Percutaneous endoscopic lumbar discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms of quality of life and ...return to work.
55 patients with percutaneous endoscopic lumbar discectomy done from 2002 to 2006 had their clinical outcomes reviewed in terms of the North American Spine Score (NASS), Medical Outcomes Study Short Form-36 scores (SF-36) and Pain Visual Analogue Scale (VAS) and return to work.
The mean age was 35.6 years, the mean operative time was 55.8 minutes and the mean length of follow-up was 3.4 years. The mean hospital stay for endoscopic discectomy was 17.3 hours. There was significant reduction in the severity of back pain and lower limb symptoms (NASS and VAS, p < 0.05) at 6 months and 2 years. There was significant improvement in all aspects of the Quality of Life (SF-36, p < 0.05) scores except for general health at 6 months and 2 years postoperation. The recurrence rate was 5% (3 patients). 5% (3 patients) subsequently underwent lumbar fusion for persistent back pain. All patients returned to their previous occupation after surgery at a mean time of 24.3 days.
Percutaneous endoscopic lumbar discectomy is associated with improvement in back pain and lower limb symptoms postoperation which translates to improvement in quality of life. It has the advantage that it can be performed on a day case basis with short length of hospitalization and early return to work thus improving quality of life earlier.
Abstract
Background and Aims
Hypertension and type 2 diabetes mellitus (T2DM) are important, intertwined issues in public health. People with both conditions face significantly elevated risks of ...complications, particularly albuminuria, which is an independent risk factor for cardiovascular (CV) events, kidney failure and all-cause mortality, and thus deserves more attention among physicians and patients. The purpose of this study is to describe the development of recommendations for the management of hypertension and T2DM by a multidisciplinary expert panel.
Method
The panel included eight specialists (three cardiologists, three endocrinologists and two nephrologists) experienced treating patients with hypertension or T2DM. The panel reviewed clinical trials, meta-analyses, observational studies and clinical guidelines that were obtained by searching PubMed for the publication period from January 2015 to June 2021, to address five discussion areas: (i) blood pressure (BP) targets based on CV/renal benefits; (ii) management of isolated systolic or diastolic hypertension; (iii) roles of angiotensin II receptor blockers (ARBs); (iv) implications of albuminuria for CV/renal events and treatment choices; and (v) roles and tools of screening for microalbuminuria. The panel held three virtual meetings using a modified Delphi method to discuss the literature and their experience regarding the discussion areas. After each meeting, consensus statements were derived and anonymously voted on by every panelist. A consensus statement was accepted only if ≥ 80% of the panelists selected ‘accept completely’ or ‘accept with some reservation’.
Results
A total of 17 consensus statements were formulated.
Conclusion
The key messages include: (i) home BP is considered as important as office BP in treatment decision-making; (ii) in patients with T2DM and hypertension on antihypertensive drug treatment, the targets should be < 130/80 mmHg for office BP and < 125/75 mmHg for home BP; (iii) albuminuria is an important therapeutic goal and should be screened for regularly in people with T2DM or hypertension; and (iv) an ARB with proven cardioprotective and renoprotective effects is the preferred drug treatment for patients with T2DM and hypertension.
In 2016, meetings of groups of physicians and paediatricians with a special interest in lipid disorders and familial hypercholesterolaemia were held to discuss several domains of management of ...familial hypercholesterolaemia in adults and children in Hong Kong. After reviewing the evidence and guidelines for the diagnosis, screening, and management of familial hypercholesterolaemia, consensus was reached on the following aspects: clinical features, diagnostic criteria, screening in adults, screening in children, management in relation to target plasma low-density lipoprotein cholesterol levels, detection of atherosclerosis, lifestyle and behaviour modification, and pharmacotherapy.
Type 2 diabetes mellitus (T2DM), the tenth leading cause of death in Hong Kong, has a prevalence of approximately 10%. Sodium-glucose co-transporter-2 (SGLT2) inhibitors lower glycated haemoglobin ...(HbA1c) levels in T2DM patients via a non-insulin-dependent mechanism of action, but real-world data is limited, particularly for Chinese patients.
A retrospective single-centre study was performed among Chinese patients with T2DM who were prescribed SGLT2 inhibitor therapy in Hong Kong. Changes in HbA1c levels, body weight, systolic and diastolic blood pressure, estimated glomerular filtration rate (eGFR), lipid profiles and adverse events were observed for patients who completed at least one follow-up visit during the study period.
