ABSTRACT
Nonalcoholic fatty liver disease (NAFLD) is a major cause of chronic liver diseases worldwide and covers a series of pathological manifestations from hepatic steatosis to inflammation, fibrosis, and even liver cirrhosis. NAFLD is associated with a wide range of extrahepatic diseases, including metabolic syndrome, cardiovascular disease, chronic kidney disease, endocrine diseases, obstructive sleep apnea-hypopnea syndrome, psoriasis, and skeleton-muscle diseases. The major causes of death in patients with NAFLD include cardiovascular disease, malignancies, and liver-related complications, suggesting that extrahepatic diseases associated with NAFLD should be taken seriously by clinicians. This article reviews the research advances in extrahepatic diseases associated with NAFLD, so as to provide ideas for clinical assessment and treatment.
ABSTRACT
Objective@#To investigate the correlation between nonalcoholic fatty liver disease(NAFLD)fibrosis score(NFS)and unstable plaques of carotid in elderly NAFLD patients.@*Methods@#The clinical and carotid plaques data of 191 elderly(≥60 years old)admitted into our department between July 2016 and January 2018 were retrospectively collected.With NFS 0.676 as a cut-off point, the patients were divided into a liver fibrosis group(NFS ≥0.676, n=65)and a non-liver fibrosis group(NFS<0.676, n=126). Based on quartiles of NFS, the patients were divided into four groups: the Q1 group(NFS<-0.865, n=48), the Q2 group(-0.865≤NFS<0.100, n=48), the Q3 group(0.1≤NFS<1.070, n=47), the Q4 group(NFS≥1.070, n=48). The correlation of NFS with the property of carotid plaques was analyzed.@*Results@#The detection rate of unstable carotid plaques was increased along with the increase of NFS(F=8.573, P=0.004). The detection rate of unstable carotid plaques was higher in the liver fibrosis group than in the non-liver fibrosis group(78.5% or 51/65 vs.60.3% or 76/126, χ2=5.883, P=0.015). Multiple logistic regression analysis showed that liver fibrosis(NFS≥0.676)was independently correlated with unstable carotid plaques(β=0.816, 95%CI: 1.110~4.607, OR=2.261, P=0.025)after adjusting for possible confounding factors including age, gender, diabetes mellitus, hypertension, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein.@*Conclusions@#NFS is correlated with unstable carotid plaques in elderly NAFLD patients, and the higher NFS is the independent risk factor for unstable carotid plaques for elderly NAFLD patients with NFS higher than 0.676.We should pay more attention to the evaluation of unstable carotid plaques.
ABSTRACT
Objective To investigate the correlation between nonalcoholic fatty liver disease (NAFLD)fibrosis score(NFS)and unstable plaques of carotid in elderly NAFLD patients.Methods The clinical and carotid plaques data of 191 elderly(≥ 60 years old)admitted into our department between July 2016 and January 2018 were retrospectively collected.With NFS 0.676 as a cut-off point,the patients were divided into a liver fibrosis group(NFS ≥0.676,n=65)and a non-liver fibrosis group (NFS＜0.676,n=126).Based on quartiles of NFS,the patients were divided into four groups..the Q1 group(NFS＜-0.865,n=48),the Q2 group(0.865≤NFS＜0.100,n=48),the Q3 group(0.1≤ NFS＜ 1.070,n=47),the Q4 group (NFS≥ 1.070,n =48).The correlation of NFS with the property of carotid plaques was analyzed.Results The detection rate of unstable carotid plaques was increased along with the increase of NFS(F--8.573,P =0.004).The detection rate of unstable carotidplaques was higher in the liver fibrosis group than in the non-liver fibrosis group(78.5％ or 51/65 vs.60.3 ％ or 76/126,x2 =5.883,P--0.015).Multiple logistic regression analysis showed that liver fibrosis(NFS≥0.676)was independently correlated with unstable carotid plaques(β=0.816,95％CI:.1.110～4.607,OR=2.261,P=0.025)after adjusting for possible confounding factors including age,gender,diabetes mellit us,hypertension,total cholesterol,triglyceride,high-density lipoprotein,lowdensity lipoprotein.Conclusions NFS is correlated with unstable carotid plaques in elderly NAFLD patients,and the higher NFS is the independent risk factor for unstable carotid plaques for elderly NAFLD patients with NFS higher than 0.676.We should pay more attention to the evaluation of unstable carotid plaques.
