AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patien...AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical). Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis. Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures, presenting signs, and admitting service with time to surgery.RESULTS: Seventy cases met inclusion and exclusion criteria, among which 12 were admitted to the medical service and 58 to the surgical service. Mean ± SD time to surgery was 39.3 ± 43 h, with 87% of operations performed within 72 h of hospital arrival. In the adjusted models, longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP, P = 0.01) as well with admission to medical service without adjustment for ERCP (P < 0.05). Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery. Patients admitted to the surgical versus medical service underwent surgery earlier (30.4 ± 34.9 vs 82.7 ± 55.1 h, P < 0.01), had less post-operative complications (12% vs 58%, P < 0.01), and shorter length of stay (4.3 ± 3.4 vs 8.1 ± 5.2 d, P < 0.01).CONCLUSION: Admission to the medical service and performance of numerous diagnostic procedures, ERCP, or MRCP combined with CT scan were associated with longer time to surgery. Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.展开更多
AIM:To identify patients' characteristics associated with double balloon endoscopy(DBE)outcomes in investigation of obscure gastrointestinal bleeding(OGIB).METHODS:Retrospective study performed at an academic tert...AIM:To identify patients' characteristics associated with double balloon endoscopy(DBE)outcomes in investigation of obscure gastrointestinal bleeding(OGIB).METHODS:Retrospective study performed at an academic tertiary referral center.Evaluated endpoints were clinical factors associated with no diagnostic yield or non-therapeutic intervention of DBE performed for OGIB evaluation.RESULTS:We included fifty-five DBE between August 2010 and April 2012.The mean age of the sample was 67 with 32 males(58.2%).Twenty-four DBE had no diagnostic yield and 30 DBE did not require therapy.Non-diagnostic yield was associated with performing two or more DBE studies in one day [odds ratio(OR):13.72,P=0.008],absence of blood transfusions within a year of the DBE(OR:7.16,P=0.03)and absence of ulcers or arteriovenous malformations(AVMs)on prior esophagogastroduodenoscopy(EGD)or colonoscopy(OR:19.30,P=0.033).Non-therapeutic DBE was associated with performing two or more DBE per day(OR:18.579,P=0.007),gastrointestinal bleeding episode within a week of the DBE(OR:11.48,P=0.003),fewer blood transfusion requirements prior to DBE(OR:4.55,P=0.036)and absence of ulcers or AVMs on prior EGD or colonoscopy(OR:8.47,P=0.027).CONCLUSION:Predictors of DBE yield and therapeutic intervention on DBE include blood transfusion requirements,previous endoscopic findings and possibly endoscopist fatigue.展开更多
BACKGROUND The Karnofsky Performance Status(KPS)scale has been widely validated for clinical practice for over 60 years.AIM To examine the extent to which poor pre-transplant functional status,assessed using the KPS s...BACKGROUND The Karnofsky Performance Status(KPS)scale has been widely validated for clinical practice for over 60 years.AIM To examine the extent to which poor pre-transplant functional status,assessed using the KPS scale,is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.METHODS This study included 38278 United States adults who underwent first,non-urgent,liver-only transplantation from 2005 to 2014(Scientific Registry of Transplant Recipients).Functional impairment/disability was categorized as severe,moderate,or none/normal.Analyses were conducted using multivariableadjusted Cox survival regression models.RESULTS The median age was 56 years,31%were women,median pre-transplant Model for End-Stage for Liver Disease score was 18.Functional impairment was present in 70%;one-quarter of the sample was severely disabled.After controlling for key recipient and donor factors,moderately and severely disabled patients had a 1-year mortality rate of 1.32[confidence interval(CI):1.21-1.44]and 1.73(95%CI:1.56-1.91)compared to patients with no impairment,respectively.Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13(CI:1.02-1.24)and 1.16(CI:1.02-1.31),respectively.CONCLUSION Pre-transplant functional status is a useful prognostic indicator for 1-year posttransplant patient and graft survival.展开更多
The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no ...The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.展开更多
Metabolic syndrome has been implicated in the pathogenesis of uric acid stones.Although not completely understood,its role is supported by many studies demonstrating increased prevalence of uric acid stones in patient...Metabolic syndrome has been implicated in the pathogenesis of uric acid stones.Although not completely understood,its role is supported by many studies demonstrating increased prevalence of uric acid stones in patients with metabolic syndrome and in particular insulin resistance,a major component of metabolic syndrome.This review presents epidemiologic studies demonstrating the association between metabolic syndrome and nephrolithiasis in general as well as the relationship between insulin resistance and uric acid stone formation,in particular.We also review studies that explore the pathophysiologic relationship between insulin resistance and uric acid nephrolithiasis.展开更多
atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative compl...atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identifcation of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine （SCr）, which is known to be an inaccurate marker of early changes in renal function. Therefore, several newurinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings.展开更多
BACKGROUND The impact of pancreatic tumor location on patient survival has been studied in large national data-based analyses which yielded controversial results.AIM To explore if pancreatic head cancer(PHC)and pancre...BACKGROUND The impact of pancreatic tumor location on patient survival has been studied in large national data-based analyses which yielded controversial results.AIM To explore if pancreatic head cancer(PHC)and pancreatic body/tail cancer(PBTC)have different overall survival(OS),molecular signature and response to chemotherapy.METHODS We retrospectively queried patient records from July 2016 to June 2020 in our institution.Patient demographics,cancer stage on diagnosis,tumor location,somatic mutations,treatment,and survival are recorded and analyzed.A test is considered statistically significant if the P value was<0.05.RESULTS We reviewed 101 patients with complete records,among which 67(66.34%)were PHC and 34(33.66%)were PBTC.More PHC were diagnosed at younger age[61.49 vs 68.97,P=0.010],earlier stages(P=0.006)and underwent surgical resection(P=0.025).There were no significant differences among all mutations and pathways studied except for TP53 mutations(37.0%in PHC vs 70.0%in PBTC,P=0.03).OS was not statistically different between PHC and PBTC(P=0.636)in the overall population and in subgroups according to surgical resection status or stages.In terms of response to chemotherapy,chemotherapy regimens(FOLFIRINOX-based vs gemcitabine-based)didn’t impact disease free interval in those who had surgical resection in either PHC(P=0.546)or PBTC(P=0.654),or the duration of response to first line palliative treatment in those with advanced disease in PHC(P=0.915)or PBTC(P=0.524).CONCLUSION Even though PHC and PBTC have similar poor OS and response to chemotherapy,the different presentations and molecular profiles indicate they are different diseases.Utilization of molecular profiling to develop targeted therapy for individualization of treatment is needed.展开更多
