Effect of ideal cardiovascular health metrics on the incidence rate of nonalcoholic fatty liver disease / 临床肝胆病杂志

Objective To investigate the association of ideal cardiovascular health metrics with the incidence rate of nonalcoholic fatty liver disease (NAFLD), and to provide a basis for the prevention and control of NAFLD. Methods A prospective cohort study was conducted for the data of 50 511 employees of Kailuan Group who participated in physical examination from July 2006 to June 2007, and the onset of NAFLD was observed during follow-up once every two years. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test used for comparison of continuous data with skewed distribution between multiple groups; the chi-square test was used for comparison of categorical data between groups. The subjects were divided into four groups according to the quartile of cardiovascular health score (CHS), and person-year incidence rate was used to calculate the incidence rate of NAFLD in each group. Restricted cubic spline (RCS) curve was used to calculate the dose-response relation between continuous variables and outcome events; the Cox proportional hazards model was used to analyze hazard ratio ( HR ) and 95% confidence interval ( CI ) in each group and investigate the effect of ideal cardiovascular health metrics on the incidence rate of NAFLD. Results During the mean follow-up time of 5.58 years, a total of 15 265 cases of NAFLD were observed, and the incidence rate of NAFLD was 77.88/1000 person-year in the Q1 group, 61.33/1000 person-year in the Q2 group, 46.37/1000 person-year in the Q3 group, and 33.69/1000 person-year in the Q4 group. RCS results showed a non-linear relationship between CHS continuous variable and the risk of NAFLD ( P < 0.05). The multivariate Cox proportional risk model analysis showed that compared with the Q1 group in terms of the risk of NAFLD, the Q2, Q3, and Q4 groups had an HR of 0.78 (95% CI 0.74~0.81), 0.57 (95% CI 0.54~0.59), and 0.38 (95% CI 0.36~0.41), respectively, and similar results were observed in subjects stratified by sex and age. The analysis of each component showed that ideal body mass index ( HR =0.37, 95% CI : 0.36~0.39), ideal blood glucose ( HR =0.80, 95% CI : 0.77~0.84), ideal blood pressure ( HR =0.72, 95% CI : 0.69~0.75), ideal cholesterol ( HR =0.86, 95% CI : 0.83~0.89), and ideal diet ( HR =0.94, 95% CI : 0.90~0.99) were protective factors against NAFLD. Conclusion Ideal cardiovascular health metrics are protective factors against NAFLD, and maintaining a healthy lifestyle may help to prevent the onset of NAFLD.

Research advances in abnormal gluconeogenesis in hepatocellular carcinoma / 临床肝胆病杂志

Tumors still perform glycolysis in the aerobic environment to accelerate the uptake of glucose and produce a large amount of lactic acid in tumor microenvironment, provide biomolecular precursors of nucleotides, lipids, and proteins for tumor cell proliferation, and inhibit the function of immune cells and promote the metastasis of tumor cells in acidic environment. Gluconeogenesis, as the reverse reaction of glycolysis, is inhibited in hepatocellular carcinoma, especially the downregulated expression of the four key rate-limiting enzymes pyruvate carboxylase, phosphoenolpyruvate carboxykinase, fructose-1, 6-diphosphate 1, and glucose-6-phosphatase 4, which promotes the growth and proliferation of hepatocellular carcinoma by promoting aerobic glycolysis and its branched pathways, and meanwhile, it is also associated with the overall survival time and prognosis of patients with hepatocellular carcinoma and is considered an inhibitor for hepatocellular carcinoma. Therefore, this review summarizes the changes and mechanism of action of the key enzymes of gluconeogenesis in the development and progression of hepatocellular carcinoma and analyzes the shortcomings and future directions of related research in hepatocellular carcinoma, so as to provide new ideas for the treatment of hepatocellular carcinoma.

Fasting Blood Glucose, Cholesterol, and Risk of Primary Liver Cancer: The Kailuan Study / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#The influence of fasting blood glucose (FBG) and cholesterolemia primary liver cancer (PLC) in china was analyzed via a large prospective cohort study based on a community population, and the combined effects between them were investigated. @*Materials and Methods@#Overall, 98,936 staff from the Kailuan Group who participated in and finished physical examinations between 2006 and 2007 were included in the cohort study. Their medical information was collected and they were followed up after examination. The correlations of serum FBG or TC with PLC were analyzed. Then, we categorized all staff into four groups: normal FBG/ non-hypocholesterolemia, normal FBG/hypocholesterolemia, elevated FBGon-hypocholesterolemia, elevated FBG/hypocholesterolemia and normal FBG/ non-hypocholesterolemia was used as a control group. The combined effects of elevated FBG and hypocholesterolemia with PLC were analyzed using the Age-scale Cox proportional hazard regression model. @*Results@#During 1,134,843.68 person*years follow up, a total of 388 PLC cases occured. We found the elevated FBG and hypocholesterolemia increases the risk for PLC, respectively. Compared with the non-hypocholesterolemiaormal FBG group, the risk of PLC was significantly increased in the non-hypocholesterolemia/elevated FBG group (HR=1.19,95%CI 0.88–1.62) and hypocholesterolemiaormal FBG group (HR=1.53,95%CI 1.19–1.97), and in the hypocholesterolemia/elevated FBG group (HR=3.16 95%CI2.13-4.69). And, a significant interaction effect was found of FBG and TC on PLC. All results were independent from the influence of liver disease. @*Conclusion@#Elevated serum FBG and hypocholesterolemia are risk factors for PLC, especially when combined. Thus, for the prevention and treatment of PLC, serum FBG and TC levels should be investigated.

Molecular analysis of an individual with CisAB phenotype / 中华医学遗传学杂志

OBJECTIVE@#To explore the molecular basis for an individual with ABO subtype.@*METHODS@#The ABO phenotype of the proband was determined by convention serological testing. Exons 6 and 7 of the ABO gene were subjected to PCR amplification and bi-directional Sanger sequencing. Haplotypes for exons 6 and 7 of the proband was determined using an ABO haplotype-specific amplification and sequencing technique.@*RESULTS@#Red blood cells of the proband showed a 4+ agglutination strength with anti-A or anti-H, no agglutination reaction with anti-A1, and a 3+ agglutination strength with anti-B. His serum had no reaction with standard A cells, O cells or self cells, but was weakly reactive with B cells at 4℃. The proband was assigned as an ABO subtype based on his serological features. Bi-directional sequencing of the ABO gene revealed heterozygosity of 261 G/del, 297AG, 526CG, 657CT, 703GA, 803GC and 930GA, and homozygosity of 796CC in the proband. Haplotype-specific amplification and sequencing showed that one of his alleles was ABO*O.01.01, and another contained a c.796A>C variation compared with the ABO*B.01 allele, which led to replacement of methionine by leucine at position 266. Searching the ABO allele database of International Society of Blood Transfusion suggested the variation to be a novel one.@*CONCLUSION@#The c.796A>C variation in the ABO*B.01 allele probably underlies the CisAB subtype. Accurate identification of the ABO subtype requires combined use of serological method and genetic testing.

