Associations between blood pressure levels and diabetic retinopathy in patients with diabetes mellitus: A population-based study.

Purpose: To evaluate the associations of blood pressure levels with diabetic retinopathy (DR), proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) in patients with diabetes mellitus. Design: A cross-sectional, population-based study. Subjects: A total of 152,844 patients with diabetes from 90 major cities in 19 provincial regions of mainland China during 2018-2021 were finally recruited. Methods: Blood pressure was graded into 5 levels: normal (without hypertension and <120/80 mmHg), normal high (without hypertension and ≥120/80 mmHg), HT-intensive (hypertension and <120/80 mmHg), HT-moderate (hypertension and blood pressure between 120/80 mmHg and 140/90 mmHg) and HT-high (hypertension and ≥140/90 mmHg). Logistic regression was employed to verify the associations of hypertension and blood pressure levels with DR, PDR and DME. The impacts of blood pressure levels on the outcomes were qualified with nomogram models. Main outcome measures: The main outcome was DR. Results: There were 16,685 (10.92%) participants having DR, 2841 (1.86%) having PDR, and 1566 (1.02%) having DME. There were 8126 (5.32%) patients without hypertension and 1350 (0.88%) patients with hypertension having blood pressure <120/80 mmHg. When compared to the normal group with covariates adjusted, an increased prevalence of DR was observed in normal high (adjusted odds ratio [OR] = 1.114, 95% confidence interval [CI] = 1.033-1.202), HT-moderate (adjusted OR = 1.163, 95% CI = 1.065-1.271), and HT-high (adjusted OR = 1.203, 95% CI = 1.114-1.300). Conclusions: There were associations between hypertension and DR, PDR, and DME in the diabetic population. Increased prevalence of DR was found with blood pressure >120/80 mmHg in both patients with and without hypertension. A nomogram was developed for DR prediction based on blood pressure levels.

The First-Year Variation in Central Retinal Thickness Predicts Legal Blindness in Patients with Neovascular Age-Related Macular Degeneration.

BACKGROUND: Due to its progressive nature, early evaluation and timely prediction of legal blindness are important in patients with neovascular age-related macular degeneration (nAMD). We examined the association between early-stage variation in central retinal thickness (CRT) and long-term visual outcomes in patients with nAMD. METHODS: We included 103 nAMD patients who were administered anti-vascular endothelial growth factor (anti-VGEF). Participants were considered qualified if they were: 1) 50 years and older, 2) treatment-naïve, 3) received standard anti-VEGF treatment and had complete baseline information. We further excluded patients with less than one-year follow-up data and those who experienced best-corrected visual acuity (BCVA) ≤35. Early-stage variability in CRT was measured as the first-year coefficient of variability (CV) of CRT. Patients were then classified into the high-variability and the low-variability groups according to the X-tile. A product-limit plot was used to demonstrate the differences and tested with the log-rank test. The association between first-year variability and visual outcomes was quantified using Cox regression models. Time-to-event primary endpoint was the overall visual preservation (OVP) rate, defined as the time from the first injection to legal blindness, i.e., BCVA ≤ 35 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. RESULTS: A threshold of 20% of first-year CV in CRT was used to categorized 76 qualified patients into high-variability (35, 46.1%) and low-variability (41, 53.9%). The 5- and 10-year OVPs for patients with high- vs. low-variability were 76% vs. 48%, and 59% vs. 22%, respectively. High early-stage CRT variability showed a significantly higher risk of legal blindness. Even after adjusting for the demographic and clinical features, the variability remained significant (HR=2.39, 95% CI: 1.20 to 4.78). CONCLUSIONS: First-year variability of CRT was predictive of long-term visual outcomes in patients with nAMD, and 20% of the variability could be used as a clinically convenient threshold to qualitatively classify patients into high- and low-variability groups. The current study is important for identifying high-risk populations and for long-term disease management.

[Consistency comparison of the parameters of the lumbar spine-pelvic sagittal plane between the whole-spine EOS images system and traditional X-ray].

OBJECTIVE: To explore the consistency of the parameters of the lumbar spine pelvic sagittal plane between the whole spine EOS images (EOS) and traditional X-ray imaging. METHODS: A total of 50 patients (26 males and 24 females) hospitalized in the Spine Surgery Department of Beijing Jishuitan Hospital from May to July 2019 were selected for standard standing EOS full-length spine anterolateral and traditional X-ray lumbar pelvic anterior and lateral X-rays. Two attending physicians used Surgimap software to measure the pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL) of the two types of images and repeated these process after two weeks. The consistency test (reliability analysis) was performed on the results measured by two physicians, and the results measured at the two time points were tested for intra-observer consistency (repeatability analysis).The data were combined to perform consistency and difference tests for the parameters between two types of images finally. RESULTS: The mean values of PI measured by EOS imaging and traditional X-ray imaging were(50.5±12.6)° and (51.4±12.2)°, mean difference 0.9, 95% credible interval (0.2-1.6), P=0.020; the mean values of PT were (16.2±8.9)° and (16.9±8.6)°, mean difference 0.7, 95% credible interval (-0.6-2.0), P=0.283; the mean values of SS were (34.3±9.9)° and (34.5±10.4)°, mean difference 0.2, 95% credible interval (-1.2-1.5), P=0.800;the mean values of LL were (42.7±14.9)° and (43.3±15.3)°, mean difference 0.6, 95% confidence interval (-0.8-2.0), P=0.149. The difference in PI between the two imaging methods was statistically significant (P =0.020, P <0.05), but the average difference was small (0.9°), there was no clinical difference. There were no significant differences in PT, SS and LL between the two imaging methods (P>0.05). Inter-group reliability analysis showed excellent agreement between the two physicians in measuring lateral PI, PT, SS and LL using Surgimap software (correlation coefficients within EOS imaging were 0.984, 0.993, 0.980, 0.989;correlation coefficients within X-ray imaging were 0.975, 0.985, 0.976, 0.988). Repeatability analysis showed that PI, PT, SS and LL measured by the two attending physicians at two time points had excellent consistency(ICC within the group was 0.963-0.996). CONCLUSION: In the local lumbar pelvis segment, the PI, PT SS and LL measured by EOS imaging and traditional X-ray imaging had good agreement, and there was no difference in guiding clinical application.