Objective: To explore whether the 2007 IOM recommendations had an impact on the reasons for calls to a cancer telephone helpline and determine the major reasons for calls at two different time periods after the 2007 r...Objective: To explore whether the 2007 IOM recommendations had an impact on the reasons for calls to a cancer telephone helpline and determine the major reasons for calls at two different time periods after the 2007 recommendations. Methods: Caller data with identifiers removed were extracted from a cancer helpline database. Baseline data included calls made to the helpline between April 2, 2008 and September 2, 2009 (Period 1). Then, a second data set was built from data collected between September 3, 2009 and May 2, 2011 (Period 2). Results: The major reasons for calls to the cancer telephone helpline during the two different time periods were the same: financial assistance, helpline services information, coping assistance, support groups, and questions related to treatment. Four of the top five reasons were non-treatment related (i.e., financial issues, helpline services information, coping, and support). Conclusions: The nature of calls to the helpline suggests that the financial and psychosocial needs of people with cancer are not being addressed by healthcare providers. Practice implications: The new “normal” for cancer care includes decisions about complex care coupled with new regulatory and financial constraints. This underscores the importance of focused planning of cancer care across multiple care settings in order to ensure continuity of care for the whole person.展开更多
BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist ...BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist where higher body mass index(BMI)may in fact confer a survival benefit.This is frequently observed in patients with advanced HCC and cirrhosis,who often present late with advanced tumor features and cancer related weight loss.AIM To explore the relationship between BMI and survival in patients with cirrhosis and HCC.METHODS This is a retrospective cohort study of over 2500 patients diagnosed with HCC between 2009-2019 at two United States academic medical centers.Patient and tumor characteristics were extracted manually from medical records of each institutions'cancer registries.Patients were stratified according to BMI classes:<25 kg/m^(2)(lean),25-29.9 kg/m^(2)(overweight),and>30 kg/m^(2)(obese).Patient and tumor characteristics were compared according to BMI classification.We performed an overall survival analysis using Kaplan Meier by the three BMI classes and after adjusting for Milan criteria.A multivariable Cox regression model was then used to assess known risk factors for survival in patients with cirrhosis and HCC.RESULTS A total of 2548 patients with HCC were included in the analysis of which 11.2%(n=286)were classified as noncirrhotic.The three main BMI categories:Lean(n=754),overweight(n=861),and obese(n=933)represented 29.6%,33.8%,and 36.6%of the total population overall.Within each BMI class,the non-cirrhotic patients accounted for 15%(n=100),12%(n=94),and 11%(n=92),respectively.Underweight patients with a BMI<18.5 kg/m^(2)(n=52)were included in the lean cohort.Of the obese cohort,42%(n=396)had a BMI≥35 kg/m^(2).Out of 2262 patients with cirrhosis and HCC,654(29%)were lean,767(34%)were overweight,and 841(37%)were obese.The three BMI classes did not differ by age,MELD,or Child-Pugh class.Chronic hepatitis C was the dominant etiology in lean compared to the overweight and obese patients(71%,62%,49%,P<0.001).Lean patients had significantly larger tumors compared to the other two BMI classes(5.1 vs 4.2 vs 4.2 cm,P<0.001),were more likely outside Milan(56%vs 48%vs 47%,P<0.001),and less likely to undergo transplantation(9%vs 18%vs 18%,P<0.001).While both tumor size(P<0.0001)and elevated alpha fetoprotein(P<0.0001)were associated with worse survival by regression analysis,lean BMI was not(P=0.36).CONCLUSION Lean patients with cirrhosis and HCC present with larger tumors and are more often outside Milan criteria,reflecting cancer related cachexia from delayed diagnosis.Access to care for hepatitis C virus therapy and liver transplantation confer a survival benefit,but not overweight or obese BMI classifications.展开更多
OBJECTIVES: We sought to evaluate the long-term costeffectiveness of clopidogrel for up to one year after an acute coronary syndrome(ACS) without ST-segment elevation. BACKGROUND: The efficacy of platelet inhibition w...OBJECTIVES: We sought to evaluate the long-term costeffectiveness of clopidogrel for up to one year after an acute coronary syndrome(ACS) without ST-segment elevation. BACKGROUND: The efficacy of platelet inhibition with clopidogrel for up to one year after ACS was demonstrated in the Clopidogrel in Unstable angina to prevent Recurrent Events(CURE) trial, a randomized trial of 12,562 patients in 28 countries that was conducted between 1998 and 2000. Patients were given clopidogrel(300-mg load followed by 75 mg/day) versus placebo, both in addition to aspirin, for a mean of nine months. METHODS: We used patient-level clinical outcomes and resource use from the CURE trial and estimates of life expectancy gains as a result of the prevention of the clinical events of death, stroke, and myocardial infarction on the basis of data from external sources. RESULTS: Excluding clopidogrel costs, average costs of hospitalizations alone were ＄325 less for the clopidogrel arm(95%confidence interval -＄722 to ＄45) using diagnosis-related group-based Medicare reimbursement rates. When including clopidogrel costs(＄766 greater for the clopidogrel arm), average total costs were ＄442 higher for the clopidogrel arm(95%confidence interval ＄62 to ＄820). The incremental cost-effectiveness ratio(ICER) on the basis of the Framingham Heart Study was ＄6,318 per life-year gained(LYG) with clopidogrel, with 94%of bootstrap-derived ICER estimates <＄50,000/ LYG; based on Saskatchewan, the ICER was ＄6,475/LYG with 98%of estimates <＄50,000. CONCLUSIONS: Platelet inhibition with clopidogrel in patients for up to one year after presentation with an acute coronary syndrome is both effective and cost-effective.展开更多