Molecular analysis of an individual with CisAB phenotype / 中华医学遗传学杂志

Objective@#To explore the molecular basis for an individual with ABO subtype.@*Methods@#The ABO phenotype of the proband was determined by convention serological testing. Exons 6 and 7 of the ABO gene were subjected to PCR amplification and bi-directional Sanger sequencing. Haplotypes for exons 6 and 7 of the proband was determined using an ABO haplotype-specific amplification and sequencing technique.@*Results@#Red blood cells of the proband showed a 4+ agglutination strength with anti-A or anti-H, no agglutination reaction with anti-A1, and a 3+ agglutination strength with anti-B. His serum had no reaction with standard A cells, O cells or self cells, but was weakly reactive with B cells at 4℃. The proband was assigned as an ABO subtype based on his serological features. Bi-directional sequencing of the ABO gene revealed heterozygosity of 261 G/del, 297AG, 526CG, 657CT, 703GA, 803GC and 930GA, and homozygosity of 796CC in the proband. Haplotype-specific amplification and sequencing showed that one of his alleles was ABO*O.01.01, and another contained a c. 796A>C variation compared with the ABO*B.01 allele, which led to replacement of methionine by leucine at position 266. Searching the ABO allele database of International Society of Blood Transfusion suggested the variation to be a novel one.@*Conclusion@#The c. 796A>C variation in the ABO*B.01 allele probably underlies the CisAB subtype. Accurate identification of the ABO subtype requires combined use of serological method and genetic testing.

Influence of longitudinal trajectories of body mass index on new-onset gallstone disease / 临床肝胆病杂志

ObjectiveTo investigate the effect of longitudinal trajectories of body mass index (BMI) on new-onset gallstone disease. MethodsA prospective cohort study was conducted for 44168 employees who underwent physical examination in Kailuan General Hospital in 2006, 2008, and 2010, and related data, including BMI, were collected. Physical examination was performed once every two years, and the employees were followed up to observe the onset of gallstone disease. According to the longitudinal trajectories of BMI, the employees were divided into low-stable group with 14888 employees, medium-stable group with 22334 employees, and high-stable group with 6948 employees. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups; the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used to calculate the cumulative incidence rate of gallstone disease in each group, and the log-rank test was used for comparison between groups. The Cox proportional-hazards regression model was used to analyze the influence of longitudinal trajectories of BMI on the onset of gallstone disease. Resultsthe mean follow-up of 5.41 years, a total of 902 patients with gallstone disease were observed, and the cumulative incidence rates of gallstone disease in the low-stable group, the medium-stable group, and the high-stable group were 4.80%, 5.25%, and 9.45%, respectively, with a significant difference between groups based on the log-rank test (χ2=81.86, P＜0.01). After adjustment for confounding factors in the Cox proportional hazards model, compared with the low-stable group, the medium-stable group and the high-stable group had a risk of gallstone disease increased by 1.55 times (95% confidence interval［CI］: 1.31-1.84) and 2.29 times (95% CI: 1.86-2.80), respectively. ConclusionThe ncreased longitudinal trajectory of BMI is an independent risk factor for the onset of gallstone disease.

Correlation between different body mass indexes and incidence of digestive carcinoma: a multicentre retrospective study (A report of 95 177 cases) / 中华消化外科杂志

Objective To explore the correlation between different body mass indexes and incidence of digestive carcinoma.Methods The retrospective cohort study was conducted.The data of 95 177 participants (75 909 males and 19 268 females) aged (51± 12)years with the range of 18-98 years who participated health examination at the Kailuan General Hospital,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan' gezhuang Hospital,Kailuan Jinggezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from July 2006 to December 2015 were collected.According to definition of body mass indexes from Chinese guideline for prevention and control of adult overweight and obesity,all the 95 177 participants were allocated into the 3 groups,including 37 660 with BMI＜24 kg/m2 in the normal BMI group,39 793 with with 24 kg/m2 ≤BMI＜ 28 kg/m2 in the overweight group and 17 724 with BMI≥28 kg/m2 in the obesity group.All participants received the same-order health examinations by the fixed team of doctors in 2006,2008,2010,2012 and 2014 at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) comparisons of clinical characteristics among the 3 groups;(2) incidence of digestive carcinoma in the participants;(3) risk factors analysis affecting new-onset digestive carcinoma;(4) comparisons of the fitting degree of BMI on new-onset digestive carcinoma model;(5) stratified analysis of risk factors affecting new-onset digestive carcinoma at different locations.Measurement data with normal distribution were represented as Mean±SD,and comparisons among groups were analyzed using the one-way ANOVA.Measurement data with skewed distribution were described as M (range),and comparisons among groups were analyzed using the Kruskal-Wallis test.Count data were described as case number and percentage,and comparisons among groups were analyzed using the chi-square test.The cumulative incidence was calculated by the Kaplan-Meier method,and comparisons of incidences among groups were done by the Log-rank test.The incidences of digestive carcinomain patients with different BMI were calculated by person-year incidence (incidence density).The hazard ratio (HR) and 95％ confidence interval (CI) of different BMI (continuous variable and classification variable) on new-onset digestive carcinoma were estimated by the COX proportional hazards regression models.Restrictive cubic spline regression was used to calculate the dose-response relation between the continuous variable and the risks of digestive carcinoma.The fitting degree of BMI on new-onset digestive carcinoma model was calculated by the likelihood ratio test and akaike information criterion (AIC).Results (1) Comparisons of clinical characteristics among the 3 groups:age,sex (male),systolic pressure,diastolic pressure,waistline,total cholesterol (TC),triglyceride (TG),fasting plasma glucose (FPG),C reactive protein,cases with smoking,drinking,physical exercise,positive HBsAg,high salt intake,malignant tumor in immediate family were (51± 13)yeas,28 607,(125±20) mmHg (1 mmHg=0.133 kPa),(80± 11) mmHg,(81±9) cm,(4.9± 1.1) mmol/L,1.05 mmol/L(range,0.75-1.49 mmol/L),(5.3±1.6) mmol/L,0.58 mmol/L (range,0.20-1.60 mmol/L),11 962,6 845,5 676,711,.3 640,1 298 in the normal BMI group and (52±12)years,32 928,(133±21) mmHg,(85±11) mmHg,(89±8)cm,(5.0±1.2) mmol/L,1.39 mmol/L (range,0.99-2.08 mmol/L),(5.6± 1.7)mmol/L,0.84 mmol/L (range,0.33-2.07 mmol/L),12 364,7 413,6 322,839,4 401,1 463 in the overweight group and (51 ± 12) years,14 374,(139 ± 21) mmHg,(88 ± 12) mmHg,(96 ± 9) cm,(5.1 ± 1.2) mmol/L,1.67 mmol/L (range,1.18-2.51 mmol/L),(5.7± 1.8) mmol/L,1.22 mmol/L (range,0.53-2.82 mmol/L),5 092,2 818,2 847,355,2 235,704 in the obesity group,showing statistically significant differences among groups (F=90.60,x2 =576.34,F=2 768.38,3 570.80,22 319.30,256.99,x2 =9 108.21,F=507.11,x2 =3 219.47,52.78,64.38,13.36,0.76,130.39,9.74,P＜0.05).(2) Incidence of digestive carcinoma in the participants:all the 95 177 participants were followed up for 845 085 person-year,1 215 were diagnosed as new-onset digestive carcinoma,with a total person-year incidence of 1.44 thousand person / year.Of 1 215 patients,413 had colorectal-anal cancer,306 had liver cancer,234 had gastric cancer,113 had esophageal cancer,91 had the pancreatic cancer,36 had gallbladder carcinoma or cholangiocarcinoma,25 had intestinal cancer.Three patients had intestinal cancer complicated with colorectal-anal cancer.The person-year incidence of digestive carcinoma was 1.46 thousand person / year,1.37 thousand person / year and 1.53 thousand person / year in the normal BMI group,overweight group and obesity group,respectively.The cumulative incidences of digestive carcinoma in the normal BMI,overweight,obesity group were respectively 11.8‰,10.1‰ and 12.1‰,showing a statistically significant difference among 3 groups (x2=6.13,P＜0.05).There was no statistically significant difference between the normal BMI group and obesity group (x2 =1.07,P＞0.05),and statistically significant differences between the overweight group and normal BMI group and obesity group,respectively (x2=3.90,4.10,P ＜ 0.05).(3) Risk factors analysis affecting new-onset digestive carcinoma.Results of COX proportional hazards regression models showed that continuous BMI was not related factor affecting new-onset digestive carcinoma after adjustment of age,gender,systolic pressure,TC,TG,FPG,smoking,drinking,physical exercise,positive HBsAg,high salt intake,malignant tumor in immediate family (HR=0.99,95％CI:0.98-1.01,P＞0.05).After adding BMI as classification variable in the COX model,risk of new-onset digestive carcinoma in the overweight group was reduced compared with normal BMI group (HR =0.88,0.88,95％CI:0.78-1.01,0.77-0.98,P＜0.05) and risk of new-onset digestive carcinoma in the obesity group was not affected (HR=1.03,1.04,95％CI:0.88-1.20,0.89-1.22,P＞0.05).Results of restrictive cubic spline regression showed a "U" shaped relationship between BMI and incidence risk of digestive carcinoma and the lowest incidence of digestive carcinoma in patients with BMI as 25-27 kg/m2.(4) Comparisons of the fitting degree of BMI on new-onset digestive carcinoma model:multivariate model was constructed after adding risk factors of age,gender,systolic pressure,TC,TG,FPG,smoking,drinking,physical exercise,positive HBsAg,high salt intake,malignant tumor in immediate family,and-2Log L and AIC were 27 175.05 and 27 203.05 for the multivariate model.Then BMI variable was added into the multivariate model,and the-2Log L and AIC of the multivariate model+BMI model were 27 169.53 and 27 201.53,respectively,with a statistically significant difference compared with normal BMI group (x2 =5.52,P＜0.05).(5) Stratified analysis of risk factors affecting new-onset digestive carcinoma at different locations.Results of COX proportional hazards regression models showed risks of new-onset digestive carcinoma in the overweight and obesity groups were reduced compared with normal BMI group (HR=0.57,0.42,95％CI:0.38-0.84,0.23-0.79,P＜0.05) in the esophageal cancer model.Risks of new-onset digestive carcinoma in the overweight group were reduced compared with normal BMI group (HR=0.72,95％CI:0.55-0.93,P＜0.05) and risk of new-onset digestive carcinoma in the obesity group was not affected (HR=1.10,95％CI:0.82-1.47,P＞0.05) in the liver cancer model.Conclusions Participants in the overweight group have the lowest incidence of digestive carcinoma,especially in the esophageal cancer and liver cancer model.Incidence of digestive carcinoma is the lowest with BMI as 25-27 kg/m2.

