Background Previous research has linked elevated low-density lipoprotein cholesterol (LDL-C) and remnant cholesterol (RC) with diabetes mellitus (DM). The present study aims to estimate the RC-related DM risk beyond LDL-C, and to investigate the extent to which the association of RC and DM is mediated via insulin resistance and inflammation. Methods We enrolled 7308 individuals without previous history of DM into the present study from the China Health and Nutrition Survey. Fasting RC was calculated as total cholesterol minus LDL-C and high-density lipoprotein cholesterol. Subjects were divided into four groups according to their LDL-C (100 mg/dL) and RC (24 mg/dL) levels to evaluate the role of LDL-C vs. RC on DM. A logistic regression analysis was then employed to evaluate the relationships between the discordant/concordant LDL-C and RC and DM. A mediation analysis was undertaken to identify potential mediators. Results Of all the participants, a total of 625 (8.55%) patients were newly diagnosed with DM. Compared to the high LDL-C/low RC group, the low LDL-C/high RC group was more common in DM patients. After a multivariate adjustment, elevated LDL-C and RC were associated with DM. Moreover, the low LDL-C/high RC group and the high LDL-C/low RC group manifested a 4.04-fold (95% CI 2.93–5.56) and 1.61-fold (95% CI 1.21–2.15) higher risk of DM, relative to those with low LDL-C/low RC. The subgroup analysis indicated that low LDL-C/high RC was more likely to be related to DM in females. Similar results were also shown when the sensitivity analyses were performed with different clinical cut-points of LDL-C. Insulin resistance and inflammation partially mediated the association between RC and DM. Conclusions Our findings provided evidence for RC beyond the LDL-C associations with DM that may be mediated via insulin resistance and the pro-inflammatory state. In addition, women are more susceptible to RC exposure-related DM.

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Objective Evidence of therapy for dysfunctional coronary circulation in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) is limited. This study was performed to compare the effects of atorvastatin and rosuvastatin on dysfunctional coronary circulation. Methods This retrospective study enrolled 597 consecutive patients with STEMI who underwent pPCI in 3 centers from June 2016 to December 2019. Dysfunctional coronary circulation was defined by the thrombolysis in myocardial infarction (TIMI) grade and the TIMI myocardial perfusion grade (TMPG). Logistic regression analysis was used to evaluate the impact of different statin types on dysfunctional coronary circulation. Results The incidence of TIMI no/slow reflow did not differ between the two groups, but the incidence of TMPG no/slow reflow was significantly lower in the atorvastatin than rosuvastatin group (44.58% vs. 57.69%, respectively). After multivariate adjustment, the odds ratio with 95% confidence interval of rosuvastatin was 1.72 (1.17–2.52) for after pretreatment TMPG no/slow reflow and 1.73 (1.16–2.58) for after stenting TMPG no/slow reflow. Atorvastatin and rosuvastatin showed no significant differences in clinical outcomes during hospitalization. Conclusions Compared with rosuvastatin, atorvastatin was associated with better coronary microcirculatory perfusion in patients with STEMI who underwent pPCI.

Purpose. To identify and characterize the 100 most-cited articles in the field of transient elastography. Methods. The top-cited articles focusing on transient elastography from 1999 to 2017 were retrieved from Science Citation Index Expanded (SCI-E) database. The most prolific article, journal, country and continent, top-cited article in different period, international collaboration, cocitation analysis of journal were retrieved and analyzed in this article. Bibexcel 2016, Microsoft Excel 2010, and VOSviewer 1.6.5 were used to analyze bibliometric records we downloaded. Results. The 100 most-cited articles were published between 2003 and 2015. The total citations ranged from 54 to 1376 (mean, 167.52 ± 208.46; median, 89.5) and the annual citations ranged from 4.91 to 98.24 (mean, 17.21±15.68; median, 12.1). The top-cited article was published in Gastroenterology in 2005 by Castera L. et al. (n=1376). The most-cited articles in 2003-2007 (n=1380), 2008-2012 (n=599) and 2013-2017 (n=159) were located. All of the most-cited articles in three periods were focusing on the topic of noninvasive assessment of liver fibrosis. The most prolific author was de Ledinghen V. (n=21) and France (n=43) was the leading country. The most productive journal was Journal of Hepatology (n=20). The major article type was original research article. Conclusions. We undertook efforts to provide an insight into the features and evolvement of the most-cited articles in the field of transient elastography. For transient elastography, as a noninvasive assessment of liver fibrosis, its use in the evaluation of liver fibrosis is gradually mature and shows great advantages. Moreover, the field of transient elastography is in a stage of rapid development.

