2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis.

BACKGROUND & AIMS: The increasing rates of obesity and type 2 diabetes mellitus may lead to increased prevalence of nonalcoholic fatty liver disease (NAFLD). We aimed to determine the current and recent trends on the global and regional prevalence of NAFLD. METHODS: Systematic search from inception to March 26, 2020 was performed without language restrictions. Two authors independently performed screening and data extraction. We performed meta-regression to determine trends in NAFLD prevalence. RESULTS: We identified 17,244 articles from literature search and included 245 eligible studies involving 5,399,254 individuals. The pooled global prevalence of NAFLD was 29.8% (95% confidence interval [CI], 28.6%-31.1%); of these, 82.5% of included articles used ultrasound to diagnose NAFLD, with prevalence of 30.6% (95% CI, 29.2%-32.0%). South America (3 studies, 5716 individuals) and North America (4 studies, 18,236 individuals) had the highest NAFLD prevalence at 35.7% (95% CI, 34.0%-37.5%) and 35.3% (95% CI, 25.4%-45.9%), respectively. From 1991 to 2019, trend analysis showed NAFLD increased from 21.9% to 37.3% (yearly increase of 0.7%, P < .0001), with South America showing the most rapid change of 2.7% per year, followed by Europe at 1.1%. CONCLUSIONS: Despite regional variation, the global prevalence of NAFLD is increasing overall. Policy makers must work toward reversing the current trends by increasing awareness of NAFLD and promoting healthy lifestyle environments.

Increased Risk of Liver-Related Outcomes in Chronic Hepatitis B Patients with Metabolic Syndrome: A Systematic Review and Meta-Analysis.

INTRODUCTION: Chronic hepatitis B (CHB) patients with metabolic syndrome (MetS) may present increased risk of liver-related outcomes (LROs), but prior studies were limited by small sample size and/or conflicting results. Using a systematic review and meta-analytic approach, we aimed to determine the association between MetS and LROs in CHB. METHODS: Two researchers independently screened studies from the PubMed, Embase, Web of Science, and Cochrane Library databases from inception to January 21, 2020, and extracted the data. Estimates were pooled using a random-effects model. RESULTS: We screened 2,228 articles and included 10 eligible studies (18,360 CHB patients, 2,557 with MetS). MetS was significantly associated with LROs overall (odds ratio = 2.45, 95% confidence interval = 1.39-4.32) but not the individual LRO components but subgroup analyses were limited by small study numbers. DISCUSSION/CONCLUSION: MetS is associated with almost 3-folds higher risk of LROs in CHB and should be considered in management decisions. However, additional studies are needed.

Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes.

Coronavirus disease 2019 (COVID-19) has become a pandemic, but its reported characteristics and outcomes vary greatly amongst studies. We determined pooled estimates for clinical characteristics and outcomes in COVID-19 patients including subgroups by disease severity (based on World Health Organization Interim Guidance Report or Infectious Disease Society of America/American Thoracic Society criteria) and by country/region. We searched Pubmed, Embase, Scopus, Cochrane, Chinese Medical Journal, and preprint databases from 1 January 2020 to 6 April 2020. Studies of laboratory-confirmed COVID-19 patients with relevant data were included. Two reviewers independently performed study selection and data extraction. From 6007 articles, 212 studies from 11 countries/regions involving 281 461 individuals were analyzed. Overall, mean age was 46.7 years, 51.8% were male, 22.9% had severe disease, and mortality was 5.6%. Underlying immunosuppression, diabetes, and malignancy were most strongly associated with severe COVID-19 (coefficient = 53.9, 23.4, 23.4, respectively, all P < .0007), while older age, male gender, diabetes, and hypertension were also associated with higher mortality (coefficient = 0.05 per year, 5.1, 8.2, 6.99, respectively; P = .006-.0002). Gastrointestinal (nausea, vomiting, abdominal pain) and respiratory symptoms (shortness of breath, chest pain) were associated with severe COVID-19, while pneumonia and end-organ failure were associated with mortality. COVID-19 is associated with a severe disease course in about 23% and mortality in about 6% of infected persons. Individuals with comorbidities and clinical features associated with severity should be monitored closely, and preventive efforts should especially target those with diabetes, malignancy, and immunosuppression.