The predictive value of combined application of the different obesity measures on incident gallstone diseases:a multicenter retrospective study (A report of 88 947 cases) / 中华消化外科杂志

Objective To explore the predictive value of combined application of the different obesity measures on incident gallstone disease (GD) and find the optimal combination.Methods The retrospective cohort study was conducted.The data of 88 947 participants who participated in health examination at the Kailuan General Hospital,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Jinggezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from July 2006 to December 2015 were collected.All participants received the same-order health examinations by the fixed team of doctors in 2006,2008,2010,2012 and 2014 at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) comparisons of general data between 2 genders;(2) incidence of GD;(3) risk factors analysis of the different obesity measures affecting incident GD;(4) comparisons of the fitting degree and predictive value of combined application of the different obesity measures on incident GD model.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were analyzed using the t test.Measurement data with skewed distribution were described as M (P25,P75),and comparisons between groups were analyzed using the rank sum test.Comparisons of count data were analyzed using the chi-square test.The incidences of GD between 2 genders were calculated by person-year of follow-up.The hazard ratio (HR) and 95％ confidence interval (CI) of the different obesity measures on incident GD were estimated by the COX proportional hazard model.The fitting degree of different combination of obesity measures on incident GD model was calculated by the likelihood ratio test and akaike information criterion (AIC).Results (1) Comparisons of general data between 2 genders:of 88 947 participants,age,body mass index (BMI),waist circumference (WC),systolic pressure,diastolic pressure,total cholesterol (TC),triglyceride (TG),fasting plasma glucose (FPG),cases with diabetes,hypertension,smoking,drinking and physical exercise were respectively (51± 12) years old,(25±3) kg/m2,(88± 10) cm,(132±20) mmHg (1mmHg=0.133 kPa),(84± 12) mmHg,(4.95± 1.16) mmol/L,1.18 mmol/L (0.81 mmol/L,1.74 mmol/L),(5.5±1.6)mmol/L,6 223,31 816,26 993,15 779,11 063 in male participants and (49± 11)yearsold,(25±4)kg/m2,(83±11)cm,(124±21)mmHg,(7911)mmHg,(4.98±1.08)mmol/L,1.30 mmol/L (0.92 mmol/L,2.00 mmol/L),(5.3±1.6)mmol/L,1 409,5 866,248,87,2 450 in female participants,with statistically significant differences [t=587.20,894.27,1 064.97,813.49,986.22,630.97,H(x2)=642.39,t=452.87,x2=35.10,1 205.40,9 619.42,4 901.75,84.82,P＜0.05].(2) Incidence of GD:88 947 participants were followed up for 713 345 person-year,4 291 participants had incident GD,with a total person-year incidence of 6.02 thousand person / year.The total follow-up time,cases with incident GD and person-year incidence were respectively 562 821 person-year,3 268,5.81 thousand person / year in male participants and 150 524 person-year,1 023,6.80 thousand person / year in female participants.(3) Risk factors analysis of the different obesity measures affecting incident GD:the results of COX proportional hazard model:in male participants,adjusted for age,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,BMI was associated with increased risk of incident GD (HR=1.35,1.63,95％CI:1.24-1.46,1.48-1.80,P＜0.05);WC was associated with increased risk of incident GD (HR=1.27,1.53,95％CI:1.15-1.40,1.39-1.67,P＜0.05);waist-to-height ratio (WHtR) was associated with increased risk of incident GD (HR=1.20,1.44,95％CI:1.09-1.32,1.31-1.58,P＜0.05).In female participants,BMI was associated with increased risk of incident GD (HR=1.35,1.77,95％CI:1.16-1.56,1.49-2.10,P＜0.05);WC was associated with increased risk of incident GD (HR=1.38,1.72,95％CI:1.15-1.66,1.44-2.07,P＜0.05);WHtR was associated with increased risk of incident GD (HR=1.34,1.71,95％CI:1.12-1.61,1.43-2.04,P＜0.05).(4) Comparisons of the fitting degree and predictive value of combined application of the different obesity measures on incident gallstone diseases model:multi-factor model of male participants was constructed after adding risk factors of age,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,and-2log L and AIC were 71 257 and 71 275.Then BMI,WC,WHtR,BMI+WC,BMI+WHtR,WC+WHtR and BMI+WC+ WHtR were respectively added into the multi-factor model,and-2log L and AIC were respectively 71 156 and 71 178,71 170 and 71 192,71 197 and 71 219,71 134 and 71 160,71 132 and 71 162,71 170 and 71 196,71 132 and 71 162.The minimal mode of AIC was multi-factor model+BMI+WC,with a difference of 123 compared with multi-factor model of-2log L,showing a statistically significant difference (x2 =123.00,P＜ 0.05).The multi-factor model of female participants was constructed after adding risk factors of age,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,and-2log L and AIC were 19 612 and 19 630.Then BMI,WC,WHtR,BMI+WC,BMI+WHtR,WC+WHtR and BMI+WC+WHtR were respectively added into the multi-factor model,and-2log L and AIC were respectively 19 568 and 19 590,19 575 and 19 597,19 574 and 19 596,19 558 and 19 584,19 557 and 19 583,19 571 and 19 597,19 556 and 19 586.The minimal mode of AIC was multi-factor model+BMI+WHtR,with a difference of 55 compared with multi-factor model of-2log L,showing a statistically significant difference (x2 =55.00,P＜0.05).Conclusions The increased BMI,WC and WHtR are independent risk factors for incident GD,no matter the gender.In males,the combination of BMI and WC can improved the predictive value of the incident GD,while in females,BMI and WHtR are the best combination for predicting incident GD.

