To evaluate the concordance between oscillometric ABI and standard Doppler ABI in diabetic Chinese patients with or without diabetic foot. n = 459 limbs) were included. The right and left ABIs were determined with both devices by the same investigator. The concordance and agreement were assessed by kappa index and the Bland-Altman method.  230 consecutive diabetic patients (p < 0.001). There was good agreement between the two measurements, with a kappa value of 0.869 on the right and 0.919 on the left. Regarding the Doppler ABI as the gold standard, the accuracy, sensitivity, specificity, +LR, and −LR of oscillometric ABI reached 95.22%, 94.34%, 95.48%, 20.873%, and 0.059% on the right. For the left, it was 96.94%, 96.43%, 97.11%, 33.364%, and 0.036%.  The average Doppler ABI was 1.003 ± 0.286 on the right and 0.990 ± 0.287 on the left, while oscillometric ABI was 1.002 ± 0.332 and 0.993 ± 0.319, which had no significance. The average time for oscillometric ABI was 8.600 versus 16.980 minutes for Doppler ABI ( The oscillometric measurement is a reliable, convenient, and less time-consuming alternative to standard Doppler ABI in patients. It should be widely used for PAD detection. Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis in patients with diabetes in China . The preTo overcome such obstacles and simplify measurement procedures, automatic devices have been developed. Some recent studies have shown that the automated oscillometric method appears to be convenient and useful compared with eco-Doppler , 13. Then = 459 limbs, mean age 61.28 ± 14.50 years, 126 men, 82 diabetic foot) were included our study. 328 consecutive patients with diabetes who were admitted to the Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, from May 2013 to June 2014 were recruited. Participants were excluded if they reported any history of previous bypass surgery or angioplasty, any major amputations on the lower or upper limbs, marked edema of one or both feet, and atrial fibrillation. Finally, 230 consecutive patients with diabetes (All measurements were obtained after the patients had rested for ten min in the supine decubitus position in a room with a comfortable temperature (24 ± 1°C), without smoking, heavy exercise, and drinking alcohol or caffeinated beverages for at least 2 h before the examination. The ABI was determined by the automatic method using a validated oscillometric device (OMRON BP-203RPEIII) that allows simultaneous arm-leg BP measurements and using a validated and calibrated sphygmomanometer and a two-way Doppler with an 8 MHz probe (Bidop Es-100V3. HADECO) by the same specially trained nurse with 10 years of experience in ABI measurement. Doppler-ABI measurement was invariably performed first because of the higher degree of subjectivity. For oscillometric ABI, they used appropriate cuff sizes on the arms and ankles, thus avoiding a potential bias by variations of blood pressure. Ankle pressures were measured over the dorsalis and posterior tibial arteries. Limbs were measured twice at the same time and the time interval was 10 seconds. ABI was calculated by dividing the highest value obtained at each ankle by the highest of the arm values. The ABI of both the left and right legs was recorded, and for the definition of PAD, the lower value between the two was considered .t-test. The intermethod concordance between both techniques was assessed by kappa coefficient and the Bland-Altman method was determined to analyze the agreement. Diagnostic accuracy was assessed via sensitivity, specificity, accuracy, positive likelihood ratio (+LR), negative likelihood ratio (−LR), with ABI readings dichotomized (ABI ≤ 0.9), and receiver operating characteristic (ROC) curve analysis using both univariable and multivariable logistic regressions. Conventionally, Cohen's kappa statistic below 0.2 is considered poor agreement, 0.21–0.4 fair, 0.41–0.6 moderate, 0.61–0.8 strong, and over 0.8 near complete agreement [p < 0.05 was accepted as indicating statistical significance. The statistical analysis was carried out using the SPSS statistics package, version 16.0  and MedCalc 15.8 software.The results were analyzed by diagnostic test analysis method. Continuous variables are summarized as mean ± standard deviation (SD) when normally distributed and as median (interquartile range) when asymmetrically distributed and categorical variables as percentage. ABI measurements were compared using a paired Student's greement . p < 0.0Patient characteristics are shown in p = 0.930) and left legs . Pathological ABI by eco-Doppler was detected in 67 (29.13%) subjects, including 43 subjects with abnormal ABI at two limbs and 24 subjects at one limb and in 66 (28.70%) subjects using the automated oscillometric measurement including 43 subjects at two limbs and 23 subjects at one limb. The prevalence across the categories of Doppler and oscillometric ABI values are shown in x2 = 2.703, p = 0.259). Compared to ABI obtained by eco-Doppler, the automated oscillometric measurement produced a false positive result in 6 (8.96%) patients and a false negative result in 6 (3.82%) patients.ABI values measured by eco-Doppler showed 1.003 ± 0.286 (0.210–1.390) on the right limb and 0.990 ± 0.287 (0.000–1.000) on the left limb, while the automated oscillometric measurement showed 1.002 ± 0.332 (0.000–1.900) on the right and 0.993 ± 0.319 (0.000–1.390) on the left. The difference of the oscillometric ABIs and the Doppler ABIs was not significant on the right  in the right limbs and 0.0031 in the left limbs. The value-to-value comparison showed good agreement between the two methods.The Bland-Altman plots of the difference comparison assessing the agreement of the two methods for all 230 patients are shown in Regarding the eco-Doppler measurement as the gold standard (defined ABI ≤ 0.9 as PAD), there were 173 true negatives, 50 true positives, 4 false negatives, and 3 false positives in the right legs, and 13 patients with an automatic index that was not measurable were classified correctly as true positives. There were 171 true negatives, 53 true positives, 2 false negatives, and 3 false positives in the left legs, and there were 11 patients with an automatic index that was not measurable. While in the analysis in terms of patients rather than limbs in the 230 patients with determination of ABI by both methods, there were 157 true negatives, 61 true positives, 6 false negatives, and 6 false positives, and there were 16 patients with an automatic index that was not measurable. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, accuracy, and kappa values of the oscillometric method are shown in p < 0.001).The mean time consumption for measurements with the automatic device and the handheld Doppler device was 8.60 ± 1.38 (ranges: 7.00–14.00) and 16.98 ± 3.20 (ranges: 10.00–30.00) minutes per patient, respectively. Compared to the handheld Doppler, the process of performing the automated oscillometric device consumed significantly less time  and “three low”  conditions . PAD wasn = 151 legs), which showed a sensitivity of 66.7%, a specificity of 96.8%, and an accuracy of 91.39%, with a kappa coefficient of 0.684 and AUC = 0.944 (95% CI = 0.905 to 0.983). Furthermore, when they were considering calcified legs as PAD equivalents (n = 180 legs), the sensitivity, specificity, and accuracy were 78.2%, 96%, and 90.56%, respectively, with a kappa coefficient of 0.645 and AUC = 0.914 (95% CI = 0.872 to 0.955). The differences between the study of Herráiz-Adillo et al. and our study maybe due to the different selected subjects and the detection equipment (OMRON M3 versus OMRON BP-203RPEIII). Especially, high sensitivity (90%) and specificity (98%) of oscillometric test for stenosis of ≥50% in the arteries of the lower limbs were found in this and other studies [In this study, we found that the automated oscillometric-ABI-measuring results was highly consistent with those by eco-Doppler methods and the former is less time consuming. The previous studies showed the correlation between the two methods ranging from 0.53 to 0.86 –23. This studies . However studies , 30 showThe time needed for Doppler ABI was longer than that for oscillometric-ABI methods (16.98 ± 3.20 (10.00–30.00) min versus 8.60 ± 1.38 (7.00–14.00) min). It may be due to the necessity of additional steps with Doppler, such as pulse palpation, the application of gel, signal viewing, and operational levels. The different results between the two methods were acceptable. The eco-Doppler method was affected by the operator and the intrinsic bias existed during measurement. And the automated oscillometric-ABI value was not influenced by the operator and the results were more reliable.Most published researches were based on nondiabetic population and suggested that an automated oscillometric ABI measurement is a reliable and practical alternative to the conventional Doppler measurement for the detection of PAD. Our objectives of the study were involved diabetic patients to validate. Our study was a single-center study and a sample size was not enough; further studies need to be performed.In conclusion, our finding suggested that ABI values measured by automated oscillometric method were highly consistent with those by eco-Doppler method. The former was convenient and less time consuming, which can be widely used in the primary care center without special training.


