OBJECTIVE

This study aimed to determine the association between Asia-Pacific classification of body mass index, waist circumference and waist hip ratio and clinical outcomes of COVID-19 moderate & severe patients at the height of the COVID-19 pandemic.

A This study involved adult patients diagnosed with COVID-19. 182 patients were analyzed and divided into 167 moderate and 15 severe COVID-19 patients. Primary outcomes (respiratory decompensation, septic shock, and mortality) of patients were compared among Asia Pacific BMI groups.

Among patients with moderate and severe COVID-19, 7 out of 10 patients were obese. Respiratory decompensation and sepsis were more frequently seen in obese patients. Obesity and waist circumference were significantly associated with the odds of respiratory decompensation (95% CI p=0.010 and p=0.002), however this association was not sustained upon adjustment for confounders. On univariate analysis, waist and hip circumferences were significantly associated with the odds of ICU admission (95% CI, p=.013 and p=.034), however after controlling for confounders, only hip ratio retained significant association. Among patients with severe COVID-19, there was insufficient evidence to support significant variations in distributions of outcomes of interest across Asia-Pacific BMI groups.

Our study emphasized that although respiratory decompensation and sepsis were more frequently seen in obese patients. progression of respiratory decompensation and mortality is not significantly associated with obesity as defined by the Asia Pacific BMI classification, warranting the need for larger prospective studies.

OBJECTIVE: To investigate a new noninvasive diagnostic model for nonalcoholic fatty liver disease (NAFLD) based on features of tongue images. METHODS: Healthy controls and volunteers confirmed to have NAFLD by liver ultrasound were recruited from China-Japan Friendship Hospital between September 2018 and May 2019, then the anthropometric indexes and sampled tongue images were measured. The tongue images were labeled by features, based on a brief protocol, without knowing any other clinical data, after a series of corrections and data cleaning. The algorithm was trained on images using labels and several anthropometric indexes for inputs, utilizing machine learning technology. Finally, a logistic regression algorithm and a decision tree model were constructed as 2 diagnostic models for NAFLD. RESULTS: A total of 720 subjects were enrolled in this study, including 432 patients with NAFLD and 288 healthy volunteers. Of them, 482 were randomly allocated into the training set and 238 into the validation set. The diagnostic model based on logistic regression exhibited excellent performance: in validation set, it achieved an accuracy of 86.98%, sensitivity of 91.43%, and specificity of 80.61%; with an area under the curve (AUC) of 0.93 [95% confidence interval (CI) 0.68-0.98]. The decision tree model achieved an accuracy of 81.09%, sensitivity of 91.43%, and specificity of 66.33%; with an AUC of 0.89 (95% CI 0.66-0.92) in validation set. CONCLUSIONS The features of tongue images were associated with NAFLD. Both the 2 diagnostic models, which would be convenient, noninvasive, lightweight, rapid, and inexpensive technical references for early screening, can accurately distinguish NAFLD and are worth further study.
Humans ; Non-alcoholic Fatty Liver Disease/diagnostic imaging* ; Ultrasonography ; Anthropometry ; Algorithms ; China

BACKGROUND: Chronic illnesses such as Type 2 diabetes mellitus (T2DM) and obesity have been implicated as risk factors in the development of cognitive impairment (CI), but despite this, definite association between the two conditions in increasing cognitive impairment risk is not well defined. OBJECTIVE: This study aims to examine the association between body mass index (BMI) and cognitive impairment (CI) in elderly patients with Type 2 diabetes mellitus. METHODS: This is a cross-sectional study conducted in the outpatient clinics of a private hospital in Manila which included elderly patients with Type 2 diabetes. BMI categories of the subjects were determined using the Asia-Pacific criteria and the Montreal Cognitive Assessment – Philippines (MOCA-P) was administered to subjects who fulfilled the inclusion criteria. Descriptive statistics were used to determine the prevalence of impaired cognition among subjects while risk ratio analysis was used to determine the correlation between BMI and CI. Correlation analysis and linear regression analysis were used to determine the presence of association between cognition (measured by MOCA-P scores) and BMI. For all analysis, a 95% level of significance was used. RESULTS: A total of 109 subjects from the outpatient clinics were included in the study. A high percentage of the study population (90.83%) had CI based on MOCA-P scores. Subjects that belonged to the extremes of BMI- underweight and obese class 2 had higher incidence of CI compared to the other groups. Underweight subjects had 1.103 (95% CI: 1.038 to 1.172) times likelihood of having impaired cognition (p-value 0.0016), while obese 2 subjects had 1.110 (95% CI: 1.040 to 1.184) times likelihood of having impaired cognition (p-value 0.0016). Regression analysis revealed that in subjects with diabetes of less than 10 years, cognition scores were negatively correlated to BMI (p-value 0.0454). Correlation analysis revealed that at the general population level, regardless of the external factors, increasing or decreasing BMI did not have significant effect on cognition scores. CONCLUSION Subjects who belonged to the extremes of BMI-underweight and obese class 2 – had higher incidence of CI compared to the other BMI groups. Among subjects with T2DM duration of less than 10 years, cognition scores tend to be negatively correlated to BMI.
diabetes mellitus, Type 2 ; cognitive impairment ; cognitive dysfunction ; Body Mass Index

