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Recent randomized trials demonstrating the beneficial effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in type 2 diabetes suggest that early reductions in eGFR upon initiation of SGLT2i therapy are associated with improved renal outcomes. Multiple concomitant medications, including antidiabetic and antihypertensive agents, are commonly used, however, which may modify the renal hemodynamic action of SGLT2is. Here we found that background treatment with metformin diminished the SGLT2i-induced reductions in eGFR after 3 months of SGLT2i therapy in patients with type 2 diabetes and hypertension (-2.29 ± 0.90 vs -5.85 ± 1.27 mL/min/1.73 m2 for metformin users (n = 126) and nonusers (n = 97), respectively). Other antidiabetic agents (DPP4 inhibitors, sulfonylureas and insulin) had no effect on the eGFR response to SGLT2is. Antihypertensive drugs, including calcium channel blockers (CCBs) and β blockers, did not affect the SGLT2i-induced changes in eGFR, whereas renin-angiotensin system inhibitors (RASis) tended to enhance this response (p = 0.059). Next, we evaluated the interaction between metformin and RASis in the eGFR responses to SGLT2is. Under no background treatment with RASis, metformin abrogated the eGFR response to SGLT2is, but this response was preserved when RASis had been given along with metformin (decreases of 0.75 ± 1.28 vs. 4.60 ± 1.15 mL/min/1.73 m2 in eGFR, p = 0.028). No interaction between metformin and insulin or between metformin and DPP4 inhibitors was observed. In conclusion, metformin blunts the SGLT2i-induced decrease in eGFR, but coadministration of RASis ameliorates this response. Furthermore, the inability of CCBs to modify the SGLT2i-induced reduction in eGFR suggests that the SGLT2i-induced renal microvascular action is mediated predominantly by postglomerular vasodilation rather than preglomerular vasoconstriction.Hypertension is a serious global health problem. Hypertensive retinopathy is generally considered to be a predictor of vascular disease elsewhere in the human body. In the past few decades, a variety of grading systems have been proposed for hypertensive retinopathy. However, these grading systems have some limitations. This study utilized optical coherence tomography angiography (OCTA) to investigate the morphological changes and macular retinal microvasculature in depth among 100 patients with hypertensive retinopathy and 66 healthy participants. Five main pathological changes were discovered in hypertensive retinopathy, as follows focal capillary sparsity, scattered microangioma, focal macular arch ring defects, focal capillary disorder, and focal capillary nonperfusion at the levels of the superficial and deep vascular networks. this website In addition, we have found that the number of various pathological changes shows an increasing trend as hypertensive retinopathy progresses and may be related to renal damage. Finally, deep vessel density tended to decrease with progressive stages of hypertensive retinopathy and could be the best indicator to predict the risk of hypertensive retinopathy. Our study, therefore, proposes 3 stages of hypertensive retinopathy without macular edema according to the pathophysiology found by OCTA stage 1 (only focal capillary sparsity), taking the place of KWB grade I; stage 2 (focal capillary sparsity and scattered microangioma), taking the place of KWB grade II; and stage 3 (focal capillary sparsity, scattered microangioma, focal capillary disorder, and nonperfusion), taking the place of KWB grade III. Hence, OCTA may be a potentially useful tool for evaluating the pathophysiology and staging of hypertensive retinopathy. Further longitudinal prospective studies are needed to confirm our findings.Adult-onset hypogonadism (AOH) is associated with sexual dysfunction, poor bone mineralization, decreased muscle mass, metabolic syndrome disorder, and cognitive suppression. Historically, testosterone has been contraindicated in men with a history of prostate cancer. However, there has been a modern resurgence in re-evaluating this belief. Not only can testosterone be safely utilized to alleviate AOH symptoms in prostate cancer survivors, it has been also touted as a treatment option for aggressive prostatic cancer. While much work remains in understanding the relationship between testosterone and prostate cancer, those who survive this disease should not be automatically turned away from an opportunity to be treated and restored.Xincun Lagoon is an important fishing area in northern Hainan Island, China. It has long been exposed to pollutants from local sewage, breeding cages and fishing boats, resulting in serious pollution threats to the survival of fish. In this study, we examined the concentrations of seven trace metals (Cu, Pb, Zn, Cd, Hg, As and Cr) in sixteen economic fish species collected from Xincun Lagoon and their exposed environment (water and sediment). The concentrations of Pb and Zn in the water column were higher than the safety threshold stipulated by Chinese legislation, while the contents of all examined metals in the sediment and fish species were lower than the legislative thresholds set by China and international organizations. The contents of trace metals in the fish species in high trophic levels or those that prefer to live in/on the sediment layer were significantly higher than those in other trophic levels and pelagic/subbenthic fish, these species had homogeneous anthropogenic pollution sources for Cu, Zn, Cd, Hg and As. Our results show that the trace metal contents in fish were mainly affected by trophic level and habitat preference. The contribution of metal exposure from the sediment to metal accumulation in fish was lower than that in water, especially for the Cd and Hg in the sediment. These results provide valuable information for further understanding the species-specific patterns of metal accumulation in fish and the development of targeted conservation measures for the environment and fish consumers.Silicon carbide (SiC) formation plays an important role during the production of elemental silicon. SiC forms through a high temperature reaction between silicon monoxide gas (SiO) and carbon. Currently, the carbon sources are solids, however finding a way of substituting the solid carbon with methane could have several advantages. SiC formation was studied in argon, hydrogen and methane containing atmospheres at 1650 °C and 1750 °C. SiO gas was generated from pellets of a 12 molar ratio of SiC and silica (SiO2). The reactions were investigated through CO off-gas analysis in conjunction with measuring the weight change. After each experiment, the reaction products were examined in a scanning electron microscope with secondary electrons and through energy-dispersive X-ray spectroscopy. It was confirmed that SiC may form from SiO and methane. Increasing the methane content to 5% caused a significant increase in SiC formation. Furthermore, the SiC structure was also highly sensitive to the methane content that was used.
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