Microlens arrays are the key component in the next generation of 3D imaging system, for it exhibits some good optical properties such as extremely large field of view angles, low aberration and ...distortion, high temporal resolution and infinite depth of field. Although many fabrication methods or processes are proposed for manufacturing such precision component, however, those methods still need to be improved. In this review, those fabrication methods are categorized into direct and indirect method and compared in detail. Two main challenges in manufacturing microlens array are identified: how to obtain a microlens array with good uniformity in a large area and how to produce the microlens array on a curved surface? In order to effectively achieve control of the geometry of a microlens, indirect methods involving the use of 3D molds and replication technologies are suggested. Further development of ultraprecision machining technology is needed to reduce the surface fluctuation by considering the dynamics of machine tool in tool path planning. Finally, the challenges and opportunities of manufacturing microlens array in industry and academic research are discussed and several principle conclusions are drawn.
The prevalence of diabetes is increasing in young adults in Asia, but little is known about metabolic control or the burden of associated complications in this population. We assessed the prevalence ...of young-onset versus late-onset type 2 diabetes, and associated risk factors and complication burdens, in the Joint Asia Diabetes Evaluation (JADE) cohort.
JADE is an ongoing prospective cohort study. We enrolled adults with type 2 diabetes from 245 outpatient clinics in nine Asian countries or regions. We classified patients as having young-onset diabetes if they were diagnosed before the age of 40 years, and as having late-onset diabetes if they were diagnosed at 40 years or older. Data for participants' first JADE assessment was extracted for cross-sectional analysis. We compared clinical characteristics, metabolic risk factors, and the prevalence of complications between participants with young-onset diabetes and late-onset diabetes.
Between Nov 1, 2007, and Dec 21, 2012, we enrolled 41,029 patients (15,341 from Hong Kong, 9107 from India, 7712 from Philippines, 5646 from China, 1751 from South Korea, 705 from Vietnam, 385 from Singapore, 275 from Thailand, 107 from Taiwan). 7481 patients (18%) had young-onset diabetes, with age at diagnosis of mean 32·9 years SD 5·7 versus 53·9 years 9·0 with late-onset diabetes (n=33,548). Those with young-onset diabetes had longer disease duration (median 10 years IQR 3-18) than those with late-onset diabetes (5 years 2-11). Fewer patients with young-onset diabetes achieved HbA1c concentrations lower than 7% compared to those with late-onset diabetes (27% vs 42%; p<0·0001) Patients with young-onset diabetes had higher mean concentrations of HbA1c (mean 8·32% SD 2·03 vs 7·69% 1·82; p<0·0001), LDL cholesterol (2·78 mmol/L 0·96 vs 2·74 0·93; p=0·009), and a higher prevalence of retinopathy (1363 20% vs 5714 (18%); p=0·011) than those with late-onset diabetes, but were less likely to receive statins (2347 31% vs 12,441 37%; p<0·0001) and renin-angiotensin-system inhibitors (1868 25% vs 9665 29%; p=0·006).
In clinic-based settings across Asia, one in five adult patients had young-onset diabetes. Compared with patients with late-onset diabetes, metabolic control in those with young-onset diabetes was poor, and fewer received organ-protective drugs. Given the risk conferred by long-term suboptimum metabolic control, our findings suggest an impending epidemic of young-onset diabetic complications.
The Asia Diabetes Foundation (ADF) and Merck.
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
Hypertension and type 2 diabetes mellitus (T2DM) are important, intertwined public health issues. People with both conditions face significantly elevated risks of cardiovascular (CV) and renal ...complications. To optimize patient care, a multidisciplinary expert panel met to review recent evidence on optimal blood pressure (BP) targets, implications of albuminuria, and treatment regimens for hypertensive patients with T2DM, with the aim of providing recommendations for physicians in Hong Kong. The panel reviewed the relevant literature, obtained by searching PubMed for the publication period from January 2015 to June 2021, to address five discussion areas: (i) BP targets based on CV/renal benefits; (ii) management of isolated systolic or diastolic hypertension; (iii) roles of angiotensin II receptor blockers; (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 address the discussion areas. After each meeting, consensus statements were derived and anonymously voted on by every panelist. A total of 17 consensus statements were formulated based on recent evidence and expert insights regarding cardioprotection and renoprotection for hypertensive patients with T2DM.
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.