Relationship between alcohol consumption and new-onset cholelithiasis: a multicentre retrospective study(A report of 77 755 cases) / 中华消化外科杂志

Objective To explore the relationship between alcohol consumption and new-onset cholelithiasis.Methods The retrospective cohort study was conducted.The data of 77 755 participants who participated health examination at the Kailuan General Hospital,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Jinggezhuang Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from June 2006 to December 2015 were collected.According to definition of alcohol consumption from literature,all the 77 755 participants were allocated into the 5 groups,including 50 695 with never drinking in the never group,3 154 with alcohol withdrawal time≥ 1 year in the past group,12 410 with light drinking in the light group,1 606 with moderate drinking in the moderate group and 9 890 with heavy drinking in the heavy group.All participants received the same-order health examinations by the fixed team of doctors in 2006,2008,2010,2012 and 2014 at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) comparisons of clinical characteristics among the 5 groups;(2) incidence of cholelithiasis;(3) risk factors analysis affecting new-onset cholelithiasis;(4) comparisons of the fitting degree of alcohol consumption on new-onset cholelithiasis model.Measurement data with normal distribution were represented as (x)±s,and comparisons among groups were analyzed using the one-way ANOVA.The pairwise comparison and homogeneity of variance were done using the least significance difference (LSD) test.Heterogeneity of variance was analyzed by the Dunnett's T3 test.Measurement data with skewed distribution were described as M (Q),and comparisons among groups were analyzed using the rank sum test.Comparisons of count data were analyzed using chi-square test.The cumulative incidence of new-onset cholelithiasis was calculated by the Kaplan-Meier method,and comparisons of incidences among groups were done by the Log-rank test.The hazard ratio (HR) and 95％ confidence interval (CI) of different intakes of alcohol on new-onset cholelithiasis were estimated by the COX proportional hazards regression models.The fitting degree of alcohol consumption on new-onset cholelithiasis model was calculated by the likelihood ratio test and akaike information criterion (AIC).Results (1) Comparisons of clinical characteristics among the 5 groups:male,age,systolic pressure,diastolic pressure,body mass index (BMI),total cholesterol (TC),triglyceride (TG),fasting plasma glucose (FPG) and waistline and cases with diabetes,hypertension,smoking and physical exercise were respectively 33 406,(51±12)years,(130±21) mmHg (1mmHg=0.133 kPa),(83± 12)mmHg,(25±4)kg/m2,(4.93±1.13)mmol/L,1.26 mmol/L (0.90-1.88 mmol/L),(5.5±1.7)mmol/L,(86±10) cm,4 538,21 773,5 873,6 140 in the never group and 3 077,(56±12) years,(134±22)mmHg,(85±12)mmHg,(25± 3) kg/m2,(4.93 ± 1.21) mmol/L,1.29 mmol/L (0.91-1.90 mmol/L),(5.6 ± 1.8) mmol/L,(89 ±9)cm,420,1 652,856,856 in the past group and 11 859,(46±12)years,(127±19)mmHg,(82±11)mmHg,(25±3)kg/m2,(4.89± 1.15) mmol/L,1.30 mmol/L (0.89-2.01 mmol/L),(5.4± 1.4) mmol/L,(87±9)cm,891,4294,2 186,2 186 in the light group and 1 585,(58±11)years,(134±22)mmHg,(84±11)mmHg,(25±3)kg/m2,(5.06±1.21)mmoL/L,1.23 mmoL/L (0.85-1.82 mmol/L),(5.5±1.7) mmol/L,(88±9)cm,159,762,591,591 in the moderate group and 9 868,(52±9) years,(135±21)mmHg,(86±12)mmHg,(25±3)kg/m2,(5.18±1.21)mmoL/L,1.36 mmol/L (0.92-2.19 mmol/L),(5.5±1.5)mmoL/L,(88±9) cm,819,4 900,2 183,2 183 in the heavy group,showing statistically significant differences among groups [x2 =9 989.71,F=869.28,F=254.13,195.97,27.52,112.63,H(x2) =154.09,F=11.92,63.37,x2 =128.17,656.31,23 561.80,656.31,P＜0.05].(2) Incidence of cholelithiasis:all 77 755 participants were observed for (6.8±2.1)years,3 757 were diagnosed as new-onset cholelithiasis,with a cumulative incidence of new-onset cholelithiasis of 4.5％.The cumulative incidences of new-onset cholelithiasis in the never,past,light,moderate and heavy groups were respectively 5.1％,4.9％,3.7％,3.4％ and 3.3％,showing a statistically significant difference among groups (x2=83.14,P＜0.05).The cumulative incidence of new-onset cholelithiasis in the never group was significantly different from that in the past,light,moderate and heavy groups (x2 =18.34,40.58,45.41,48.44,P＜0.05).The cumulative incidence of new-onset cholelithiasis in the past group was significantly different from that in the light,moderate and heavy groups (x2 =18.72,20.47,25.41,P＜0.05).There were statistically significant differences in the cumulative incidence of new-onset cholelithiasis among the light,moderate and heavy groups (x2=8.47,12.41,P＜0.05) and no statistically significant difference between the moderate and heavy groups (x2=0.85,P＞0.05).(3) Risk factors analysis affecting new-onset cholelithiasis:results of COX proportional hazards regression models showed that risks of new-onset cholelithiasis in the light,moderate and heavy groups were reduced compared with never group after adjustment of gender,age,TC,TG,BMI,hypertension,diabetes,smoking and physical exercise (HR=0.88,0.82,0.73,95％CI:0.79-0.98,0.76-0.89,0.64-0.83,P＜0.05).(4) Comparisons of the fitting degree of alcohol consumption on newonset cholelithiasis model:multivariate model was constructed after adding risk factors of gender,age,BMI,TG,TC,hypertension,diabetes mellitus,smoking and physical exercise,and-2Log L and AIC were 76 331.83 and 76 353.83 for the multivariate model.Then drinking variable was added into multivariate model,and the-2Log L and AIC of the multivariate model+drinking model were 76 307.86 and 76 337.86,respectively,with statistically significant differences (x2=23.97,P＜0.05).Conclusion Alcohol consumption is an independent protective factor for new-onset cholelithiasis,and the risk of cholelithiasis is decreased with increasing alcohol intake.