The aim of this study was to investigate the possible prognostic factors and predictive accuracy of the Glasgow Prognostic Score (GPS) for patients with unresectable locally advanced esophageal squamous cell carcinoma (LAESCC) treated with chemoradiotherapy.One hundred forty-two patients were enrolled in JCOG0303 and assigned to the standard cisplatin and 5-fluorouracil (PF)-radiotherapy (RT) group or the low-dose PF-RT group. One hundred thirty-one patients with sufficient data were included in this analysis. A Cox regression model was used to analyze the prognostic factors of patients with unresectable LAESCC treated with PF-RT. The GPS was classified based on the baseline C-reactive protein (CRP) and serum albumin levels. Patients with CRP ≤1.0 mg/dL and albumin ≥3.5 g/dL were classified as GPS0. If only CRP was increased or only albumin was decreased, the patients were classified as GPS1, and the patients with CRP >1.0 mg/dL and albumin <3.5 g/dL were classified as GPS2.The patients’ backgrounds were as follows: median age (range), 62 (37–75); male/female, 119/12; ECOG PS 0/1/2, 64/65/2; and clinical stage (UICC 5th) IIB/III/IVA/IVB, 3/75/22/31. Multivariable analyses indicated only esophageal stenosis as a common factor for poor prognosis. In addition, overall survival tended to decrease according to the GPS subgroups : GPS0/GPS1/GPS2 16.1/14.9/8.7).Esophageal stenosis was identified as a candidate stratification factor for randomized trials of unresectable LAESCC patients. Furthermore, GPS represents a prognostic factor for LAESCC patients treated with chemoradiotherapy.UMIN000000861. Despite substantial improvements in screening and diagnosis, esophageal cancer (EC) is frequently diagnosed at a very advanced stage . The thoThe status of each patient with invasive thoracic esophageal cancer varies widely due to variability in the extent of the tumors and the nutritional and general status of the patients. Thus, establishing the factors that are involved in therapeutic effectiveness and prognosis is important for tailoring an optimized treatment strategy and further improving treatment outcomes. Emerging evidence suggests that TNM stage, a weight loss of more than 10% of one’s body mass, dysphagia, large tumors, older age, and lymphatic micrometastases  are independent predictors of a poor prognosis in patients with advanced EC who have undergone surgery [Moreover, hypoalbuminemia and C-reactive protein (CRP) are associated with a poor prognosis in cancer patients . The Glahttp://www.umin.ac.jp/ctr/) with the identification number UMIN000000861.Key eligibility criteria were as follows: age of 75 years or younger, patients with histologically proven squamous cell carcinoma, adenosquamous, or basaloid carcinoma of the thoracic esophagus, and an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0–2; in addition, patients who had any of the following conditions were included: definite clinical T4 cancer, at least 1 unresectable metastatic regional lymph node due to invasion into an adjacent organ, or computed tomography (CT)-based evidence of M1 Lym disease, such as fixed supraclavicular or celiac lymph nodes. Regional lymph nodes were defined using criteria specified by the 5th edition of the Union for International Cancer Control (UICC) TNM staging system . After c2 cisplatin given on days 1 and 29 combined with a continuous infusion of 700 mg⁄m2 5-FU given on days 1–4 and 29–32. Patients in arm B received a 1 h infusion of 4 mg⁄m2 cisplatin before RT, combined with a continuous infusion of 200 mg⁄m2 5-FU on the first 5 days of each week. Treatment completion was defined as the termination of two courses of chemotherapy and 60 Gy of radiotherapy within 63 days.The patients were randomized to receive either SDPF-RT (arm A) or LDPF-RT (arm B). The chemotherapy regimen in arm A consisted of 70 mg⁄mFor the analysis of prognostic factors using pretreatment factors, the OS was calculated from the date of randomization until death from any cause, or the OS was censored at the time of the last follow-up. An initial univariable Cox regression analysis was performed to evaluate factors that could potentially affect the survival outcomes. Furthermore, a multivariable analysis that included all covariates and a multivariable analysis with the stepwise selection method were performed.3, 8000/mm3, 13 g/dL, 1.0 mg/dL, 3.5 g/dL, 30 IU/L, 15 mg/dL, 80 mL/min, 5 ng/mL, and 1.5 ng/mL, respectively. The cutoff points of each laboratory test were determined based on a clinical perspective. Survival curves were estimated using the Kaplan–Meier method. Two-sided p values <0.05 were considered statistically significant. All statistical analyses were performed with SAS9.2 .The following pretreatment factors were tested in the analyses: age (≥65 vs. <65 years), sex , ECOG PS (0 vs. 1 or 2), clinical T stage , clinical N stage (N0 vs. N1), clinical M stage (M0 vs. M1a or M1b), histological subtype of SCC (well-differentiated or moderately differentiated vs. poorly differentiated vs. unknown), location of the primary tumor (upper vs. middle or lower), clinically diagnosed esophageal stenosis (absent vs. present), adjacent organ invasion mediated by LN metastasis (absent vs. present), intramural metastasis (absent vs. present), and the laboratory data described below, which were obtained upon enrollment in the trial. The white blood cell count, neutrophil count, hemoglobin level (Hb), CRP level, albumin level, GPT, BUN, creatinine clearance (CrC), CEA level, and SCC level were dichotomized, with cutoff points at 10,000/mmThe GPS was determined as previously described by several groups –15. PatiIn all, 142 patients from 24 participating institutions of the Japan Esophageal Oncology Group of the JCOG were enrolled between May 2000 and May 2006. Of these, 71 patients were randomly assigned to SDPF-RT (arm A) and 71 patients were randomly assigned to LDPF-RT (arm B). Of the patients randomized into the two groups, 7 in arm A and 4 in arm B were excluded from this ancillary study because there were no documented data for the aforementioned prognostic factors. Thus, 131 patients comprised the population for the analysis based on prognostic factors  of all randomized 142 patients and of the final 131 patients included in this study were 14.4 months. Among all randomized patients, the 1- and 3-year survival rates were 57.0 and 23.9%, respectively, while those rates of the patients included in this study were 58.8 and 22.9%, respectively  in the multivariable analysis with stepwise selection (Table p = 0.001)  and histological subtype of SCC (unknown) were significantly associated with poor survival. A multivariable analysis with stepwise selection also confirmed esophageal stenosis as an indicator of poor survival, although a serum Alb level <3.5 g/dL was not an independent prognostic factor in the multivariable analysis that included all covariates. The hazard ratio for patients with esophageal stenosis (present) was 1.60 (95% CI 1.10–2.32) compared with patients without esophageal stenosis (absent) (p = 0.35) and was 1.95  in GPS2 patients to GPS0 patients. Patients with a GPS of 0 had a median survival of 16.1 months, while patients with a GPS of 1 and 2 had a median survival of 14.9 and 8.7 months, respectively (p = 0.001) . Zenda et al. described that low pretreatment levels of Hb were significantly associated with the efficacy of CRT in patients with T4/M1 EC . SimilarThus far, SCC and CEA are well-known tumor markers for esophageal cancer . NeverthPatients with advanced EC comprise a heterogeneous population, as represented by differences in variables such as age, co-morbidities, primary tumor location, and ECOG PS. Additionally, simple and inexpensive markers are desirable to establish a prognosis of ESCC. Therefore, we evaluated the utility of the GPS in unresectable LAESCC because these markers can be easily analyzed using typical blood tests. The GPS, which takes into account the serum CRP and albumin levels, simply reflects the systemic inflammation status of patients with cancer and their prognosis, as described for various cancer types. In addition, a series of work by McMillan and other groups outlined the indisputable association between an increased CRP level and poor survival in various tumor types , 24–29. This analysis does have some limitations. One of the limitations is that the patients enrolled in this clinical trial, who might have a better prognosis, are compared with patients in clinical practice. Therefore, other factors that affect the prognosis of “real” patients may be obscured. Another limitation is the definition of “stenosis”. In the JCOG0303 trial, stenosis of the primary lesion was not strictly defined, and the clinical investigators who participated in this study diagnosed it subjectively. Thus, “stenosis” seemed to vary among investigators. Some investigators reported stenosis in patients who experienced dysphagia, while other investigators reported stenosis in patients whose primary lesions were too narrow for an endoscopy to be performed. Collecting and evaluating data in an objective manner using the dysphagia score (DS) would be a better procedure to follow in the next clinical trial .In conclusion, esophageal stenosis was thought to be a potential stratification factor in a randomized trial that included patients with unresectable LAESCC. Furthermore, the GPS represents a prognostic factor in patients with LAESCC who are treated with CRT. These data can be easily collected before treatment. Further studies are needed to clarify the association between these pretreatment data and clinical outcomes and to be able to use these parameters as stratification factors in the next prospective randomized trial of CRT for LAESCC.