Congenital Heart Disease(CHD)is the most common birth defect and a leading cause of infant morbidity and mortality worldwide.While genetic factors play a significant role in its development,up to 30%of CHD is associat...Congenital Heart Disease(CHD)is the most common birth defect and a leading cause of infant morbidity and mortality worldwide.While genetic factors play a significant role in its development,up to 30%of CHD is associated with modifiable risk factors and external maternal exposures.Climate change,driven by increased atmospheric pollutants fromfossil fuel combustion,leads to rising global temperatures andworsening air quality,which pose emerging threats to maternal and fetal health.This review explores the mechanisms by which environmental factors associated with climate change,specifically extreme heat and air pollution,may influence CHD incidence.Maternal exposure to extreme heat during the first trimester is linked to an increased risk of atrial and ventricular septal defects in offspring,with risk correlating to the intensity and duration of heat exposure.Air pollution—particularly fine particulate matter and gases like ozone,nitrogen dioxide,and sulfur dioxide—is associated with a broader spectrum of CHD,including tetralogy of Fallot,pulmonary stenosis,and coarctation of the aorta.These effects are present even when the exposure occurred prior to conception.Synergistic effects between air pollution and other exposures,such as tobacco use,may further amplify CHD risk.Clinicians should be aware of the potential risks associated with environmental exposures and counsel prospective mothers accordingly to mitigate CHD risk in their offspring.展开更多
The launch of a new journal is an opportunity to innovate.Bringing fresh ideas and practices to academic scientific communication is an implicit responsibility for a new journal focusing on health care science and the...The launch of a new journal is an opportunity to innovate.Bringing fresh ideas and practices to academic scientific communication is an implicit responsibility for a new journal focusing on health care science and the improvement of health care and health outcomes.展开更多
Background:The FAVOR(Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease)III China trial demonstrated that percutaneous coronary inter...Background:The FAVOR(Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease)III China trial demonstrated that percutaneous coronary intervention(PCI)lesion selection using quantitative flow ratio(QFR)measurement,a novel angiography-based approach for estimating fractional flow reserve,improved two-year clinical outcomes compared with standard angiography guidance.This study aimed to assess the cost-effectiveness of QFR-guided PCI from the perspective of the current Chinese healthcare system.Methods:This study is a pre-specified analysis of the FAVOR III China trial,which included 3825 patients randomized between December 25,2018,and January 19,2020,from 26 centers in China.Patients with stable or unstable angina pectoris or those≥72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50%and 90%in a coronary artery with a≥2.5 mm reference vessel diameter by visual assessment were randomized to a QFR-guided strategy or an angiography-guided strategy with 1:1 ratio.During the two-year follow-up,data were collected on clinical outcomes,quality-adjusted life-years(QALYs),estimated costs of index procedure hospitalization,outpatient cardiovascular medication use,and rehospitalization due to major adverse cardiac and cerebrovascular events(MACCE).The primary analysis calculated the incremental cost-effectiveness ratio(ICER)as the cost per MACCE avoided.An ICER of¥10,000/MACCE event avoided was considered economically attractive in China.Results:At two years,the QFR-guided group demonstrated a reduced rate of MACCE compared to the angiography-guided group(10.8%vs.14.7%,P<0.01).Total two-year costs were similar between the groups(¥50,803±21,121 vs.¥50,685±23,495,P=0.87).The ICER for the QFR-guided strategy was¥3055 per MACCE avoided,and the probability of QFR being economically attractive was 64%at a willingness-to-pay threshold of¥10,000/MACCE avoided.Sensitivity analysis showed that QFR-guided PCI would become cost-saving if the cost of QFR were below¥3682(current cost:¥3800).Cost-utility analysis yielded an ICER of¥56,163 per QALY gained,with a 53%probability of being cost-effective at a willingness-to-pay threshold of¥85,000 per QALY gained.Conclusion:In patients undergoing PCI,a QFR-guided strategy appears economically attractive compared to angiographic guidance from the perspective of the Chinese healthcare system.展开更多
Background： Despite the rapid growth in the incidence of acute myocardial infarction （AMI） in China, there is limited information about patients＇ experiences after AMI hospitalization, especially on long-tern1 adv...Background： Despite the rapid growth in the incidence of acute myocardial infarction （AMI） in China, there is limited information about patients＇ experiences after AMI hospitalization, especially on long-tern1 adverse events and patient-reported outcomes （PROs）. Methods： The China Patient-centered Evaluative Assessment of Cardiac Events （PEACE）-Prospective AMI Study will enroll 4000 consecutive AM I patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to docunlent their treatment, recovery, and outcomes. Details of patients＇ medical history, treatment, and in-hospital outcomes are abstracted from medical charts. Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization. As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity. Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge. Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center. Blood and urine samples are also obtained at baseline, 1 - and 12-month follow-up. In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics. Conclusion： The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient＇s experiences and outcomes alter AMI in China and seiwe as a foundation for quality improveinent activities.展开更多