Predictive value of serum uric acid on new-onset cholelithiasis (a report of 97 469 cases) / 中华消化外科杂志

Objective To explore the predictive value of serum uric acid on new-onset cholelithiasis.Methods The retrospective cohort study was conducted.The data of 97 469 subjects who participated health examination at the Kailuan General Hospital Affiliated to the North China University of Science and Technology,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Jinggezhuang Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from June 2006 to December 2015 were collected.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.All the subjects were allocated into 4 groups according to squartiles of serum uric acid:24 140 with serum uric acid ＜232 μmol/L in the Q1 group,24 473 with 232 μmol/L≤ serum uric acid ＜282 μmol/L in the Q2 group,24 382 with 282 μmol/L≤ serum uric acid ＜338 μmol/L in the Q3 group and 24 474 with serum uric acid ≥ 338 μmol/L in the Q4 group.Observation indicators:(1) comparisons of clinical characteristics among the 4 groups;(2) incidence of cholelithiasis in the 4 groups;(3) effects of serum uric acid on the new-onset cholelithiasis:① the dose-response relationship between serum uric acid and the risk of cholelithiasis,② comparisons of the fitting degree of serum uric acid on the cholelithiasis model,③ effects of different serum uric acid levels on incidence of cholelithiasis after stratification by sex,④ serum uric acid of different gender on the boxplots,⑤ effects of different serum uric acid levels on the incidence of cholelithiasis after stratification by age.Measurement data with normal distribution were expressed as (x)±s,and comparisons among groups were analyzed using the one-way ANOVA.Measurement data with skewed distribution is expressed by M (Q),and comparisons among groups were analyzed using the nonparametric Krustal-willis test.Count data were represented by percentage,and comparisons among groups were analyzed using chi-square test.The incidences of cholethiasis in 4 groups of different serum uric acid were calculated by person-year incidence.Restrictive cubic spline regression was used to calculate the dose-response relation between the continuous variable and the risks of new-onset cholelithiasis and 95％ confidence interval (CI).COX regression model was used to analyze the hazard ratio (HR) and 95％ CI of different serum uric acid levels on new-onset cholelithiasis.Likelihood ratio test and akaike information criterion (AIC) were used to calculate the fitting degree of serum uric acid on new-onset cholelithiasis model.Boxplots were used to describe serum uric acid in different genders.Results (1) comparisons of clinical characteristics among the 4 groups:sex (male),age,body mass index (BMI),systolic pressure,diastolic pressure,fasting plasma glucose (FPG),total cholesterol (TC),triglyceride (TG),high sensitive C-reactive protein,diabetes,hypertension,smoking,drinking and physical exercise were 15 162,(50± 11) years,(24±3)kg/m2,(123±21)mmHg (1 mmHg=0.133 kPa),(82± 12)mmHg,(5.6±2.0) mmol/L,(4.8±1.2) mmol/L,1.14 mmol/L (range,0.81-1.63 mmol/L),0.70 mmol/L (range,0.23-2.23 mmol/L),2 537,9 415,4575,2380,2 649 in the Q1 group,19 079,(51±12) years,(25±3)kg/m2,(130±21)mmHg,(83±12) mmHg,(5.5 ± 1.7) mmol/L,(4.9 ± 1.2) mmol/L,1.20 mmol/L (range,0.86-1.76 mmol/L),0.71 mmol/L (range,0.28-1.98 mmol/L),2 287,10 124,6 918,3 649,3 288 in the Q2 group,21 132,(52±13)years,(25±3)kg/m2,(132±21)mmHg,(84±12)mmHg,(5.5±1.6)mmol/L,(5.0±1.2) mmol/L,1.29 mmol/L (range,0.91-1.94 mmol/L),0.80 mmol/L (range,0.30-2.06 mmol/L),2 027,10 755,8 259,4 730,3 958 in the Q3 group,22 651,(53± 14) years,(26± 3) kg/m2,(134± 21) mmHg,(85±12)mmHg,(5.4±1.5)mmol/L,(5.1±1.2)mmol/L,1.54 mmol/L (range,1.05-2.35 mmol/L),1.02 mmol/L (range,0.43-2.50 mmol/L),1 981,12 082,9 562,6 209,4 758 in the Q4 group,respectively,with statistically significant differences among the 4 groups (x2 =7 624.63,F=279.93,961.91,330.84,271.40,38.25,353.18,H =3 406.30,912.23,x2 =108.15,590.49,2567.07,2 209.21,760.15,P＜0.05).(2)Incidence of cholelithiasis in the 4 groups:97 469 participants were followed up for 592 922 person-year,4 270 participants had new-onset cholelithiasis,with a total person-year incidence of 7.20 thousand person / year.The person-year incidence were respectively 6.34 (971/153 205 * 1 000),6.91 (1 034/149 686 * 1 000),7.44 (1 090/146 549 * 1 000),8.19 (1 175/143 482 * 1 000) thousand person / year in Q1,Q2,Q3 and Q4 group.(3) Effects of serum uric acid on the new-onset cholelithiasis.① The dose-response relationship between serum uric acid and the risk of cholelithiasis:restricted cubic spline regression showed a linear relationship between continuous serum uric acid,logarithmic transformated serum uric acid and the risk of cholelithiasis (x2 =11.74,8.01,P＜0.05).② Comparisons of the fitting degree of serum uric acid on the cholelithiasis model:adjusted for sex,age,BMI,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,risks of new-onset cholelithiasis increased in Q3 and Q4 groups compared with Q1 group (HR=1.10,1.12,95％CI:1.01-1.20,1.03-1.23,P＜0.05).The-2Log L and AIC value of multivariate model,serum uric acid+multivariate model were 92 532.39,92 550.39 and 92 525.35,92 549.35,respectively,with a statistically significant difference (x2=7.04,P ＜ 0.05).③ Effects of different serum uric acid levels on incidence of cholelithiasis after stratification by sex:in female participants,adjusted for age,BMI,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,risk of new-onset cholelithiasis in Q1 group was not statistically significant different from that in Q2,Q3,Q4 group (HR=1.06,1.15,1.09,95％CI:0.88-1.28,0.93-1.34,0.91-1.31,P＞0.05).In male participants,adjusted for age,BMI,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,risks of new-onset cholelithiasis in Q2,Q3 and Q4 groups were increased compared with Q1 group (HR=1.17,1.24,1.30,95％CI:1.06-1.30,1.12-1.37,1.18-1.44,P＜0.05).④ Serum uric acid of different gender on the boxplots:in female participants,the level of serum uric acid was (249 ± 61) μmol/L,(235±50)μmol/L,(231±56) μmol/L,(250±66) μmol/L,(266±75) μmol/L,(281±81) μmol/L,(298±76) μmol/L,(379±86)μmol/L respectively in the group of 18-27 years old,28-37 years old,38-47 years old,48-57 years old,58-67 years old,68-77 years old,78-87 years old,88-97 years old after stratified by 10 years old.In male participants,the level of serum uric acid was respectively (310±76)μmol/L,(298 ±75) μmol/L,(298±74) μmol/L,(294±74) μmol/L,(302±78) μmol/L,(311 ±80) μmol/L,(322±80) μmol/Land (330±75)μmol/L after participants stratified by 10 years old.⑤ Effects of different serum uric acid levels on the incidence of cholelithiasis after stratification by age:in participants with age ≤ 60 years old,adjusted for sex,BMI,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,risk of new-onset cholelithiasis in the Q2 and Q3 groups were not increased compared with Q1 group (HR=1.05,1.10,95％CI:0.94-1.17,0.99-1.23,P＞0.05),however,risk of new-onset cholelithiasis was increased in the Q4 group (HR =1.15,95％CI:1.02-1.28,P＜0.05).In participants with age ＞ 60 years old,adjusted for sex,BMI,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,risk of new-onset cholelithiasis in the Q2 groups was not increased compared with Q1 group (HR=1.16,95％CI:0.99-1.36,P＞0.05),however,risks of new-onset cholelithiasis were increased in the Q3 and Q4 groups (HR =1.19,1.21,95％CI:1.02-1.40,1.04-1.41,P＜ 0.05).Conclusion Elevated serum uric acid is an independent risk factor for the new-onset cholelithiasis.