Subclinical hypothyroidism (SH) is associated with adverse obstetric outcomes and neurodevelopment disorders. Both iodine deficiency and excess are associated with SH; however, few data regarding iodine nutrition status of pregnant women with SH are available. This study aimed to clarify whether iodine deficiency or excess is associated with SH, especially, when test results for anti-thyroid autoantibodies are negative.A total of 115 women with SH and 104 women with euthyroidism (EH) in early pregnancy in Tianjin, China were investigated, and their serum thyroid-stimulating hormone, free thyroxine, free triiodothyronine, anti-thyroid peroxidase antibody (TPOAb), anti-thyroid globulin antibody (TGAb), urinary iodine (UIC), and urinary creatinine (UCr) concentrations were measured. Thyroid ultrasonography was performed to determine thyroid echogenicity and volume. The UIC, UIC/UCr ratio, prevalence of TPOAb and TGAb positivity, and thyroid gland volume were compared between the EH and SH groups. UIC and ultrasonographic features were analysed in subjects in the SH group who were negative for TPOAb and TGAb.P < 0.01). The percentage of subjects with UIC ≥ 250 μg/L in the SH group was significantly higher than that in the EH group (p = 0.004). The percentage of subjects negative for autoantibodies and UIC ≥ 250 μg/L in the SH group tended to be higher than that in subjects in the EH group negative for autoantibodies, but the difference was not statistically significant . Eight of 18 subjects in the SH group with negative results for TPOAb and TGAb were diagnosed with Hashimoto thyroiditis by means of thyroid ultrasonography.Median UIC of SH (154.0 μg/L) and EH (150.1 μg/L) met the World Health Organization criterion for iodine sufficiency in pregnant women. Neither UIC nor the UIC/UCr ratio differed significantly between groups. The prevalence of TPOAb and TGAb positivity in the SH group was significantly higher than that in the EH group (Women in early pregnancy with SH in Tianjin were iodine sufficient, but still at risk of iodine deficiency as pregnancy progressed. UIC ≥ 250 μg/L was associated with increased risk of SH. Serological negative autoimmune thyroiditis and UIC ≥ 250 μg/L may play a role in pathogenesis of SH cases with negative results for autoantibodies. Clinical hypothyroidism can result in retarded foetal growth, mental development disorders, and adverse obstetric outcomes. Mounting clinical evidence suggests that SH contributes to an increased rate of obstetric complications and adverse birth outcomes including gestational diabetes, gestational hypertension, miscarriage, premature birth, small-for-gestational-age babies, placental abruption, and postpartum haemorrhage . The thyroid volume was a sum of the volumes of both lobes .3, FT4, TSH, UIC, and UIC/UCr) were presented as median and interquartile range (25th–75th percentiles). Two independent-sample t-tests were used to compare age and gestational weeks, and Wilcoxon rank sum tests were used to compare FT3, FT4, TSH, UIC, and UIC/UCr between the two groups. The chi-squared test or Fisher’s exact test was adopted for frequency comparison. Spearman rank bivariate correlation was adopted for correlation analysis. Two-tailed cut-offs were used, and a P value <0.05 was considered statistically significant.Data were analysed using SPSS 19.0 software . Normally distributed data  were reported as mean ± standard deviation, and skewed data  with an average age of 28.3 ± 3.1 years were enrolled in the study. One hundred four subjects in the EH group were aged 28.0 ± 3.0 years and had gestated for 10.1 ± 2.3 weeks, while 115 subjects in the SH group were aged 28.6 ± 3.2 years and had gestated for 10.2 ± 2.0 weeks. There were no significant differences between age and gestational week between the two groups (Table p = 0.231). The median UIC/UCr ratio in the SH and EH groups was 140.7(98.1–226.4) μg/g and 131.7(82.8–183.9) μg/g, respectively, and was not significantly different between the groups  . The percentage of those with UIC ≥ 250 μg/L in the SH group was significantly higher than that in the EH group  (Table The median (range) UIC in the SH and EH groups was 154.093.1–243.1) μg/L and 150.1(103.5–187.5) μg/L, respectively, with no significant difference between the groups . FT4 level in the SH group was significantly lower than that in the EH group , however FT3 and thyroid volume did not differ significantly between the two groups. There was no significant relationship between TSH or FT4 and TPOAb level in women in early pregnancy (p > 0.05).The prevalence of TPOAb and TGAb in the SH group was significantly higher than that in the EH group . To explore the possible aetiology of SH in subjects with negative anti-thyroid autoantibodies, we analysed UIC and ultrasonographic features of the subjects. The distribution frequencies in the autoantibody-negative SH group among those with UIC < 150 μg/L, 150–249 μg/L and ≥250 μg/L were 38.9% (7/18), 33.3% (6/18), and 27.8% (5/18), respectively, while those in the autoantibody-negative EH group were 50.0% (20/40), 45.0% (18/40), and 5.0% (2/40), respectively. The distribution frequencies tended to be different between the two groups, but the difference was not statistically significant (p = 0.066)  .UIC was not significantly correlated with FTDemand for iodine as a nutrient increases in pregnancy to support a series of physiological changes , 17, incAs >90% of ingested iodine is ultimately excreted in the urine, UIC is a good indicator of iodine nutritional status, and median UIC from a large sample in a previous study has been widely used as a biomarker of population iodine intake . WHO recThe current study showed that the percentage of those with more-than-adequate and excessive iodine in the SH group was significantly higher than that in the EH group. These findings indicate that iodine excess, rather than iodine deficiency, is associated with SH in early pregnancy in Tianjin. In most cases, excessive iodine intake may inhibit thyroid hormone synthesis and secretion to protect the body from thyrotoxicosis, the so-called acute Wolff-Chaikoff effect , which iThe prevalence of TPOAb (79.1%) and TGAb (69.6%) positivity in early pregnancy with SH was significantly higher than that in subjects with euthyroidism, suggesting that autoimmune thyroiditis is the major cause of SH in early pregnancy in Tianjin. Additionally, TPOAb and TGAb positivity is a risk factor for postpartum thyroiditis  and thus4 level was not significantly different between the autoantibody-negative and -positive subgroups. Eight of 18 subjects in the SH group with negative thyroid antibodies were diagnosed as autoimmune thyroiditis by means of thyroid ultrasonography. Rago has confirmed the value of thyroid ultrasonography in detecting autoimmune thyroiditis in cases with negative thyroid antibodies [Although 15.7% of subjects in the SH group were both TPOAb- and TGAb-negative, the serum TSH and FTtibodies . TherefoThere were remaining ten subjects both negative for thyroid antibodies and ultrasonography, in the literature, such cases are referred to as “idiopathic subclinical hypothyroidism”  or “non-There are some limitations in our study. Firstly, the incidence of SH in pregnancy has been reported to be 2–4% , and somIn summary, the current results show that women with SH in early pregnancy in Tianjin were iodine sufficient, but remained at risk of iodine deficiency as pregnancy progressed. Moreover, more-than-adequate and excess iodine (UIC ≥ 250 μg/L) were associated with SH. In addition, serological negative autoimmune thyroiditis and UIC ≥ 250 μg/L may play a role in pathogenesis of SH with negative autoantibodies. However, owing to the small sample size and limited usefulness of spot UIC, a larger sample study is needed to confirm the results.


Background and objective: Two endothelin receptor antagonists (ETRAs), bosentan and ambrisentan, are approved for patients with pulmonary arterial hypertension (PAH). However, there is little information about the transition strategy between these two ETRAs. We aimed to evaluate the safety and efficacy from ambrisentan to bosentan. Methods: Twenty PAH patients were enrolled into the single-center, open-labelled prospective study. Echocardiogram, WHO functional class (WHO-FC), 6-minute walking distance (6MWD), right heart catheterization, and hemotology were collected. After receiving oral 5 mg ambrisentan daily initially for one year, the patients were divided into two arms: eight patients switched to bosentan, while the remaining 12 patients continued ambrisentan. Characteristics at baseline, 1-and 2-year follow-up points were compared. Results: There were no significant differences in echocardiogram, WHO-FC, hemodynamics, demographics and liver function at baseline, 1-and 2-year points in both arms. 6MWD in bosentan group was significantly shorter at baseline. But there were no significant differences of 6MWD at 1- and 2-year points. Conclusions: It is safe for stable PAH patients to transition from ambrisentan to bosentan without hemodynamic or hematologic deterioration. Pulmonary arterial hypertension (PAH) is a progressive disease characterized by increasing pulmonary arterial pressure and pulmonary vascular resistance, leading to right heart failure and ultimately death , 2. EndoSide effects such as liver toxicity and drug interactions differ between these ETRAs . We presn = 8) or ambrisentan (n = 12) group. Data were collected from each patient at baseline, 1-year, and 2-year points. Collected data included 6-minute walk distance (6MWD), NT-pro-brain natriuretic peptide (NT-proBNP), WHO functional class (WHO FC), echocardiography parameters (tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure, LV eccentricity index, pericardial effusion), arterial oxygen saturation, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and uric acid plasma concentrations (UA).We performed a prospective single-center study at our center. All patients included are ethnic Chinese . Twenty Ethical approval was received from the ethics committee of Shanghai Pulmonary Hospital. All patients consented to be included in the study.t tests for normally distributed data and Mann–Whitney U tests for not normally distributed data. Chi-square tests were used to analyze changes of pericardial effusion and WHO FC. Statistical analyses were conducted using SPSS 20.0. A P value < 0.05 was considered statistically significant.Data are presented as mean ± standard deviation, unless stated differently. Comparisons of characteristics, 6MWD, echocardiography parameters, and hematology between two groups were performed using independent Demographic and baseline characteristics are outlined in P < 0.05. 6MWD was 422.3 ± 81.1 m and 409.0 ± 92.0 m at 1 year and 2 year in the bosentan group, and 517.3 ± 60.8 m and 520.0 ± 72.4 m in the ambrisentan group. 6MWD deviation from baseline to 1 year was 10.3 ± 14.5 m and −5.6 ± 38.9 m, and the deviation from 1 year to 2 year was 13.3 ± 29.6 m and −2.8 ± 21.2 m, respectively, in bosentan and ambrisentan groups  at baseline, 1 year, and 2 year in two groups   .P > 0.05) (P > 0.05) from baseline to 1 year or from 1 year to 2 year between bosentan and ambrisentan groups (P > 0.05)  . No sign > 0.05) .P > 0.05). WHO FC was also not significantly different between two groups (P > 0.05)  .Our study is a single-center, open-label prospective controlled study, and we believe that it is the first time to study the effects of transition between bosentan and ambrisentan in PAH. Our data suggested that switching from a selective ETRA ambrisentan to an unselective ETRA bosentan may be reasonable and safe.After transition, there was no marked change in hemodynamics as assessed by echocardiography, or in hematologic parameters, 6MWD, and WHO FC. Cost is commonly cited as a reason for transition to bosentan by Chinese patients. There could be potential bias on the outcomes of the patients because of the unevenness of the socioeconomic status of the patients and the discrepancy of the drug price. In fact, the socioeconomic factors have been balanced to be similar to each other amongst all the patients before their enrollment in this study. Even so, we did not ignore the role of economic factors, as the effect of drug prices on treatment exists in China. Also, if there is intolerance to ambrisentan, transition to bosentan may be an effective choice.Although there was a statistical difference at baseline in 6MWD between the two groups , hemodynN = 5/2/1 and 11/1/0, resp.). Thus, bosentan is similar to ambrisentan in maintaining stability of exercise capacity.Many studies have used 6MWD as the primary end point . 6MWD reNT-proBNP and uric acid levels are biomarkers of heart failure, and their high plasma levels have consistently been reported as predictors of mortality –18. SignThe evaluation of pulmonary arterial hypertension requires a multimodality approach. Echocardiography continues to be a valuable tool to evaluate disease progression as it generates a wealth of information about response of the right heart to elevated pulmonary pressure. Numerous measurements can be used to identify alterations in right heart morphology, pressure, and function. Although each variable in isolation may have little utility, meaningful information is revealed when multiple parameters are considered together . In this