ABSTRACT
Objective@#To investigate the clinical and microbiological characteristics of Myroides odoratimimus producing MUS-1 carbapenemase. @*Methods@#A strain of gram-negative bacterium isolated from the urine sample of one patient hospitalized in the oncology department of Affiliated Hospital of Xuzhou Medical University was identified by the Vitek 2 automatic microbial analyzer and 16S RNA sequencing, and its bla MUS-1 gene was detected with PCR. The minimum inhibitory concentrations (MICs) of antimicrobial drugs were determined by the broth dilution method. @*Results@#One strain of MUS-1 carbapenemase producing Myroides odoratimimus was found. The drug susceptibility test showed that it was resistant to most of antibiotics conventionally used, but sensitive to minocycline and meropenem, the MIC of imipenem was 8 μg/mL, which was judged as intermediate. @*Conclusion@#The bla MUS-1 gene may be the cause leading Myroides odoratimimus to resistant carbapenems drugs.
ABSTRACT
Objective To investigate the risk factors for NAFLD patients with mild cognitive impairment ( MCI) in elderly through comparing the clinical features among elderly NAFLD patients with MCI. Methods A total of one hundred and sixteen elderly patients with NAFLD were enrolled in this study and were divided into MCI group (37 cases) and non-MCI group (79 cases). The clinical data including medical history of myocardial infarction,diabetes mellitus,hypertension,medications,blood pressure,BMI,liver function, kidney parameters,glucose metabolism, serum lipid profile, vitamin D, NAFLD fibrosis score, HOMA-IR and carotid plaques were analyzed and compared. Results Compared with non-MCI group,the age,AST/ALT ratio, serum creatinine,NAFLD fibrosis score,serum uric acid of MCI group were significantly higher ((80. 5±7. 4) years vs.(72.5±8.0)years,t＝5.87,P＜0.001; (1.33±0.51) vs. (1.09±0.30),t＝2.599, P＝0.012;(100.86±78.02) μmol/L vs. (78.12±22.12) μmol/L,t＝2.402, P＝0.018; (0.73±1.01) vs. (0.03 ±1. 17),t＝3. 132,P＝0. 002; (382. 95±79. 61) μmol/L vs (349. 99±79. 18) μmol/L,t＝2. 086,P＝0. 039), while serum γ-glutamyl transpeptidase (γ-GT),diastolic blood pressure (DBP),estimated glomerular filtration rate (eGFR) of MCI group were significantly lower than those in the non-MCI group (22. 00(17. 00,26. 00) U/L vs. 28. 00(19. 00,39. 50) U/L,Z＝－3. 038,P＝0. 002;(69. 30±6. 78) mmHg vs. (74. 30±9. 45)mmHg,t＝－3.252, P＝0.002; (62.60±17.78)(ml/min×1.73 m2) vs. (79.41±16.95)(ml/min×1.73 m2),t＝－4. 900,P＜0. 001). Detection rates of carotid unstable plaques and high BMI in MCI group were higher than those in the non-MCI group (83. 78%(31/37) vs. 64. 56%(51/79),χ2＝4. 496, P＝0. 034)(83. 78%(31/37) vs. 60. 76%(48/79),χ2＝6. 149, P＝0. 013) . There were no significantly differences between the two groups in history of myocardial infarction,diabetes mellitus,hypertension,usage rates of antiplatelet drugs and statins. Logistic regression showed that age (regression coefficient＝0. 166,OR＝1. 181,95%CI 1. 078－1. 293,P＜0. 001), high BMI (regression coefficient＝1. 942,OR＝6. 974,95%CI 1. 466－33. 176,P＝0. 015),diastolic blood pressure ( regression coefficient＝ －0. 099, OR＝ 0. 905, 95%CI 0. 828－0. 990, P＝ 0. 029 ), γ-GT (regression coefficient＝－0. 094,OR＝0. 910,95%CI 0. 852－0. 972,P＝0. 005), serum uric acid (regression coefficient＝－0. 009,OR＝1. 009,95%CI 1. 000－1. 017,P＝0. 039) and low density lipoprotein cholesterol ( LDL-C) (regression coefficient＝0. 898,OR＝2. 454,95%CI 1. 029－5. 854,P＝0. 043) were related to elderly NAFLD patients with MCI. Conclusion The high BMI,diastolic blood pressure,serum uric acid,low density lipoprotein are related to MCI in elderly patients with NAFLD. For elderly patients with NAFLD,these indicators may be used to assess the risk of MCI and to locate high-risk groups at an early stage.
