[Establishment and Analysis of Risk Prediction Model for Metabolic Dysfunction-Associated Fatty Liver Disease in Physical Examination Population].

Objective: To analyze the risk factors of metabolic dysfunction-associated fatty liver disease (MAFLD) in the physical examination population, to establish a risk prediction model for the occurrence of MAFLD, and to provide management strategies for the prevention and occurrence of the disease. Methods: A total of 14664 people who underwent physical examination at the Physical Examination Center, West China Hospital, Sichuan University between January 2018 and December 2021 were selected as research subjects. The subjects were divided into a MAFLD group ( n=4013) and a non-MAFLD group ( n=10651) according to whether they had MAFLD. The differences in biochemical indices, for example, glycolipid metabolism levels, were compared and logistic regression was conducted to analyze the risk factors for MAFLD, thereby establishing a nomogram prediction model. The prediction effect of the model was validated and evaluated with the consistency index (C-index) and the calibration curve. Results: Among the 14664 subjects who underwent physical examination, 4013 were MAFLD patients, presenting an overall prevalence of 27.37%, with significantly higher prevalence in men than that in women (38.99% vs. 10.06%, P<0.001). Compared with those of the non-MAFLD group, the levels of glucose (GLU), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transpeptidase (GGT) and uric acid (UA) were increased ( P<0.05), while the high density lipoprotein cholesterol (HDL-C) level was decreased ( P<0.05) in the MAFLD group. The results of logistic regression analysis showed that male sex, age, body mass index, GLU, TG and hypertension were all independent risk factors of MAFLD, while HDL-C was a protective factor of MAFLD. The risk factors were used to establish a nomogram risk prediction model and the C-index and calibration curve showed that the nomogram model produced good predictive performance. The receiver operating characteristic (ROC) curve showed that the nomogram model had good predictive value for the risk of MAFLD. Conclusion: We found a relatively high prevalence of MAFLD in the physical examination population, and the nomogram model established with routine physical examination screening can provide indications for the clinical screening and analysis of high-risk patients, which has an early warning effect on the high-risk population.

[Exploration and Practice of Specialty Training Program in General Practice].

Innovation is the lifeline of medical education reform in the new era. Based on the strategic goals of the Healthy China Initiative, we presented in this paper the practical experience of the Department of General Practice, West China Hospital, Sichuan University. We proposed the construction of an integrated model of general practitioner (GP) core competency training program consisting of 4 components, medical service, management, education, and academic ability. The integration of "generalist-specialist" and "hospital-community health service center" forms the basis of the coordinated training rotation plans. This model of training promotes collaboration among the GPs. Furthermore, GP with special interests (GPwSI) training is organically incorporated into the content of the program. In addition, we discussed the diversified approaches to evaluation incorporating formative and summative evaluation measures adopted for the training program. We summarized the innovative implementation plan of GPwSI, which is an efficient, replicable, and generalizable standardized specialty training program compatible with the Healthy China Initiative, intending to contribute constructive information and references to the education reform of the GP standardized training under the new circumstances.

[Effect of Social Support on Multimorbidity and Related Outcomes of Middle-Aged and Older Adults in China].

Objective: To analyze the current status of social support for middle-aged and older adults with multimorbidity and to explore the correlation between different dimensions of social support and multimorbidity and the related outcomes on the basis of China Health and Retirement Longitudinal Study (CHARLS) 2015 survey data so as to reveal the complex social background of multimorbidity and the impact of social support on multimorbidity. Methods: A total of 9168 valid samples, with an average age of 59.60 years, were included in the study. Using the social support-related variables of the respondents, we conducted factor analysis and constructed regression models of common factors of social support and multimorbidity-related outcomes, intending to analyze the impact of common factors of social support on multimorbidity in the middle-aged and older adults. Results: The multimorbidity of middle-aged and older adults in China was related to multiple factors of social support, and the differences were statistically significant. Logistic regression showed that social support in the form of activity/recreational facilities and medical resources was a protective factor of multimorbidity, that family emotional support and economic support had a positive effect on life satisfaction of comorbid patients, and that social support in the form of education, social life and housing conditions was negatively correlated with catastrophic medical expenditure of the comorbid population ( P<0.05). Conclusion: Social support for middle-aged and older adults in China is unevenly distributed. Social support in the form of activity/recreational facilities and medical resources may reduce the risks of multimorbidity among middle-aged and older adults. Good family economic and emotional support can improve the life satisfaction of middle-aged and older adults with multimorbidity. Social support in the form of education, social life and housing conditions may reduce the risk of catastrophic medical expenditure in middle-aged and older adults with multimorbidity.