NASH/Liver Fibrosis Prevalence and Incidence of Nonliver Comorbidities among People with NAFLD and Incidence of NAFLD by Metabolic Comorbidities: Lessons from South Korea.

BACKGROUND: NAFLD incidence, NASH prevalence, NAFLD fibrosis prevalence, incidence of metabolic comorbidities, and mortality data in the NAFLD population remain limited. AIMS: We used a meta-analytic approach to "stage" NAFLD among the Korean population. METHODS: We searched PubMed, Embase, Cochrane Library, and KoreaMed from inception until June 29, 2019, and calculated pooled estimates via the random-effects model. RESULTS: We screened 1,485 studies and analyzed 191 eligible studies: 179 (3,556,579 participants) for NAFLD prevalence and outcome analysis and 32 (1,089,785 participants) for NAFLD incidence analysis. NAFLD prevalence was 31.46% overall and 50-60% in those with metabolic risks. The incidence (per 1,000 person-years) of NAFLD was 42.8 overall and 70-77% in those with metabolic risk. The incidence (per 1,000 person-years) of new-onset T2DM, hypertension, cardiovascular disease, and chronic kidney disease was found to be 16.9, 47.9, 100.6, and 13.9, respectively. From biopsy data, 30.21% of the NAFLD population had moderate-to-severe steatosis (9 studies, 2,461 participants) and 52.27% had NASH (7 studies, 1,168 participants) and 85.41% had fibrosis

Inhibition of HES-1 might play a protective role in endothelial cells under cholesterol stimulation via PI3K/AKT signaling pathway.

The occurrence of atherosclerotic cardiovascular disease (ASCVD) was closely related to low-density lipoprotein (LDL) cholesterol. HES-1 is critical for maintains of stem cells, quiescent cells or cancer cells, and contributes to drug resistance and metastasis of tumor cells. In this study, we established a cell model of HES-1 inhibition and overexpression in Ea.hy 926 cells, and firstly detected the proliferation rete of Ea.hy 926 cells under cholesterol stimulation using MTT assay, and apoptosis of Ea.hy 926 cells were detected using flow cytometry. Expression of HES-1, apoptosis related proteins and phosphatidylinositol 3 kinase (PI3K)/protein kinase B (AKT) signaling pathway were detected using Western blotting analysis. The expression of apoptotis related genes were detected using polymerase chain reaction (PCR) method. The concentration of angiogenesis cytokines was detected using enzyme-linked immunosorbent assay (ELISA) method. We found that proliferation of Ea.hy 926 cells was inhibited after stimulation of cholesterol, inhibition of HES-1 expression would reduce this effect. We also found that expression of apoptosis related molecules was increased and expressions of angiogenesis factors were decreased after cholesterol treatment. Besides, we revealed that these effects were mediated via PI3K/AKT signaling pathway, and HES-1 inhibition could increase the activity of this signaling pathway.

On-chip protein isoelectric focusing using a photoimmobilized pH gradient.

An immobilized pH gradient was directly constructed on the inner wall of a microfluidic chip channel by photoimmobilizing focused carrier ampholytes onto the wall. A mixture of carbonic anhydrase, myoglobin, and trypsin inhibitor was successfully isoelectric-focused and separated with good linearity between the pI values of proteins and the location of the focused bands. Furthermore, coating methods for the resistance of protein nonselective adsorption and simultaneously for pH gradient photocoupling were screened. The PEG-silane coating method was found to be better than the cross-linked polyacrylamide coating and aminosilane modification methods. Finally, based on the open tubular column mode of carrier ampholytes' immobilization and effective antiadsorption coating, the immobilized pH gradient was reused and the chip was recycled for the first time. By virtue of its remarkable features including simplicity, convenience, high efficiency of protein enrichment and separation, and potential for coupling site-selective IEF with other analytical or separation techniques, this novel method promises to be useful in several applications related with zwitterionic biomolecules.

A simplified network topology for fruit detection, counting and mobile-phone deployment.