Predictive value of metabolic syndrome on new-onset cholelithiasis / 中华消化外科杂志

Objective To investigate the predictive value of metabolic syndrome (MS) on new-onset cholelithiasis.Methods The retrospective cohort study was conducted.The data of 89 553 subjects who participated health examination at the Kailuan General Hospital Affiliated to the North China University of Science and Technology,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Jinggezhuang Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from June 2006 to December 2015 were collected.According to the diagnostic criteria of MS published by International Diabetes Federation,all the patients were divided into 4 groups,including 70 657 without MS in the normal group,14 075 corresponded with 3 diagnostic criteria of MS in the MS-3 group,4 556 corresponded with 4 diagnostic criteria of MS in the MS-4 group and 265 corresponded with 5 diagnostic criteria of MS in the MS-5 group.Health examinations were applied to all subjects by the fixed team of doctors at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) comparisons of clinical characteristics among the 4 groups;(2) incidence of cholelithiasis in the 4 groups;(3) risk factors analysis affecting new-onset cholelithiasis.Measurement data with normal distribution were represented as (x) ± s and comparisons among groups were analyzed using the one-way ANOVA.Pairwise comparison and homogeneity of variance were done using the LSD test.Heterogeneity of variance was done using the Dunnett's T3 test.Measurement data with skewed distribution were described as M (Q) and comparisons among groups were analyzed using the nonparametric Kruskal-Wallis test.Comparisons of count data were analyzed by the chi-square test.The incidence of cholelithiasis in the 4 groups were calculated by the Kaplan-Meier method and comparisons of incidence were done by the Log-rank test.The COX proportional hazards model was used to analyze the hazard ratios (HR) and 95％ confidence interval (95％ CI) of MS on new-onset cholelithiasis.Results (1) Comparisons of clinical characteristics among the 4 groups:age,sex (male),systolic blood pressure (SBP),diastolic blood pressure (DBP),waistline,triglyceride (TG),total cholesterol (TC),high density lipoprotein-cholesterol (HDL-C),fasting blood glucose,BMI,cases with hypertension,diabetes,drinking,smoking and physical exercise were (50± 12) years,52 895,(127 ± 20) mmHg (1 mmHg =0.133 kPa),(81 ± 11) mmHg,(85±9)cm,1.14 mmol/L (range,0.83-1.56 mmol/L),(4.9±1.1) mmol/L,(1.56±0.39)mmol/L,(5.2± 1.3)mmol/L,(24.5±3.3) kg/m2,24 016,7 696,11 636,20 689,10 245 in the normal group and (54± 11)years,12905,(142±19)mmHg,(90±11)mmHg,(94±8)cm,2.08 mmol/L (range,1.51-3.04 mmol/L),(5.1±1.3)mmol/L,(1.50±0.42)mmol/L,(6.3±2.1)mmol/L,(27.1±3.2) kg/m2,10 031,5 737,3 090,4 762,2 353 in the MS-3 group and (54±10)years,4 556,(146±19)mmHg,(92±11)mmHg,(97±7)cm,2.57 mmol/L (range,2.03-3.80 mmol/L),(5.2± 1.4)mmol/L,(1.44±0.45)mmol/L,(7.2±2.4)mmol/L,(28.1±3.1)kg/m2,3 696,2 971,1 091,1 699,867 in the MS-4 group and (56±11)years,265,(146± 17)mmHg,(92±11)mmHg,(98±6)cm,2.60 mmol/L (range,2.06-3.91 mmol/L),(4.9±1.1)mmol/L,(0.86±0.14) mmol/L,(7.7± 2.9) mmol/L,(28.7 ± 2.9) kg/m2,221,196,62,93,78 in the MS-5 group,respectively,with statistically significant differences among the 4 groups (F =481.40,x2 =3 359.07,F =3 551.06,3 280.16,5 915.20,x2 =18 358.71,F=211.30,473.42,4 168.34,3 909.75,x2 =9 829.51,14 449.74,375.78,225.14,145.73,P ＜ 0.05).(2) Incidence of cholelithiasis in the 4 groups:89 553 subjects were observed for (8.0± 1.1) years,and 4 313 had new-onset cholelithiasis with a cumulative incidence of 4.8％.The cumulative incidences of cholelithiasis in the normal,MS-3,MS-4 and MS-5 groups were respectively 4.5％,5.6％,6.3％ and 13.2％,with a statistically significant difference among the 4 groups (x2 =89.96,P＜ 0.05).There were statistically significant differences in the cumulative incidences of cholelithiasis among the normal,MS-3,MS-4 and MS-5 groups (x2=28.56,29.25,43.48,17.13,35.75,16.82,P＜0.05).(3) Risk factors analysis affecting new-onset cholelithiasis:results of COX proportional hazards model showed that hazard of the new-onset cholelithiasis in the normal group was increased compared with that in the MS-3,MS-4 and MS-5 groups with adjustment for sex,age,high-sensitivity C-reactive protein,smoking,drinking and physical exercise (HR=1.16,1.33,2.68,95％CI:1.07-1.26,1.17-1.51,1.92-3.74,P＜0.05).Conclusion MS is an independent risk factor of new-onset cholelithiasis,and the increased incidence risk of new-onset cholelithiasis is consistent with subjects corresponded with diagnostic criteria of MS.