Background::Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization.Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score i...Background::Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization.Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score is a comprehensive system to evaluate the complexity of the overall lesions.We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease(CAD).Methods::In this single-center,historical control study,patients with stable CAD with coronary lesion stenosis≥50%were consecutively recruited.During the control period,SYNTAX scores were calculated by treating cardiologists.During the intervention period,SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making.The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results::A total of 3245 patients were enrolled and assigned to the control group(08/2016-03/2017,n=1525)or the intervention group(03/2017-09/2017,n=1720).For SYNTAX score tertiles,17.9%patients were overestimated and 4.3%were underestimated by cardiologists in the control group.After adjustment,inappropriate revascularization significantly decreased in the intervention group compared with the control group(adjusted odds ratio[OR]:0.83;95%confidence interval[CI]:0.73-0.95;P=0.007).Both inappropriate percutaneous coronary intervention(adjusted OR:0.82;95%CI:0.74-0.92;P<0.001)and percutaneous coronary intervention utilization(adjusted OR:0.88;95%CI:0.79-0.98;P=0.016)decreased significantly in the intervention group.There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions::Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registration::Nos.NCT03068858 and NCT02880605;https://www.clinicaltrials.gov.展开更多
Introduction Obesity affects one-third of the US population and accounts for$200 billion/year in expenditures[1].Diet and exercise form the cornerstone of management,yet are often ineffective[2].Mobile health applicat...Introduction Obesity affects one-third of the US population and accounts for$200 billion/year in expenditures[1].Diet and exercise form the cornerstone of management,yet are often ineffective[2].Mobile health applications(mHealth apps)can augment traditional strategies;Gill and Panda[3]demonstrated that obese patients can modify their eating behavior and lose weight using an mHealth app to track food intake.While promising,these apps typically require active data input and currently lack passively collected,physiologic input to support sustained behavior change.展开更多
To the Editor:Postoperative organ injuries and complications are the leading causes of perioperative morbidity and mortality.Although many retrospective studies have revealed the association between intraoperative hyp...To the Editor:Postoperative organ injuries and complications are the leading causes of perioperative morbidity and mortality.Although many retrospective studies have revealed the association between intraoperative hypotension and perioperative organ injury,[1]the results of prospective randomized trials with regard to tight blood pressure management and clinical outcomes were inconsistent.[2–4]Organ injury could be also provoked by surgery-induced stress.Dexmedetomidine has been validated to attenuate the over-expression of stress mediators;however,whether perioperative dexmedetomidine can improve clinical outcomes remains uncertain.[5,6]Therefore,this 2×2 factorial randomized trial was designed to investigate whether targeted blood pressure management with/without dexmedetomidine administration could minimize the occurrence of a composite of major organ injuries and complications within 30 days in moderateto-high risk patients after major non-cardiac surgery.展开更多
Introduction:This study investigated the prevalence of metabolic dysfunction-associated steatotic liver disease(MASLD)with clinically significant fibrosis among obese patients with type 2 diabetes mellitus(T2DM).Metho...Introduction:This study investigated the prevalence of metabolic dysfunction-associated steatotic liver disease(MASLD)with clinically significant fibrosis among obese patients with type 2 diabetes mellitus(T2DM).Methods:This multicenter study enrolled T2DM patients from tertiary hospitals and primary care facilities across 21 cities in China between 2017 and 2024.Clinically significant fibrosis was defined as liver stiffness measurement(LSM)≥8 kPa assessed by vibration-controlled transient elastography(VCTE)or biopsy-confirmed fibrosis stage≥F2.Results:Of the 10,281 patients included,9,725 comprised the VCTE cohort(5,171 from clinics and 4,554 from primary care),while 556 comprised the biopsy cohort.Overall,25.6%were obese.The prevalence of MASLD with clinically significant fibrosis reached 26.7%in obese patients,significantly exceeding that in non-obese patients(8.4%).This prevalence increased progressively with rising body mass index and demonstrated a strong association with the number of cardiometabolic risk factors.Furthermore,a non-invasive model incorporating age,waist circumference,alanine aminotransferase,total bilirubin,and triglycerides exhibited reliable performance in stratifying the risk of MASLD with clinically significant fibrosis among obese patients with T2DM[Area under the receiver operating characteristic curve(AUC):0.799(95%CI:0.767-0.832)].Conclusions:MASLD with clinically significant fibrosis is highly prevalent among obese patients with T2DM,emphasizing the necessity for systematic risk stratification and integrated management of these interconnected metabolic conditions.展开更多
文摘AIM: To determine patient and process of care factors associated with performance of timely laparoscopic cholecystectomy for acute cholecystitis. METHODS: A retrospective medical record review of 88 consecutive patients with acute cholecystitis was conducted. Data collected included demographic data, co-morbidities, symptoms and physical findings at presentation, laboratory and radiological investigations, length of stay, complications, and admission service (medical or surgical). Patients not undergoing cholecystectomy during this hospitalization were excluded from analysis. Hierarchical generalized linear models were constructed to assess the association of pre-operative diagnostic procedures, presenting signs, and admitting service with time to surgery.RESULTS: Seventy cases met inclusion and exclusion criteria, among which 12 were admitted to the medical service and 58 to the surgical service. Mean ± SD time to surgery was 39.3 ± 43 h, with 87% of operations performed within 72 h of hospital arrival. In the adjusted models, longer time to surgery was associated with number of diagnostic studies and endoscopic retrograde cholangio-pancreatography (ERCP, P = 0.01) as well with admission to medical service without adjustment for ERCP (P < 0.05). Patients undergoing both magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) scans experienced the longest waits for surgery. Patients admitted to the surgical versus medical service underwent surgery earlier (30.4 ± 34.9 vs 82.7 ± 55.1 h, P < 0.01), had less post-operative complications (12% vs 58%, P < 0.01), and shorter length of stay (4.3 ± 3.4 vs 8.1 ± 5.2 d, P < 0.01).CONCLUSION: Admission to the medical service and performance of numerous diagnostic procedures, ERCP, or MRCP combined with CT scan were associated with longer time to surgery. Expeditious performance of ERCP and MRCP and admission of medically stable patients with suspected cholecystitis to the surgical service to speed up time to surgery should be considered.