The complex network topology, deployment unfriendliness, computation cost, and large parameters, including the natural changeable environment are challenges faced by fruit detection. Thus, a Simplified network topology for fruit detection, tracking and counting was designed to solve these problems. The network used common networks of Conv, Maxpool, feature concatenation and SPPF as new backbone and a modified decoupled head of YOLOv8 as head network. At the same time, it was validated on a dataset of images encompassing strawberry, jujube, and cherry fruits. Having compared to YOLO-mainstream variants, the params of Simplified network is 32.6%, 127%, and 50.0% lower than YOLOv5n, YOLOv7-tiny, and YOLOv8n, respectively. The results of mAP@50% tested using test-set show that the 82.4% of Simplified network is 0.4%, -0.2%, and 0.2% respectively more accurate than 82.0% of YOLOv5n, 82.6% of YOLOv7-tiny, and 82.2% of YOLOv8n. Furthermore, the Simplified network is 12.8%, 17.8%, and 11.8% respectively faster than YOLOv5n, YOLOv7-tiny, and YOLOv8n, including outperforming in tracking, counting, and mobile-phone deployment process. Hence, the Simplified network is robust, fast, accurate, easy-to-understand, fewer in parameters and deployable friendly.

Biomimetic Prussian blue nanozymes with enhanced bone marrow-targeting for treatment of radiation-induced hematopoietic injury.

There is an urgent medical need to develop effective therapies that can ameliorate damage to the radiation-exposed hematopoietic system. Nanozymes with robust antioxidant properties have a therapeutic potential for mitigating radiation-induced hematopoietic injury. However, enhancing nanozyme recruitment to injured tissues in vivo while maintaining their catalytic activity remains a great challenge. Herein, we present the design and preparation of a biomimetic nanoparticle, a mesenchymal stem cell membrane camouflaged Prussian blue nanozyme (PB@MSCM), which exhibits biocompatible surface properties and demonstrates enhanced injury site-targeting towards the irradiated murine bone marrow niche. Notably, the constructed PB@MSCM possessed redox enzyme-mimic catalytic activity and could scavenge overproduced reactive oxygen species in the irradiated bone marrow cells, both in vitro and ex vivo. More importantly, the administration of PB@MSCM significantly mitigated hematopoietic cell apoptosis and accelerated the regeneration of hematopoietic stem and progenitor cells. Our findings provide a new targeted strategy to improve nanozyme therapy in vivo and mitigate radiation-induced hematopoietic injury.

Baffled-flow culture system enables the mass production of megakaryocytes from human embryonic stem cells by enhancing mitochondrial function.

Human embryonic stem cells (hESCs) have become an ideal cell source for the ex vivo generation of megakaryocyte (MK) and platelet products for clinical applications. However, an ongoing challenge is to establish scalable culture systems to maximize the yield of stem cell-derived MKs that release platelets. We defined a specific dynamic 3D manufacturing system in a baffled-flow manner that could remarkably facilitate megakaryopoiesis and increase the yield of platelet-producing MKs from hESCs within a 12-day induction period. Additionally, an increased number of >16N ploidy MKs, proplatelets, and platelets were generated from induced cells harvested on Day 12 using the specific dynamic culture method. The specific dynamic culture method significantly enhanced endothelium-to-haematopoietic transition and early haematopoiesis. More importantly, MK fate was significantly facilitated in a specific dynamic manner during early haematopoiesis. Mechanistically, this dynamic culture significantly enhanced mitochondrial function via the oxidative phosphorylation pathway and caused differentiation skewing of hESCs toward megakaryopoiesis. This study can aid in the automatic and scalable production of MKs from stem cells using baffled-flow bioreactors and assist in the manufacturing of hESC-derived MK and platelet products.

The relationship between living arrangements and depression among older adults in Shandong, China: The mediating role of social support.

Background: Living arrangements and social support have an impact on depression among older adults. However, the underlying mechanism between those variables remains unknown. This study aims to investigate the mediating role of social support in the relationship between living arrangements and depression among older adults. Materials and methods: Multi-stage stratified sampling method was used to select 3,859 older adults from Taian City, Shandong Province, China, for cross-sectional investigation. Living arrangements were measured by a question. Social support and depression were measured using the Multidimensional Scale of Perceived Social Support and Patient Health Questionnaire-9. Multiple linear regression models were used to assess the relationship between living arrangements and depression and the possible influence of social support on the relationship between living arrangements and depression. Results: Statistics showed that 15.08% of older adults lived alone. After controlling for covariates, living arrangements (ß = 0.45, t = 2.87, P < 0.01) and social support (ß =-0.08, t =-16.93, P < 0.001) were significantly associated with depression. The linear regression model showed that social support mediated the relationship between living arrangements and depression, and the mediating effect accounted for 18.20% of the total effect. Conclusion: This study revealed that living arrangements played an essential role in indirectly predicting depression in older adults through social support. This provided evidence for how to reduce depression in older adults.

