Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is associated with a multitude of adverse outcomes. We aimed to estimate the pooled incidence of NAFLD-related adverse events. Methods: We performed a systematic review and meta-analysis of cohort studies of adults with NAFLD to evaluate the pooled incidence of adverse events. Results: 19,406 articles were screened, 409 full-text articles reviewed, and 79 eligible studies (1,377,466 persons) were included. Mean age was 51.47 years and body mass index 28.90 kg/m2. Baseline comorbidities included metabolic syndrome (41.73%), cardiovascular disease (CVD) (16.83%), cirrhosis (21.97%), and nonalcoholic steatohepatitis (NASH) (58.85%). Incidence rate per 1,000 person-years for mortality included: all-cause (14.6), CVD-related (4.53), non-liver cancer-related (4.53), and liver-related (3.10). Incidence for liver-related events included overall (24.3), fibrosis progression (49.0), cirrhosis (10.9), liver transplant (12.0), and hepatocellular carcinoma (HCC) (3.39). Incidence for non-liver events included metabolic syndrome (25.4), hypertension (25.8), dyslipidemia (26.4), diabetes (19.0), CVD (24.77), renal impairment (30.3), depression/anxiety (29.1), and non-liver cancer (10.5). Biopsy-proven NASH had higher incidence of HCC (P=0.043) compared to non-NASH. Higher rates of CVD and mortality were observed in North America and Europe, hypertension and non-liver cancer in North America, and HCC in Western Pacific/Southeast Asia (P<0.05). No significant differences were observed by sex. Time-period analyses showed decreasing rates of cardiovascular and non-liver cancer mortality and increasing rates of decompensated cirrhosis (P<0.05). Conclusions People with NAFLD have high incidence of liver and non-liver adverse clinical events, varying by NASH, geographic region, and time-period, but not sex.

Facial feminization surgery (FFS) refers to a set of procedures aimed at altering the features of a masculine face to achieve a more feminine appearance. In the second part of this twopart series, assessment and operations involving the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty, are discussed. Finally, we provide a review of the literature on patient-reported outcomes in this population following FFS and suggest a path forward to optimize care for FFS patients.

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided.

Facial feminization surgery (FFS) incorporates aesthetic and craniofacial surgical principles and techniques to feminize masculine facial features and facilitate gender transitioning. A detailed understanding of the defining male and female facial characteristics is essential for success. In this first part of a two-part series, we discuss key aspects of the general preoperative consultation that should be considered when evaluating the prospective facial feminization patient. Assessment of the forehead, orbits, hairline, eyebrows, eyes, and nose and the associated procedures, including scalp advancement, supraorbital rim reduction, setback of the anterior table of the frontal sinus, rhinoplasty, and soft tissue modifications of the upper and midface are discussed. In the second part of this series, bony manipulation of the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty are discussed. Finally, a review of the literature on patient-reported outcomes in this population following FFS is provided.

Objective: To analyze the relationship between medication taken during pregnancy and congenital heart disease of the newborns. Methods: A large cross-sectional survey was conducted between August and November 2013. A questionnaire survey was conducted among the childbearing aged women, selected through multistage stratified random sampling in Shaanxi from 2010 to 2013. All of the childbearing aged women under study were in pregnancy and with definite pregnancy outcomes. Multivariable Poisson regression was conducted for data analyses. Results: A total of 28 680 cases were included in this study. The proportion of medication taken at any time during pregnancy was 16.0%, and the prevalence of congenital heart disease among the newborns was 67.9/10 000. After adjustment for factors as general demographic characteristic, history of heart disease and drug allergy and the situation of disease during pregnancy of these women, results from the multivariable Poisson regression showed that, factors as taking drugs (RR=1.95, 95%CI: 1.42- 2.68), cold medicine (RR=1.68, 95%CI: 1.07-2.64), antibiotics (RR=1.90, 95%CI: 1.25-2.90), salicylates (RR=5.01, 95%CI: 1.84-13.64) and antifungal drugs (RR=10.22, 95%CI: 3.25-32.19) during pregnancy were all related to congenital heart disease, and with the history of taking cold medicine (RR=1.90, 95%CI: 1.01-3.61), antibiotics (RR=2.18, 95%CI: 1.17-4.06), salicylates (RR=6.07, 95%CI: 1.45-25.41), antifungal drugs (RR=21.01, 95%CI: 4.17-105.87) and other drugs (RR=2.31, 95%CI: 1.19-4.47) during early pregnancy. These factors were with higher risks for congenital heart disease. Conclusion: Women of childbearing age who took cold medicine, antibiotics, salicylic acid drugs, antifungal drugs and other drugs during early pregnancy would increase the risks related to congenital heart diseases.
Adult ; Cross-Sectional Studies ; Drug Therapy ; Drug-Related Side Effects and Adverse Reactions ; Female ; Heart Diseases/epidemiology* ; Humans ; Infant, Newborn ; Pregnancy ; Pregnancy Outcome ; Prevalence ; Surveys and Questionnaires