文摘AIM:To identify patients' characteristics associated with double balloon endoscopy(DBE)outcomes in investigation of obscure gastrointestinal bleeding(OGIB).METHODS:Retrospective study performed at an academic tertiary referral center.Evaluated endpoints were clinical factors associated with no diagnostic yield or non-therapeutic intervention of DBE performed for OGIB evaluation.RESULTS:We included fifty-five DBE between August 2010 and April 2012.The mean age of the sample was 67 with 32 males(58.2%).Twenty-four DBE had no diagnostic yield and 30 DBE did not require therapy.Non-diagnostic yield was associated with performing two or more DBE studies in one day [odds ratio(OR):13.72,P=0.008],absence of blood transfusions within a year of the DBE(OR:7.16,P=0.03)and absence of ulcers or arteriovenous malformations(AVMs)on prior esophagogastroduodenoscopy(EGD)or colonoscopy(OR:19.30,P=0.033).Non-therapeutic DBE was associated with performing two or more DBE per day(OR:18.579,P=0.007),gastrointestinal bleeding episode within a week of the DBE(OR:11.48,P=0.003),fewer blood transfusion requirements prior to DBE(OR:4.55,P=0.036)and absence of ulcers or AVMs on prior EGD or colonoscopy(OR:8.47,P=0.027).CONCLUSION:Predictors of DBE yield and therapeutic intervention on DBE include blood transfusion requirements,previous endoscopic findings and possibly endoscopist fatigue.
文摘BACKGROUND The Karnofsky Performance Status(KPS)scale has been widely validated for clinical practice for over 60 years.AIM To examine the extent to which poor pre-transplant functional status,assessed using the KPS scale,is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.METHODS This study included 38278 United States adults who underwent first,non-urgent,liver-only transplantation from 2005 to 2014(Scientific Registry of Transplant Recipients).Functional impairment/disability was categorized as severe,moderate,or none/normal.Analyses were conducted using multivariableadjusted Cox survival regression models.RESULTS The median age was 56 years,31%were women,median pre-transplant Model for End-Stage for Liver Disease score was 18.Functional impairment was present in 70%;one-quarter of the sample was severely disabled.After controlling for key recipient and donor factors,moderately and severely disabled patients had a 1-year mortality rate of 1.32[confidence interval(CI):1.21-1.44]and 1.73(95%CI:1.56-1.91)compared to patients with no impairment,respectively.Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13(CI:1.02-1.24)and 1.16(CI:1.02-1.31),respectively.CONCLUSION Pre-transplant functional status is a useful prognostic indicator for 1-year posttransplant patient and graft survival.
文摘The management options for ureteral obstruction are diverse, including retrograde ureteral stent insertion or antegrade nephrostomy placement, with or without eventual antegrade stent insertion. There is currently no consensus on the ideal treatment or treatment pathway for ureteral obstruction owing, in part, to the varied etiologies of obstruction and diversity of institutional practices. Additionally, different clinicians such as internists, urologists, oncologists and radiologists are often involved in the care of patients with ureteral obstruction and may have differing opinions concerning the best management strategy. The purpose of this manuscript was to review available literature that compares percutaneous nephrostomy placement vs ureteral stenting in the management of ureteral obstruction from both benign and malignant etiologies.
文摘Metabolic syndrome has been implicated in the pathogenesis of uric acid stones.Although not completely understood,its role is supported by many studies demonstrating increased prevalence of uric acid stones in patients with metabolic syndrome and in particular insulin resistance,a major component of metabolic syndrome.This review presents epidemiologic studies demonstrating the association between metabolic syndrome and nephrolithiasis in general as well as the relationship between insulin resistance and uric acid stone formation,in particular.We also review studies that explore the pathophysiologic relationship between insulin resistance and uric acid nephrolithiasis.
基金supported by the Professor Walter Morris-Hale Distinguished Chair in Urologic Oncology at the Brigham and Women’s Hospital
文摘atients undergoing urologic surgery are at risk of acute kidney injury （AKI） and consequently long-term deterioration in renal function. AKI is further associated with signifcantly higher odds of perioperative complications, prolonged hospital stay, higher mortality and costs. Therefore, better awareness and detection of AKI, as well as identifcation of AKI determinants in the urological surgery setting is warranted to pre-empt and mitigate further deterioration of renal function in patients at special risk. New consensus criteria provide precise definitions of diagnosis and description of the severity of AKI. However, they rely on serum creatinine （SCr）, which is known to be an inaccurate marker of early changes in renal function. Therefore, several newurinary and serum biomarkers promise to address the gap associated with the use of SCr. Novel biomarkers may complement SCr measurement or most likely improve the diagnostic accuracy of AKI when used in combinations. However, novel biomarkers have to prove their clinical applicability, accuracy, and cost effectiveness prior to implementation into clinical practice. Most preferably, novel biomarkers should help to positively improve a patient’s long-term renal functional outcomes. The purpose of this review is to discuss currently available biomarkers and to review their clinical evidence within urologic surgery settings.