[Subacute Thyroiditis Following HPV Vaccination: A Case Report].

Subacute thyroiditis (SAT) is the most common self-limiting thyroid disease causing pain. The etiology of the disease remains unknown, but it is usually related to viral infection or allergic reaction after viral infection. SAT after vaccination is extremely rare. The patient had a fever of no clearly defined cause about 8 hours after receiving the first dose of a 0.5 mL 9-valent human papillomavirus vaccine (Gardasil 9). The highest temperature was 37.8 ℃, accompanied by a pain in the neck, fatigue and the increasing pain when swallowing. After the patient was admitted to the hospital, physical examination revealed Ⅱ° enlargement of the thyroid gland, which was hard and tender, and no vascular murmur was heard. There was no redness, swelling or ulceration at the vaccination site, and no obvious abnormalities were observed in other physical examinations. Laboratory findings were as follows: C-reactive protein, 25.20 mg/L; erythrocyte sedimentation rate, 55 mm/1 h; leukocyte, 4.94×10 9 L -1; thyrotropin, 0.137 mU/L; free thyroxine, 22.32 pmol/L; antithyroglobulin antibody, 69.18 IU/mL; anti-thyroid peroxidase antibody, 21.66 IU/mL. Thyroid ultrasonography showed diffuse enlargement of bilateral thyroid with uneven internal echo. The patient was diagnosed with SAT. After 5 days of treatment with ibuprofen, the patient no longer had low fever and the neck pain was relieved. The patient was followed up till now, and had completed the vaccination of the three-dose 9-valent human papillomavirus vaccine. The function of thyroid was found to be normal in follow-up visits, and SAT did not recur.

Adiponectin receptor agonist AdipoRon attenuates calcification of osteoarthritis chondrocytes by promoting autophagy.

Cartilage calcification contributes to the development and progression of osteoarthritis (OA). It has been well-investigated adiponectin regulates vascular calcification. The purpose of this study is to investigate the therapeutic value and the molecular mechanism of AdipoRon, an adiponectin receptor agonist, on the chondrocytes calcification. Primary chondrocytes were isolated and cultured from normal cartilage and OA cartilage. The calcification in tissues was evaluated by inductively coupled plasma/atomic emission spectroscopy and alizarin red S staining. The calcification in chondrocytes was determined using the alkaline phosphatase (ALP) staining and an ALP assay kit. The cellular effects of AdipoRon were assessed by immunofluorescence staining and Western blot analysis. We found that calcification was significantly increased in OA cartilage tissues and cells. Importantly, the degree of calcification and ALP activity of the OA chondrocytes was decreased upon the treatment with AdipoRon. The AdipoRon-induced cellular effects, including the reduction of the calcification of chondrocytes and improvement of autophagy, were blocked by dorsomorphin, an 5'-adenosine monophosphate-activated protein kinase (AMPK) inhibitor. Moreover, autophagy activation by AdipoRon was mediated by the AMPK-mammalian target of rapamycin (mTOR) signaling pathway. Our results suggest that AdipoRon significantly alleviates the calcification of OA chondrocytes via activating AMPK-mTOR signaling to promote autophagy. Therefore, AdipoRon could be a potential therapeutic agent for the prevention and treatment of OA.

[Effect of Nifuroxazide on Proliferation, Migration, and Invasion of Thyroid Papillary Carcinoma Cells].