Fasting plasma glucose (FPG) ≥7.0 mmol/L was the reference standard for type 2 diabetes, and FPG between 6.1 and 6.9 mmol/L as impaired fasting glucose.A diagnostic validation study of HbA3645 adults (of whom 63% were women) recruited from two demographic surveillance study sites in urban and rural Malawi. This analysis excluded those who had a previous diagnosis of diabetes or had history of taking diabetes medication.1c demonstrated excellent validity to detect FPG-defined diabetes, with an area under the receiver operating characteristic (AUROC) curve of 0.92 (95% CI 0.90 to 0.94). At HbA1c ≥6.5% (140 mg/dL), sensitivity was 78.7% and specificity was 94.0%. Subgroup AUROCs ranged from 0.86 for participants with anaemia to 0.94 for participants in urban Malawi. There were clinical and metabolic differences between participants with true diabetes versus false positives when HbA1c was ≥6.5% (140 mg/dL).HbA1c to detect type 2 diabetes. As HbA1c testing is substantially less burdensome to patients than either FPG testing or oral glucose tolerance testing, it represents a useful option for expanding access to diabetes care in sub-Saharan Africa.The findings from this study provide justification to use HbA Further, HbA1c testing does not require any special pretest preparations, such as overnight fasting or glucose loading.The diagnosis of diabetes has traditionally been based on the detection of elevated plasma glucose levels, either after fasting or 2 hours after an oral glucose tolerance test, or, in symptomatic individuals, after a random blood glucose check.1c levels which may be relevant for diagnostics in sub-Saharan Africa.1c to diagnose diabetes for people who have malaria,1c to diagnose type 2 diabetes and its precursor, impaired fasting glucose, in sub-Saharan Africa, we conducted a diagnostic accuracy study in Malawi, and have reported results here.There are acknowledged limitations when attempting to measure HbAThis report uses data collected as part of a Malawi Epidemiology and Intervention Research Unit survey, which aimed to understand the burden and risk factors of non-communicable diseases in Malawi,1c was performed using the Beckman Coulter Chemistry Analyzer AU480 system according to the manufacturer’s guidelines.Detailed study procedures have been previously reported.1c testing was conducted on all participants samples for which FPG results were greater than 5.6 mmol/L and in a 10% random sample of those with FPG lower than 5.6 mmol/L. The laboratory technician who conducted the HbA1c test was blind to the participants’ clinical characteristics and FPG result. Nearly all (87%) of HbA1c tests were completed within 24 hours of FPG test. Cut-points recommended by WHO were used to define FPG as normal (<6.1 mmol/L), impaired fasting glucose (6.1 to 6.9 mmol/L) or diabetes (≥7.0 mmol/L).2), overweight (25≤BMI<30) and obese (BMI ≥30) and categories for anaemia (haemoglobin <12.0 g/dL for women and <13.5 for men) were used.FPG testing was conducted on all participant samples. HbA1c level was compared by FPG result (<7.0 vs ≥7.0 mmol/L) with logistic regression. Third, the validity of HbA1c for diagnosing diabetes, using FPG (>7.0 mmol/L) as reference standard, was assessed by using Somers’ D statistic with Harrell’s C transformation to estimate the area under the receiver operating characteristics (AUROCs) curve and 95% CI. Validity statistics  were reported for standardised HbA1c scores which correspond to 1.0, 2.0, 3.0 and 4.0 SD above the sample’s mean HbA1c score, at an ‘optimal’ value identified by Youden’s J statistic (where the sum of the sensitivity and specificity reaches its maximum),1c scores from the diabetes-negative participants with HbA1c test results  such that the subsampled participants were upweighted 10-fold before generating the distribution. Fourth, to consider the validity of HbA1c to detect diabetes across subgroups, the ROC analysis was stratified by site, sex, BMI and haemoglobin level. Within each stratum, the sensitivity, specificity and positive and negative likelihood ratio when using HbA1c ≥6.5% (140 mg/dL) as a cut-off score were reported. Fifth, the AUROC and 95% CI for detecting impaired fasting glucose (FPG ≥6.1 mmol/L) with HbA1c were estimated among those who did not have diabetes (FPG <7.0 mmol/L). Finally, the clinical characteristics were described for the subsets of participants who had FPG-defined diabetes, and for true/false-positive participants with HbA1c ≥6.5% (140 mg/dL). Again, medians and IQRs were reported for continuous measures and proportions for categorical measures. The analysis was conducted using Stata SE V.14.2   were described separately for the Karonga and Lilongwe samples. Medians and IQRs were reported for the continuous measures, as most of these measures were skewed, and proportions for categorical measures. Second, distribution of HbA10.1136/bmjopen-2017-020972.supp1Supplementary file 1The study protocol was reviewed and approved. Participants identified as having diabetes were referred to chronic care clinics established in conjunction with the Malawi Ministry of Health, where they initiated management per national treatment guidelines.The Karonga and Lilongwe population platforms’ research priorities have reflected the Malawi National Health Research Agenda, and operate through a long-standing research partnership with the Malawi National Ministry of Health and Malawi College of Medicine. The design and aims of these platforms were developed in a stakeholders’ meeting in Lilongwe, the capital city of Malawi, attended by policy makers, policy implementers and researchers. The designs of the platforms were influenced by staff working closely with the communities and engaging through community meetings. Prior to launching new substudies, the research team conducts community sensitisation events with dancing, dramas and question and answer sessions. In Karonga, village elders and other responsible community members were responsible for enumerating households, and for reporting household vital events and household migrations. In Lilongwe, block leaders were involved in sensitisation and communication with the community prior to enumeration by research staff. Preliminary results from this study have been disseminated at a conference held at the University of Malawi College of Medicine, and presentations for lay audiences, such as for the participating communities, are being prepared.1c levels measured, and who did not report prior diagnosis of diabetes by a medical professional.As shown in the Standards for Reporting of Diagnostic Accuracy Studies (STARD) flow diagram , 30 574 The demographic and clinical characteristics of analysis participants are reported in 1c level was 5.3% (IQR 4.9–5.7) and 7.3% had HbA1c level of 6.5% (140 mg/dL) or higher. The median FPG level was 4.7 mmol/L (IQR 4.3–5.0); 1.8% of participants had an FPG level consistent with impaired fasting glucose and another 1.7% with diabetes.For the 3645 participants, the median age was 33 years (IQR 24–44) and 63% were women. The median HbA1c score, there was an almost threefold increase in the odds of having FPG-defined diabetes  75.5, p<0.001). Further, HbA1c demonstrated excellent validity to detect for FPG-defined diabetes, with an AUROC of 0.92 (95% CI 0.90 to 0.94). Validity statistics are presented for a range of HbA1c cut-points in For every percentage unit increase in HbA1c value of 6.0% corresponded to 1.0 SD above the mean in the diabetes-negative sample’s distribution of HbA1c scores; at this cut-point, 84.4% of people with diabetes would test positive (sensitivity) and 86.9% of people without diabetes would test negative (specificity). At the commonly recommended HbA1c threshold of 6.5% (140 mg/dL), sensitivity was 78.7% and specificity was 94.0%. Youden’s J was at an HbA1c value of 6.6%, where sensitivity was 78.3% and specificity was 94.6%. Stratum-specific AUROCs (1c ≥6.5% (140 mg/dL), participants with anaemia had 61.5% sensitivity, 96.4% specificity and a positive likelihood ratio of 17.4, and the corresponding figures for participants in Lilongwe were 70.2%, 95.4% and 15.2.An HbAc AUROCs  ranged f1c score had average validity to detect impaired fasting glucose .Among participants who did not have FPG-defined diabetes, the HbAThe clinical characteristics of participants who had FPG-defined diabetes and for participants who had true/false-positive results are presented in 2 (IQR 24.2–32.5) and the median systolic blood pressure 133.5 mm Hg (IQR 121.5–153). The characteristics of true-positive participants (HbA1c ≥6.5% (140 mg/dL) and FPG ≥7.0 mmol/L) and the false-positive participants (HbA1c ≥6.5% (140 mg/dL) and FPG <7.0 mmol/L) are also described in The participants who had FPG-defined diabetes (FPG ≥7.0 mmol/L) had a median age of 50 years (IQR 41–60) and 65.5% were women. The median BMI was 27.9 kg/m1c is highly predictive of FPG-defined type 2 diabetes, a relationship which was consistent across several subgroups. HbA1c was less predictive for impaired fasting glucose. Using a cut-off value of HbA1c6.5% (140 mg/dL) to detect diabetes, there were demographic and clinical differences between true-positive and false-positive participants.In a large, multisite sample of adults in Malawi, we found that HbA1c as a stand-alone test to detect type 2 diabetes in a black African population in sub-Saharan Africa, and the first from Malawi. In Uganda, Mayega et al found that HbA1c had moderate validity (AUROC 0.75) for detecting FPG-defined diabetes,et al in South Africa (AUROC 0.95). These findings from sub-Saharan Africa complement meta-analyses of studies in East Asia, Middle East and Europe which show that HbA1c is a valid test for detecting diabetesThis analysis is one of the first to compare HbA1c ≥6.5% (140 mg/dL). Compared with participants who had HbA1c ≥6.5% (140 mg/dL) and FPG <7.0 mmol/L, those who had both FPG ≥7.0 and HbA1c ≥6.5% (140 mg/dL) were more likely to be women, to be older and to have higher BMI and blood pressure. These findings are consistent