文摘BACKGROUND The impact of pancreatic tumor location on patient survival has been studied in large national data-based analyses which yielded controversial results.AIM To explore if pancreatic head cancer(PHC)and pancreatic body/tail cancer(PBTC)have different overall survival(OS),molecular signature and response to chemotherapy.METHODS We retrospectively queried patient records from July 2016 to June 2020 in our institution.Patient demographics,cancer stage on diagnosis,tumor location,somatic mutations,treatment,and survival are recorded and analyzed.A test is considered statistically significant if the P value was<0.05.RESULTS We reviewed 101 patients with complete records,among which 67(66.34%)were PHC and 34(33.66%)were PBTC.More PHC were diagnosed at younger age[61.49 vs 68.97,P=0.010],earlier stages(P=0.006)and underwent surgical resection(P=0.025).There were no significant differences among all mutations and pathways studied except for TP53 mutations(37.0%in PHC vs 70.0%in PBTC,P=0.03).OS was not statistically different between PHC and PBTC(P=0.636)in the overall population and in subgroups according to surgical resection status or stages.In terms of response to chemotherapy,chemotherapy regimens(FOLFIRINOX-based vs gemcitabine-based)didn’t impact disease free interval in those who had surgical resection in either PHC(P=0.546)or PBTC(P=0.654),or the duration of response to first line palliative treatment in those with advanced disease in PHC(P=0.915)or PBTC(P=0.524).CONCLUSION Even though PHC and PBTC have similar poor OS and response to chemotherapy,the different presentations and molecular profiles indicate they are different diseases.Utilization of molecular profiling to develop targeted therapy for individualization of treatment is needed.
文摘Objective: To explore whether the 2007 IOM recommendations had an impact on the reasons for calls to a cancer telephone helpline and determine the major reasons for calls at two different time periods after the 2007 recommendations. Methods: Caller data with identifiers removed were extracted from a cancer helpline database. Baseline data included calls made to the helpline between April 2, 2008 and September 2, 2009 (Period 1). Then, a second data set was built from data collected between September 3, 2009 and May 2, 2011 (Period 2). Results: The major reasons for calls to the cancer telephone helpline during the two different time periods were the same: financial assistance, helpline services information, coping assistance, support groups, and questions related to treatment. Four of the top five reasons were non-treatment related (i.e., financial issues, helpline services information, coping, and support). Conclusions: The nature of calls to the helpline suggests that the financial and psychosocial needs of people with cancer are not being addressed by healthcare providers. Practice implications: The new “normal” for cancer care includes decisions about complex care coupled with new regulatory and financial constraints. This underscores the importance of focused planning of cancer care across multiple care settings in order to ensure continuity of care for the whole person.
基金Supported by in part David W Crabb Professorship Endowment at Indiana University School of Medicine and an intramural grant from the Atrium Health Center for Outcomes Research and Evaluation(CORE)(to deLemos AS).
文摘BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist where higher body mass index(BMI)may in fact confer a survival benefit.This is frequently observed in patients with advanced HCC and cirrhosis,who often present late with advanced tumor features and cancer related weight loss.AIM To explore the relationship between BMI and survival in patients with cirrhosis and HCC.METHODS This is a retrospective cohort study of over 2500 patients diagnosed with HCC between 2009-2019 at two United States academic medical centers.Patient and tumor characteristics were extracted manually from medical records of each institutions'cancer registries.Patients were stratified according to BMI classes:<25 kg/m^(2)(lean),25-29.9 kg/m^(2)(overweight),and>30 kg/m^(2)(obese).Patient and tumor characteristics were compared according to BMI classification.We performed an overall survival analysis using Kaplan Meier by the three BMI classes and after adjusting for Milan criteria.A multivariable Cox regression model was then used to assess known risk factors for survival in patients with cirrhosis and HCC.RESULTS A total of 2548 patients with HCC were included in the analysis of which 11.2%(n=286)were classified as noncirrhotic.The three main BMI categories:Lean(n=754),overweight(n=861),and obese(n=933)represented 29.6%,33.8%,and 36.6%of the total population overall.Within each BMI class,the non-cirrhotic patients accounted for 15%(n=100),12%(n=94),and 11%(n=92),respectively.Underweight patients with a BMI<18.5 kg/m^(2)(n=52)were included in the lean cohort.Of the obese cohort,42%(n=396)had a BMI≥35 kg/m^(2).Out of 2262 patients with cirrhosis and HCC,654(29%)were lean,767(34%)were overweight,and 841(37%)were obese.The three BMI classes did not differ by age,MELD,or Child-Pugh class.Chronic hepatitis C was the dominant etiology in lean compared to the overweight and obese patients(71%,62%,49%,P<0.001).Lean patients had significantly larger tumors compared to the other two BMI classes(5.1 vs 4.2 vs 4.2 cm,P<0.001),were more likely outside Milan(56%vs 48%vs 47%,P<0.001),and less likely to undergo transplantation(9%vs 18%vs 18%,P<0.001).While both tumor size(P<0.0001)and elevated alpha fetoprotein(P<0.0001)were associated with worse survival by regression analysis,lean BMI was not(P=0.36).CONCLUSION Lean patients with cirrhosis and HCC present with larger tumors and are more often outside Milan criteria,reflecting cancer related cachexia from delayed diagnosis.Access to care for hepatitis C virus therapy and liver transplantation confer a survival benefit,but not overweight or obese BMI classifications.