OBJECTIVE: To explore the effect of nifuroxazide on proliferation, migration, and invasion of thyroid papillary carcinoma cells. METHODS: BCPAP and TPC-1 cell lines treated with different concentration (0, 1.25, 2.5, 5, 10, 20 µmol/L) of nifuroxazide, respectively. Cell viability and proliferation of BCPAP and TPC-1 was evaluated by MTT and colony formation assay. Apoptosis analysis and cell nuclear changes were determined by staining with Hoechst 33258 and visualized by a fluorescence microscope after treatment with nifuroxazide. Western blot analysis was used to evaluate protein expressions of apoptosis and invasion of BCPAP cells treated (48 h) with nifuroxazide. Transwell assay was conducted to evaluate ability of cell migration and invasion. RESULTS: After being treated with nifuroxazide (0, 1.25, 2.5 µmol/L and 0, 1.25 µmol/L) for 24, 48, 72 h respectively, decreased proliferations of BCPAP and TPC-1 cell lines were not obvious ( P>0.05). However, treated BCPAP and TPC-1 cells with higher concentration respectively (5, 10, 20 µmol/L and 5, 10 µmol/L) of nifuroxazide for 24, 48, 72 h, the inhibitory effects were significantly obvious ( P<0.05), and the inhibitory effects were increased in a CM(155mm]concentration- and time-dependent manner. The inhibition in proliferation of TPC-1 cell with nifuroxazide (2.5, CM)]5 µmol/L) took effect from 72 h and 48 h ( P<0.05), respectively. Clone formations of BCPAP and TPC-1 cells were significantly inhibited after being exposed to nifuroxazide (2.5, 5 µmol/L) for 10 d ( P<0.05). Hoechst 33258 staining assay showed that nifuroxazide (10 µmol/L) treatment resulted in cell shrinking, nuclear fragmentation and formation of condensed nuclei with bright-blue fluorescence. After 48 h, the percentage of apoptotic cells of BCPAP and TPC-1 significantly increased respectively as the concentration of nifuroxazide with 10 µmol/L ( P<0.005). Pro-apoptotic protein CC-3 and Bax expression levels increased significantly ( P<0.05), and the expression of anti-apoptotic protein Bcl-2 decreased significantly ( P<0.05) in BCPAP cells after nifuroxazide-treatment (10 µmol/L) for 48 h. The percentage of migrations and invasions of BCPAP and TPC-1 significantly decreased ( P<0.05) in the presence of nifuroxazide (10 µmol/L, 48 h). Nifuroxazide (10 µmol/L) treatment significantly decreased the expressions of matrix metalloproteinase (MMP)-2 and MMP-9 in BCPAP cells ( P<0.05) . Expression of MMPs family inhibitor-tissue inhibitors of metalloproteinase (TIMP)-2 increased ( P<0.05). CONCLUSION: Nifuroxazide inhibits the proliferation of thyroid cancer cells BCPAP and TPC-1, induceds the cell apoptosis by up-regulating the expressions of CC-3 and Bax proteins in vitro, and blocks migration and invasion of cells in vitro by reducing protein expressions of MMP-2 and MMP-9.

[Precision Medicine in Obesity Research and Practice].

Obesity now already becomes a critical health problem in our country and the world. Since the genomic and biochemical technology has developed in the era of precision medicine, great progression has been achieved in the field of obesity research and clinical practice. Obesity is considered to be a series of diseases with high heterogeneity beyond expectations, which brings up the challenges on its diagnosis and classification. Predictive models for obesity remain absent in clinical practice and commercial use. It is important to further understand the roles of gastric hormones and related molecules, proteins in feeding and reward system, as well as gut microbiota in obesity and associated diseases. The diagnosis and treatment of obesity require further progression in molecular biology and genetics with fruitful investigation of precision medicine, which might help the clinical translation in future.

[Serum Wnt5a and Its Associations with Liver Steatosis and Fibrosis in Overweight and Obese People].