ABSTRACT
Objectives To investigate the correlation between the triglyceride and glucose (TyG) index and nonalcoholic fatty liver disease (NAFLD) and to evaluate the predictive value of TyG for NAFLD.Methods This retrospective study included 279 individuals aged 60 or over (115 with NAFLD and 164 without NAFLD).Clinical data including height and weight (for body mass index,BMI),presence of diabetes mellitus,lipid-regulating medications,glucose-lowering medications,alanine aminotransferase (ALT),aspartate transaminase (AST),gamma-glutamyltransferase (GGT),albumin,fasting plasma glucose (FPG),serum lipid profiles,serum uric acid,glycosylated hemoglobin,and serum creatinine were collected and analyzed.The TyG index was calculated according to FPG and fasting serum trig[ycerides.Binary logistic regression was carried out to determine the correlation between TyG and NAFLD.Receiver operating characteristic (ROC) curve analysis was used to test the predictive value of TyG and TyG combined with ALT and BMI for NAFLD.Results According to the quartiles of TyG,the subjects were divided into four groups:Q1 (TyG≤ 7.40)、Q2 (TyG≤ 7.80)、Q3(TyG≤＜≤8.31)、Q4(TyG≤8.13).The rates of NAFLD were 16.2％ in Q1,29.6％ in Q2,53.7％ in Q3,and 65.3％ in Q4 (P ＜0.0001).Logistic regression showed that TyG was independently associated with NAFLD;Compared with Group Q1,the adjusted odds ratios (ORs) and 95％ confidence intervals (CIs) for NAFLD of Q2,Q3,and Q4 were 1.677 (95％ CI:0.641-4.384),3.279 (95％ CI:1.285-8.364),and 5.447 (95％ CI:2.172-13.658),respectively.The ROC analysis indicated that the area under the ROC curve (AUC) was 0.730 (95％ CI:0.67-0.79) and that,with the cut-off point at 7.78,the largest Youden's index value was 0.402,with a sensitivity of 74.6％ and a specificity of 65.6％ for NAFLD.When combining TyG with BMI and ALT,the AUC could reach 0.822 (95％ CI:0.771-0.872).Conclusions TyG is correlated with NAFLD in the elderly.Besides,TyG combined with BMI and ALT is effective to predict NAFLD in the elderly.
ABSTRACT
Objective To evaluate the applicationof the double-disk synergy test(DDST) and combined disk test(CDT) in clini cal metal enzyme phenotype deteetion.To evaluate the value of multiplex PCR in detecting the metallo-β-1actamase in clinical.Methods 56 strains of metallo-β-1actamase-positive strains were identified [NDM-1(n=9),VIM(n=32),IMP(n=15)]for appraise the two methods.By optimizing the design of PCR primers,3 pairs of primers were designed and detected (IMP,VIM,NDM-1) in one tube for evaluate the method.Results The DDST was 80.36％(45/56),and 100.00％(56/56) in the CDT.The accuracy of multiplex PCR was 100.00 ％ (56/56),and the size of the amplified fragment was used to distinguish three types of metallo-β-lactamase.Conclusion The CDT is more suitable for clinical application than DDST.Multiplex PCR has the characteristics of simple,rapid and accurate in detection of metallo-β-1actamase.It is suitable for daily use of clinical microbiological laboratory,which will help the clinical timely and effective administration.