BackgroundBlood lipids disorder and atherosclerosis are closely related to coronary artery disease (CAD). This study aims to compare different blood lipid parameters combined with carotid intima-media thickness (cIMT) in predicting CAD.MethodsThis was a retrospective study including patients who underwent coronary angiography for highly suspected CAD. Blood samples were taken for lipid profile analysis and cIMT was evaluated by carotid ultrasound. Logistic analysis was used to establish different models of different lipid parameters in predicting CAD. The area under the receiver operating characteristic curve (AUC) was used to examine the predictive value. The optimal lipid parameter was also used to explore the relationship with multi-vessel CAD.ResultsPatients were classified into two groups based on whether CAD existed. Compared with non-CAD patients, the CAD group had higher lipoprotein (a) [Lp (a)], apolipoprotein B/apolipoprotein A, total cholesterol/high-density lipoprotein cholesterol (HDL-C), triglyceride/HDL-C and LDL-C/HDL-C. According to the AUCs, Lp (a) combined with cIMT (AUC: 0.713, P < 0.001) had the best performance in predicting CAD compared to other lipid parameters. High level of Lp (a) was also associated with multi-vessel CAD (odds ratio: 1.41, 95% confidence interval: 1.02–1.95, P = 0.036).ConclusionFor patients with highly suspected CAD, Lp (a) better improved the predictive value of CAD rather than most of blood lipid indices, especially in the absence of high levels of LDL-C. Lp (a) also can be used to predict the multi-vessel CAD.

A novel three‐stage treatment process corresponding to three reactors (R1, R2 and R3) was developed for advanced defluoridation from industrial wastewater with fluoride concentration as high as 245 mg/L. In the first stage (R1), 90.6 ± 0.8% of fluoride was removed through CaF2 precipitation. Subsequently, the second stage (R2) was operated for advanced defluoridation through fluorapatite (FAP) precipitation. Importantly, the residual calcium in effluent of R1 participated in FAP precipitation in R2, reducing extra calcium dosage. In the third stage (R3), further defluoridation was observed in R3, and the final fluoride content in the effluent was as low as 0.15 mg/L in Phase 2. Advanced defluoridation from industrial wastewater with high‐concentration fluoride could be obtained through this process without coagulant addition to reduce sludge production and obtain relative pure chemical precipitates, and residual reagents could be utilized again in the next step during the process to decrease reagents dosage.

BackgroundCoronary microvascular dysfunction (CMVD), an important etiology of ischemic heart disease, has been widely studied. D-dimer is a simple indicator of microthrombosis and inflammation. However, whether an increase in D-dimer is related to CMVD is still unclear.Materials and MethodsThis retrospective study consecutively enrolled patients with myocardial ischemia and excluded those with obstructive coronary artery. D-dimer was measured at admission and the TIMI myocardial perfusion grade (TMPG) was used to distinguish CMVD. Patients were divided into the two groups according to whether the D-dimer was elevated (>500 ng/ml). Logistic models and restricted cubic splines were used to explore the relationship between elevated D-dimer and CMVD.ResultsA total of 377 patients were eventually enrolled in this study. Of these, 94 (24.9%) patients with CMVD had older age and higher D-dimer levels than those without CMVD. After full adjustment for other potential clinical risk factors, patients with high D-dimer levels (>500 ng/ml) had a 1.89-times (95% CI: 1.09–3.27) higher risk of CMVD than patients with low D-dimer levels. A non-linear relationship was found between concentrations of D-dimer and CMVD. With increased D-dimer level, the incidence of CMVD increased and then remained at a high level. Stratified analysis was performed and showed similar results.ConclusionElevated D-dimer level is associated with the incidence of CMVD and potentially serves as a simple biomarker to facilitate the diagnosis of CMVD for patients with angina.

Background: Blood lipids disorder and atherosclerosis are closely related to coronary artery disease (CAD). This study aims to compare different blood lipid parameters combined with carotid intima-media thickness (cIMT) in predicting CAD.Methods: This was a retrospective study including patients who underwent coronary angiography for highly suspected CAD. Blood samples were taken for lipid profile analysis and cIMT was evaluated by carotid ultrasound. Logistic analysis was used to establish different models of different lipid parameters in predicting CAD. The area under the receiver operating characteristic curve (AUC) was used to examine the predictive value. The optimal lipid parameter was also used to explore the relationship with multi-vessel CAD. Results: Patients were classified into two groups based on whether CAD existed. There was no difference in low-density lipoprotein cholesterol (LDL-C) between the two groups. Compared with non-CAD patients, the CAD group had higher lipoprotein (a) (Lp (a)), apolipoprotein B/apolipoprotein A, total cholesterol/high-density lipoprotein cholesterol (HDL-C), triglyceride/HDL-C and LDL-C/HDL-C. According to the AUCs, Lp (a) combined with cIMT (AUC: 0.713, p < 0.001) had the best performance in predicting CAD compared to other lipid parameters. High levels of Lp (a) was also associated with multi-vessel CAD (odds ratio: 1.41, 95% confidence interval: 1.02–1.95, P = 0.036).Conclusion: For patients with highly suspected CAD, Lp (a) better improved the predictive value of CAD rather than most of blood lipid indices, especially in the absence of high levels of LDL-C. Lp (a) also can be used to predict the multi-vessel CAD.