Objective:Hypothyroidism (HO) can induce metabolic dysfunctions related to insulin resistance and dyslipidemia. Our previous studies showed that homocysteine (Hcy) impaired the coronary endothelial function and that Hcy can promote chemokine expression and insulin resistance (IR) by inducing endoplasmic reticulum stress in human adipose tissue and hypothyroid patients. The aim of this study was to investigate the potential harmful correlation between plasma Hcy and low-density lipoprotein cholesterol (LDL-C) in patients with HO.Methods:A total of 286 subjects were enrolled. All subjects were divided into the following 3 groups: HO group, subclinical hypothyroidism (SHO) group, and control group. Statistical analyses were carried out to evaluate the correlation between the plasma levels of Hcy and LDL-C in HO patients. The changes in the plasma Hcy levels and other metabolic parameters were measured before and after levothyroxine (L-T4) treatment. The relationship between the changes in the plasma Hcy level and the LDL-C level was also evaluated after L-T4 treatment.Results:In the patients with HO, both the plasma Hcy and LDL-C levels were significantly higher than those of the controls. The plasma levels of Hcy were positively correlated with the LDL-C level in the HO group. L-T4 treatment resulted in a significant decrease in the BMI, total cholesterol (TC), LDL-C, triglycerides (TG), apolipoprotein B (ApoB), and Hcy levels. Moreover, the decrease in Hcy (ΔHcy) was positively correlated with decreased LDL-C (ΔLDL-C) levels after L-T4 treatment in HO patients.Conclusion:Our results suggest that the increased Hcy level was positively correlated with the LDL-C in the HO group. A potential harmful interaction may exist between Hcy and LDL-C under the HO condition. In addition to reducing the plasma levels of Hcy, L-T4 treatment exerts beneficial effects on patients with HO by improving dyslipidemia, including a decrease in the LDL-C level.

BACKGROUND: Automated external defibrillators (AEDs) enable laypeople to provide early defi brillations to patients undergoing cardiac arrest, but scant information is available on the general public's ability to use AEDs. This study assessed the ability of laypeople to operate AEDs, the effect of a 15-minute training, and whether skills differed by age. METHODS: From May 1 to December 31, 2018, a prospective simulation study was conducted with 94 laypeople aged 18-65 years (32 aged 18-24 years, 34 aged 25-54 years, and 28 aged 55-65 years) with no prior AED training. The participants' AED skills were assessed individually pretraining, post-training, and at a three-month follow-up using a simulated cardiac arrest scenario. The critical actions and time intervals were evaluated during the AED operating process. RESULTS: Only 14 (14.9%) participants (eight aged 18-24 years, four aged 25-54 years, and two aged 55-65 years) successfully delivered defi brillations before training. AED operation errors were more likely to occur among the participants aged 55-65 years than among other age groups. After training, the proportion of successful defi brillations increased signifi cantly (18-24 years old: 25.0% vs. 71.9%, P<0.01; 25-54 years old: 11.8% vs. 70.6%, P<0.01; 55-65 years old: 7.1% vs. 67.9%, P<0.01). After three months, 26.1% of the participants aged 55-65 years successfully delivered defi brillations, which was signifi cantly lower than that of participants aged 18-24 years (54.8%) and 25-54 years (64.3%) (P=0.02). There were no differences in time measures among three age groups in each test. CONCLUSIONS: The majority of untrained laypeople cannot effectively operate AEDs. More frequent training and refresher courses are crucial to improve AED skills.

No abstract

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a chronic liver disease. NAFLD includes a spectrum of hepatic pathologies: simple fatty liver, steatohepatitis and cirrhosis. Insulin resistance may contribute to NAFLD. The liver plays an important role in the production and metabolism of homocysteine (HCY), which is known to be an independent risk factor for cardiovascular disease. High HCY level can aggravate NAFLD by increasing the reactive oxygen species and activating oxidative stress. In this study, we investigated the relationship between HCY and NAFLD in euglycemic patients.Material/MethodsA total of 1143 euglycemic patients were recruited: 519 patients with non-alcoholic fatty liver disease (NAFLD) and 624 sex and age-matched controls without NAFLD.ResultsThe NAFLD group had significantly higher HCY level (13.78±5.84 vs. 11.96±3.58 mmol/L, p<0.001), as well as higher body mass index (BMI), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglyceride (TG), glutamic-pyruvic transaminase (ALT), glutamic-oxalacetic transaminase (AST), fasting plasma glucose (FPG), fasting insulin (FINS), homeostasis model assessment for insulin resistance (HOMA-IR), homeostasis model assessment for beta cell function (HOMA-B), and lower high density lipoprotein cholesterol (HDL-C). HCY level was positively correlated with HOMA-IR (r=0.239, p<0.001), TG (r=0.356, p<0.001) and negatively correlated with HDL-C (r=−0.161, p<0.001). In the logistic regression analysis, BMI (beta=0.345, p<0.001), HOMA-IR (beta=0.654, p<0.01), TG (beta=0.881, p<0.001), and HCY (beta=0.04, p=0.044) were the predictors of NAFLD.ConclusionsHigher HCY level existed in NAFLD patients and was correlated with the severity of insulin resistance. HCY is an independent risk factor for NAFLD.