ABSTRACT
Objective To evaluate the applicationof the double-disk synergy test(DDST) and combined disk test(CDT) in clini cal metal enzyme phenotype deteetion.To evaluate the value of multiplex PCR in detecting the metallo-β-1actamase in clinical.Methods 56 strains of metallo-β-1actamase-positive strains were identified [NDM-1(n=9),VIM(n=32),IMP(n=15)]for appraise the two methods.By optimizing the design of PCR primers,3 pairs of primers were designed and detected (IMP,VIM,NDM-1) in one tube for evaluate the method.Results The DDST was 80.36％(45/56),and 100.00％(56/56) in the CDT.The accuracy of multiplex PCR was 100.00 ％ (56/56),and the size of the amplified fragment was used to distinguish three types of metallo-β-lactamase.Conclusion The CDT is more suitable for clinical application than DDST.Multiplex PCR has the characteristics of simple,rapid and accurate in detection of metallo-β-1actamase.It is suitable for daily use of clinical microbiological laboratory,which will help the clinical timely and effective administration.
ABSTRACT
Objective To identify the drug resistance-related genes in a clinically isolated strain of Enterobacter cloacae.Methods A strain of Enterobacter cloacae was isolated from sputum of a patient with chronic obstructive pulmonary disease from the Affiliated Hospital of Xuzhou Medical University in March 2013.Modified Hodge test and metal enzyme inhibition test were performed for drug-resistant phenotype screening.Carbapenemase genes blaMUS-1, blaVIM-1, blaVIM-2, blaIMP, blaKPC-2, blaNDM-1, blaOXA-48 and blaGESwere amplified by polymerase chain reaction (PCR), and the positive products were sequenced and analyzed.Plasmid conjugation and transformation experiments were used to confirm that the resistance gene mediated by plasmids.Agar dilution method was used for antibiotic susceptibility test.Results Both modified Hodge test and metal enzyme inhibition test were positive in this strain of Enterobacter cloacae.blaNDM-1 gene and blaKPC-2 gene were detected by PCR, and further confirmed by sequencing.blaNDM-1 gene was carried by IncX plasmid with 54×103 bp, KPC-2 gene was carried by untyping plasmid with 42×103 bp.The strain was only sensitive to tetracycline (MIC=2 μg/mL) and tigecycline (MIC=1 μg/mL).The symptoms were improved after the patient was treated by tigecycline combined with Piperacillin/Tazobactam.Conclusion blaNDM-1 and blaKPC-2 genes in Enterobacter cloacae can be mediated by plasmids, and appropriate therapy for its infection should be based on the result of antibiotic susceptibility test.
ABSTRACT
To detect furaltadone metabolite 3-amino-5-morpholinomethyl-2-oxazolidinone ( AMOZ ) in fish sample, an Eu3+ labeling time-resolved fluoroimmunoassay ( TRFIA ) was developed. The effects of experimental conditions including AMOZA-OVA concentration, dilution of antibody, and reaction time on the sensitivity of TRFIA were explored. The results showed that the optimized assay conditions were as follows:the AMOZA-OVA concentration was 0. 25 μg/mL; the antibody was diluted 5í104 folds, and the competitive reaction time was 50 min. Under optimal conditions, the method showed a detection limit of 0. 01 ng/mL, an IC50 of 0. 26 ng/mL and a linear range (IC20-IC80) of 0. 025-2. 83 ng/mL. The recoveries of AMOZ in fish at three spiked levels ranged from 78 . 0% to 86 . 0%, and the relative standard deviations were less than 15%. Good correlation between the ic-TRFIA and high performance liquid chromatography-tandem mass spectrometry was obtained for spiked food samples. The proposed ic-TRFIA method was suited for the determination of AMOZ residue in food samples.