with data from the Uganda where the AUROC for all participants was 0.75, but was significantly higher at 0.90 for overweight participants and 0.98 for obese participants. This suggests that HbA1c is particularly useful in in detecting diabetes in individuals with insulin resistance or metabolic syndrome . In contrast, the false-positive group (HbA1c ≥6.5% (140 mg/dL) and FPG <7.0 mmol/L) lacked features of metabolic syndrome. The false-positive group is likely to include individuals with isolated postprandial hyperglycaemia, rather than fasting hyperglycaemia (perhaps from pancreatic deficiency rather than insulin resistance), which would require oral glucose tolerance testing (OGTT) to demonstrate. Notably, HbA1c has been shown to strongly predict OGTT-defined diabetes in South Africa, where Hird et al estimated the AUROC at 0.94.There were several notable demographic and clinical differences between participants who were true versus false positives for FPG-defined diabetes at HbA1c had poor predictive ability for detecting impaired fasting glucose. This is consistent with other studies in Africa and evidence from a recent meta-analysis by Kodama et al.1c may not be appropriate for detecting impaired fasting glucose in this population.We found that HbA1c to detect diabetes across a range of groups. However, AUROC values were lowest for those with anaemia, which appear to be driven by a drop in sensitivity. Different forms of anaemia  affect the integrity and quantity of HbA1c-carrying red blood cells, resulting in HbA1c having diminished utility as a stand-alone diagnostic tool among individuals with anaemia.et al also found that the AUROC for HbA1c to detect OGTT-defined diabetes in South Korea was lower for adults with anaemia (0.86 vs 0.88).1c testing maintains its validity.Stratum-specific AUROC analysis indicated largely consistent values across strata , which is evidence of suitability of HbA1c using FPG-defined diabetes as the diagnostic standard, compared with nine using OGTT.1c validation studies conducted among black populations in sub-Saharan Africa, Hird et al used both FPG and OGTT as diagnostic standards, with consistent results .26We used FPG rather than OGTT as the reference standard for diabetes in this analysis. A 2013 meta-analysis of 13 cohort studies found that FPG is highly correlated to present and to future diabetes,1c as well as relevant implications for clinical practice. A final limitation concerns the decay in glucose levels which occurs when blood is stored in fluoride tubes. The reduction in variation in glucose levels was independent of OGTT result, and so would have resulted our underestimating the AUROCs for diabetes and for impaired fasting glucose.Not collecting OGTT data constitutes an important limitation of our study. In addition, although the overall sample size was large and the overall AUROC estimate was precise, the subgroups had fewer diabetes cases which resulted in our conducting of descriptive rather than hypothesis-confirming analysis of subgroup validity. Another limitation is that we did not assess the cause or type of anaemia, which would have had differential effects on HbA1c testing is less burdensome to patients than FPG and OGTT, it represents a useful option for expanding access to diabetes care. This will become particularly important as countries in sub-Saharan Africa allocate increasing resources to the health sector, and as operating costs for the HbA1c test reduce over the next few years.Demographic models indicate that sub-Sahara will experience a substantial increase in diabetes prevalence in the coming years, which will require urgent strategies to scale up detection and treatment in order to increase access to care. As HbA


Independent variables were ethanol concentration, extraction temperature, solid-to-solvent ratio, and extraction time. The result of RSM analysis showed that the four variables investigated have a significant effect (p < 0.05) for Y1, Y2, Y3, Y4, and Y5 with R2 value of 0.9120, 0.9793, 0.9076, 0.9125, and 0.9709, respectively. Optimal conditions for the highest extraction yield of 39.28%, PTP-1B inhibition rate of 86.21%, α-glycosidase enzymes inhibition rate of 96.56%, and ABTS inhibition rate of 77.38% were derived at ethanol concentration 50.11%, extraction temperature 72.06°C, solid-to-solvent ratio 1 : 22.73 g/mL, and extraction time 2.93 h. On the basis of total polyphenol content of 48.44% in this optimal condition, the quantitative analysis of effective part of KWZ was characterized via UPLC method, 12 main components were identified by standard compounds, and all of them have shown good regression within the test ranges and the total content of them was 11.18%.By using extraction yield, total polyphenolic content, antidiabetic activities (PTP-1B and  But the better extraction method for obtaining high yield, polyphenol content, and active parts was still unknown and the chemical constituents of the active part were still confused.With the rising morbidity of diabetes, the medicinal plants are widely used for the treatment and prevention of diabetes. The medicinal plants or natural products involve retarding the absorption of glucose by inhibiting the carbohydrate-hydrolyzing enzymes, such as d effect . Geraniucopoeia”  and “kazcopoeia” . Differemedicine . G. collpruritus . Aerial tivities . Under oG. collinum is the Geraniaceae of the genus Geranium and distributed in the east, west Asia, central Asia, central Europe, and Xinjiang of China [ Geranium was the important herbal medicine in folk and modern society. Recently researches show that this kind of plant has a variety of biomedical activities such as antioxidant activity, anti-inflammatory activity, use against diarrhea, ulcer healing, reducing blood sugar, and prevention and treatment of diabetes complications [of China . Speciesications –15. The ications .H. scabrum is one of the species of genus Hypericum; Hypericum species also have many biological activities such as antiviral, wound healing, antioxidant, antimicrobial, antifungal, anxiolytic, and anticonvulsant activities [ Hypericum also show effect in the treatment of burns and gastrointestinal diseases and as antidepressant. The species contain a variety of compounds such as tannins, flavonoids, hyperforin derivates, and essential oil [tivities , 17. Bestial oil . Recentltial oil .α-glucosidase are the most efficient inhibitors of carbohydrate-hydrolyzing enzymes, serving as a most common therapeutic target for type 2 diabetes mellitus (T2DM), as well as being beneficial in the management of blood glucose in patients with T2DM, insulin resistance, and obesity [α-glucosidase have received significant attention as the important drug target for T2DM [With the development of people's living standard and aging of population, the incidence of diabetes has risen sharply. According to the World Health Organization (WHO), approximately 350 million individuals suffer from diabetes mellitus (DM) and this may double by 2030 . Protein obesity , 23. At for T2DM .Response Surface Methodology (RSM) is the mathematical and statistical analysis method for optimizing extraction processes in order to obtain the desirable responses, and the Box-Behnken has become the most popular design tools for estimates of the effects of individual variables . For thiOver the past years, the qualitative and quantitative analysis of major components in medicinal plants were widely used by high performance liquid chromatography (HPLC) method because of its convenience and efficiency –28. HoweAt present, this prescription is in private consumption for diabetic mellitus. However, there is no comprehensive guideline on the medical application, qualitative and quantitative analysis of active ingredients, and the best way to get active parts. Therefore, according to the source of folk prescription and hypoglycemic activity, the best ratio of 7 : 3 was determined. Then, the experiment was designed to find the best extraction method using response surface methodology and quantitative analysis of active parts with the lowest cost, high yield, and strong hypoglycemic activity.α-glucosidase activity), and antioxidant activity. 12 kinds of main components in effective parts for KWZ were identified and quantitative analyzed by UPLC.In this paper, the optimal extract conditions for prescription materials were found. The influence of the extraction conditions including ethanol concentration, temperature, sample-to-solvent ratio and extraction time, and responses were observed including extraction yield, polyphenol content, antidiabetic activity . The plants were identified by Professor Yusuf Nuraliev from Avicena's Institute of Medicine and Pharmacology of the Republic of Tajikistan. Voucher specimens  were deposited at the Herbarium of the Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences.Root of P-nitrophenyl phosphate (pNPP), α-glucosidase, 4-N-trophenyl-a-D-glucopyranoside (pNPG), ABTS, and DPPH were purchased from Sigma Aldrich Co., LLC . The standard compounds for content determination were purchased from Beijing Century Aoke Biology Research Co., Ltd.  or Shanghai PureOne Bio Tech Co., Ltd.  and their purity were higher than 98%.All of the solvents used for chromatographic analysis were of HPLC grade , solvents used for extract were of analytical grade , and water was double distilled. PTP-1B  was expressed and purified in the Key Laboratory of Plant Resources and Chemistry of Arid Zone, Uygur drug activity screening room, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, and stored in a −80°C. G. collinum: aerial parts of H. scabrum = 7 : 3) 5 g and placed in round-bottom flask and then was extracted (reflux extraction) using ethanol/water as solvent in different concentration  , different temperature  , different sample-to-solvent ratio  , and different extraction time  . All experiment materials were extracted 3 times  for all experiments. Filtered extracts were evaporated in a rotary vacuum evaporator and then dried at 45°C for 24 h. Then the evaporated extracts were further dried using freeze-drying  at −80°C for 36 h. Then the dried matter was powdered, weighed, and packed in zip pack bags, stored at 4°C for further analysis.In this study, powdered part of prescription medicine materials was accurately weighed in accordance with the ratio (root ofW1 is the weight of KWZ after the extraction (g) and W2 is the weight of KWZ before extraction (g).The extraction yield was calculated as the weight (g) of KWZ in the extract compared to that in the dried raw material, expressed as a percentage, as shown in μg/mL and aliquots of 0.5 mL placed in 25 mL brown volumetric flask, and add 1 mL phosphomolybdic acid test solution and 11.5 mL water and 15% NaHCO3 volume to the scale. After 30 min incubation at room temperature, the absorbance of the mixtures was measured at 760 nm by using UV/Vis spectrophotometer  against a blank sample. Gallic acid (GA) was used as the standard (R2 = 0.9995). The results were calculated as the microgram of gallic acid equivalents per milliliter of liquid extracts compared to the total sample concentration, expressed as a percentage, as shown in C1 is the microgram of gallic acid equivalents per milliliter of liquid extracts (μg/mL) and C2 is the total sample concentration (μg/mL).Total polyphenols in the extracts were estimated according to the determination of tannin content method . The ext pNPP  as a substrate. In each well in the 96-well microtiter plate  we added 178 μL PBS buffer , 1 μL PTP-1B (0.115 mg/mL), and 1 μL test sample (or Dimethyl sulfoxide as a blank), then mixed well for 10 min, and added 20 μL 35 mM substrate pNPP. Thereafter, the plate was incubated without light at 25°C for 20 min, and the reaction terminated with 10 μL of 3 M sodium hydroxide. The absorbance values were measured by SpectraMax MD5 Microplate Reader  at 405 nm, with the system without enzyme solution in a blank. The inhibition rate (IR) was calculated using the following equation:PC is the absorbance of the control and PS is the absorbance of the sample.In this study, the 29 extracts were tested to determine the activity of PTP-1B usingα-Glu inhibitory activity was determined in a 96-well plate using pNPG as a substrate. In each of the 96 wells in a microtiter plate  we added 68.5 μL 0.1 mM phosphate buffer (pH 6.8), 1.5 μL enzyme solution (0.2 U/mL α-glucosidase in a phosphate buffer), and 5 μL test sample (or Dimethyl sulfoxide as a blank) mixed and incubated at room temperature for 10 min, and then 25 μL 20 mM pNPG was added. Thereafter, the plate was incubated at 37°C for 20 min. The absorbance values were measured by SpectraMax MD5 Microplate Reader at 405 nm, with the system without enzyme solution in a blank. The inhibition rate (IR) was calculated using the following equation:GO is the absorbance of the blank and GS is the absorbance of the sample.