Objective: To understand the effect of interpregnancy interval (IPI) of childbearing aged women on the birth weight of single live birth neonates in Shaanxi province. Methods: A questionnaire survey was conducted among the childbearing aged women selected through multistage stratified random sampling in Shaanxi during 20l0-2013, all the childbearing aged women had definite pregnancy outcomes. The interpregnancy interval of the childbearing aged women and the birth weight of the newborns were used as the independent variables and dependent variables respectively in multiple linear regression model and quantile regression model, and confounding factors were controlled. Results: A total of 13 063 women at childbearing age and their infants were investigated. The incidence of low birth weight and macrosomia was 3.54% and 7.62% respectively. Multiple linear regression analysis showed that there was no significant difference in birth weight among different IPI group and control group. Quantile regression analysis showed when birth weight was at 5 percentiles, the difference in birth weight between newborns whose mothers had short interpregnancy interval (<12 months) and those in control group was significant, when the birth weight was ≥90 percentiles, the birth weights of newborns whose mothers had long interpregnancy interval (60-119 months) were higher than those in control group, the difference was significant. As the increase of the percentiles of birth weight, the extent of changes gradually increased. Conclusion: The analysis indicated that both short (<12 months) and long (60-119 months) interpregnancy interval would had negative effects on birth weights of newborns. Therefore, planning for pregnancy is important for having a good perinatal outcome.
Birth Intervals ; Birth Weight ; Female ; Fetal Macrosomia/epidemiology* ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Live Birth ; Macrolides ; Male ; Maternal Age ; Mothers ; Pregnancy ; Pregnancy Outcome ; Risk Factors ; Surveys and Questionnaires

Objective: To explore the association between maternal respiratory infection in early pregnancy and gestational age of single live birth. Methods: A face to face questionnaire survey was conducted among child bearing aged women in 30 counties (district) of Shaanxi province selected through stratified multistage sampling. Propensity score (PS) matched (1∶1) analysis was used to match participants with respiratory infections to those without respiratory infections. A multilevel linear model was used to investigate the association between respiratory infections and gestational age. Through the control of the confounders step by step, three models were established in this study: model 1 for the variable of respiratory infections before PS matching, model 2 was adjusted for variables in model 1 plus some other individual differences of mother and baby, and model 3 for the variable of respiratory infections after PS matching. Results: Of 28 848 child bearing aged women surveyed, 3 676 (12.74%) had respiratory infections in early pregnancy. After PS matching, 2 762 pairs were matched. Analysis with model 1 indicated that a decrease of 0.111 week (P<0.001) in gestational age was associated with a respiratory infection during the first trimester. Analysis with model 2 and model 3 indicated that a decrease of 0.058 week (P=0.025) and a decrease of 0.076 week (P=0.036) were associated with respiratory infection during the first trimester, respectively. Conclusion: The respiratory infection during the first trimester was associated with the decrease of the gestational age of newborn.
Bacterial Infections/epidemiology* ; Child ; China/epidemiology* ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Mothers ; Pregnancy ; Pregnancy Trimester, First ; Propensity Score ; Respiratory Tract Infections/epidemiology*