OBJECTIVES: To determine serum Wnt5a and its associations with liver steatosis and fibrosis in overweight and obese people. METHODS: The study participants were recruited from those who visited our hospital for health examinations. They were divided into three groups according to body mass index (BMI), controlled attenuation parameter (CAP)values and elasticity (E) values of liver fibroscan: Control ( n=27), Mild NAFLD (non-alcoholic fatty liver disease, n=51) and Moderate/severe NAFLD ( n=56). The waist circumference (WC), hip circumference (HC), oral glucose tolerance test (OGTT), insulin releasing test (IRT), liver function, blood lipid, serum Wnt5a and ß-catenin of those participants were measured. RESULTS: The three groups of participants had no significant differences in age, gender, BMI, WC or HC ( P>0.05). Significant differences appeared in fasting glucose, 2 h postprandial glucose and fasting insulin level between the three groups ( P<0.05), but not in 2 h postprandial insulin level ( P>0.05).The participants with NAFLD had higher levels of serum Wnt5a and ß-catenin than controls ( P<0.05). Wnt5a level was correlated with CAP value ( r=-0.19, P<0.000 1), but barely with E value ( r=0.02, P=0.241). CONCLUSIONS: Wnt5a may play a role at different stages of NAFLD in overweight/obese people.

[Preliminary Study on the Wnt5a Expression in Obese Mice with Hepatocellular Carcinoma].

OBJECTIVES: To investigate the Wnt5a expression in obese mice with hepatocellular carcinoma. METHODS: Two groups of 6-week C57BL/6J mice were fed with chow-diet and high-fat-diet for 8 weeks respectively, to establish obesity model in the latter group. Mice in Hepal-6 group (including normal-body mass mice and obese mice) were injected with Hepa1-6 hepatocarcinoma cell lines through caudal vein, while the controls were given NS. Serum and tissue samples were taken at the age of 18 weeks for serological and morphological study. The expression of Wnt5a and ß-catenin in liver were examined by immunohistochemistry. RESULTS: At the age of 18-week, tatty degeneration was observed in the livers of obese control mice. Tumor cell masses were found in the livers of both obese and (including normal-body mass mice and obese mice) control mice by inoculation with Hepal-6, while focal necrosis was only observed in the obese+Hepal-6 group. The levels of serum transaminases, cholesterol and alpha-fetoprotein (AFP) were significantly different between groups ( P<0.05). The immunohistochemistry showed that the highest expression of Wnt5a was observed in liver tissues of normal control group, followed in sequence by obese control group, normal+Hepal-6 group, and obese+Hepal-6 group ( P<0.05). The expression of ß-catenin was just opposite ( P<0.05). CONCLUSIONS: The expression of Wnt5a was decreased, and the ß-catenin was abnormal accumulation. It may be closely related to the formation and progression of hepatocellular carcinoma.

[The Preliminary Investigation of GLP-1 Receptor Agonist on Liver Steatosis in Obese Mice].

OBJECTIVES: To investigate the effects of glucagon-like peptide-1 (GLP-1) receptor agonist, exenatide, on liver function and steatosis in obese mice. METHODS: Male c57BL/6J mice (8 weeks old) were divided into high-fat-diet group (for obesity model construction) and chow diet group. 12 weeks later, mice of high-fat diet group were randomly divided into high-dose exenatide group [H group, intraperitoneal injection 0.02 µg/ (g·d) , high-fat-diet], low-dose exenatide group [L group, intraperitoneal injection 0.01 µg/ (g·d) , high-fat-diet], saline group (NS group, intraperitoneal injection of saline, high-fat-diet) , diet control group (D group, shifted to chow diet) and high-fat control group (M group, high-fat-diet) for 4-week treatments , respectively. The body mass and serum biochemical indicators of were detected. Liver tissues were stained with HE, and steatosis score was measured. RESULTS: After 4-week treatments, H group showed more body mass loss than L group and D group ( P<0.05). The serum alanine aminotransferase (ALT) level of NG group was higher than that of H, L, M, and NS groups ( P<0.05). Serum cholesterol and triglyceride declined to normal levels by diet intervention or drug treatment. High-dose exenatide treatment ran a risk of increasing serum uric acid level. The serum levels of aspartate aminotransferase (AST), glucose, homeostasis model assessment-insulin resistance (HOMA-IR), lipase, and amylase had no significant differences between groups (P>0.05). Hepatic steatosis score was reduced by diet intervention or drug treatment. CONCLUSIONS: High-dose exenatide treatment can effectively reduce body mass of obese mice, but it has little difference when compared with dietary intervention in improving blood fat and liver steatosis.