Background: The association of obesity with adverse COVID-19 outcomes is known, but unexplored in younger adults. Objective: To determine the association of obesity [body mass index (BMI) of ≥30] with severe COVID-19 outcomes in younger and older adults. Design: Retrospective cohort study. Participants: 391 patients with COVID-19 (226 younger adults aged 18-60 years, and 165 older adults aged >60 years). Setting: Southern Philippines Medical Center, Davao City, January 2021 to September 2021. Main outcome measures: Severe COVID-19 outcomes (high-flow oxygen administration, ICU admission, mechanical ventilation, death); odds ratio of severe outcomes in patients with BMI of ≥30. Main results: Of 391 patients (median age of 57 years), 286 had a BMI of <30, while 105 had a BMI of ≥30. Univariate regression analysis showed that a BMI of ≥30 was significantly associated with any severe COVID-19 outcomes (OR=2.68; 95% CI 1.68 to 4.27; p<0.001). This remained after adjusting for age, sex, hypertension, diabetes, and cardiovascular disease (adjusted OR=3.19; 95% CI 1.93 to 5.27; p<0.001). A BMI of ≥30 was also significantly associated with any severe outcomes among younger adults (adjusted OR=4.04; 95% CI 2.23 to 7.32; p<0.001), but not among older adults (adjusted OR=1.80; 95% CI 0.70 to 4.64; p=0.227). Conclusion In our study, among all adults, a BMI of ≥30 significantly increased the odds of experiencing any severe COVID-19 outcomes. This association was also observed in the younger adult subgroup, but not in the older adult subgroup.
SARS-CoV-2 ; Body Mass Index ; Immunity ; Critical Care

Obesity ; Body Mass Index ; Leptin ; Inflammation ; Adipose Tissue

Humans ; Intra-Abdominal Fat/diagnostic imaging* ; Coronary Artery Disease ; Body Mass Index

Humans ; Blood Pressure/physiology* ; Hypertension/prevention & control* ; Body Mass Index ; Healthy Lifestyle

OBJECTIVES: To investigate the effect of different soft-tissue morphologies on the treatment of skeletal class Ⅰ malocclusion patients by analyzing measurement data before and after treatment. METHODS: Pre- and post-treatment lateral cephalograms of 55 adult female Angle class Ⅰ patients were collected in the Department of Orthodontics, Hospital of Stomatology, Jilin University from January 2012 to December 2020. Chin soft-tissue morphologies in the lateral cranial radiographs were used to divide the patients into an abnormal chin morphology group (flat and retracted chins, n=27) and a normal chin morphology group (rounded and prominent chins, n=28). Relevant soft- and hard-tissue indexes were selected to study in-group varieties and intergroup differences in the varying chin morphologies before and after treatment. RESULTS: The chin-lip angle, mandibular chin angle, mandibular chin vertex angle, PP-MP, LL-E, UL-E, Po-Pos, and B-B' thickness in the abnormal chin morphology group were significantly higher than those in the normal chin morphology group (P<0.05). Furthermore, m∶BMe and n∶B'Mes in the abnormal chin morphology group were signi-ficantly lower than those in the normal chin morphology group (P<0.05). After treatment, the mandibular chin angle, mandibular chin vertex angle, U1-SN, L1-MP, LL-E, UL-E, SNA, SNB, and B-B' thickness of the abnormal chin morphology group significantly decreased (P<0.05), whereas the nasolabial angle, m∶BMe, n∶B' Mes, and Po-Pos significantly increased (P<0.05). In the normal chin morphology group, the U1-SN, L1-MP, LL-E, UL-E, and B-B' thicknesses decreased significantly (P<0.05), whereas the nasolabial angle significantly increased (P<0.05). Among them, m∶BMe and n∶B' Mes were positively correlated. CONCLUSIONS Chin morphology affects the formulation of treatment plans. Compared with the normal chin morphology group, the abnormal chin morphology group required a larger retraction of incisors. Although the chin of soft-tissue morphology is related to the morphology of bones, the changes in soft tissue chin after treatment cannot be directly predicted according to the bone changes. Soft-tissue chin morphology affects the aesthetic assessment of the soft-tissue lateral profile and the change in soft tissue before and after treatment. The method of predicting the change in soft-tissue chin after treatment should consider the morphology of the soft-tissue chin.
Adult ; Humans ; Female ; Chin ; Lip ; Cephalometry/methods* ; Esthetics, Dental ; Mandible