ABSTRACT
Objective To analyze the epidemiological characteristics of brucellosis for improving its clinical and laboratory diag‐nostic ability .Methods The clinical and laboratorial data of the patients with brucellosis in our hospital from January 2013 to Sep‐tember 2015 were retrospectively analyzed .Results In 39 cases of brucellosis ,the majority had the sheep‐contacting history and the clinical manifestations were mainly fever (100 .0% ) ,bone and joint pain(64 .1% ) ,hidrosis(51 .3% ) ,weak(33 .3% ) ,lymph node en‐largement(23 .1% ) and hepatosplenomegaly(12 .8% ) .The laboratory detections showed the abnormal liver function ,rapid erythro‐cyte sedimentation rate(ESR) ,hypersensitive C ‐ reactive protein(hs‐CRP)increase ,lymphocytes percentage increase ,positive for brucellosis antibody agglutination test ,positive blood culture or medulloculture ,which was identified as Brucella melitensis by bacte‐riology .Conclusion The clinical manifestations of brucellosis are diversity and is easy to be misdiagnosed .The sporadic cases in northern Jiangsu area are increased year by year .The epidemiological clue should be paid attention to and the recognition on brucel‐losis should be strengthened .The patients with fever of undetermined origin should be conducted the blood culture and brucellosis antibody agglutination test as early as possible .
ABSTRACT
Objective To investigate the mechanism related to reduced antibiotic sensitivity of Acinetobacter baumannii inducted by meropenem in vitro.Methods Three strains of clinically isolated carbapenems-sensitive Acinetobacter baumannii were induced by meropenem in vitro, and the mutant strains (MS1, MS2 and MS3) were obtained.Minimal inhibitory concentrations (MICs) of antimicrobial agents to strains before and after induction were determined by automatic drug sensitivity analyzer .The homology of strains was analyzed by Enterobacterial repetitive intergenic consensus -polymerase chain reaction ( ERIC-PCR).Modified Hodge test and EDTA-Na2-double disk synergy test were used to detect carbapenemase and metallo-β-lactamase (MBL), respectively.Main carbapenemase genes were detected by PCR and followed by DNA sequencing.Expressions of adeB and outer membrane proteins in strains before and after induction were detected with fluorescence quantitative PCR and SDS -polyacrylamide gel electrophoresis , respectively.t test was used for data analysis .Results The sensitivity of mutant Acinetobacter baumannii strains to meropenem and most antibiotics was reduced , except to imipenem, amikacin and polymyxin; and the reduced sensitivity to meropenem in MS2 and MS3 was of genetic stability.ERIC-PCR showed 100%homology between the mutant strains and parental strains .Both carbapenemase and metallo -β-lactamase were negative in mutant strains and parental strains , and only OXA-51 gene was found.The expressions of adeB gene in mutant strains were 24.26 ±0.91, while those in parental strains were 22.81 ±0.38, and the difference was not significant (t =2.534, P >0.05).Outer membrane protein with molecular weight 54 000 was missing in MS1, while that with molecular weight 47 000 was missing in MS2 and MS3.Conclusion Reduced antibiotics sensitivity in meropenem -induced Acinetobacter baumannii may be correlated with the deficiency of outer membrane protein with molecular weight 47 000.