[Obesity and Bone Mineral Density in Menopausal Women].

OBJECTIVES: To determine the association between obesity and bone mineral density in menopausal women. METHODS: We recruited menopausal women aged 50 years and older who undertook health examinations in West China Hospital of Sichuan University in this study. Bone mineral density of the participants was measured by MetriScan Bone Densitometry. The participants were categorized into three groups according to the T value: normal density, osteopenia and osteoporosis. RESULTS: Of the 4 938 participants, 8.55% had obesity [body mass index (BMI)>28 kg/m2]. The three groups of participants were different in BMI, a body shape index (ABSI), body mass, waist circumference, hip circumference and height ( P<0.01). The age-adjusted T values were positively correlated with height, body mass, waist circumference, hip circumference, waist-hip ratio (WHR), waist-height ratio (WHtR) and body roundness index (BRI) ( P<0.05). The areas under curves (AUC) of receiver operator characteristic (ROC) were 0.540 and 0.568, respectively, for waist circumference and BMI in those with osteoporosis. CONCLUSIONS: Obesity in menopausal women is negatively associated with osteoporosis. The clinical significance of such an association requires further studies with a longitudinal design.

[Effects of VEGF on Proliferation, Apoptosis and Insulin Secretion in Rat Pancreatic Islet Cells].

OBJECTIVE: To investigate the effect of vascular endothelial growth factor (VEGF) on proliferation, apoptosis, insulin secretion and related gene expression in rat pancreatic islet cell (INS-1). METHODS: INS-1 cells were treated with different concentrations of VEGF. CCK-8 kit was used to detect the proliferation of INS-1 cells and the cell apoptosis were evaluated by using Annexin V and propidium iodide (PI) double staining kit. INS-1 cells were treated with VEGF and the standard glucose stimulated insulin secretion test with ELISA was conducted. The expression of related genes in pancreatic islets was detected by real-time quantitative PCR. The effect of VEGF on isulin protein expression was evaluated with Western blot. RESULTS: No significant changes (P > 0.05) in INS-1 cells were observed after treated with different concentrations of VEGF at 24 h, 48 h and 72 h. But when VEGF concentration were 80 ng/mL and 160 ng/mL, an inhibitory effect on cell apoptosis were noticed (P < 0.01). The addition of VEGF to the high-glucose media significantly reduced the release of insulin at the concentration of 40 ng/mL. A decreasing trends of the expression level of sulfonylurea receptor gene (Sur), inwardly rectifying potassium channel gene 6. 2 (Kir6. 2) as well as the release of insulin were noticed as the increasing of VEGF concentrations. The expression of glucokinase gene (GCK) first decreased and then increased, but the expression of glucose transporter gene 2 (Glut 2) were increased first and then decreased. CONCLUSION; VEGF inhibited the secretion of insulin from INS-1 cells in the high-glucose condition. Our study provides new clues to the function of VEGF on the glucose metabolism.

[Effects of FGF-21 on Osteogenic Differentiation of Human Bone Marrow Mesenchymal Stem Cells in High Glucose Environment].

