Metabolic associated fatty liver disease(MAFLD)is currently the most common liver disease around the world.MAFLD may easily progress to the adverse outcomes such as hepatitis,liver fibrosis,and liver cirrhosis,and it is often accompanied by comorbidities such as diabetes,hypertension,hyperlipidemia,hyperuricemia,and cardiovascular and cerebrovascular diseases.Etiological treatment is the cornerstone of MAFLD treatment,and due to the complexity and adverse outcome of MAFLD,it is of great significance to explore the pathogenesis of MAFLD and develop effective prevention and treatment regimens and drugs.This article reviews the pathogenesis of MAFLD from the aspects of genetic factors,improper diet and oxidative stress,spleen-stomach damp-heat and insulin resistance,damp-heat and pathogenic Qi,organic acid metabolism,and intestinal microecology.

Humans ; Stomach Neoplasms ; Tumor Microenvironment ; Prognosis ; Adenosine

Objective To investigate the association of lipid accumulation product (LAP) and visceral fat index (VAI) with nonalcoholic fatty liver disease (NAFLD) and the value of LAP and VAI in predicting the risk of NAFLD. Methods A total of 708 subjects who underwent physical examination in China-Japan Friendship Hospital from September 2018 to May 2019 were enrolled and divided into NAFLD group ( n =426) and non-NAFLD group ( n =282), and the two groups were compared in terms of LAP, VAI, and related biochemical parameters. The independent samples t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups.The chi-square test was used for comparison of categorical data between groups. The Spearman test was used for correlation analysis. The subjects were divided into L1-L4 groups based on LAP and V1-V4 groups based on VAI, and the distribution of NAFLD was compared between groups; a logistic regression analysis was used to calculate the risk of NAFLD at different levels of LAP and VAI, and the receiver operating characteristic (ROC) curves were plotted for LAP, VAI, waist circumference (WC), and body mass index (BMI) in predicting NAFLD in different sex and body weight subgroups, so as to evaluate the value of each index in the prediction and diagnosis of NAFLD. Results Compared with the non-NAFLD group, the NAFLD group had significantly higher age, proportion of male subjects, proportion of subjects with a smoking history, and levels of LAP, VAI, WC, BMI, systolic blood pressure, diastolic blood pressure, alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglyceride, low-density lipoprotein cholesterol, fasting blood glucose, and serum uric acid, as well as a significantly lower level of high-density lipoprotein cholesterol (all P < 0.01). NAFLD was positively correlated with the levels of LAP and VAI (Cramer's V=0.552 and 0.464). The multivariate logistic regression analysis showed that after adjustment for related risk factors, the risk of NAFLD in the L4 group was still 8.811 (95% confidence interval [ CI ]: 4.335-17.910) times that in the L1 group ( P < 0.001), and the risk of NAFLD in the V4 group was still 5.967 (95% CI : 3.263-10.912) times than that in the V1 group ( P < 0.001). The ROC curve analysis showed that both LAP and VAI had an area under the ROC curve (AUC) of > 0.7 in predicting the onset of NAFLD in different sex and body weight subgroups; the AUCs of LAP and VAI in the female subgroup were significantly higher than those in the male subgroup (LAP: 0.886 vs 0.785, P < 0.05; VAI: 0.824 vs 0.748, P < 0.05), and the corresponding sensitivities and specificities of LAP and VAI in the female subgroup were also higher than those in the male subgroup (sensitivity: LAP: 79.8% vs 63.7%; VAI: 77.9% vs 77.0%; specificity: LAP: 85.0% vs 81.1%; VAI: 77.6% vs 62.3%). Conclusion The risk of NAFLD increases with the increase in the levels of LAP and VAI. Both LAP and VAI have a good value in predicting NAFLD in different sex and body weight subgroups, especially in predicting NAFLD in the female population.

Objective:To investigate the relationship between the E2 and E4 alleles of apolipoprotein E (apoE) gene and myocardial infarction (MI) in type 2 diabetes Mellitus (T2DM) patients, and to explore the relationship between apoE polymorphism and blood lipid metabolism.Methods:This case control study was conducted from August 2016 to March 2020 in China-Japan Friendship Hospital, 3 459 inpatients with T2DM were included including 3 044 patients without MI (T2DM group) and 415 patients with MI (T2DM+MI group). Real time fluorescent quantitative PCR was used to detect apoE polymorphism. Automatic biochemical analyzer was used to detect lipid levels. Logistic regression analyses were performed to determine the association of apoE with risk of MI in patients with T2DM.Results:(1) The frequency of E4 allele in T2DM+MI group (12.29%, 102/830) was significantly higher than in T2DM group (9.13%,556/6 088), while the frequency of E2 allele in T2DM+MI group (7.35%,61/830) was significantly lower than that in T2DM group (8.21%,500/6 088), P=0.012. Logistic regression analyses showed that E4 allele carrier (E3/E4+E4/E4) faced a higher risk for MI in T2DM patients ( OR=1.48, 95% CI 1.14-1.92, P=0.003), while E2 allele carrier(E2/E3+E2/E2)did not face a higher risk of MI in T2DM patients ( OR=0.88, P=0.642). (2) The levels of apoE polymorphism and blood lipid: The levels of TC, LDL-C and apoB increased in the order of E4 allele, wild type and E2 allele ( P<0.05). The levels of HDL-C, apoA1 and apoE decreased in the order of E4 allele, Wild type and E2 allele ( P<0.05). Conclusion:The E4 allele is a risk factor for MI in T2DM patients, and apoE polymorphism can affect blood lipid level in this patent cohort.

