lead (p &lt, 0.001), body mass index (BMI) (p = 0.009), and TG (p &lt, 0.001) were independently associated with serum uric acid. After multiple adjustments, blood lead was significantly associated with a higher prevalence of hyperuricemia when female subjects were categorized into quartiles (for the highest quartile vs. the lowest quartile, odds ratio (OR) = 2.190, 95% confidence interval (CI): 1.106–4.338, p = 0.025), however, no such association was observed for male subjects. Continuous lead exposure has an independent impact on serum uric acid for both males and females, although this impact is more pronounced for females than for males. Lead exposure is significantly associated with hyperuricemia for females but not for males.

Background/Aims: To examine the relationships among blood lead levels, blood pressure and kidney function in a population-based sample of adults in an area of China with lead pollution. Methods: This cross-sectional study included a sample of 1447 adults older than 20 years of age who underwent physical examinations in hospitals within a lead-polluted area of China from January to December 2013. Results: Blood lead levels were high among the local population (152.47µg/L) and did not change with age (P=.182). Overall, changes in both systolic blood pressure (SBP) and diastolic blood Pressure (DBP) were associated with changes in blood lead level (P=.012, P=.001), whereas BUN and CCr did not change along with the blood lead level (P>.05). This relationship was strongest among people 20-45 years of age; in this group, the beta coefficients for SBP and DBP were 0.009 (0.003), P=.001 and 0.005 (0.002), P=.004, respectively. Compared with young men, young women's blood pressures were more affected by blood lead levels (beta for SBP=0.031 for women vs. 0.008 for men; beta for DBP=0.015 for women vs. 0.005 for men). Conclusion: Continuous lead exposure causes increased blood lead levels among local residents. Blood lead levels are positively associated with both SBP and DBP increases among adults aged 20-44 years. The relationships between blood lead levels and SBP and DBP are most pronounced in young women. Chronic saturnism does not increase blood pressure by altering kidney function. These results provide support for continued efforts to control blood pressure in the population living in a lead-polluted region of China, particularly in young women.

Objectives: To determine whether healthy lifestyle decreases the risk of developing hypertension in pre-hypertensive patients. Study design: A longitudinal study. Setting & participants: Randomly selected pre-hypertensive young adults 20-45 years old without any vascular disease such as stroke or diabetes. Predictors: Four lifestyle factors (a body mass index [BMI] of 18.5-24.9 kg/m2, regular physical activity, no alcohol use and 6-8 h of sleep per day), individually and in combination. Outcomes: Hypertension was defined as a systolic blood pressure (SBP) ≥ 140 mmHg, or a diastolic BP (DBP) ≥ 90 mmHg or self-reported hypertension. Measurements: Multivariate adjusted Cox proportional hazards. Results: During a median follow-up of 4.7 years, 1009 patients were enrolled in our study, and 182 patients developed hypertension. Compared with a BMI of 18.5-24.9 kg/m2, a BMI of 25-30 kg/m2 and a BMI of >30 kg/m2 were associated with an increased risk of hypertension occurrence (hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.19-2.84 and HR, 2.62; 95% CI, 1.01-6.80, respectively). Compared with sleep duration of >8 h/day, 6-8 h/day of sleep was associated with a lower risk of hypertension occurrence (HR, 0.40; 95% CI, 0.18-0.86). There were no statistically significant associations between physical activity or alcohol use and hypertension occurrence (P>0.05). Limitation: All lifestyle factors were measured only once. Conclusion: Healthy BMI (18.5-24.9 kg/m2) and sleep duration (6-8 h/day) were associated with a lower risk of the occurrence of hypertension in pre-hypertension patients.

The gut-liver axis is associated with the progression of non-alcoholic fatty liver disease (NAFLD). Targeting the gut-liver axis and bile acid-based pharmaceuticals are potential therapies for NAFLD. The effect of tauroursodeoxycholic acid (TUDCA), a candidate drug for NAFLD, on intestinal barrier function, intestinal inflammation, gut lipid transport and microbiota composition was analysed in a murine model of NAFLD.The NAFLD mouse model was established by feeding mice a high-fat diet (HFD) for 16 weeks. TUDCA was administered p.o. during the last 4 weeks. The expression levels of intestinal tight junction genes, lipid metabolic and inflammatory genes were determined by quantitative PCR. Tissue inflammation was evaluated by haematoxylin and eosin staining. The gut microbiota was analysed by 16S rRNA gene sequencing.TUDCA administration attenuated HFD-induced hepatic steatosis, inflammatory responses, obesity and insulin resistance in mice. Moreover, TUDCA attenuated gut inflammatory responses as manifested by decreased intestinal histopathology scores and inflammatory cytokine levels. In addition, TUDCA improved intestinal barrier function by increasing levels of tight junction molecules and the solid chemical barrier. The components involved in ileum lipid transport were also reduced by TUDCA administration in HFD-fed mice. Finally, the TUDCA-treated mice showed a different gut microbiota composition compared with that in HFD-fed mice but similar to that in normal chow diet-fed mice.TUDCA attenuates the progression of HFD-induced NAFLD in mice by ameliorating gut inflammation, improving intestinal barrier function, decreasing intestinal fat transport and modulating intestinal microbiota composition.