OBJECTIVES: To determine the effect of fibroblast growth factor-21(FGF-21)on the osteogenic differention of human bone mesenchymal stem cells (hBMSCs) exposed to a hyperglycemia condition in vitro. METHODS: hBMSCs were isolated from adult bone marrows, and identified by Alizarin red and oil red O staining. The expressions of immunophenotype were analysed using flow cytometry (CD105, CD90, CD73, CD44).HBMSCs were divided into control group[glucose (Glu) concentration of 5.5 mmol/L], Glu A, B, C groups(Glu 16.5, 25, 40 mmol/L), FGF-21 group (Glu 5.5mmol/ L+ FGF-21 ),Glu B+ FGF-21 group, and Glu B +FGF-21+cell mitogen activated protein kinase (MAPK) blocker (PD98059, SP600125 ,and SB203580) groups. The effect of FGF-21 on the differentiation of hBMSCs was detected using indicators as follows: alkaline phosphatase(ALP)on day 14, mRNA expressions ofALP, osteocalcin(OCN)and Runx2, protein expressions and phosphorylation of extracellular signal regulated kinase (ERK), mitogen-activated protein kinase(P38) and c-Jun N-terminal kinases(JNK) on day 21. RESULTS: hBMSCs differentiated into osteoblast cells and lipocyte. The hBMSCs were identified by flow cytometry.Compared with control group, significant increases of ALP mRNA, OCN mRNA and Runx2mRNA levels, as well as phosphorylation of ERK, P38 and JNK were observed in Glu A, B, C groups.Compared with Glu B group, ALP, OCN and Runx2 mRNA levels, and phosphorylation of ERK, P38 and JNK were decreased in Glu B+FGF-21 group .Compared with Glu B+FGF-21 group, ALP and Runx2 mRNA levels, and phosphorylation of ERK, JNK and P38 were decreased in Glu B +FGF-21 +MAPK blocker groups. CONCLUSIONS: High glucose could promote the biomineralization of hBMSCs. FGF-21 in high glucose environment could inhibit the osteogenic differentiation of hBMSCs.

[Association Between Serum Uric Acid and Acute Cerebral Infarction: a Case Control Study].

OBJECTIVE: To determine the association between serum uric acid levels and acute cerebral infarction. METHODS: 700 patients with acute cerebral infarction were recruited in the study, with 700 healthy individuals serving as controls. Blood samples of the participants were collected to measure uric acid, triglyceride, cholesteral, blood glucose, urea and creatinine. Logistic regression model was established to examine the association between serum uric acid and acute cerebral infarction. RESULTS: The patients with acute cerebral infarction had lower levels of serum uric acid than the healthy controls (P <0. 05). The logistic regression model showed that decreased levels of serum uric acid were barely associated with acute cerebral infarction (odds ratio: 0. 998, 95% confidence interval: 0. 996-1. 000, P<0. 05), after controlling for other confounding factors. CONCLUSION: Association between serum uric acid and acute cerebral infarction is not confirmed.

[The Association Between Serum Uric Acid and Creatinine in Patients with Hypothyroidism].

OBJECTIVE: To determine the relationship between serum uric acid (SUA) and creatinine (SCr) in patients with hypothyroidism. METHODS: A total of 2 078 people who took physical examinations in the West China Hospital, Sichuan University in May 2014 participated in this study. Serum thyrotropin (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) were detected by electrochemiluminescence. SUA was measured using uricase UV method. The participants were divided into three groups according to their thyroid function: hypothyroidism, subclinical hypothyroidism (SCH) and control. The prevalence of hyperuricemia in each group was Estimated. Correlation analyses were performed for the serum indicators. RESULTS: There were 1 685 participants in the control group, 38 in the hypothyroidism group, and 355 in the subclinical hypothyroidism group. Hypothyroidism patients had significantly higher levels of TSH than those in the control and SCH groups. Significant differences in serum levels of FT3 and FT4 were found between the three groups. Higher levels of SCr (P=0. 005) and SUA (P=0. 008) were also found in hypothyroidism patients compared with those in the control and SCH groups. In those younger than 60 years, men were more likely to catch hyperuricemia than women, with 50-59 year old men having the highest prevalence of hyperuricemia. Higher prevalence of hyperuricemia in men (compared to women) was also found in those older than 60 years, but without statistical significance (P=0. 09). After correcting for gender, TSH showed no correlations with SUA (r=-0. 01, P=0. 648) and SCr (r=-0. 02, P=0. 284); FT4 showed negative correlations with SUA (r= -0. 978, P=0. 001) and SCr (r= -0. 599, P= 5. 012); FT3 showed negative correlations with SUA (r= -0. 745, P=0. 007) and SCr (r -0. 457, P=0. 034). CONCLUSION: Reduced thyroid hormone levels may lead to elevated SCr levels. And elevated SCr levels may be issociated with elevated levels of SUA in patients with hypothyroidism.

