Synergistic association of hyperuricemia and hyperhomocysteinemia with chronic kidney disease in middle-aged adults and the elderly population

Chronic kidney disease (CKD) is a major global public health issue. Both hyperhomocysteinemia (HHcy) and hyperuricemia are independent risk factors for CKD. In this study, we evaluated the association of HHcy and hyperuricemia with CKD in the middle-aged and elderly populations in Taiwan.In this cross-sectional study, we collected the data of 5910 patients aged ≥50 years after their self-paid health examination at a single medical center. Homocysteine (Hcy) levels were divided into 4 quartiles (Q1, <8.2; Q2, 8.2–9.8; Q3, 9.9–11.7; and Q4, >11.7 μM/L). Renal function was determined using the Chronic Kidney Disease Epidemiology Collaboration equation. Patients were considered to have CKD if their estimated glomerular filtration rate was < 60 mL/min/1.73 m².The prevalence of CKD significantly increased with the quartiles of uric acid (UA) and Hcy. In multiple logistic regression analysis, the odds ratios (ORs) of CKD increased with the quartiles of Hcy, independent of UA. There was 22.9 in Q4 in the normal serum UA group and 18.3 in the hyperuricemia group compared with Q1 of Hcy. Both hyperuricemia (OR 2.9) and Q4 of Hcy (OR 8.1) were significant independent risk factors for CKD. Furthermore, hyperuricemia and HHcy had significant synergistic association (synergy index, 1.7) with CKD.The ORs of CKD increased with the quartiles of Hcy, independent of hyperuricemia. Hyperuricemia and HHcy had synergistic association with CKD.     

Fructose metabolism as a common evolutionary pathway of survival associated with climate change,food shortage and droughts

Mass extinctions occur frequently in natural history. While studies of animals that became extinct can be informative, it is the survivors that provide clues for mechanisms of adaptation when conditions are adverse. Here, we describe a survival pathway used by many species as a means for providing adequate fuel and water, while also providing protection from a decrease in oxygen availability. Fructose, whether supplied in the diet (primarily fruits and honey), or endogenously (via activation of the polyol pathway), preferentially shifts the organism towards the storing of fuel (fat, glycogen) that can be used to provide energy and water at a later date. Fructose causes sodium retention and raises blood pressure and likely helped survival in the setting of dehydration or salt deprivation. By shifting energy production from the mitochondria to glycolysis, fructose reduced oxygen demands to aid survival in situations where oxygen availability is low. The actions of fructose are driven in part by vasopressin and the generation of uric acid. Twice in history, mutations occurred during periods of mass extinction that enhanced the activity of fructose to generate fat, with the first being a mutation in vitamin C metabolism during the Cretaceous–Paleogene extinction (65 million years ago) and the second being a mutation in uricase that occurred during the Middle Miocene disruption (12–14 million years ago). Today, the excessive intake of fructose due to the availability of refined sugar and high‐fructose corn syrup is driving ‘burden of life style’ diseases, including obesity, diabetes and high blood pressure.     

急性冠脉综合征患者血尿酸升高相关因素分析

目的探讨急性冠脉综合征（ACS）患者血尿酸升高的相关危险因素。方法将228例ACS患者按照血尿酸水平分为A组（血尿酸〈260.0μmol/L）、B组（血尿酸260.0～305.5μmol/L）、C组（血尿酸305.5～376.5μmol/L）、D组（血尿酸〉376.5μmol/L）组,观察各组性别、年龄、高血压史、糖尿病史、吸烟史、左心室的射血分数（LVEF）、血尿素氮（BUN）、血肌酐（Cr）、总胆固醇（CHO）、甘油三酯（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、空腹血糖（BFS）,采用Logistic回归分析血尿酸升高的主要因素。结果四组间性别、吸烟史、BUN、Cr、TG和LVEF存在统计学差异,P〈0.05;Logistic回归分析显示,BUN、Cr、TG、吸烟史是ACS患者血尿酸升高的危险因素。结论 BUN、Cr、TG水平升高和吸烟可能为ACS患者发生高尿酸血症的重要原因。     