+ radical cation, and the mixture was kept in dark room temperature for 12–16 h before use. After that, the ABTS+ solution was diluted with ethanol to an absorbance of 0.70 ± 0.2 at 734 nm. 16 μL of test sample was mixed with 184 μL of ABTS solution in 96 wells' plate, and absorbance values were measured by SpectraMax MD5 Microplate Reader after 5 min, and the system without ABTS solution was used as the blank.The antioxidant ability of extracts was determined by ABTS and DPPH. The ABTS scavenging assay was performed according to Hui's method  with a sμL) was mixed with 0.2 mM DPPH solution in 100 μL. The reaction was incubated in the dark for 30 min at the room temperature. The absorbance was measured at the wavelength of 515 nm, and the inhibition rate was calculated. The positive controls in the ABTS and DPPH tests were vitamin C. The inhibition rate (IR) was calculated using the following equation:AO is the absorbance of the blank and A1 is the absorbance of the sample.DPPH test was performed according to Zhang's method  with a sX1, %), temperature , sample-to-solvent ratio , and extraction time ) were encoded as −1, 0, and +1. The coded and uncoded variables are listed in Y1), TPC (Y2), PTP-1B inhibition rate (Y3), α-glucosidase inhibition rate (Y4), and ABTS inhibition rate (Y5)) were selected based on our preliminary study. The model equation for the response (Y) to the four independent variables  is given in the following equation:In order to determine the effects of extraction parameters and optimize conditions for various responses RSM optimization method was applied. Box-Behnken design (BBD) consisted of 29 randomized runs with 5 replicates at the central point. The effects of extraction independent parameters  was extracted with 50% ethanol (1 : 20 w/v) three times for 3 h at 70°C. The extract was concentrated under vacuum to 1.02 g/mL. Concentrated extractive (250 mL) was purified with a column of HPD300 macroreticular resin (50 mL) and after that washed with 150 mL of distilled water, then first eluted with 100 mL of 30% ethanol, and after that eluted with 150 mL of 70% ethanol. Thereafter, the eluted parts of 30% ethanol and 70% ethanol were combined, and then they were concentrated and dried using freeze-drying  at −80°C for 36 h. The dried matter was powdered, weighed, and packed in zip pack bags, stored at 4°C for further analysis.2O and filtered through 0.22 μm nylon membrane microfilters . The chromatographic analysis was achieved using a Waters ACQUITY Ultraperformance Liquid chromatography (UPLC) with a photodiode detector (PDA) . Reversed-phase separation was performed on an ACQUITY UPLC BEH Shield RP18  column at 35°C. Mobile phases comprised (A) 0.2% formic acid in water and (B) acetonitrile. The sample was injected (2 μL injection volume) onto the column and eluted at a flow rate of 0.25 mL/min according to the following gradients: initial 5.0% B; 0.0–3.0 min/5.0–6.0% B; 3.0–14.0 min/6.0–7.0% B; 14.0–15.0 min/7.0–9.5% B; 15.0–15.5 min/9.5–10.0% B; 15.5–20.0 min/10.0% B; 20.0–20.5 min/10.0–11.0% B; 20.5–35.0 min/11.0% B; 35.0–36.0 min/11.0–11.5% B; 36.0–43.0 min/11.5% B; 43.0–57.0 min/11.5–16.0% B; 57.0–72.0 min/16.0–21.0% B; 72.0–78.0 min/21.0–24.0% B; 78.0–84.0 min/24.0–30% B; 84.0–90.0 min/30.0–38.0% B; 90.0–93.0 min/38.0–60.0% B; 93.0–94.0 min/60.0–100.0% B. Ultraviolet detection was set to 254 nm.The purified prescription was dissolved in 50% methanol/HIn this study, 29 experiments that were planned with the BB design were carried out for building quadratic models, with 5 replications of the center points to estimate the experimental errors. The weighed extracts were calculated with extraction yield using Microsoft Excel™ 2016  and used for antidiabetic activities and antioxidant activities analysis. The data were calculated with inhibition rate and half-inhibition concentration using SPSS 19.0 . The Design Expert v.8 trial  was used for data analysis, regression model building, and experimental design and to predict the optimal processing parameters.R2 = 0.9120. In a general way, high F values with low P values lead to more significant correspondence amongst independent variables. X2, X3, X12, X22, and X32 were significant (p < 0.05), whereas X1, X4, X42, X1X2, X2X3, X1X4, X2X3, X2X3, X2X3, X2X4, X2X4, and X3X4 were not significant (p > 0.05). X3. EY in examined samples decreased with a low X3, increased with more X3. This is probably because the less solvent is leading to incomplete extraction, whereas too much solvent can result in a high experimental cost [It is well known that solvent concentration, temperature, sample-to-solvent ratio, and extraction time were factors that most influence the yield of extractions in plant extracts. In this study, the EY of 29 designed experiments in the current BBD are shown in X3 would improve the EY, as well as the high polyphenol content, and good results of antidiabetic activities and wally antioxidant activity would be got about 1 : 20 g/mL X3. Hwang et al. reported that high extraction yield and high polyphenol content should be obtained by longer extraction time and higher solvent volume [X2, but with high value of X2 causing loss of polyphenol content and decrease of antidiabetic activities and antioxidant activity. Moreover, experimental results of response variables were similarly influenced by X4 as the change of time in the medium. Jeong et al. [X3, perhaps because the solvent volume increased diffusion and enhanced desorption of active part from prescription. Optimal conditions for the highest EY of 40.84% were derived at X1 = 48.80%, X2 = 74.29°C, X3 = 1 : 25.09 g/mL, and X4 = 3.04 h , the increase of X1 and X3 caused an increase of TPC, and they decrease with an increase of X2 and X4. The relationship between TPC and both factors is shown in X1 increased from 38% to 54% and X3 increased from 1 : 15 g/mL to 1 : 25 g/mL, TPC value also increased about 48%. X1, X2, X3, and X4 volume were 50.11%, 72.06°C, 1 : 22.73 g/mL, and 2.93 h, respectively.The effects of different extraction parameters on the TPC are shown in X1 and X3 directly affect the TPC, X2 is also one of the main factors that influence the polyphenol content. Low X2 was ineffective in the extraction process to release bioactive substance from KWZ, causing destruction of the activity by high X2. Mašković et al. [X3 (1 : 15–1 : 25 g/mL) and X4 (>2.5 h) and lower X1 (45–55%), in comparison with higher temperature and higher sample-to-solvent ratio.Although ć et al.  reportedα-glucosidase) for antidiabetic activities of 29 designed experiments. Protein tyrosine phosphatase-1B (PTP-1B) and α-glucosidase (α-Glu) are two of the most commonly insulin resistance states for T2DM and received the significant attention during the recent years [α-glucosidase inhibitor is the preferred drug for the treatment of T2DM [In this study we have determined two responses   . The α-Gectively .X2 and X4. As can be seen in Figures X2 and X4 will also affect the activities of antidiabetics. The low X2 and short X4 may have effect on the extraction of active substances completely, and the high X2 and X4 maybe cause the loss of active substances. Mohamed et al. reported that they found the most active inhibition of α-glucosidase and alpha-amylase with 50% ethanol concentration [X2 and X3. X2, X3, and X4 have shown effects on inhibition rate by their interaction. Then, the present extraction studies demonstrated that appreciable antidiabetic activities would be achieved in about 45–55%  X1 and about 65–75°C X2 and 2.30 −3.30 h X4, respectively.As a whole, the most influencing extraction factors for antidiabetic activities are ntration . The higX3 > X2 > X1 > X4, respectively. R2 = 0.9709 and quadratic equation for the regression coefficient of ABTS are shown in X1 = 52.70%, X2 = 71.50°C, X3 = 1 : 22.38 g/mL, and X4 = 3.01 h  of 18.2 min in the chromatogram as reference peak (peak 5). The intraday precision variation of the RRT and RPA of the 12 peaks was less than 0.20% and 2.00%, respectively. The stability test was evaluated by analysis of the same sample solution on two consecutive days at different time intervals , and the RSD values of RRT and RPA of the 12 peaks were below 0.30% and 2.00%, respectively. It means the sample solution was stable within 48 h. The repeatability test was calculated by analysis of six independently prepared solutions of the same sample. The RSD values of RRT and RPA did not exceed 0.30% and 2.00%, respectively. The results of the precision, stability, and repeatability tests are shown in According to the early studies on the chemical constituents of the two medicinal plants, the standard compounds were purchased and used for quantitative analysis. UPLC chromatogram of purified prescription and 12 compounds of mixed standard is shown in  y = ax + b, where y and x were peak area and concentration, respectively . The contents of the 12 components were calculated by one point external standard method. Retention times, component names, regression equations, contents, and linear range of the 12 components are shown in Twelve components were identified in the effective part of KWZ . To deteα-glycosidase enzymes inhibition rate of 96.56%, and ABTS inhibition rate of 77.38%. Furthermore, 12 components were discovered on the effective parts with UPLC analysis, and the quantitative determination shows the total content of the 12 components is 11.18%. This optimal condition and quantitative analysis contribute to the better utilization of the prescription with high antidiabetic activity and antioxidant activity and are also helpful for industrial production improvement.In conclusion, the best extraction conditions of extraction yield, polyphenol content, antidiabetic activities, and antioxidant activity were optimized using response surface methodology, and BBD strategy demonstrated that it could be used for optimization of extraction process for KWZ. All of the optimization process and quantitative analysis should be useful for industrial production. Optimal conditions were found to be percentage of ethanol concentration 50.11%, extraction temperature 72.06°C, solid-to-solvent ratio 1 : 22.73 g/mL, and extraction time 2.93 h, which gave a maximum extraction yield of 39.28%, PTP-1B inhibition rate of 86.21%, All of the additional experimental data, including standard curve of 12 compounds , screening test results of different proportion (Table S1) and the results of single-factor experiment (Tables S2–S6) can be found in supplementary materials.


