Objective:To investigate the association of nonalcoholic fatty liver disease (NAFLD) and obesity with risk of atherosclerotic cardiovascular disease (ASCVD).Methods:A total of 1 486 individuals, including 1 051 males and 635 women aged (56.0±9.0) years, who underwent health check-up at the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from January 2020 to November 2021 were enrolled. The participants were divided into non-NAFLD group ( n=564), NAFLD without obesity group ( n=689), and NAFLD with obesity group ( n=233) according to the presence of NAFLD and body mass index. The general information, smoking history, alcohol consumption, medical history and results of physical examination, laboratory tests and liver ultrasound of participants were collected from the electronic medical record system. Body mass index≥28.0 kg/m 2 was defined as obesity, fatty liver was diagnosed by ultrasonography, and ASCVD risk was assessed according to the criteria of the Chinese guideline on the primary prevention of cardiovascular diseases( 2020). Multivariate logistic regression model was used to analyse the relationship of NAFLD and obesity with risk of ASCVD. Results:The proportions of individuals at high risk for ASCVD in the non-NAFLD group, the NAFLD without obesity group and the NAFLD with obesity group were 27.5%(155/564), 50.1%(345/689) and 61.8%(144/233), respectively, and the proportions of individuals at high ASCVD risk in the NAFLD without obesity group and the NAFLD with obesity group were higher than that in the non-NAFLD group (all P<0.05), and the proportion in the NAFLD with obesity group was higher than the NAFLD without obesity group ( P<0.05). Multivariate logistic regression analysis showed that NAFLD was significantly associated with a higher risk of ASCVD after correction for sex, alcohol consumption and alanine aminotransferase, and the association was stronger in the NAFLD with obesity, and the results were unchanged after further correction for uric acid, fasting glucose and systolic blood pressure (all P<0.001). Conclusion:NAFLD is strongly associated with the risk of ASCVD with or without obesity, and obesity may strengthen this association.

A 6-month primary care quality improvement (QI) project was conducted for 63 general practice residents at Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from November 2021 to April 2022. The effectiveness of the QI project on the post competency of general practice residents was comprehensively assessed by three dimensions: self-satisfaction, objective evaluation and teacher-evaluation. The overall satisfaction score of general practice residents was significantly increased after the implementation of QI project((3.83±0.67) vs. (3.41±0.63), t=3.35, P=0.009). The total score of objective assessment was increased from (73.48±8.04) before the project implementation to (78.14±5.24) after the implementation ( t=3.37, P=0.001). The total score of training effectiveness significantly increased from (57.57±11.84) before the project implementation to (79.27±8.40) after the implementation ( t=30.07, P<0.001). The results indicate that the primary care QI project can improve the post competency of general practice residents, and also improve the self-satisfaction of residents for active learning and participation in the training.