Overall, 100 patients were included, and 53 patients attended an additional final visit. By the final visit, SGLT2 inhibitor therapy had significantly decreased HbA1c levels (change Δ 0.31%, 95% confidence interval CI -0.11% to -0.51%, p < 0.001), body weight (Δ -4.59 kg, 95% CI -3.75 to -5.54 kg, p < 0.001) and systolic blood pressure (Δ -5.72 mmHg, 95% CI -1.72 to -9.72 mmHg, p < 0.001) from baseline. No significant change in eGFR or lipid profiles was observed, except for a significant reduction in high-density lipoprotein cholesterol (Δ -0.09 mmol/L, 95% CI -0.16 to -0.02 mmol/L, p < 0.05). Adverse events were consistent with previous reports for SGLT2 inhibitors, apart from appetite loss associated with canagliflozin.
The real-world efficacy and safety profile of SGLT2 inhibitors in Chinese patients was comparable to that reported in Phase III clinical trials, with the exception of appetite loss among patients who received canagliflozin.
White Blood Cell Count Is Associated With Macro- and Microvascular Complications in Chinese Patients With Type 2 Diabetes
Peter C. Tong , PHD 1 ,
Ka-Fai Lee , MBCHB 1 ,
Wing-Yee So , MBCHB 1 ,
...Margaret H. Ng , MD 2 ,
Wing-Bun Chan , MBCHB 1 ,
Matthew K. Lo , MBCHB 1 ,
Norman N. Chan , MD 1 and
Juliana C. Chan , MD 1
1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong
Kong
2 Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin,
N.T., Hong Kong
Address correspondence and reprint requests to Dr. Peter C.Y. Tong, Department of Medicine and Therapeutics, The Chinese University
of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. E-mail: ptong{at}cuhk.edu.hk
Abstract
OBJECTIVES —There are close associations among raised white blood cell (WBC) count, coronary heart disease, and metabolic syndrome in
the general population. The association between WBC count and vascular complications of diabetes has not been explored. We
carried out a cross-sectional cohort study to determine the association between WBC count and the presence of macro- and microvascular
complications in type 2 diabetes.
RESEARCH DESIGN AND METHODS —In this study, 3,776 patients with type 2 diabetes and normal WBC count (3.5–12.5 × 10 9 /l) underwent a comprehensive assessment of complications and cardiovascular risk factors based on the European DiabCare protocol.
Demographic and anthropometric parameters were recorded. Metabolic profiles, including complete blood picture and urinary
albumin excretion, were measured.
RESULTS —Patients with higher WBC counts (categorized into quintiles) had adverse metabolic profiles as evidenced by higher blood
pressure, BMI, HbA 1c , fasting plasma glucose, LDL cholesterol, triglycerides, and urinary albumin excretion, but lower HDL cholesterol (all P <0.001 for trend). The prevalence of macro- and microvascular complications increased in a dosage-related manner with WBC
count. After adjustments for smoking and other known cardiovascular risk factors, a 1-unit (1 × 10 9 /l) increment of WBC count was associated with a 15.8% (95% CI 9.3–22.6; P < 0.001) and 12.3% increase (5.8–19.1; P < 0.001) in the prevalence of macro- and microvascular complications, respectively.
CONCLUSIONS —Elevated WBC count, even within the normal range, is associated with both macro- and microvascular complications in type
2 diabetes. Chronic inflammation, as indicated by a higher WBC count, may play a linkage role in the development of macro-
and microvascular complications in diabetes.
TG, triglyceride
TGF-β1, transforming growth factor-β1
UAE, urinary albumin excretion
WBC, white blood cell
WHR, waist-to-hip ratio
Footnotes
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted October 5, 2003.
Received July 6, 2003.
DIABETES CARE
Mesenteric Fat Thickness Is an Independent Determinant of Metabolic Syndrome and Identifies Subjects With Increased Carotid
Intima-Media Thickness
Kin Hung Liu , PHD 1 ,
Yu Leung Chan , MD, FRCR 1 ,
...Wing Bun Chan , MBCHB, FRCP 2 ,
Juliana Chung Ngor Chan , MD, FRCP 2 and
Chiu Wing Winnie Chu , MBCHB, FRCR 1
1 Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin,
Hong Kong
2 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong
Address correspondence and reprint requests to Dr. Kin Hung Liu, Department of Diagnostic Radiology and Organ Imaging, Prince
of Wales Hospital, Shatin, Hong Kong. E-mail: tongyc{at}netvigator.com
Abstract
OBJECTIVE —Mesenteric fat, a reflection of visceral adiposity, may play an important role in the pathogenesis of metabolic syndrome
and cardiovascular diseases (CVD). In this study, we examined the independent relationship between mesenteric fat thickness
and metabolic syndrome and defined its optimal cutoff value to identify high-risk subjects for metabolic syndrome and CVD.