Distribution characteristics and release mechanisms of Pb in surface sediments in different aquatic environments.

As a trace heavy metal, lead (Pb) has many anthropogenic applications but also produces many environmental pollution problems because of its high toxicity. In this study, we combined two in situ high-resolution sampling techniques - high-resolution dialysis (HR-Peeper) and diffusive gradients in thin films (DGT) - with the DGT-induced fluxes in sediment (DIFS) model to explore the mechanism of Pb release and resupply between sediments and pore water in the lower reaches and estuary of the Jiuxi River and the adjacent coast. An analysis of the chemical forms of Pb in the sediments showed that the content of the acid-extractable fraction (F1) was higher at the coastal site than at the other sampling sites, which indicates that Pb in the coastal sediments had greater activity and was more likely to cause Pb pollution. The apparent diffusion fluxes of Pb across the sediment-water interface (SWI) in the lower reaches, estuary and coastal zone are negative, and the absolute value of Pb flux in the estuary is several times higher than that in the other two stations, indicating a strong downward Pb diffusion trend, which may be due to water pollution caused by the nearby sewage outlet. As an insensitive element to redox, Pb did not exhibit an obvious correlation with Fe. In particular, the high Pb concentration and strong downward diffusion trend of the overlying water in the estuary caused the significant negative correlation between Pb and Fe. The calculated results of the DIFS model show that the reduced layer in the intertidal zone along the coast has the highest R value, the highest desorption rate (k-1) and the shortest response time (Tc), indicating that sediment particles in the coastal intertidal zone supply Pb to the pore water at the fastest rate; consequently, Pb pollution in the coastal zone is worthy of further attention.

Cyclical patterns and (im)mobilization mechanisms of phosphorus in sediments from a small creek estuary: Evidence from in situ monthly sampling and indoor experiments.

Internal phosphorus (P) mobility is crucially important to overlying water ecosystems, while its spatiotemporal variations and mechanisms remain to be studied, especially in dynamic estuarine sediments. In this study, in situ monthly field sampling and indoor experiments were combined to measure the soluble reactive P (SRP), soluble Fe and diffusive gradients in thin films (DGT)-labile P/S in the overlying water, sediment and porewater in the Jiuxi River Estuary by employing high-resolution dialysis (HR-Peeper), the DGT technique and a MicroRhizon sampler. The consistent tendency between DGT-labile S and P in most seasons indicates that P mobilization was dominated by intense dissimilatory sulfate reduction (DSR), causing high SRP concentrations and active exchange with the overlying water. The circannual cyclical pattern of P is summarized, where in addition to temperature, monthly changes in runoff and tidal range are crucial external factors to control long-term P cycling via changed redox environments and terrigenous materials inputs. The mobile P, Fe and S present higher values during flood tides and lower values during ebb tides in tidal simulation experiments, demonstrating that the short-term cycling of P, Fe and S in intertidal surface sediments is highly redox-sensitive and controlled by tidal processes. The results also reveal that DSR greatly facilitates P mobility and release, while sediment oxidation and the induced enhancement in DIR and Fe cycling can effectively control P immobilization.

Metal/metalloid and phosphorus characteristics in porewater associated with manganese geochemistry: A case study in the Jiulong River Estuary, China.

Sediment porewater can be an important source of contaminants in the overlying water, but the mechanisms of metal(loid) and phosphorus (P) remobilization remain to be investigated. In this study, high-resolution dialysis (HR-Peeper) and diffusive gradients in thin films (DGT) samplers were used to determine the porewater dissolved iron (Fe), manganese (Mn), cobalt (Co), chromium (Cr), vanadium (V), selenium (Se), arsenic (As), P and DGT-Labile S in coastal sediments in the Jiulong River Estuary (JRE), China. The results showed that high concentrations of dissolved Mn, Se and P were present in the overlying water, indicating potential water pollution with excessive amounts of Mn, Se and P. The dissolved Mn concentrations in the porewater were higher than the dissolved Fe concentrations, especially at submerged sites, demonstrating that Mn(III/IV) reduction is the dominant diagenetic pathway for organic carbon (OC) degradation, which directly affects Fe cycling by the competitive inhibition of Fe(III) reduction and Fe(II) reoxidation. Dissolved Co, Cr, V, Se, As and P show significant positive correlations with Mn but nearly no correlations with Fe, suggesting that the mobility of these metal(loid)s and P is associated with Mn but not Fe cycling in this region. In addition, the coelevated concentrations of the metal(loid)s, P and Mn at the submerged sites are attributed to the strengthened Mn reduction coupled with OC degradation fueled by hypoxia. The higher positive diffusion fluxes of Mn, Se and P were consistent with the excess Mn, Se and P concentrations in the overlying water, together with the approximately positive fluxes of the other metal(loid)s, indicating that sediment Mn(III/IV) reduction and concomitant metal(loid) and P remobilization might be vital pathways for metal(loid) and P migration to the overlying water.