Morbidly obese patients are at risk for non-alcoholic fatty liver disease (NAFLD) and vitamin D deficiency (VDD). Non-alcoholic steatohepatitis (NASH) is the progressive variant of NAFLD and can advance to fibrosis, cirrhosis, and liver cancer. We aimed to examine prevalence of liver fibrosis and its non-invasive predictors in bariatric patients with VDD (<75 nmol/l).Baseline liver biopsy of a randomized controlled trial was performed in 46 patients with omega loop gastric bypass. Clinical, laboratory, and histological data were examined and tested with univariate and multivariable analysis.2. Twenty-six percent had diabetes mellitus (DM) and 44 % metabolic syndrome (MeS). Seventy-two percent had NASH, 11 % simple steatosis, and 17 % normal liver. In total, 30 % demonstrated significant fibrosis (F ≥ 2) with 9 % of advanced (F3) and 4 % cirrhosis (F4). Increased stages of fibrosis were primarily associated with higher levels of HOMA2-insulin resistance (IR), procollagen type I propeptide (P1NP), lower osteocalcin, albumin-corrected calcium, parathyroid hormone, vitamin D, male sex, and higher age. Other independent risk factors for advanced fibrosis were MeS  and DM . The fibrosis FIB-4 index <10.62 and NAFLD fibrosis score <−26.93 had a negative predictive value of 100 and 96 %, respectively.In total, 80 % were females, aged 42 (SD 13) years with BMI 44 (4) kg/mLiver fibrosis is frequent in morbidly obese patients with concurrent DM and/or MeS. Increased serum levels of IR, P1NP, lower osteocalcin, and VDD are clinically relevant predictors of fibrosis. Consequently, we suggest that patients with preoperative presence of these markers are at increased risk for liver fibrosis and should be monitored closely. F ≥ 3) in 4–16 %, and cirrhosis in 1–7 %  were collected . After actively,  and suffctively, . Moreovectively, . Metabolctively, . Additioctively, , 20.Kleiner et al. 2D3 was primarily associated with higher levels of GFR in our population. Since the liver is involved in vitamin D metabolism, it may be assumed that patients with chronic liver disease show a high prevalence of vitamin D deficiency [3 levels were associated with higher stages of fibrosis, which is in line with previously published studies [As vitamin D is hydroxylated by the liver and afterwards converted into the active form in the kidney , 1α,25 in this randomized controlled trial , no compThe present study shows that significant fibrosis is frequent in vitamin D deficient, morbidly obese patients with concurrent DM, and/or MeS. Additionally, increased levels of IR, P1NP, lower osteocalcin, and vitamin D deficiency are associated with increased stages of fibrosis. Based on our results, we suggest that patients with preoperative presence of such markers and high scores of non-invasive fibrosis markers are at high risk for liver fibrosis. As a consequence, rigorous monitoring regarding liver function and avoidance of macro- and micronutrient deficiencies, in particular calcium, vitamin D, and protein, by sufficient nutritional counseling must be guaranteed in a multidisciplinary team.


Type 2 diabetes (T2D) is one of the most psychologically demanding chronic medical illness in adult. Comorbidity between diabetes and depression is quite common, but most studies were based on developed country sample. Limited data exists to document biopsychosocial predictors of depressive symptoms in Ethiopian patients. Therefore, the aim of the study was to describe the association of depressive symptoms and T2D and explore the potential underlying associated biopsychosocial risk factors.Institution based cross-sectional study was conducted on 276 patient with T2D at diabetic clinic, Black Lion General Specialized Hospital in Ethiopia. Patients were selected using systematic random sampling technique. Depressive symptoms score, which constructed from a validated nine-item Patient Health Questionnaire (PHQ-9), was an outcome variable. Finally, significant associated factors were identified using multiple linear regression analysis with backward elimination procedure. Statistical Package for Social Science (SPSS) version 22.0 (IBM SPSS Corp.) was used to perform all analysis.Total of 264 patient data was analyzed with 95.7% response rate. Patients mean (SD) current age and age at diagnosis was 55.9 (10.9) and 43.9 (10.9) years, respectively. Patients waist circumference (mean ± SD) was 98.9 ± 11.1 cm. The average PHQ-9 score was 4.9 (SD 4.1) and fasting blood glucose was 166.4 (SD 73.2). Marital status (divorced), occupation (housewife), diabetic complication (nephropathy), negative life event in the last six months, and poor social support significantly associated with increased mean PHQ-9 score after adjustment for covariates. Whereas not fearing diabetic-related complication and death significantly lower mean PHQ-9 score.Biopsychosocial variables including marital status, negative life event in the last 6 months, occupation, diabetic complication, and poor social support significantly increase average depressive symptoms score. Evidence-based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms.The online version of this article (doi:10.1186/s13033-016-0106-2) contains supplementary material, which is available to authorized users. Diabetes mellitus (DM) has been affecting millions of people from all over the world. In 2013, 382 million people had diabetes; this estimate is expected to rise to 592 million by 2035 . During Thomas Willis, British physician, recognized the association between depression and diabetes since 17th century . EpidemiEngel’s  biopsychT2D patients were poorly diagnosed and inadequately treated in sub-Saharan Africa . In geneWe conducted an institution based cross-sectional study among T2D outpatients on regular follow-up at Black Lion General Specialized Hospital from February to April 2013.The outcome variable was depressive symptoms score. The explanatory variables were biological factors: age, sex, comorbid disease, diabetic complication, diabetic treatment, fasting blood glucose, body mass index; psychological factors: unemployment, financial stress, negative life event, polypharmacy, smoking, lack of regular physical activity, perceived fear of complication and death, perceived high healthcare cost; and social factors: socioeconomic status, educational status, marital status, major family conflict, poor social support. We defined polypharmacy as taking greater than or equal to four prescribed medications per day. Poor social support was defined as lack of support or care from the family, friends, and neighbors. Another studied factor was, which referred to an event such as accident and death in the last six months that leads to a feeling of stress or anxiety, negative life event. Perceived fear of complication and death was defined as individual feeling or opinion about his/her illness and related complication. Perceived high healthcare cost was defined as personal feeling or idea about the expense of diabetes treatment. Physical activity was defined as doing any aerobic exercise 3–5 times per week at least for 30 min.Patients were chosen based on three criteria: T2D diagnosis at least for one year, age ≥20 years old, capable of independent communication, and signed written informed consent. Patients treated for depression, or other psychological illnesses  were excluded. Systematic random sampling technique was used to reach individual patients. The data was collected by two trained Nurses from every three patients . All biological  data was collected from patients’ medical chart. Face-to-face interview was conducted in the treating private clinics to collect psychological and social data. Twelve patients refused to take part because of lack of interest to participate and a shortage of time. In total 264 cases were included in the final analysis.Depression, which refers to symptoms experienced during the last two weeks, was measured by Patient Health Questionnaire (PHQ-9) , 37. TheFirst of all, four cases were not included in our analysis because of outlying PHQ-9 score (≥20). Descriptive statistics including mean, standard deviation, percentage, and cross-tabulation was performed for all patient parameters. Univariate linear regression analysis was performed per each biopsychosocial variable. The full model of multiple linear regression included all significant variables. Finally, significantly associated factors were identified by backward elimination procedure. QQ-plot, histogram and scatter plot of ‘Standardized residuals’ against ‘Standardized predicted values’ were used to check the assumptions of linearity of relationships, normal distribution and homoscedasticity of residuals for the final model. Two-tailed test at 5% level of significance was used for all association test. Statistical Package for Social Science (SPSS) version 22.0 (IBM SPSS Corp.) was used to perform all analysis. The study was adherent to the STROBE criteria.Total of 264 patient data was analyzed with 95.7% response rate. Patients mean (SD) current age and age at diagnosis was 55.9 10.9) and 43.9 (10.9) years, respectively. Also, patients waist circumference (mean ± SD) was 98.9 ± 11.1 cm while patients family median monthly income was 750 Ethiopian Birr (651–1400). The average PHQ-9 score was 4.9 (SD 4.1) and fasting blood glucose was 166.4 (SD 73.2). The mean ± SD of PHQ-9 score was 6 ± 4.7 in female, 7.3 ± 5.7 in divorced, 6.6 ± 4.5 in educational level of grade 1–8, and 6.77 ± 5.3 in housewife patient. The mean ± SD of number of comorbid diseases and body mass index was 1.1 ± 0.9 and 25.4 ± 3.7, respectively (Table 0.9 and 4Patient mean PHQ-9 score was significantly increased by 1.4 (95% CI 0.4–2.4) in female, 2.2 (95% CI 0.7–3.7) in divorced, and 1.7 (95% CI 0.4–3.0) in housewife. One unit increase in number of comorbidities was associated with a 0.6 unit (p = 0.04) increase in PHQ-9 score. One unit increase in number of diabetic complication was associated with a 0.5 unit (p = 0.02) increase in PHQ-9 score. Increased age at diagnosis (i.e. late-onset diabetes), increased monthly family income, high educational status (college or university), doing physical activity and not fearing diabetes-related complication and death significantly lower mean PHQ-9 score  and experiencing negative life events, psychological factors, significantly increased risk of depression in line with other earlier studies , 57, 61.Finally, we confirmed marital status (divorce) and poor social support, social factors similar to previous studies , 21, 57,Similar to previous studies , 67–70, Most of these inconsistencies might be attributed to inadequacies in study design, implementation , interpretation (i.e. categorizing and using different cutoff point to diagnose depression), inadequately powered sample groups, and using different depression diagnostic tool. Using dichotomized PHQ-9 score as an outcome variable clearly causes loss of information, loss of power, bias, incomplete correction for confounding factors, and difficulty for robust replication of associated risk factors –73. SimiThis study has important public health implication for health care practice in Black Lion General Specialized Hospital and another health facility, where clinician diagnosis of mental illness (depression) rate is low because of high patient load, lack of screening tool, role confusion, and lack of training. Another important barrier to the care of people with mental and physical health problem in lower and middle-income country is the lack of an integrated model for mental and medical health service . We suggThe strength of this study includes the use of PHQ-9 score as continuous outcome variable. Variables were defined based on Engel’s biopsychosocial model as well. However, this study has certain limitation. Most parameters estimated were biologic (physiologic) factors. This might underestimate the effect of psychological and social factors. Poor social support, which was identified as a highly significant associated factor, was assessed by a single item. Additionally, this study was conducted in one institution that might limit external validity of the finding. This study examined only the associations between the selected variables and PHQ-9 score. Lastly, the role of inflammation and genetic susceptibility for the emergence of depressive symptoms was not assessed.In general biopsychosocial variables including marital status, negative life event in the last six months, occupational status, diabetic complication, and poor social support significantly increased risk of depression. Evidence-based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms. Our study finding described the effect of various biopsychosocial factors on patient’s mood because depression-related factors frequently missed in people with diabetes . This wi