OBJECTIVE:--International guidelines recommend optimal control of risk factors in diabetes to prevent cardiovascular events. We examined risk associations between achieving treatment targets for ...glycemia, blood pressure and lipid control, and other risk factors on subsequent cardiovascular events in Chinese patients with type 2 diabetes. RESEARCH DESIGN AND METHODS--Between 1995 and 2005, 6,386 Chinese type 2 diabetic patients without a history of coronary heart disease (CHD) or stroke were recruited. They were classified according to the number of treatment targets attained at baseline, and their cardiovascular outcomes were compared. Treatment targets were defined as A1C <7.0%, blood pressure <130/80 mmHg, and LDL cholesterol <2.6 mmol/l. RESULTS:--After a median follow-up of 5.7 years, cumulative incidence of CHD or stroke (n = 749) increased with decreasing numbers of treatment targets attained at baseline. Attainment of two or more targets at baseline was associated with reduced risk of CHD compared with those with no target achieved (hazard ratio 0.69 95% CI 0.50-0.94, P = 0.020). However, the association lost its significance after adjustment for urinary albumin-to-creatinine ratio, estimated glomerular filtration rate, and hemoglobin. CONCLUSIONS:--Reaching more treatment targets was associated with reduced risk of new onset of CHD in Chinese patients with type 2 diabetes.
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•CBG film can serve as not only a protective mold coating but also a heating element.•CBG-based Joule heating is employed to glass hot embossing for the first time.•The embossed glass ...microlens arrays show high surface integrity and replication fidelity.•The proposed hot embossing technique is energy-saving and has low thermal cycle time.•The surface evolution of a typical MLA at different processing stages were studied.
This paper reports the fabrication of high-quality microstructures on optical glass via hot embossing using carbide-bonded graphene (CBG) based Joule heating for the first time. In this study, a tailor-made micro hot embossing tool equipped with a modified CBG-based Joule heating system was designed and developed for transferring microstructures (e.g., microlens arrays, MLAs for short) from the CBG-coated silicon mold insert into the optical glass (P-SK57). Initially, the surface topographies of a typical 3 × 3 MLA from a bare silicon mold to an embossed glass replica were compared for evaluating form errors brought in during different preparation stages. The feasibility of the CBG-based Joule heating technique for the non-equilibrium thermal imprinting of optical glass was evaluated by the surface integrity and replication fidelity of the embossed MLA features. Thermally induced residual stress and imaging performance of the embossed glass lens were assessed as well. Experimental results indicate that the proposed CBG-assisted hot embossing technique, in combination with single point diamond turning technology, has the capability of producing high-quality glass MLAs. Moreover, this technique allows notably fine replication of surface shapes at the microscale, as well as roughness information at the nanoscale. Consequently, the embossed MLA replica shows satisfactory imaging performance.
A recently halted clinical trial showed that intensive treatment of type 2 diabetes mellitus was associated with increased mortality. Given the phenotypic heterogeneity of diabetes, therapy targeted ...at insulin status may maximize benefits and minimize harm.
In this longitudinal cohort study, we followed 503 patients with type 2 diabetes who were free of cardiovascular disease from 1996 until data on mortality and cardiovascular outcomes were censored in 2005. Phenotype-targeted therapy was defined as use of insulin therapy in patients with a fasting plasma C peptide level of 0.2 nmol/L or less and no insulin therapy in patients with higher C peptide levels.
The mean age of the cohort was 54.4 (standard deviation 13.1) years, and 56% were women. The mean duration of diabetes was 4.6 years (range 0-35.9 years). Of the 503 patients, 110 (21.9%) had a low C peptide level and 111 (22.1%) were given insulin. Based on their C peptide status, 338 patients (67.2%) received phenotype-targeted therapy (non-insulin-treated, high C peptide level n = 310 or insulin-treated, low C peptide level n = 28), and 165 patients (32.8%) received non-phenotype-targeted therapy (non-insulin-treated, low C peptide level n = 82 or insulin-treated, high C peptide level n = 83). Compared with the insulin-treated, low-C-peptide referent group, the insulin-treated, high-C-peptide group was at a significantly higher risk of cardiovascular events (hazard ratio HR 2.85, p = 0.049) and death (HR 3.43, p = 0.043); the risk was not significantly higher in the other 2 groups. These differences were no longer significant after adjusting for age, sex and diabetes duration.
Patients with low C peptide levels who received insulin had the best clinical outcomes. Patients with normal to high C peptide levels who received insulin had the worst clinical outcomes. The results suggest that phenotype-targeted insulin therapy may be important in treating diabetes.
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.
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