文摘OBJECTIVES: We sought to evaluate the long-term costeffectiveness of clopidogrel for up to one year after an acute coronary syndrome(ACS) without ST-segment elevation. BACKGROUND: The efficacy of platelet inhibition with clopidogrel for up to one year after ACS was demonstrated in the Clopidogrel in Unstable angina to prevent Recurrent Events(CURE) trial, a randomized trial of 12,562 patients in 28 countries that was conducted between 1998 and 2000. Patients were given clopidogrel(300-mg load followed by 75 mg/day) versus placebo, both in addition to aspirin, for a mean of nine months. METHODS: We used patient-level clinical outcomes and resource use from the CURE trial and estimates of life expectancy gains as a result of the prevention of the clinical events of death, stroke, and myocardial infarction on the basis of data from external sources. RESULTS: Excluding clopidogrel costs, average costs of hospitalizations alone were ＄325 less for the clopidogrel arm(95%confidence interval -＄722 to ＄45) using diagnosis-related group-based Medicare reimbursement rates. When including clopidogrel costs(＄766 greater for the clopidogrel arm), average total costs were ＄442 higher for the clopidogrel arm(95%confidence interval ＄62 to ＄820). The incremental cost-effectiveness ratio(ICER) on the basis of the Framingham Heart Study was ＄6,318 per life-year gained(LYG) with clopidogrel, with 94%of bootstrap-derived ICER estimates <＄50,000/ LYG; based on Saskatchewan, the ICER was ＄6,475/LYG with 98%of estimates <＄50,000. CONCLUSIONS: Platelet inhibition with clopidogrel in patients for up to one year after presentation with an acute coronary syndrome is both effective and cost-effective.
文摘Congenital Heart Disease(CHD)is the most common birth defect and a leading cause of infant morbidity and mortality worldwide.While genetic factors play a significant role in its development,up to 30%of CHD is associated with modifiable risk factors and external maternal exposures.Climate change,driven by increased atmospheric pollutants fromfossil fuel combustion,leads to rising global temperatures andworsening air quality,which pose emerging threats to maternal and fetal health.This review explores the mechanisms by which environmental factors associated with climate change,specifically extreme heat and air pollution,may influence CHD incidence.Maternal exposure to extreme heat during the first trimester is linked to an increased risk of atrial and ventricular septal defects in offspring,with risk correlating to the intensity and duration of heat exposure.Air pollution—particularly fine particulate matter and gases like ozone,nitrogen dioxide,and sulfur dioxide—is associated with a broader spectrum of CHD,including tetralogy of Fallot,pulmonary stenosis,and coarctation of the aorta.These effects are present even when the exposure occurred prior to conception.Synergistic effects between air pollution and other exposures,such as tobacco use,may further amplify CHD risk.Clinicians should be aware of the potential risks associated with environmental exposures and counsel prospective mothers accordingly to mitigate CHD risk in their offspring.
文摘The launch of a new journal is an opportunity to innovate.Bringing fresh ideas and practices to academic scientific communication is an implicit responsibility for a new journal focusing on health care science and the improvement of health care and health outcomes.
基金This study is supported by grants from the National High Level Hospital Clinical Research Funding(Nos.2022-GSP-GG-20 and 2023-GSP-GG-3)the Capital’s Funds for Health Improvement and Research(No.2022-2-4033)the Chinese Academy of Medical Sciences(No.2022-I2M-C&T-A-009).
文摘Background:The FAVOR(Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease)III China trial demonstrated that percutaneous coronary intervention(PCI)lesion selection using quantitative flow ratio(QFR)measurement,a novel angiography-based approach for estimating fractional flow reserve,improved two-year clinical outcomes compared with standard angiography guidance.This study aimed to assess the cost-effectiveness of QFR-guided PCI from the perspective of the current Chinese healthcare system.Methods:This study is a pre-specified analysis of the FAVOR III China trial,which included 3825 patients randomized between December 25,2018,and January 19,2020,from 26 centers in China.Patients with stable or unstable angina pectoris or those≥72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50%and 90%in a coronary artery with a≥2.5 mm reference vessel diameter by visual assessment were randomized to a QFR-guided strategy or an angiography-guided strategy with 1:1 ratio.During the two-year follow-up,data were collected on clinical outcomes,quality-adjusted life-years(QALYs),estimated costs of index procedure hospitalization,outpatient cardiovascular medication use,and rehospitalization due to major adverse cardiac and cerebrovascular events(MACCE).The primary analysis calculated the incremental cost-effectiveness ratio(ICER)as the cost per MACCE avoided.An ICER of¥10,000/MACCE event avoided was considered economically attractive in China.Results:At two years,the QFR-guided group demonstrated a reduced rate of MACCE compared to the angiography-guided group(10.8%vs.14.7%,P<0.01).Total two-year costs were similar between the groups(¥50,803±21,121 vs.¥50,685±23,495,P=0.87).The ICER for the QFR-guided strategy was¥3055 per MACCE avoided,and the probability of QFR being economically attractive was 64%at a willingness-to-pay threshold of¥10,000/MACCE avoided.Sensitivity analysis showed that QFR-guided PCI would become cost-saving if the cost of QFR were below¥3682(current cost:¥3800).Cost-utility analysis yielded an ICER of¥56,163 per QALY gained,with a 53%probability of being cost-effective at a willingness-to-pay threshold of¥85,000 per QALY gained.Conclusion:In patients undergoing PCI,a QFR-guided strategy appears economically attractive compared to angiographic guidance from the perspective of the Chinese healthcare system.
文摘Background： Despite the rapid growth in the incidence of acute myocardial infarction （AMI） in China, there is limited information about patients＇ experiences after AMI hospitalization, especially on long-tern1 adverse events and patient-reported outcomes （PROs）. Methods： The China Patient-centered Evaluative Assessment of Cardiac Events （PEACE）-Prospective AMI Study will enroll 4000 consecutive AM I patients from 53 diverse hospitals across China and follow them longitudinally for 12 months to docunlent their treatment, recovery, and outcomes. Details of patients＇ medical history, treatment, and in-hospital outcomes are abstracted from medical charts. Comprehensive baseline interviews are being conducted to characterize patient demographics, risk factors, presentation, and healthcare utilization. As part of these interviews, validated instruments are administered to measure PROs, including quality of life, symptoms, mood, cognition, and sexual activity. Follow-up interviews, measuring PROs, medication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 months after discharge. Supporting documents for potential outcomes are collected for adjudication by clinicians at the National Coordinating Center. Blood and urine samples are also obtained at baseline, 1 - and 12-month follow-up. In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics. Conclusion： The China PEACE-Prospective AMI study will be uniquely positioned to generate new information regarding patient＇s experiences and outcomes alter AMI in China and seiwe as a foundation for quality improveinent activities.