To determine whether TG/HDL-C ratio, which has been shown to be an indicator of the metabolic syndrome (MetS) and insulin resistance (IR), can predict cardiovascular risk factors in the Chinese Han population in Xinjiang.The cardiovascular risk survey (CRS) was conducted from October 2007 to March 2010. A total of 14,618 representative participants were selected using a four-stage stratified sampling method. A total of 5757 Han participants were included in the study. The present statistical analysis was restricted to the 5595 Han subjects who had complete anthropometric data. The sensitivity, specificity, and distance on the receiver operating characteristic (ROC) curve in each TG/HDL level were calculated. The shortest distance in the ROC curves was used to determine the optimal cutoff of the TG/HDL-C ratio for detecting cardiovascular risk factors.The prevalence of hypertension, hypercholesterolemia, and hypertriglyceridemia was higher with higher TG/HDL-C ratio for both men and women. The TG/HDL-C ratio was positively associated with systolic blood pressure, diastolic blood pressure, and serum concentrations of total cholesterol. The optimal TG/HDL-C ratio cutoffs for predicting hypertension, dyslipidemia, diabetes, and ≥2 of these risk factors for Han adults in Xinjiang were 1.3, 1.3, 1.4, and 1.4 in men and 0.9, 1.0, 1.0, and 1.1 in women, respectively.The evaluation of TG/HDL-C ratio should be considered for one of cardiovascular risk factor predictors among Han adults in Xinjiang.  Cardiovascular disease (CVD) is the leading cause of death in the world, and mortality due to CVD is higher in low- and middle-income countries comparing with developed countries. It is expected to sharply increase the disease burden over the next 10 years . It was Lipid metabolic disorders have been proved as one of the pathogenesis of atherosclerosis, which is fundamental to the occurrence of CVD. Elevated serum lipid is one of the most important risk factors for cardiovascular disease in Western Countries as well as Asian populations –8. High In Xinjiang Uighur Autonomous Region northwest of China, which is located in the center of Asia. The largest Chinese administrative division has a unique culture and lifestyle. The total Han population was 8.75 million in 2012 and takes 40.1 % of the total population in Xinjiang. Several studies have reported the condition of dyslipidemia among adults in Xinjiang –21, but Eligible patients were selected from the cardiovascular risk survey (CRS) study, and the detailed description of the study population and the methods were described previously , 23. BriBlood samples were obtained from an antecubital vein into vacutainer tubes containing EDTA in the morning after an overnight fasting period. Blood samples were centrifuged within 2 h at the survey site. Plasma was transferred to separate labeled tubes and transported immediately on dry ice at prearranged intervals to the Xinjiang Key Laboratory of Cardiovascular Disease. Serum concentrations of serum total cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and fasting glucose were measured by the Clinical Laboratory Department of the First Affiliated Hospital of Xinjiang Medical University with a biochemical analyzer  , 23.A mercury sphygmomanometer was used to measure blood pressure in the sitting position after a 10-min rest period. During the 30-min preceding measurement, the subjects were required to refrain from smoking or consuming caffeine. The appearance of the first sound was used to define systolic blood pressure, and the disappearance of sound was used to define diastolic blood pressure . Two rea2) were defined as overweight. Total cholesterol concentrations >6.22 mmol/L (240 mg/dl) were defined as hypercholesterolemia. Triglyceride concentrations >2.26 mmol/L (200 mg/dl) were defined as hypertriglyceridemia. LDL cholesterol concentrations >4.14 mmol/L (160 mg/dl) were defined as high LDL cholesterol. HDL cholesterol concentrations <1.04 mmol/L (40 mg/dl) were defined as low HDL cholesterol. Dyslipidemia was defined as TG ≥ 2.26 mmol/l, TC ≥ 6.22 mmol/l, LDL-C ≥ 4.14 mmol/l, HDL-C < 1.04 mmol/l, or if receiving a lipid-lowering drug . The TG/HDL value with the shortest distance on the ROC curve was considered in the determination of optimal cutoff. The overall performance of the TG/HDL test for detecting cardiovascular risk factors was assessed by computing the area under the curves (AUC). An AUC of 1 is considered to have perfect discriminatory power, and an AUC of 0.5 suggests that the discriminatory power is no better than chance.Statistical analysis was conducted using SPSS version 17.0 for Windows . Continuous variables were expressed as sex-specific means and standard deviations, and discrete variables were expressed as sex-specific proportions. Analysis of variance was used for continuous variables, and the chi-square test was used for categorical variables. A value of P < 0.001), the fasting glucose increased from 5.15 ± 1.68 to 6.05 ± 2.66 (P < 0.001), the HDL cholesterol decreased from 1.60 ± 0.50 to 0.93 ± 0.37 (P < 0.001), and the LDL cholesterol decreased from 3.07 ± 0.83 to 2.63 ± 0.94 (P < 0.001) in men. In Table P < 0.001), the fasting glucose increased from 4.88 ± 1.12 to 5.77 ± 2.03 (P < 0.001), the HDL cholesterol decreased from 1.64 ± 0.60 to 0.85 ± 0.34 (P < 0.001), and the LDL cholesterol decreased from 3.06 ± 0.95 to 2.56 ± 0.88 (P < 0.001) in women. We also noticed the triglycerides increased from 0.85 ± 0.78 to 3.39 ± 2.27 (P < 0.001) in women with the increase of TG/HDL-C; we did not notice the same trend in men.As presented in Table P < 0.001), the prevalence of low HDL cholesterol increased from 10.9 to 65.1 % in men and from 7.6 to 73.6 % in women as the TG/HDL-C increased (both P < 0.001), and the prevalence of diabetes and hypertriglyceridemia showed no trend as TG/HDL-C increased for both men and women. The prevalence of hypertension increased from 21.6 to 55 % in women as the TG/HDL-C ratio increased (P < 0.001); however, we did not observe any trend in the prevalence of hypertension as TG/HDL-C increased for men . Although some lipid variables were associated with the extent of coronary disease, the ratio of triglycerides to HDL cholesterol (TG/HDL-C) showed the strongest association with extent . This stIn addition, the TG to HDL-C ratio (TG/HDL-C) has been proposed as a useful lipid parameter associated with metabolic syndrome (MetS), insulin resistance (IR), and cardio-metabolic risk , 17, 26.The reasons why there are higher optimal cutoffs of TG/HDL among Han adults in Xinjiang are unclear. Possible reasons may be associated with differences in diet, living conditions, climate, and some important genes that regulate body fat distribution. First, the main reason may be a difference in diet in Xinjiang Han adults compared with Guangdong, Zhuhai, and Ghanaian. The Han population in Xinjiang consumes more meat, milk products, salt, and pasta than Asian populations in other regions. Second, a characteristic feature of the living conditions and climate in Xinjiang is that the temperature difference during day and night is considerable, summer is extremely hot, and winter is extremely cold. Therefore, drinking strong wine, eating more animal fat, and a higher salt intake in the Han population may lead to fat deposition thicker than other populations for adaptation to the external environment in Xinjiang. Third, certain genes that regulate body fat distribution may be different in different populations, so that body fat is more likely to accumulate –37. In aWe also found that the TG/HDL-C cutoff in Han women in Xinjiang was the same as the ATPIII and JIS criteria, but it was higher than in Guangdong and Ghanaian. The reason why there are higher optimal cutoffs may be associated with differences of eating habits and lifestyles. We also found that the cutoffs in Han men were higher than women in Xinjiang, similar to the ATPIII and JIS criteria. The reason why there are higher cutoffs may be more smoking and alcohol consumption and less exercise.The ratio TG/HDL-C, initially proposed by Gaziano et al., is an atherogenic index that has proven to be a highly significant independent predictor of cardiovascular disease, even stronger than TC/HDL-C and LDL-C/HDL-C . The CopOur study has several strengths. It is the first representative sample of the general adult Han population in Xinjiang. These results may be generalized to the full adult population of Hans aged above 35 years. Additionally, we provided information on cutoffs and AUC for many anthropometric and atherogenic parameters stratified by sex. Future studies can use the cutoffs suggested here for the screening and intervention of cardiovascular disease in a representative sample of the adult Han population in Xinjiang. The limitation of this study is this is a cross-sectional study, and it may not able to predict the prognosis of the disorders. Future studies can use the ratio of TG/HDL cutoffs suggested here as a reference to evaluate the associated risk factors and intervention effects of dyslipidemia in other adult Han population.In conclusion, this study showed a TG/HDL-C ratio value of 1.3 and 1.0 in men and women, respectively, as an appropriate cutoff to distinguish high cardiovascular risk patients. The continuous relationship between cardiovascular disease risk factors and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio was documented here. For all the anthropometric and atherogenic parameters, the ratio of TG/HDL-C cutoff had the best predicting ability of CVD in both men and women.