Related factors of serum uric acid in patients with primary hypertension and hyperhomocysteinemia

Objective: To investigate the related factors of serum uric acid in patients with primary hypertension and hyperhomocysteinemia. Methods: One hundred and ten patients with primary hypertension and hyperhomocysteinemia (homocysteine levels >10 μmol/L) were enrolled into this study, ages from 18 years to 75 years. They were divided into the normal serum uric acid group which contained 74 cases patients (41 cases of male and 33 cases of female) and the hyperuricemia group which contained 36 cases patients (20 cases of male and 16 cases of female). Plasma concentrations of homocysteine, serum uric acid, serum folic acid, blood sugar, triglyceride, total cholesterol, serum low density lipoprotein cholesterol, serum high density lipoprotein cholesterol, blood urea nitrogen, and creatinine were detected in these patients, and the deference of them between the two groups was compared. And then the risk factors of serum uric acid with univariate analysis and multivariate analysis by logistic regression analysis were analyzed. Results: The result of multivariate analysis showed that the incidence of serum uric acid in patients with primary hypertension and hyperhomocysteinemia had significant relationships with systolic blood pressure (OR [odds ratio]: 1.132, 95%CI [confidence interval]: 1.003~1.290, p = 0.043), diastolic blood pressure (OR: 1.353 95%CI: 1.023~1.789, p = 0.034, homocysteine (OR: 1.264, 95%CI: 1.016~1.573, p = 0.035), triglyceride (OR: 9.726, 95%CI: 1.288~73.466, p = 0.027), and creatinine (OR: 1.031, 95%CI: 1.005~1.508, p = 0.018). Conclusion: The indices of systolic blood pressure, diastolic blood pressure, homocysteine, triglyceride, and creatinine were important risk factors of serum uric acid in patients with primary hypertension and hyperhomocysteinemia. It is of great significance to measure multiple risk factors in patients with primary hypertension and hyperhomocysteinemia.     

Factors associated with healthy aging: the cardiovascular health study

OBJECTIVES: To identify factors associated with remaining healthy in older adults. DESIGN: Longitudinal cohort study. SETTING: Data were collected at the four Cardiovascular Health Study field centers. PARTICIPANTS: 5,888 participants age 65 years and older in the Cardiovascular Health Study. MEASUREMENTS: Presence of chronic disease was assessed at baseline and over a maximum 7-year follow-up period. Participants who were free of chronic disease (no cardiovascular disease (CVD), chronic obstructive pulmonary disease, or self-reported cancer, except nonmelanoma skin cancer) at the baseline examination were then monitored for the onset of incident cancer, cardiovascular disease, and fatal outcomes. RESULTS: A high proportion of these older adults was healthy at the initial examination and remained healthy over the follow-up period. Numerous behavioral factors were associated with continued health, including physical activity, refraining from cigarette smoking, wine consumption (women), higher educational status, and lower waist circumference. A number of CVD risk factors and subclinical disease measures were associated with continued health, including higher high-density lipoprotein (HDL) cholesterol, lack of diabetes, thinner common carotid intimal nmedial thickness, lower blood pressure, lower C-reactive protein, and higher ankle-arm blood pressure ratio. Among the behavioral factors, exercise, not smoking, and not taking aspirin remained significant predictors of health even after controlling for CVD risk factors and subclinical disease in older adults. CONCLUSIONS: These data suggest that a number of modifiable behavioral factors (physical activity, smoking, and obesity) and cardiovascular risk factors (diabetes, HDL cholesterol, and blood pressure) are associated with maintenance of good health in older adults.     