Objective:To understand the status quo and impact of Beijing Standardized Residency Training program following three years of the medical education synergy policy from the perspective of residents.Methods:Online questionnaire was used from April to May 2018 to investigate two types of residents who had completed the program in Beijing in 2018, and a comparison was made with the 2014 training program, activities, evaluation, and support conditions. Statistical descriptions and Wilcoxon signed-rank test were used for analysis.Results:A total of 3 293 residents completed the Beijing Standardized Residency Training, of which 54.75% were resident physicians, and 45.25% were graduate students in clinical medicine. Compared with 2014, the completion rate of the disease types and quantity, clinical operation types and quantity required by the training plan has been significantly improved, with the proportions being 93.77% and 92.80%, respectively. The implementation rate of examinations in 7 departments including Internal Medicine was greater than 90%, which is significantly higher than that in 2014; The conditions for training support had improved significantly.Conclusions:The impact of Beijing Standardized Residency Training Program was already emerging since the medical education synergy policy in place. It was recommended that various measures be taken to steadily improve the quality of the " dual-track system" .

Objective:To evaluate visceral sensitivity,gut barrier function and autonomic nerve function (ANF) in patients with diarrhea-predominant irritable bowel syndrome (IBS-D),and to explore their roles in IBS-D pathophysiology.Methods:A total of 46 IBS-D patients (IBS-D group) were selected from the Department of Gastroenterology of China-Japan Friendship Hospital from October 2015 to March 2016,and 20 healthy volunteer were served as a control group (HC group).Clinical and psychological symptoms were evaluated by questionnaire,and visceral sensitivity to rectal balloon distention,gut barrier function and autonomic nerve function (ANF) were examined.The difference in the abovementioned indexes were compared between the 2 groups,and the correlations in the parameters were analyzed in the IBS-D group.Results:The scores of IBS symptom severity scale (IBS-SSS),Hamilton anxiety scale (HAMA),Hamilton depression scale (HAMD) and visceral sensitivity index (VSI) were significantly higher in the IBS-D group than those in the HC group (P＜0.01).In the visceral sensitivity test,maximum tolerable threshold in the IBS-D group was significantly decreased compared to that in the HC group (P＜0.01);there was no significant difference in first sensation threshold and defecating sensation threshold between the two groups (P＞0.05).As gut barrier function markers,the serum diamine oxidase (DAO) and d-lactate were significantly increased in the IBS-D group (P＜0.05).In ANF test,the total score and parasympathetic score as well as the proportion of abnormal scores in the IBS-D group were significantly higher than those in the HC group (P＜0.05).In IBS-D group,the HAMA,VSI and serum DAO were positively correlated with IBS-SSS (r=0.528,0.575,0.507;P＜0.01),while the 3 visceral sensitivity thresholds were negatively correlated with IBS-SSS (r=-0.636,-0.476,-0.697;P＜0.01);in addition to the IBS-SSS,the HAMA,HAMD,VSI and serum DAO were also significant negatively correlated with the visceral sensitivity thresholds (all P＜0.05);no significant correlations were found between the ANF and the other parameters.Conclusion:IBS-D patients show psychological symptoms,visceral hypersensitivity,impaired gut barrier function and abnormal ANF characterized by parasympathetic dysfunction;the former 3 factors are all associated with disease severity,and thus may play vital roles in IBS-D pathophysiology.

Objective: To investigate the antimicrobial susceptibility of Brucella and to provide a scientific basis for rational drug use and effective treatment of patients with brucellosis. Methods: A total of 41 Brucella strains were isolated from the blood of patients with brucellosis in 5 counties and 2 districts in Yuxi City, China from 2014 to 2016. The susceptibility to 23 antimicrobial drugs was tested using Kirby-Bauer (K-B) disk diffusion method and the sizes of antimicrobial rings were recorded. The susceptibility testing results were interpreted according to the Drug Susceptibility Testing Guideline (2009 version) . Results: The susceptibility rate of Brucella was 100.00% to ofloxacin, ciprofloxacin, levofloxacin, and amikacin and >90% to cefotaxime, cefepime, imipenem, doxycycline, cefoperazone, minocycline, tobramycin, rifampicin, cefoperazone/sulbactam, and chloramphenicol. The high resistance to aztreonam and ampicillin was observed (87.80% and 41.46%). Doxycycline-intermediate strains, rifampicin-intermediate strains, and rifampicin-resistant strains were identified. Conclusion Doxycycline and rifampicin are commonly used in the treatment of brucellosis, but doxycycline/rifampicin-intermediate and-resistant strains have been identified. The susceptibility of Brucella to fluoroquinolones and cephalosporins was high, so the two drugs can be considered in the treatment of brucellosis.