A K-nearest Neighbor Model to Predict Early Recurrence of Hepatocellular Carcinoma After Resection.

Background and Aims: Patients with hepatocellular carcinoma (HCC) surgically resected are at risk of recurrence; however, the risk factors of recurrence remain poorly understood. This study intended to establish a novel machine learning model based on clinical data for predicting early recurrence of HCC after resection. Methods: A total of 220 HCC patients who underwent resection were enrolled. Classification machine learning models were developed to predict HCC recurrence. The standard deviation, recall, and precision of the model were used to assess the model's accuracy and identify efficiency of the model. Results: Recurrent HCC developed in 89 (40.45%) patients at a median time of 14 months from primary resection. In principal component analysis, tumor size, tumor grade differentiation, portal vein tumor thrombus, alpha-fetoprotein, protein induced by vitamin K absence or antagonist-II (PIVKA-II), aspartate aminotransferase, platelet count, white blood cell count, and HBsAg were positive prognostic factors of HCC recurrence and were included in the preoperative model. After comparing different machine learning methods, including logistic regression, decision tree, naïve Bayes, deep neural networks, and k-nearest neighbor (K-NN), we choose the K-NN model as the optimal prediction model. The accuracy, recall, precision of the K-NN model were 70.6%, 51.9%, 70.1%, respectively. The standard deviation was 0.020. Conclusions: The K-NN classification algorithm model performed better than the other classification models. Estimation of the recurrence rate of early HCC can help to allocate treatment, eventually achieving safe oncological outcomes.

Association between Dietary Patterns and Depression in Chinese Older Adults: A Longitudinal Study Based on CLHLS.

(1) Objective: This study aimed to investigate the relationship between dietary patterns and depression in Chinese older adults. (2) Method: A cohort study was conducted on the relationship between dietary patterns and the risk of depression in older adults based on the China Health and Longevity Longitudinal Survey (CLHLS) from 2011 to 2014. Exploratory factor analysis was used to identify dietary patterns. The relationship between dietary patterns and the risk of depression after four years was examined using logistic regression, and subgroup analysis was carried out to determine whether the association differed by gender. (3) Results: A total of 2873 older adults were included in our cohort study. Three dietary patterns were identified: vegetable-egg-bean-milk pattern, meat-fish pattern, and salt-preserved vegetable-garlic pattern. The vegetable-egg-beans-milk pattern was negatively correlated with the risk of geriatric depression development (adjusted OR = 0.65 (95%CI: 0.49-0.87)), and the salt-preserved vegetable-garlic pattern was positively associated with aged depression risk (adjusted OR = 1.33 (95CI: 1.00-1.77)). The meat-fish pattern was not associated with the risk of depression in older adults. These associations were consistent in both men and women. (4) Conclusions: In this cohort study, the vegetable-egg-beans-milk dietary pattern was associated with lower risk of depression, while the salt-preserved vegetable-garlic dietary pattern was associated with higher risk of depression, and there were no gender differences in these associations.

Average plasmonic enhancement of molecules-doped Au-NS@SiO2 on fluorescence.

The average plasmonic enhancement of Au nanoshell (Au-NS) coated by a molecules-doped silica layer (Au-NS@SiO2) on molecular fluorescence is studied theoretically to estimate the overall performance of a large number of Au-NS@SiO2. Using Mie theory and dyadic Green's functions, analytical solutions of the excitation rate and the apparent quantum yield are obtained to calculate the enhancement factor of Au-NS@SiO2 on the fluorescence of a molecule with a specific orientation and location at a specific excitation wavelength lambda ex and an emission wavelength lambda em. Subsequently, the average enhancement factor (AEF) is calculated by averaging all possible orientations and locations of the molecule. For example, AEF of Au-NS@SiO2 (a3 = 50 nm t2 = 15 nm, t1 = 25 nm) is 4.544 for a NIR fluorescence at lambda ex = 780 nm and lambda em = 820 nm. Our results show that Au-NS is a broadband enhancer for NIR fluorescence; the bandwidth and the peak depend on the core size and the thickness of Au shell.