2型糖尿病合并高尿酸血症的相关因素分析

目的研究2型糖尿病(T2DM)尿酸相关因素,探讨尿酸水平在代谢综合征(MS)等发病中的作用。方法将2007年3月至2008年3月辽宁医学院附属第一医院内分泌科收治的731例T2DM患者按尿酸水平分为高尿酸组及正常尿酸组,比较两组一般临床资料及MS组分情况,偏相关分析高尿酸血症的相关危险因素。结果尿酸与三酰甘油、体重指数、血压等呈正相关(P<0.05);高尿酸组的MS等患病率明显升高。结论T2DM尿酸与多因素相关,提示T2DM高尿酸血症是MS等发病的危险因素之一。     

Hyperhomocysteinaemia in HIV-infected patients: determinants of variability and correlations with predictors of cardiovascular disease

Objective

We evaluated hyperhomocysteinaemia (HHcy) in a cohort of HIV‐infected patients in order to assess its relation to cardiovascular risk (CVR) and identify determinants of HHcy variability.

Methods

Cross‐sectional observational study. HIV‐infected patients on stable highly active antiretroviral therapy (ART) were evaluated for the presence of the metabolic syndrome, lipodystrophy and traditional CVR factors. Plasma homocysteine levels were measured using high‐performance liquid chromatography.

Results

Five hundred and sixty‐seven patients (38% female) with a median age of 44 years were included in the study. Homocysteine (Hcy) was significantly higher in patients with the metabolic syndrome and lipodystrophy. No significant association was found between Hcy levels and the use of ART. However, Hcy was associated with higher blood pressure, waist circumference and waist‐to‐hip ratio, total lean body mass, visceral adipose tissue (VAT), VAT/total adipose tissue, homeostasis model assessment of insulin resistance (HOMA‐IR), triglycerides, high‐density lipoprotein cholesterol, apolipoprotein A1, B, and creatinine. All 10‐year CVR assessment scores were significantly associated with Hcy. In a multivariate regression model, systolic blood pressure, vitamin supplementation and HOMA‐IR were significantly and independently related to Hcy.

Conclusions

Hcy is elevated in HIV‐infected patients and is significantly associated with increased CVR. Measurement of Hcy might be useful in identifying particularly high‐risk populations at whom therapeutic interventions could be targeted.     

尿酸与代谢综合征及颈动脉粥样硬化的关系

目的研究尿酸与代谢综合征(MS)的关系,及其对颈动脉粥样硬化的影响,为动脉粥样硬化性心血管疾病的防治提供临床依据。方法MS诊断依据2005年国际糖尿病联盟的标准将2232例患者分为两组:MS组(1199例)和非MS组(1033例),在排除高尿酸血症前后,比较两组间年龄、尿酸、腰围、血压、血糖、血脂情况,应用彩色多普勒超声检测颈动脉内膜中层厚度(IMT)。结果MS组高尿酸血症检出率明显高于非MS组,排除高尿酸血症后,MS组与非MS组尿酸水平无明显差异(P>0.01),尿酸是MS的独立危险因素(OR=1.002,95%CI:1.001～1.004);MS组IMT明显高于非MS组(P<0.01);尿酸未进入IMT的回归方程。结论MS及高尿酸血症检出率呈同步升高;尿酸可能仅仅是MS,但不是颈动脉粥样硬化的独立危险因素。     

Factors associated with a prolonged QT interval in liver cirrhosis patients

Aim

The aim of this study was to identify factors associated with prolonged QT interval in liver cirrhosis patients.

Materials and Methods

Thirty-eight patients with liver cirrhosis were enrolled in this study. The maximal QT interval (QTmax), heart rate-corrected QT interval (QTc), QT interval in lead DII (QTII), and mean QT interval (QTm) were determined manually, using 12-lead electrocardiogram. Additional laboratory tests were also performed.

Results

The following values were obtained: QTmax, 435 ± 43 milliseconds; QTc, 493 ± 46 milliseconds; QT interval in lead DII, 405 ± 46 milliseconds; and mean QT interval, 400 ± 40 milliseconds. Ten (6%) patients had a prolonged QTmax, and 27 (71%) had a prolonged QTc. The highest values were obtained for QTc and QTmax in patients with alcoholic cirrhosis and Child-Pugh class C, respectively. A moderate correlation was observed between QTmax and serum uric acid (URCA; r = 0.504), and multiple linear regression analysis revealed that URCA was significantly associated with QTc and heart rate.