Predictive value of cumulative body mass index on new-onset cholelithiasis / 中华消化外科杂志

Objective To investigate the predictive value of cumulative body mass index (cumBMI) on new-onset cholelithiasis.Methods The retrospective cohort study was conducted.The data of 31 794 subjects who participated health examination at the Kailuan Hospital,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Jinggezhuang Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital in 2006,2008,2010,2012 and 2014 were collected.All the subjects were allocated into 4 groups according to squartiles of cumBMI:7 949 with cumBMI＜ 140.81 kg/m2 ×year in the Q1 group,7 946 with 140.81 kg/m2×year≤ cumBMI＜ 159.69 kg/m2 ×year in the Q2 group,7 949 with 159.69 kg/m2×year≤cumBMI＜ 180.49 kg/m2 ×year in the Q3 group and 7 950 with cumBMI ≥ 180.49 kg/m2×year in the Q4 group.All the subjects received respectively the five health examinations in 2006,2008,2010,2012 and 2014 at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) incidence of cholelithiasis in the 4 groups;(2) risk factors analysis affecting newonset cholelithiasis:sex,age,cumBMl,BMI,drinking,smoking,physical exercise,hypertension,diabetes,C-reactive protein (CRP),triglyceride (TG) and total cholesterol (TC).Measurement data with normal distribution were represented as-x±s and comparisons among groups were analyzed using the one-way ANOVA.Pairwise comparison and homogeneity of variance were done using the LSD test.Heterogeneity of variance was done using the Dunnett's T3 test.Measurement data with skewed distribution were described as M (Q) and comparisons among groups were analyzed using the nonparametric test.Count data were analyzed by the chi-square test.The incidence of cholelithiasis in the 4 groups were calculated by the Kaplan-Meier method and comparisons of incidence were done by the Log-rank test.The univariate analysis and multivariate analysis were done using the COX regression model.Results (1) Incidence of cholelithiasis in the 4 groups:31 794 subjects were observed for (2.1 ± 0.4) years,and 236 had new-onset cholelithiasis with an incidence of 7.42‰.Incidences of cholelithiasis in the Q1,Q2,Q3 and Q4 groups were respectively 4.03‰,7.17‰,7.93‰ and 10.57‰,with a statistically significant difference among the 4 groups (x2 =72.39,P＜0.05).(2) Risk factors analysis affecting new-onset cholelithiasis:results of univariate analysis showed that sex,age,cumBMI,BMI,hypertension and CRP were independent risk factors affecting new-onset cholelithiasis of subjects [HR =1.61,1.75,1.64,1.36,1.39,1.39,95％ confidence interval (CI):1.23-2.10,1.49-2.05,1.45-1.86,1.21-1.53,1.07-1.79,1.18-1.62,P＜0.05].Results of multivariate analysis showed that female,age between 50 years and 60 years,age≥60 years,140.81 kg/m2×year ≤cumBMI ＜159.69 kg/m2×year,159.69 kg/m2×year≤cumBMI＜ 180.49 kg/m2 ×year,cumBMI ≥ 180.49 kg/m2 × year were independent risk factors affecting new-onset cholelithiasis of subjects (HR=1.59,1.78,2.33,2.04,2.42,3.66,95％CI:1.21-2.09,1.31-2.44,1.63-3.34,1.29-3.24,1.47-3.95,2.15-6.25,P＜0.05).Conclusion Female,advanced age and increasing cumBMI are independent risk factors affecting new-onset cholelithiasis,and the incidence of cholelithiasis rises as cumBMI increases.

Surgical treatment for hepatolithiasis in patients of advanced age / 中华消化外科杂志

Objective To investigate the efficacy of surgical treatment for hepatolithiasis in patients of advanced age.Methods The clinical data of 196 patients of advanced age (≥80 years) and with hepatolithiasis who were admitted to the Kailuan General Hospital from January 2009 to October 2012 were retrospectively analyzed.All the 196 patients received surgical treatment.Patients were followed up via phone call or out-patient examination till May 2013.Results Fifty-eight patients received emergent operation within 24 hours after admission,and the other 138 patients received operation 7.4 days (range,1.0-18.0 days) after admission.Fifty patients received laparoscopic surgery,including 43 received cholecystectomy + choledocholithotomy + T tube drainage,7 received choledocholithotomy + T tube drainage.One hundred and forty-six patients received open surgery,including 78 received cholecystectomy + choledocholithotomy + T tube drainage,43 received choledocholithotomy + T tube drainage and 25 received choledocholithotomy + T tube drainage + partial hepatectomy.The operation time was (78 ± 16)minutes,and the volume of intraoperative bleeding ranged between 15 mL and 300 mL.One hundred and ninety-four patients were cured and 2 patients died.Thirty-seven patients had complications after operation,with the morbidity of 18.88％ (37/196).A total of 163 patients were followed up,with the follow-up rate of 83.16％ (163/196).The median time of follow-up was 26 months (range,7-52 months).Twelve patients had hepatolithiasis recurrence,and the recurrence rate was 7.36％ (12/163).Conclusion Surgical treatment for hepatolithiasis in patients of advanced age has the advantages of high cure rate,low incidence of complications and recurrence,and the clinical efficacy is satisfactory.

Association between the level of high sensitivity C-reactive protein and risk of breast cancer among non-diabetic females: a prospective study in Kailuan group / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the association between high sensitivity C-reactive protein (hsCRP) and breast cancer incidence among the non-diabetic females in a large-scale cohort study in Kailuan group.</p><p><b>METHODS</b>The Kailuan cohort was established on May 1, 2006. Baseline information on demography, lifestyle, medical history, and anthropometry, i.e., body height and weight, were collected during the baseline interview, and breast cancer incidence, mortality and other related outcome information were obtained by follow-up every two years and the related health condition database information were collected every year. Multivariable Cox proportional-hazards regression model was used to calculate the hazard ratios (HRs) and 95%CI (confidence interval) between the level of hsCRP at baseline interview and breast cancer incidence adjusted for age group, body mass index (BMI), marital status (married and single) and tobacco smoking (smokers and non-smokers) when appropriate.</p><p><b>RESULTS</b>By Dec 31, 2011, a total of 17 402 females were enrolled in the cohort. There were 85 286 person-years of follow-up with a mean follow-up period of (58.81 ± 4.52) months. A total of 75 incident breast cancer cases were collected. Subjects with the highest level (>3 mg/L) of hsCRP at baseline interview were associated with a significantly increased risk of breast cancer (adjusted HR = 1.80, 95%CI = 1.03-3.15) compared with those with the lowest level (<1 mg/L).</p><p><b>CONCLUSIONS</b>Elevated levels of hsCRP at baseline interview may be associated with an increased risk of breast cancer among non-diabetic females. Further follow-up and etiological exploration will help to evaluate the association between the hsCRP level and the risk of breast cancer more reliably.</p>