Areas under the ROC curves for lipid accumulation product as a predictor of non-alcoholic fatty liver disease in subjects with different levels of obesity. (DOCX 18 kb)

Background Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide, and its prevalence is likely to rise even further. To help understand the pathogenesis and early prevention of progressive NAFLD, this large-scale study was designed to explore the potential association between homocysteine and the prevalence of NAFLD. Methods A total of 7203 subjects aged 18 years or older were enrolled in this cross-sectional study. The association of homocysteine with the prevalence of NAFLD, in the total sample and stratified by subgroups, was examined using multiple logistic regression analyses. Results Subjects in the higher quartiles of homocysteine had a higher prevalence of NAFLD. After multivariate adjustment, the odds ratio (OR) for NAFLD in the highest compared with the lowest quartile of homocysteine was 2.08 (95% confidence interval [CI] 1.61, 2.67). Moreover, in the subgroup analyses, we found an effect modification by gender, body mass index (BMI) and smoking status on the association between homocysteine and the prevalence of NAFLD (P for interaction: 0.001, 0.002 and

In the past 10 years, several publications have highlighted the role of the regulator of G protein signalling (RGS) family in multiple diseases, including cardiovascular diseases. As one of the multifunctional family members, RGS14 is involved in various biological processes, such as synaptic plasticity, cell division, and phagocytosis. However, the role of RGS14 in cardiovascular diseases remains unclear. In the present study, we used a genetic approach to examine the role of RGS14 in pathological cardiac remodelling in vivo and in vitro. We observed that RGS14 was down-regulated in human failing hearts, murine hypertrophic hearts, and isolated hypertrophic cardiomyocytes. Moreover, the extent of aortic banding-induced cardiac hypertrophy and fibrosis was exacerbated in RGS14 knockout mice, whereas RGS14 transgenic mice exhibited a significantly alleviated response to pressure overload. Furthermore, research of the underlying mechanism revealed that the RGS14-dependent rescue of cardiac remodelling was attributed to the abrogation of mitogen-activated protein kinase (MEK)–extracellular signal-regulated protein kinase (ERK) 1/2 signalling. The results showed that constitutive activation of MEK1 nullified the cardiac protection in RGS14 transgenic mice, and inhibition of MEK–ERK1/2 by U0126 reversed RGS14 deletion-related hypertrophic aggravation. These results demonstrated that RGS14 attenuated the development of cardiac remodelling through MEK–ERK1/2 signalling. RGS14 exhibited great potential as a target for the treatment of pathological cardiac remodelling. Electronic supplementary material The online version of this article (doi:10.1007/s00395-016-0566-1) contains supplementary material, which is available to authorized users.

Uncertainty persists regarding the need to address blood pressure (BP) variability in the general population to reduce the heavy burden of stroke. In this cohort study, we prospectively recruited 57,927 participants from southeast of Beijing, who have completed all 3 health examinations between 2006 and 2010. BP variability was defined as the coefficient of variation (CV) across these 3 visits. Over a median follow-up of 3.0 years, we identified 582 first stroke cases. Of these, 489 (84.0%) were ischemic strokes and 94 (16.2%) were hemorrhagic strokes. After multivariable adjustment, the hazard ratios (HR) (95% Confidence Intervals, CI) of comparing participants in the highest versus lowest quartile of CV of systolic blood pressure (SBP) was 1.44 (1.11, 1.87) for any stroke, 1.33 (1.00, 1.77) for ischemic stroke, and 2.17 (1.09, 4.35) for hemorrhagic stroke. Similar results were also observed when the CV of SBP was considered as a continuous exposure variable (per SD increase). Moreover, higher variability of diastolic blood pressure (DBP) was also significantly associated with the risk of any stroke and specifically with hemorrhagic stroke, but not with ischemic stroke. In conclusion, higher visit-to-visit BP variability might be an important target to reduce stroke risk, particularly for hemorrhagic stroke.

In congenital stenosis of the external auditory canal (CSEAC) with cholesteatoma, the bony wall of the external auditory canal (EAC) is most commonly involved. This involvement will lead to bone erosion of the EAC and may subsequently lead to the formation of postaural or cervical sinuses. High-resolution computed tomography (HRCT) of temporal bone can show characteristic signs of soft tissue mass in EAC, with adjacent bone erosion.To investigate the clinical features, differential diagnosis and management of CSEAC with cholesteatoma.The clinical information for 10 cases of CSEAC with cholesteatoma was retrospectively reviewed.The patients' ages ranged from 4.75 to 22 years (average 12 years). The diameter of EACs was2 mm. All 10 ears had a history of postaural fistulae or sinuses. Bone erosion of EAC was distinctly shown in HRCT of all cases, as well as soft tissue masses, which led to enlargement of the bony canals. All patients underwent canaloplasty; eight ears received hearing reconstructions at the same time. Cholesteatoma in EACs was confirmed during the operations, accompanied by compression and destruction of the post-superior and/or inferior bony wall. Postoperative pathologic examinations proved the diagnosis of cholesteatoma, and excluded any tissue of bronchial cleft cyst or fistula. After a follow-up of 1-3 years, no recurrent cholesteatoma was found in any of the 10 cases. All reconstructed EACs were clean and smooth. The hearing levels in the eight ears that received hearing reconstructions increased 20-35 dBHL.