基金This work was supported by grants from the Capital’S Funds for Health Improvement and Research(No.2016-1-4031)National Key Research and Development Program(No.2016YFC1302000)Beijing Municipal Commission of Science and Technology Project(No.D171100002917001).
文摘Background::Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization.Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery(SYNTAX)score is a comprehensive system to evaluate the complexity of the overall lesions.We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease(CAD).Methods::In this single-center,historical control study,patients with stable CAD with coronary lesion stenosis≥50%were consecutively recruited.During the control period,SYNTAX scores were calculated by treating cardiologists.During the intervention period,SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making.The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results::A total of 3245 patients were enrolled and assigned to the control group(08/2016-03/2017,n=1525)or the intervention group(03/2017-09/2017,n=1720).For SYNTAX score tertiles,17.9%patients were overestimated and 4.3%were underestimated by cardiologists in the control group.After adjustment,inappropriate revascularization significantly decreased in the intervention group compared with the control group(adjusted odds ratio[OR]:0.83;95%confidence interval[CI]:0.73-0.95;P=0.007).Both inappropriate percutaneous coronary intervention(adjusted OR:0.82;95%CI:0.74-0.92;P<0.001)and percutaneous coronary intervention utilization(adjusted OR:0.88;95%CI:0.79-0.98;P=0.016)decreased significantly in the intervention group.There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions::Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registration::Nos.NCT03068858 and NCT02880605;https://www.clinicaltrials.gov.
基金C.V.A.and B.M.R.S.are supported by a UCLA Clinical and Translational Science Institute(CTSI)grant from the NIH/NCATS[UL1TR001881-01].
文摘Introduction Obesity affects one-third of the US population and accounts for$200 billion/year in expenditures[1].Diet and exercise form the cornerstone of management,yet are often ineffective[2].Mobile health applications(mHealth apps)can augment traditional strategies;Gill and Panda[3]demonstrated that obese patients can modify their eating behavior and lose weight using an mHealth app to track food intake.While promising,these apps typically require active data input and currently lack passively collected,physiologic input to support sustained behavior change.
基金supported by grants from the National Key Research&Development Program of China(Nos.2023YFC2506900 and 2018YFC2001800)the National High Level Hospital Clinical Research Funding(Nos.2022CR74 and 2022CR78 of Peking University First Hos pital)Braun Anesthesia Scientific Research Fund(No.BBDF-2019-004).
文摘To the Editor:Postoperative organ injuries and complications are the leading causes of perioperative morbidity and mortality.Although many retrospective studies have revealed the association between intraoperative hypotension and perioperative organ injury,[1]the results of prospective randomized trials with regard to tight blood pressure management and clinical outcomes were inconsistent.[2–4]Organ injury could be also provoked by surgery-induced stress.Dexmedetomidine has been validated to attenuate the over-expression of stress mediators;however,whether perioperative dexmedetomidine can improve clinical outcomes remains uncertain.[5,6]Therefore,this 2×2 factorial randomized trial was designed to investigate whether targeted blood pressure management with/without dexmedetomidine administration could minimize the occurrence of a composite of major organ injuries and complications within 30 days in moderateto-high risk patients after major non-cardiac surgery.
基金Supported by grants from the Key Research and Development Program of Jiangsu Province(BE2023767a)the Fundamental Research Fund of Southeast University(3290002303A2)+6 种基金the Changjiang Scholars Talent Cultivation Project of Zhongda Hospital of Southeast University(2023YJXYYRCPY03)the Research Personnel Cultivation Programme of Zhongda Hospital Southeast University(CZXM-GSP-RC125,CZXMGSP-RC119)the China Postdoctoral Science Foundation(2024M750461)the National Natural Science Foundation of China(82402413)the Natural Science Foundation of Jiangsu Province(BK20241681)the Health Research Program of Anhui(AHWJ2023A30169)the Natural Science Foundation of Anhui Province(2508085QH314).
文摘Introduction:This study investigated the prevalence of metabolic dysfunction-associated steatotic liver disease(MASLD)with clinically significant fibrosis among obese patients with type 2 diabetes mellitus(T2DM).Methods:This multicenter study enrolled T2DM patients from tertiary hospitals and primary care facilities across 21 cities in China between 2017 and 2024.Clinically significant fibrosis was defined as liver stiffness measurement(LSM)≥8 kPa assessed by vibration-controlled transient elastography(VCTE)or biopsy-confirmed fibrosis stage≥F2.Results:Of the 10,281 patients included,9,725 comprised the VCTE cohort(5,171 from clinics and 4,554 from primary care),while 556 comprised the biopsy cohort.Overall,25.6%were obese.The prevalence of MASLD with clinically significant fibrosis reached 26.7%in obese patients,significantly exceeding that in non-obese patients(8.4%).This prevalence increased progressively with rising body mass index and demonstrated a strong association with the number of cardiometabolic risk factors.Furthermore,a non-invasive model incorporating age,waist circumference,alanine aminotransferase,total bilirubin,and triglycerides exhibited reliable performance in stratifying the risk of MASLD with clinically significant fibrosis among obese patients with T2DM[Area under the receiver operating characteristic curve(AUC):0.799(95%CI:0.767-0.832)].Conclusions:MASLD with clinically significant fibrosis is highly prevalent among obese patients with T2DM,emphasizing the necessity for systematic risk stratification and integrated management of these interconnected metabolic conditions.