ABSTRACT
Objective To explore the relationship between type 2 diabetes mellitus(T2DM)and thyroid diseases by analyzing the abnormal status of thyroid hormone and antibodies in T2DM patients and the healthy control group.Methods The serum thyroid stimulating hormone (TSH),free triiodothyronine (FT3),free thyroxine (FT4),anti-thyroglobulin antibody (TGAb)and anti -thyroid peroxidase antibody (TPOAb)were measured in 396 patients with T2DM and 411 healthy persons.Results In the healthy group,the incidence rate of abnormal thyroid hormone was 7.5%,in which the male was 5.5% and female was 9.4%,the incidence rate of subclinical hypothyroidism in females was 4.7%,which was higher than 1.5% in males,there was statistically significant difference between them(P <0.05);the positive rate of TPOAb in the healthy control group was 10.2% and the positive rate of TGAb was 6.6%;in T2DM patients,the incidence rate of thyroid hormone abnormalities was 16.2%,which in males and females were 12.3% and 20.5% respectively,among them the incidence rate of subclinical hypothyroidism in females was 9.2%,which was significantly higher than 4.3% in males,the difference had statistical significance (P <0.01),T2DM patients with subclinical hypo-thyroidism accounted for 40.6% of thyroid dysfunction incidence rate;the positive rate of TPOAb was 15.2% and the positive rate of TGAb was 7.1 %.Conclusion The incidence rate of thyroid diseases in T2DM patients is significantly increased compared with the healthy control group,subclinical hypothyroidism in females is predominant;screening thyroid autoantibodies and monitoring FT3,FT4 and TSH at regular intervals in T2DM have the important clinical significance for evaluating the disease condition,jud-ging prognosis and guiding treatment.
ABSTRACT
<p><b>OBJECTIVE</b>To analyze the cause of misdiagnosis of occupational chronic n-hexane poisoning and to investigate the diagnosis and differential diagnosis of this disease.</p><p><b>METHODS</b>The clinical data of 16 patients with occupational chronic n-hexane poisoning who had been misdiagnosed with other diseases were collected. The hospital they first visited, cause of misdiagnosis, clinical features, and the misdiagnosis rate among inpatients during the same period were retrospectively analyzed.</p><p><b>RESULTS</b>Sixteen of 62 patients hospitalized during the same period were misdiagnosed at the first visit; 11 cases were in the upper first-class hospitals, and 5 cases in the upper second-class hospitals; 5 cases were misdiagnosed as Green Barry syndrome, 2 cases as motor neuron disease, 2 cases as drug-induced peripheral neuropathy, 3 cases as periodic paralysis, and 4 cases had uncertain diagnosis.</p><p><b>CONCLUSION</b>Most doctors who work in ordinary hospitals do not know occupational chronic n-hexane poisoning, which is often misdiagnosed as general neuropathies or difficult diseases. The key to correct diagnosis is to know the patient's occupational history and clinical features.</p>
Subject(s)
Humans , Chronic Disease , Diagnosis, Differential , Diagnostic Errors , Hexanes , Poisoning , Hospitals , Peripheral Nervous System Diseases , Retrospective StudiesABSTRACT
Objective To study the influence of different bed rest time on orthostatic hypotension,and explore a feasible and appropriate bed rest time for elderly patients after hemodialysis.Methods 58 elderly patients with regular hemodialysis were selected from January 2011 to May 2012.By self-control,they were divided into three groups according to different bed rest time:T0 group who got up immediately after the hemodialysis,T10 group who got up after 10-minute bed rest,T20 group who got up after 20-minute bed rest.The incidence of orthostatic hypotension was observed and compared between three groups.Results Compared to T0 group,the incidence of orthostatic hypotension in T10 and T20 groups was significantly reduced.However,no difference was seen between T10 and T20 groups.The acceptability rate in T10 group was 67.24％,higher than 17.24％ of the T20 group.Conclusions Elderly hemodialysis patients should continue to lie down for at least 10 minutes after hemodialysis,and then slowly get up,this measure can reduce the occurrence of orthostatic hypotension.
ABSTRACT
OBJECTIVE To analyze the monitoring performance and testing efficacy and reliability of standardized disposable B-D test pack and standard linen test pack,and summarize the corrective actions based on failure analyses for future reference.METHODS The two different test packs were employed to evaluate the vacuum performance of dynamic air removal sterilizer.RESULTS We enrolled 400 standardized disposable B-D test packs and standard linen test packs respectively.The disposable pack failed 4 cases with the success ratio 99%,while the linen pack failed 30 cases with the success ratio 92.5%.CONCLUSIONS The poor conformity of hand-made linen test pack,variation of steam pressure,sterilizer failure,and unprofessionalism of sterilizer operator contribute as main failure causes in B-D test.Standardized disposable B-D test pack can decrease subjective factors significantly,and the test results are more reliable and standardized.