OBJECTIVES: To evaluate the effects of a Twin-block appliance on the condyles of patients with ClassⅡmalocclusion by conducting a systematic review and a Meta-analysis. METHODS: Pubmed, Embase, Cochrane Library, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and VIP Database were electronically searched. Randomized controlled trials, controlled clinical trials, and single-arm trials on condylar changes produced by a Twin-block appliance in patients with ClassⅡmalocclusion were included. Two reviewers independently extracted and assessed the risk of bias. Meta-analyses were conducted with Review Manager 5.3. RESULTS: Eight studies were included; among which, seven were of high quality. After treatment with a twin block appliance, condyles moved anteriorly. The anterior joint spaces decreased (P<0.000 01), whereas the posterior spaces increased (P<0.000 01). The superior spaces were not changed (P=0.11). Moreover, a significant difference was observed in the increase of the condylar space index (P<0.000 01). After treatment, the anteroposterior diameters of the condyles and condylar height increased (P=0.000 2 and P<0.000 01, respectively). By contrast, no significant changes were discovered in the medial external diameters of the condyles (P=0.42). CONCLUSIONS A Twin-block appliance can promote the growth of a condyle in the posterior and upper direction and move it forward in favor of the correction of Class Ⅱ malocclusion.
Humans ; Malocclusion, Angle Class II/therapy* ; Temporomandibular Joint ; Bone and Bones ; China ; Orthodontic Appliances, Functional ; Cephalometry

OBJECTIVE: To investigate the early effectiveness of transiliac-transsacral screws internal fixation assisted by augmented reality navigation system HoloSight (hereinafter referred to as "computer navigation system") in the treatment of posterior pelvic ring injuries. METHODS: A retrospective analysis was made in the 41 patients with posterior pelvic ring injuries who had been treated surgically with transiliac-transsacral screws between June 2022 and June 2023. The patients were divided into navigation group (18 cases, using computer navigation system to assist screw implantation) and freehand group (23 cases, using C-arm X-ray fluoroscopy to guide screw implantation) according to the different methods of transiliac-transsacral screws placement. There was no significant difference in gender, age, body mass index, causes of injuries, Tile classification of pelvic fracture, days from injury to operation, usage of unlocking closed reduction technique between the two groups ( P>0.05). The time of screw implantation, the fluoroscopy times, the guide wire adjustment times of each screw, and the incidence of complications were recorded and compared between the two groups. The position of the transiliac-transsacral screw was scanned by CT within 2 days after operation, and the position of the screw was classified according to Gras standard. RESULTS: The operation was successfully completed in both groups. The time of screw implantation, the fluoroscopy times, and the guide wire adjustment times of each screw in the navigation group were significantly less than those in the freehand group ( P<0.05). There were 2 cases of incision infection in the freehand group, and the incision healed by first intention after active dressing change; there was no screw-related complication in the navigation group during operation and early period after operation; the difference in incidence of complications between the two groups (8.7% vs. 0) was not significant ( P=0.495). According to the Gras standard, the screw position of the navigation group was significantly better than that of the freehand group ( P<0.05). CONCLUSION Compared with the traditional freehand method, the computer navigation system assisted transiliac-transsacral screws internal fixation in the treatment of posterior pelvic ring injuries has advantages of improving the accuracy of screw implantation and reducing radiation damage and the time of screw implantation.
Humans ; Retrospective Studies ; Surgical Wound Infection ; Replantation ; Body Mass Index