RESEARCH DESIGN AND METHODS —A total of 290 Chinese subjects had an ultrasound examination for measurements of thickness of mesenteric, preperitoneal,
and subcutaneous fat as well as carotid intima-media thickness (IMT). Anthropometric measurements and metabolic risk profile
were assessed by physical examination and blood taking.
RESULTS —Twenty (6.9%) subjects had metabolic syndrome according to the National Cholesterol Education Panel Adult Treatment Panel
III criteria with Asian definitions for central obesity (waist circumference >80 cm in women and >90 cm in men). Mesenteric
fat thickness had significant correlations ( P < 0.05) with various metabolic variables. On multivariate regression, mesenteric fat thickness was an independent determinant
of all components of metabolic syndrome after adjustment for age, sex, homeostasis model assessment of insulin resistance,
and other fat deposits. The odds ratio of metabolic syndrome was increased by 1.35 (95% CI 1.10–1.66)-fold for every 1-mm
increase in mesenteric fat thickness. On receiver-operating characteristic curve analysis, mesenteric fat thickness of ≥10
mm was the optimal cutoff value to identify metabolic syndrome, with sensitivity of 70% and specificity of 75%. Subjects with
mesenteric fat thickness ≥10 mm had higher carotid IMT than those with thickness <10 mm (0.73 ± 0.19 vs. 0.64 ± 0.16 mm, P = 0.001).
CONCLUSIONS —Mesenteric fat thickness was an independent determinant of metabolic syndrome and identified subjects with increased carotid
IMT.
CVD, cardiovascular disease
FPG, fasting plasma glucose
HOMA-IR, homeostasis model assessment of insulin resistance
IMT, intima-media thickness
ROC, receiver-operating characteristic curve
Footnotes
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted November 16, 2005.
Received August 23, 2005.
DIABETES CARE
The effect of biphosphonate therapy on bone mineral density (BMD) in patients with primary hyperparathyroidism (PHP) is unknown. Forty postmenopausal women (mean age, 70 yr) with PHP were randomized ...to receive alendronate 10 mg/d or placebo for 48 wk, followed by treatment withdrawal for 24 wk. The mean (±sd) changes in BMD at femoral neck (+4.17 ± 6.01% vs. −0.25 ± 3.3%; P = 0.011) and lumbar spine (+3.79 ± 4.04% vs. 0.19 ± 2.80%; P = 0.016) were significantly higher with alendronate at 48 wk. Serum calcium was reduced with alendronate but not placebo (−0.09 vs. +0.01 mmol/liter; P = 0.018). Serum bone-specific alkaline phosphatase activity was lower with alendronate from 12 wk onward and increased 24 wk after treatment withdrawal (21.1 ± 12.8 to 7.3 ± 4.9 IU/liter at 48 wk, and 15.0 ± 14.8 IU/liter 24 wk after withdrawal; P = 0.002 for trend). Osteocalcin concentration decreased at 48 wk and increased 24 wk after alendronate withdrawal (P = 0.019 for trend of change over time) but not with placebo. Urinary N-telopeptide/creatinine ratio decreased with alendronate at 48 wk and increased 24 wk after treatment withdrawal (P = 0.008 for trend). N-telopeptide/creatinine ratio did not change with placebo. Alendronate improves BMD and reduces bone turnover markers in postmenopausal women with PHP.
OBJECTIVE: Visceral fat, notably mesenteric fat, which is drained by the portal circulation, plays a critical role in the pathogenesis of metabolic syndrome through increased production of free fatty ...acids, cytokines and vasoactive peptides. We hypothesize that mesenteric fat thickness as measured by ultrasound scan could explain most of the obesity-related health risk. We explored the relationships between cardiovascular risk factors and abdominal fat as determined by sonographic measurements of thickness of mesenteric, preperitoneal and subcutaneous fat deposits, total abdominal and visceral fat measurement by magnetic resonance imaging (MRI) and anthropometric indexes. DESIGN: A cross-sectional study. SUBJECTS: Subjects included 18 healthy men and 19 women (age: 27-61 y, BMI: 19-33.4 kg/m2). MEASUREMENTS: The maximum thickness of mesenteric, preperitoneal and subcutaneous fat was measured by abdominal ultrasound examination. MRI examinations of whole abdomen and pelvis were performed and the amount of total abdominal and visceral fat was quantified. The body mass index, waist circumference and waist-hip ratio were recorded. Cardiovascular risk factors were assessed by physical examination and blood taking. RESULTS: Men had more adverse cardiovascular risk profile, higher visceral fat volume and thicker mesenteric fat deposits than women. Among all the investigated obesity indexes, the mesenteric fat thickness showed the highest correlations with total cholesterol, LDL-C, triglycerides, fasting plasma glucose, HbA1c and systolic blood pressure in men, and with triglycerides and HbA(1c) in women. On stepwise multiple regression analysis with different obesity indexes as independent variables, 30-65% of the variances of triglycerides, total cholesterol, LDL-C and HbA1c in men, and triglycerides in women were explained by the mesenteric fat thickness. CONCLUSION: Compared with sonographic measurement of subcutaneous and preperitoneal fat thickness, MRI measurement of total abdominal and visceral fat and anthropometric indexes, sonographic measurement of mesenteric fat thickness showed better associations with some of the cardiovascular risk factors. It may potentially be a useful tool to evaluate regional distribution of obesity in the assessment of cardiovascular risk.