ObjectiveTo investigate the antioxidant effect of matrine and its clinical effect in the treatment of rats with nonalcoholic steatohepatitis (NASH). MethodsA total of 30 rats were randomly divided into three groups: control group, NASH group, and matrine group, with 10 in each. A high-fat diet was used to establish the rat model of NASH, and matrine was given by gavage for treatment at a dose of 36 mg·kg-１·d-1. The changes in body weight and liver weight were observed in all rats. HE staining was used to observe the histopathological changes of the liver. The serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and the content of reduced glutathione (GSH), superoxide dismutase (SOD), and malondialdehyde (MDA) in liver tissue were measured. A one-way analysis of variance was used for the comparison between multiple groups, and the SNK-q test was used for further comparison between any two groups. ResultsCompared with the NASH group, the matrine group had significant reductions in the serum levels of ALT and AST (ALT: 52.0±3.0 U/L vs 41.8±3.7 U/L, P＜0.001; AST: 233.6±9.4 U/L vs 170.1±1.8 U/L, P＜0.001). The matrine group showed marked improvement in the histopathological changes of the liver compared with the NASH group. Compared with the NASH group, the matrine group had significantly increased content of SOD and GSH in liver tissue (SOD: 17.7±2.0 μg/mg vs 27.0±3.6 μg/mg, P＜0.001; GSH: 16.5±1.6 U/mg vs 28.5±2.1 U/mg, P＜0.001) and significantly reduced content of MDA (22.9±1.9 nmol/mg vs 17.8±1.8 nmol/mg, P＜0.001). ConclusionMatrine has an antioxidant effect and a marked clinical effect in the treatment of rats with NASH.

Objective To investigate the correlation between dynamic changes in esophageal impedance and dilated intercellular space (DIS) of patients with acid-induced non erosive reflux disease (NERD).Methods From September 2013 to July 2014,a total of 35 patients with NERD and 20 healthy controls were selected and underwent 24 h multichannel intraluminal impedance and pH monitoring (MII-pH monitoring),acid perfusion test and gastroendoscopy examination.One piece of mucosa tissue was taken under gastroendoscope from the anterior and posterior walls at 2 cm above the dentate line of the esophagus.Intercellular space (ICS) of the esophageal epithelia cells was measured by software after hematoxylin and eosin staining.t test and variance analysis were performed for statistical analysis.Pearson correlation analysis was used for correlation analysis.Results Impedance baseline of distal esophagus and impedance recovery rate of patients with NERD were lower than those of healthy control group,which were (2 998±701) Ω vs (3 880±1 054) Ω and (30.1±14.0) Ω/min vs (53.0±14.5) Ω/min,and the differences were statistically significant (t=3.65,5.41;both P＜0.01).Compared with healthy control group,ICS of the esophageal epithelial cells was obviously wider (1.03 ± 0.20) μm vs (0.66±0.14) μm,and the difference was statistically significant (t=-6.57,P＜0.01).Impedance baseline of esophagus and impedance recovery rate of patients with positive acid perfusion test were lower than those of patients with negative acid perfusion test,which were (2 755±680) Ωvs (3 411±536) Ω and (25.4±13.0) Ω minvs (33.4±9.8) Ω /min,and the differences were statistically significant (t =2.99,2.03;both P＜0.05).The correlation between impedance recovery rate and ICS was negative (r=-0.70,P＜0.01).Conclusions Recurrent reflux induced injury and delayed mucosal headline may be the factors of impaired mucosal integrity in patients with NERD.The changes esophageal of impedance baseline to a certain extent reflected the degree of esophageal mucosal integrity impairment.

OBJECTIVETo investigate the epidemic status of brucellosis in the occupational population in Yuxi, China, and to develop effective prevention and control strategies.

METHODSSerological test was performed for 2320 employees involved in breeding, slaughtering, meat and dairy product processing, veterinary medicine, and sales in counties and districts where brucellosis was detected from 2008 to 2014 in Yuxi; pathogenic detection was performed for those in the occupational population who were suspected of brucellosis.

RESULTSThe results of serological test showed that the infection rate of brucellosis reached 3.32% , and 15 cases of brucellosis had clinical symptoms. The employees involved in breeding had the highest infection rate (4.89%) (χ2=25.75, P<0.05). From 2008 to 2014, the infection rate of brucellosis was 0.37%~4.93% and tended to increase; 67.85% of the occupational population did not take personal protective measures and had a significantly higher infection rate than those who took personal protective measures (4.45% vs 0.94%; χ2=19.42, P<0.05). Among the 161 patients suspected of brucellosis, 42 cases were diagnosed as current brucellosis confirmed by laboratory pathogenic detection.

CONCLUSIONThe infection rate of brucellosis and the number of newly diagnosed cases tend to increase in the occupational population in Yuxi, and the employees involved in breeding are the major infected population.

Animal Husbandry ; Brucellosis ; epidemiology ; China ; epidemiology ; Dairying ; Humans ; Meat ; Occupational Diseases ; epidemiology ; microbiology ; Veterinary Medicine