Conclusions

Liver disease severity, alcoholic etiology, and URCA are associated with prolonged QT interval in patients with liver cirrhosis.     

Metabolic syndrome and concomitant diabetes mellitus are associated with higher risk of cardiovascular comorbidity in patients with primary glomerular diseases: A retrospective observational study

BackgroundMetabolic syndrome (MS) and diabetes mellitus (DM) are risk factors for cardiovascular diseases in general population. However, there was a paucity of studies investigating their impact in primary glomerular diseases (PGD).HypothesisMS and concomitant DM are associated with higher risk of cardiovascular comorbidity in PGD.MethodsIn a retrospective observational design, we analyzed 3622 hospitalized adult PGD patients and compared the prevalence of cardiovascular comorbidity in non‐MS, MS with and without DM. Risk factors for cardiovascular comorbidity were identified using univariate and multivariate logistic regression.ResultsAmong 3622 PGD patients, 308 (8.5%) cases accompanied with MS, including 180 (5.0%) patients with DM and 128 (3.5%) without DM. One hundred and sixty four (4.5%) cases coexisted with cardiovascular comorbidity. Patients with MS and concomitant DM exhibited a higher prevalence of cardiovascular comorbidity than those without MS stratified by estimated glomerular filtration rate and pathological types. Logistic regression showed that MS and concomitant DM (OR: 2.496, 95% CI: 1.600‐3.894, P < .001), older age (OR: 1.060, 95% CI: 1.047‐1.074, P < .001), male (OR: 1.536, 95% CI: 1.072‐2.200, P = .019), higher level of serum ti (OR: 1.002, 95% CI: 1.001‐1.003, P < .001), hyperuricemia (OR: 1.901, 95% CI: 1.327‐2.725, P < .001), idiopathic membranous nephropathy (OR: 2.874, 95% CI: 1.244‐6.640, P < .001) and focal segmental glomerulosclerosis (OR: 2.906, 95% CI: 1.147‐7.358, P < .001) were independently associated with a higher risk for cardiovascular comorbidity.ConclusionsIn PGD patients, MS and concomitant DM are associated with an increased risk for cardiovascular comorbidity. More evidence for the causal link between MS/DM and cardiovascular outcomes is needed to be clarified.     

Factors associated with hyperhomocysteinemia in inflammatory bowel disease: prospective study in 81 patients

BACKGROUND: A high prevalence (52%) of hyperhomocysteinemia is observed in Crohn disease (CD), however it is not well documented in ulcerative colitis (UC). Furthermore, in the different works studying hyperhomocysteinemia the associated factors are different. AIM: Prospective evaluation of hyperhomocysteinemia in inflammatory bowel disease (IBD) patients, of the risk factors and the determination of a potential risk of colorectal carcinoma in case of hyperhomocysteinemia. PATIENTS AND METHODS: IBD patients followed in our department were prospectively recruited between November 2003-September 2004. To be included patients should have passed a coloscopy in the two years. Patients with kidney failure or drugs supposed, to interfere with homocystéine metabolism (folates, vitamin B12, methotrexate) were excluded from the study. The following parameters were analysed: age, sex, clinical activity indexes (CDAI for Crohn disease and CAI for ulcerative colitis), length-extent and type of the disease (CD or UC), smoking, plasma homocystein concentration, folates and vitamin B12. RESULTS: Eighty-one patients (60 CD, 21 UC, mean age 43.8 +/- 17.3) were included, 30 had an active disease at inclusion and 16 were smokers. The prevalence of high homocystein concentration was 55.6%. In univariate analysis a low rate of folates was the only risk factor for a high homocystein concentration (74 vs. 52.8%; P = 0.018). Smoking was almost an associated factor. In multivariate analysis, a low rate of folate was the only risk factor of hyperhomocysteinemia, OR = 3.59 [1.27-10.17]. Five endoscopic lesions considered as precancerous were described; these patients had all a hyperhomocysteinemia. CONCLUSION: The prevalence of hyperhomocysteinemia is high in UC and in CD. A low folate rate is the only risk factor observed in our study. There is a possible link between colorectal cancer and hyperhomocysteinemia. A high Plasma homocystein concentration must be search in inflammatory bowel disease patients and a substitutive treatment of folates and vitamin B12 is necessary in case of hyperhomocysteinemia.     