[Prognostic determinants of adrenocortical carcinoma in adults].

OBJECTIVE: To investigate the clinical features and prognostic determinants of adrenocortical carcinoma (ACC) in adult patients. METHODS: All adult patients (aged > or =18 years old) who were admitted to West China Hospital, Sichuan University from 1st Jan., 2000 to 31st Jan., 2013 with a pathologically diagnosed ACC were included in this study. Data about the demographics, clinical characteristics, laboratory examinations and outcomes of those patients were extracted and analyzed. RESULTS: A total of 52 cases were identified, with a median follow-up of 26 months (3-159 months). The patients had a median survival time of 29 months (1-156 months), with a 1-year, 3-year; and 5-year survival rate of 71.0%, 47.0%, and 42.7%, respectively. In the univariate analysis, aged >45 years old at diagnosis (P = 0.017), advanced stage (III-IV stage, P<0.001), incomplete resection (P = 0.011), symptomatic (P = 0.017), hypoalbuminemia (P = 0.003), and elevated lactate dehydrogenase (LDH) (P = 0.017) were associated with poor prognosis of ACC. The multivariate analysis confirmed that hypoalbuminemia Chazard ratio (HR) = 5.306; 95% confidence interval (95% CI: 1.975, 14.258; P = 0.001), female (HR = 4.020; 95% CI: 1.610, 10.038; P = 0.003), advanced stage (HR = 7.405; 95% CI: 2.561, 21.410; P < 0.001), and older age (HR = 4.628; 95% CI: 1.791, 11.959; P = 0.002) were predictors of poor prognosis of ACC. CONCLUSION: Hypoalbuminemia, female, older age, and advanced stage are independent risk factors associated with poor prognosis of ACC.in adult patients.

[Prevalence of diabetes and impaired glucose regulation in Chengdu populations and associated dietary risk factors].

OBJECTIVE: To determine the prevalence of type 2 DM and impaired glucose regulation (IGR) in Chengdu populations and to identify dietary risk factors associated with DM and IGR. METHODS: Two communities in Chengdu were selected for this study. Fasting blood-glucose (FBG) and 2-hour post-meal blood glucose (2 hGlu) tests were performed in the community residents. The participants were asked to complete a questionair recording their daily food intaking. The total calorie of food, percentage of different kinds of food, and intake of electrolyte, vietamine and micro minerals were calculated and compared between those with and without type 2 DM or IGR. RESULTS: Of the study participants, 18.59% had type 2 DM and 24.22% had IGR. Those with DM had higher levels of intake of calorie,fat,protein and sodium, and lower levels of intake of cellulose, carbohydrates, Iron, zinc, selenium,manganese and vietamine C and E compared with those without DM/IGR (P < 0.05). The participants with IGR had higher levels of intake of calorie and sodium and lower levels of intake of cellulose, zinc, selenium, manganese and vitamine C and E compared with those without DM/IGR (P < 0.05). Percentage of dietary fat was identified as an independent risk factor of type 2 DM (OR = 1.609); whearaus Vitamine E was identified as a protective factor of type 2 DM (OR = 0.733) and IGR (OR = 0.990). CONCLUSION: Chengdu has a higher than national average prevalence of type 2 DM and IGR. The high percentage of dietary fat and low levels of Vitamine E are major risk factors of type 2 DM and IGR.

[Changes of bone mineral density and bone metabolic marker in patients with subclinical hypothyroidism].