Mesenteric fat is drained by the portal circulation and has been suggested to be a key component in obesity-related health risk, notably the metabolic syndrome. There are increasing epidemiological ...and experimental data showing that fatty liver is another component of this multifaceted syndrome. Given their intimate anatomical and physiological relationships, we hypothesized that mesenteric fat thickness may be independently associated with the risk of fatty liver. To test this hypothesis, we examined the predictive role of various fat deposits including mesenteric fat thickness, and various metabolic variables on the risk of fatty liver.
A total of 291 Chinese subjects (134 men and 157 women with a mean BMI of 23.7 kg/m2, range: 16.5-33.4 kg/m2) underwent ultrasound examination for measurement of mesenteric, subcutaneous and preperitoneal fat thickness, and for diagnosis of fatty liver. Body mass index, waist circumference, and waist-hip ratio were recorded. Blood pressure was measured. Fasting plasma glucose, insulin resistance, high-density lipoprotein cholesterol (HDL-C), triglycerides, low-density lipoprotein cholesterol (LDL-C), liver enzymes were determined by common methods.
The subjects with fatty liver had greater abdominal fat thickness and higher anthropometric indexes than those without fatty liver. The subjects with fatty liver also showed higher blood pressure, worse lipid and glycaemic profile compared with those without fatty liver. Using multiple logistic regression analysis, mesenteric fat thickness was a risk factor of fatty liver, independent of body mass index, age, sex, insulin resistance, fasting plasma glucose, lipid and blood pressure. The odds ratio was 1.5 (95% confidence interval: 1.27-1.77) for every 1 mm increase in the mesenteric fat thickness. Measurement of preperitoneal and subcutaneous fat deposits did not show significant associations with fatty liver.
Mesenteric fat thickness measured on ultrasound is an independent determinant of fatty liver.
The World Health Organisation (WHO), European Group for the Study of Insulin Resistance (EGIR) and National Cholesterol Education Program (NCEP) Expert Panels had introduced definitions for the ...metabolic syndrome (MES). We aimed to estimate the prevalence of MES in a working population in Hong Kong using the three definitions for MES and compare their relative significance. The data are obtained from a prevalence survey for glucose intolerance and lipid abnormality in a Hong Kong Chinese working population. The distribution of occupational groups in these subjects was similar to that recorded in the Hong Kong Census (1991) and representative of the Hong Kong working population. Definition of obesity was modified using the Asian criterion of body mass index (BMI)
≥
25
kg/m
2, waist circumference
>
80
cm in women and >90
cm in men. Of the 1513 subjects, 910 (60.1%) were men and 603 (39.9%) were women. The mean age was 37.5
±
9.2 (median 37.0 years, range 18–66 years). Using the Asian definition for obesity, the prevalence of MES using the WHO criterion was the highest (WHO versus EGIR versus NCEP—overall: 13.4% versus 8.9% versus 9.6%,
p
<
0.001; under age of 40 years: 7.9% versus 4.9% versus 5.4%,
p
=
0.017; age of 40 years or above: 21.9% versus 14.9% versus 16.0%,
p
=
0.003). The prevalence of different components of the MES ranged from 6 to 38%. In subjects aged less than 50 years, there was a male preponderance for MES (male versus female—WHO: 9.5% versus 6.2%,
p
=
0.007; EGIR: 7.9% versus 6.2%,
p
=
0.235; NCEP: 9.5% versus 6.2%,
p
=
0.030) but this trend was reversed after the age of 50 years (WHO: 29.3% versus 31.9%,
p
=
0.721; EGIR: 13.1% versus 34.8%,
p
=
0.001; NCEP: 19.2% versus 23.2%,
p
=
0.533). The prevalence of MES in Hong Kong Chinese of working age ranges from 6.1 to 13.4% depending on various diagnostic criteria. There was a male preponderance before the age of 50 years and a female-preponderance after the age of 50 years. The inclusion of albuminuria and insulin resistance by the WHO has made it the most discriminative criterion in identifying at risk individuals in all age groups.
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