High resolution CT imaging can provide useful information about the pathological exposure of the mastoid portion of the facial nerve before mastoid surgery and can assess the injury site of the facial nerve after operation.To evaluate the diagnostic value of high resolution CT scanning of pathological exposure of the mastoid portion of facial nerve and provide valuable information for otologic surgery, and to analyse the cause of facial nerve paralysis after operation.Routine CT scanning was used to examine patients with chronic suppurative otitis media and external auditory canal cholesteatoma preoperatively by axial-transverse and coronal views. If there was any pathological exposure of the mastoid portion of the facial nerve on CT imaging, then this was compared with intraoperative findings. In addition, one patient who had suffered postoperative facial nerve paralysis was also examined by CT scanning to determine whether any pre-existing pathological exposure of facial nerve could be found.Through routine CT scanning six patients with chronic suppurative otitis media and three patients with external auditory canal cholesteatoma were found to have pathological exposure of the mastoid portion of the facial nerve. Coronal views could more clearly show the size and the position of the exposure; the corresponding surgical findings (pathological exposure) for the facial nerve could be confirmed in all nine patients. CT imaging could also show that the patient who had suffered postoperative facial nerve paralysis did indeed have pre-existing pathological exposure of the mastoid portion of the facial nerve.

To evaluate the hearing results and the effects of the prognostic factors following myringoplasty.Retrospective cohort 165 inpatients (175 ears) with preoperative conductive hearing loss were analyzed using multiple linear regression statistical analysis. They have undergone sandwich temporalis fascia myringoplasty between January 1999 and November 2003. Patients have been followed-up for more than 2 years.The average air-bone gap improvement for all 175 myringoplasty procedures was 7.1 dBHL. Multiple linear regression statistical analysis was subsequently carried out on these prognostic factors on hearing outcomes and yielded the following relative importance of the predictive is as follows: mean preoperative air conduction threshold, duration of dry ear, duration of disease, age. There is a strong correlation between subjective audition and pure tone threshold audiometry.A relatively better preoperative hearing, a relatively longer duration of dry ear, a relatively shorter duration of disease and a relatively younger age were found to be significant prognostic factors influencing the postoperative air-bone gap improvement of myringoplasty. Subjective audition improvement coupled with objective pure tone threshold audiometric improvement.

The facial nerve courses shown by preoperative CT imaging coincide with the surgical findings in most congenital aural atresia cases. CT scanning is critical in evaluation of a patient's candidacy for atresia surgery.To evaluate the diagnostic value of preoperative CT scanning of the facial nerve course in congenital aural atresia.All inpatients (135 cases) with congenital aural atresia had routine preoperative CT examination. The facial nerve courses were observed in the operation and compared with the preoperative CT imaging.CT imaging showed that the mastoid portions of the facial nerves in 57% of cases (77/135) were located at the level of the round window, and 17% (23/135) were located at the levels of the oval window and the cochlea. Differential overlapping of the oval window by the facial nerve could also be shown in most of the cases. In the majority of cases (75%, 61/81) the tympanic portions of the facial nerve on CT imaging could be confirmed by surgical findings. In severe overlapping of the oval window or cases with anterior displacement, stapedectomy or tympanoplasty, respectively, could not be performed as usual.

Conclusions. Vestibulotomy above a severely displaced facial nerve represents a new surgical approach to achieve serviceable hearing. The lack of facial nerve injury and the potential for hearing restoration make this procedure feasible in patients who would otherwise be marginal or poor surgical candidates. Objective. To investigate the feasibility of vestibulotomy above a severely displaced facial nerve. Material and methods. Eight patients with severe congenital conductive hearing loss underwent vestibulotomy above a severely displaced facial nerve and hearing reconstruction between January 2000 and January 2002. All patients had congenital middle ear deformities. The facial nerves overhung and concealed the oval window niche or lay inferior to the oval window. The facial nerves were transposed in order to reach the oval window niche in four of eight cases. Results. Hearing gain was 15 dB in 2 ears, 16–25 dB in 3 and > 26 dB in 3. There were no cases of postoperative facial paresis.

To investigate the importance of the high resolution computerized tomography of temporal bone in evaluation of traumatic lesions, particularly of the ossicular disruption.Ten patients with traumatic ossicles dislocation underwent preoperative CT scanning followed by surgical exploration of the middle ear.The radiographic finding was consistent with the operative demonstration for malleoincudal disarticulation (3 ears), incudostapedial dislocation (7 ears), and the fracture of temporal bone (8 ears).The incus was the most vulnerable ossicle in the trauma to the middle ear. CT scans can diagnose exactly the damage position in middle ear.