OBJECTIVE: To investigate the change of bone mineral density and bone metabolism biochemical markers in subclinical hypothyroidism. METHODS: This study included total 122 patients with subclinical hypothyroidism and 153 healthy age and gender matched people as control. All the patients and controls were subjected to the measurements of bone density by dual energy X-ray absorptiometry (DEXA), and serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), Ca2+, PO4(3+), alkaline phosphatase (ALP) levels. All the data was analyzed statistically with the stratification of gender and menopause status. RESULTS: Compared to the control, the patients with subclinical hypothyroidism had significantly higher incidence of bone mass loss (P < 0.005) and lower level of Serum Ca2+ (P < 0.05) and higher levels of serum PO4(3+), T-value and Z-value (P < 0.05). Furthermore, premenopausal women had higher Z-value (P < 0.01) , but no significantly differences of T-value, serum PO4(3+) was found either in pre-menopause or post-menopause women when compared to the control. Multiple linear regression analysis showed gender (B = 0.543, P < 0.0001) was positive correlation with T value, female had lower T values. Moreover, T value was negative correlated to menopausal status (B = -0.274, P = 0.001), age (B = -0.161, P < 0.0001) and TSH (B = -0.108, P < 0.0001). CONCLUSION: Subclinical hypothyroism appears decreased serum calcium and low bone density.

[Risk stratification of diabetic chronic kidney disease using eGFR equations].

OBJECTIVE: To compare different eGFR equations for risk stratification of diabetic chronic kidney disease. METHODS: A total of 601 diabetic patients participated in the study. Data about the patient serum cystatin C (Cys-C), blood urea nitrogen (BUN), creatinine (Scr), uric acid (UA), glycosylated hemoglobin (HbAlc), and urinary albumin creatinine ratio (ACR) were extracted. Simplified MDRD formula were used for calculating glomerular filtration rate (eGFR) using eGFR-EPlcrea, eGFR-EPIcys and eGFR-EPIcrea-cys. The patients were divided into three groups according to their urine ACR. Comparisons were made between the groups of patients in Cys-C, BUN, UA, eGFR and Scr. RESULTS: There were significant differences (P < 0.05) in Cys-C, eGFR-MDRD, eGFR EPIcrea, eGFR-EPIcys, and eGFR-EPIcrea-cys among the groups of patients. The different equations for risk stratification produced different distributions of patients among the three groups. Significant differences appeared among the groups in the distribution of patients using eGFR-MDRD (P < 0.05), eGFR-EPIcrea (P = 0.000) and eGFR-EPIcys (P < 0.05) and indication for stratification. No significant differences were found in the distribution of patient among the three groups (P > 0.05) using GFR-MDRD, eGFR-EPIcrea and eGFR-EPIcrea-cys as an indication for stratification. In low risk patients, eGFR-MDRD was higher than other eGFR (P < 0.05). In medium and high-risk patients, eGFR-MDRD and eGFR-EPIcrea were higher than eGFR-EPIcys and eGFR-EPIcrea-cys. In very high-risk patients, the four eGFR did not show differences. CONCLUSION: The performance of different eGFR equations differs in risk stratification of diabetic chronic kidney disease. In low-risk patients, MDRD equation may overestimate GFR level.

[Levels of serum lipids in rural populations with diabetes and pre-diabetes in Chengdu].

OBJECTIVE: To investigate the serum lipid levels in rural residents with diabetes and pre-diabetes conditions in Chengdu. METHODS: Random cluster sampling method was employed to select participants of 35-70 year-old rural residents in Chengdu. The participants (n=971) were given standard 75 g oral glucose tolerance tests (OGTT) and divided into five groups: impaired fasting glucose (IFG) group, impaired glucose tolerance (IGT) group, IFG and IGT (IFG+ IGT) group, diabetes mellitus (DM) group and normal glucose tolerance (NGT) group. Their serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-c) and low density lipoprotein cholesterol (LDL-c) were measured. RESULTS: The age-adjusted standardized prevalence of DM and pre-diabetes in rural residents in Chengdu were 12.8% and 34.5%, respectively, without significant gender differences. IGT was the most common type of abnormal glucose metabolism in pre-diabetes. High serum TG and LDL-c and low serum HDL-c were found in 45.9%, 30.6% and 9.9% participants with DM, respectively. High serum LDL-c and TG and low serum HDL-c were found in 38.1%, 30.6% and 7.6% of participants with IGR. Participants with DM or/and IGR had higher levels of LDL-c and TG and lower levels of HDL-c than those in the NGT group. CONCLUSION: Pre-diabetes and diabetes are prevalent in rural residents in Chengdu, which are usually accompanied with various degrees of dyslipidemia.