Apixaban for prevention of venous thromboembolism after major orthopedic surgery: a Meta-analysis / 中华创伤杂志

Objective To systematically assess the clinical efficacy and safety of apixaban versus enoxaparin in the prevention of venous thromboembolism (VTE) after major orthopedic surgery.Methods Based on the principles and methods of Cochrane systematic review,the Cochrane Library,PubMed,EMBASE,Chinese Bio-medicine Database,China Journal Full-text Database,VIP Database were searched from their establishment to March 2012 in whatever languages.Related journals were handsearched as well.Randomized controlled trials (RCTs) of comparing apixaban and enoxaparin in the prevention of venous thromboembolism after major orthopedic operation were included.Cochrane Collaboration' s tool was used for assessing risk of bias in the included trials.Cochrane Collaboration' s software RevMan 5.1 was used for statistical analysis.Results Four RCTs totaling 12 897 patients were included.Apixaban treatment showed significant differences in aspects of total VTE and all-cause mortality [relative risk (RR) =0.63,95％ CI(0.41,0.96)],major VTE [RR =0.59,95％ CI(0.19,0.98)] and symptomatic deep vein thrombosis (DVT) [RR =0.50,95％ CI(0.26,0.97)] when compared with enoxaparin,but the difference in fatal pulmonary embolism was insignificant[RR =1.57,95％ CI(0.41,5.99)].For patients undergoing total knee arthroplasty,apixaban was associated with significantly fewer major bleeding events[RR =0.55,95％ CI(0.32,0.96)] and fewer total bleeding events[RR =0.79,95％ CI(0.66,0.95)] than enoxaparin.For patients undergoing total hip replacement,however,the two treatments revealed no statistically significant differences.With regard to the incidence of drug-related serious adverse events,the two treatments displayed no significant difference[RR =0.97,95％ CI(0.59,1.58)].Conclusion Apixaban is effective in the prevention of VTE after major orthopedic surgery and can significantly reduce the risk of postoperative VTE.

Etiology and treatment strategies for pediatric cholecystolithiasis / 中华全科医师杂志

A total of 55 children aged under 14 years with cholecystolithiasis were treated at our hospital between January 2005 to December 2011.Their clinical data were collected and analyzed.The etiologies included pseudolithiasis (n =36),chronic hemolytic disease (n =2),obesity (n =9) and unknown (n =8).Among 50 cases on conservative treatment,42 cases were cured.Four cases underwent laparoscopic cholecystectomy.During a follow-up period of 2-4 years,there was no occurrence of significant complications.The removal of gallbladder stone was performed via laparoscopy plus choledochoscope in 1 case.There was no recurrence during a follow-up period of 2 years.Ceftriaxone sodium and obesity were the major cause of pediatric cholecystolithiasis.A proper selection of treatment regimens should be based upon the considerations of etiologies and symptoms.

Association between carotid atherosclerosis and serum magnesium in hemodialyzed patients / 中国医师杂志

Objective To investigate the association between carotid atherosclerosis(AS) and serum magnesium(Mg) in hemodialyzed (HD) patients.Methods Clinical index was measured,and intimamedia thickness (IMT) of extracranial common carotid artery and presence of atherosclerotic plaques were determined by high-resolution B-mode ultrasonography.The data were analyzed between plaque positive group and plaque negative group.Results The age,serum phosphate (P),total cholesterol (TCH),low density lipoprotein (LDL),serum C-reactive protein (CRP),serum albumin(Alb),and serum Mg all had significant difference between two groups(t =4.153,2.908,2.301,6.322,5.791,2.341,7.778,P ＜0.01 or P ＜ 0.05).The risk factors of HD patients with AS were serum Mg and CRP(P ＜ 0.01).Conclusions The occurrence of AS was related to low Mg and high CRP in HD patients.

The influence of sealing tube with urokinase on the malfunction of central venous catheter with Dacron ring / 中国基层医药

Objective To explore the effect of sealing tube with regular urokinase for the malfunction of central venous catheter(CVC) in patients with hemodialysis (HD).Methods This was a prospective randomized controlled study,132 HD patients with cuff CVC were studied.In the early stage,52 H D patients without 80 patients with regular catheter-locking solution of urokinase.To analyze effect of cuff CVC malfunction,blood flow(BF),dialysis adequacy,anemia and serum albumin (ALB) with regular catheter-locking solution of urokinase.The incidence of catheter malfunction was calculated based on the catheter dysfunction in the first 3 months.Clinical index was measured,recorded BF and calculated urea clearance rate (Kt/V).Results HD patients catheter-locking solution with regular urokinase could reduce the incidence of dialysis catheter malfunction ( 26.3％ vs 32.7％,x2 =32.727,P ＜0.01 ),increase the BF,Kt/V,levels of hemoglobin(HGB) and ALB(P＜0.05 or P ＜0.01).Conclusion Regular catheter-locking solution with urokinase is effective in reducing HD patients incidence of dialysis CVC malfunction,increasing patients BF,dialysis adequacy and the level of ALB,improving anemia.

Application of apixaban in stroke prevention in patients with atrial fibrillation / 国际脑血管病杂志

Atrial fibrillation (AF) is an independent risk factors for stroke.The stroke outcome in patients with AF is poor.The mortality and morbidity were also higher.As for the higher risk of stroke in patients with AF,the application of anticoagulant drugs is needed.Apixaban is an emerging oral direct Ⅹ a factor inhibitor in recent years.Compared to the traditional anticoagulants,such as warfarin,apixaban shows certain advantages in the prevention of stroke and systemic embolism in patients with AF.

Evaluation on adequacy of hemodialysis by on-line clearance monitoring and Kt/V of Correlation Analysis / 中国医师杂志

ObjectiveTo evaluate the adequacy of hemodialysis by online clearance monitoring (OCM) and Kt/V of correlation analysis.MethodsThe Kt/V values of 48 maintenance hemodialysis patients in the Department of Nephrology of General Hospital of PLA were accessed by both OCM of Germany BeiLang Dialog + hemodialysis machine and single-pool urea kinetic model.The Kt/V calculation value was also checked by the urea dynamics - room variable volume model.The results generated at different time point were compared,including at the real time,before and after appearing through blood by On - line Clearance Monitoring,and correlation analysis of Kt/V value was performed.ResultsThere was no significant difference on evaluating the level of Kt/v by these two methods.The relationship between the results of the two methods was significantly positive related.(r=0.539,P ＜ 0.01).ConclusionsDuring hemodialysis,the OCM option provides an accurate tool for continuous on-line monitoring of urea clearance.