Average enhancement factor of molecules-doped coreshell (Ag@SiO2) on fluorescence.

Average enhancement factor (AEF) of a coreshell (Ag@SiO(2)) on the fluorescence of molecules doped within the silica shell is proposed and studied to estimate the overall performance of a large number of coreshells. Using Mie theory and dyadic Green's functions, the enhancement factor (EF) of a coreshell is first calculated for any arbitrarily oriented and located electric dipole embedded in the shell. AEF is then obtained by averaging the individual EF over all possible orientations and positions of the electric dipoles. AEF of a FITC-doped coreshell (radius of Ag core: 25 nm, thickness of shell: 15 nm) irradiated by a laser of 488 nm for FITC's emission at 518 nm is 2.406. It is much smaller than the maximum EF (30.114) of a coreshell containing a single molecule with a radial orientation at its optimal position. For Alexa 430-doped coreshell excited at 428 nm, AEF is 12.34 at the emission of 538 nm.

Global prevalence, incidence, and outcomes of non-obese or lean non-alcoholic fatty liver disease: a systematic review and meta-analysis.

BACKGROUND: Although non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, it is increasingly being identified in non-obese individuals. We aimed to characterise the prevalence, incidence, and long-term outcomes of non-obese or lean NAFLD at a global level. METHODS: For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Library from inception to May 1, 2019, for relevant original research articles without any language restrictions. The literature search and data extraction were done independently by two investigators. Primary outcomes were the prevalence of non-obese or lean people within the NAFLD group and the prevalence of non-obese or lean NAFLD in the general, non-obese, and lean populations; the incidence of NAFLD among non-obese and lean populations; and long-term outcomes of non-obese people with NAFLD. We also aimed to characterise the demographic, clinical, and histological characteristics of individuals with non-obese NAFLD. FINDINGS: We identified 93 studies (n=10 576 383) from 24 countries or areas: 84 studies (n=10 530 308) were used for the prevalence analysis, five (n=9121) were used for the incidence analysis, and eight (n=36 954) were used for the outcomes analysis. Within the NAFLD population, 19·2% (95% CI 15·9-23·0) of people were lean and 40·8% (36·6-45·1) were non-obese. The prevalence of non-obese NAFLD in the general population varied from 25% or lower in some countries (eg, Malaysia and Pakistan) to higher than 50% in others (eg, Austria, Mexico, and Sweden). In the general population (comprising individuals with and without NAFLD), 12·1% (95% CI 9·3-15·6) of people had non-obese NAFLD and 5·1% (3·7-7·0) had lean NAFLD. The incidence of NAFLD in the non-obese population (without NAFLD at baseline) was 24·6 (95% CI 13·4-39·2) per 1000 person-years. Among people with non-obese or lean NALFD, 39·0% (95% CI 24·1-56·3) had non-alcoholic steatohepatitis, 29·2% (21·9-37·9) had significant fibrosis (stage ≥2), and 3·2% (1·5-5·7) had cirrhosis. Among the non-obese or lean NAFLD population, the incidence of all-cause mortality was 12·1 (95% CI 0·5-38·8) per 1000 person-years, that for liver-related mortality was 4·1 (1·9-7·1) per 1000 person-years, cardiovascular-related mortality was 4·0 (0·1-14·9) per 1000 person-years, new-onset diabetes was 12·6 (8·0-18·3) per 1000 person-years, new-onset cardiovascular disease was 18·7 (9·2-31·2) per 1000 person-years, and new-onset hypertension was 56·1 (38·5-77·0) per 1000 person-years. Most analyses were characterised by high heterogeneity. INTERPRETATION: Overall, around 40% of the global NAFLD population was classified as non-obese and almost a fifth was lean. Both non-obese and lean groups had substantial long-term liver and non-liver comorbidities. These findings suggest that obesity should not be the sole criterion for NAFLD screening. Moreover, clinical trials of treatments for NAFLD should include participants across all body-mass index ranges. FUNDING: None.