老年人高同型半胱氨酸高血压与血尿酸、纤维蛋白原的关系

目的：探讨老年人高同型半胱氨酸（Hcy）高血压（H型高血压）与血尿酸（UA）、纤维蛋白原（FIB）水平的关系。方法选择2013年1月至2014年1月在石河子大学医学院第一附属医院老年病科门诊及病房收治的老年原发性高血压患者251例,其中Hcy水平≥15μmol/L为老年H型高血压组121例,Hcy水平＜15μmol/L为单纯高血压组130例;另外同期选择老年健康体检患者150例为对照组。同期测定Hcy、UA、FIB水平,比较各组UA、FIB水平的差异。结果老年H型高血压组、单纯高血压组、与对照组3组UA[（320.97±106.61）、（280.74±71.27）与（261.01±71.80）μmol/L]及FIB[（3.22±0.52）、（3.05±0.52）与（2.68±0.41）g/L]两两比较差异均有统计学意义（P＜0.01）;logistic回归分析结果示,H型高血压与UA（OR＝3.896）、FIB（OR＝3.100）水平及叶酸降低水平（OR＝2.776）成正比（P＜0.05）。结论老年H型高血压与UA、FIB密切相关。监测UA及FIB对老年H型高血压的管理具有重要意义。     

Factors associated with post-electroconvulsive therapy delirium: A retrospective chart review study

Although electroconvulsive therapy (ECT) is generally a safe therapeutic method, unexpected adverse effects, such as post-ECT delirium, may occur. Despite its harmful consequences, there has been little discussion about the predictors of post-ECT delirium. Thus, the current study aimed to clarify the factors associated with post-ECT delirium by reviewing electronic medical records of 268 bitemporal ECT sessions from December 2006 to July 2018 in a university hospital.Demographic and clinical characteristics of sessions involving patients with or without post-ECT delirium were compared. Multiple logistic regression analysis was applied to analyze the correlation between variables and post-ECT delirium.Post-ECT delirium developed in 23 sessions (8.6%). Of all the demographic and clinical variables measured, only etomidate use was significantly different between delirium-positive and delirium-negative groups after Bonferroni correction. The regression model also indicated that etomidate use to be significantly associated with post-ECT delirium.In this study, etomidate was associated with a higher risk of developing post-ECT delirium, an association that appeared unrelated to other possible measured variables. Practitioners should take into account the risk of post-ECT delirium while choosing anesthetics, so as to prevent early discontinuation before sufficient therapeutic gain is achieved.     

Gallstone disease in non-alcoholic fatty liver: prevalence and associated factors

BACKGROUND: Insulin resistance is a risk factors for non-alcoholic fatty liver disease (NAFLD) and for gallstone disease (GD). Aims of the present study were to assess the prevalence of and factors associated with GD in unselected patients with NAFLD. METHODS: A total of 161 consecutive patients with NAFLD diagnosed through compatible ultrasonography in the absence of known etiologies of liver disease (in all patients) and/or confirmed histologically (in 61 patients), was studied. Gallstone disease was diagnosed through ultrasound scanning or on the basis of previous cholecystectomy. Anthropometric and biochemical variables and concurrent diseases were compared in 32 NAFLD-GD patients and in 129 NAFLD patients without GD (controls) according to gender. RESULTS: The overall prevalence of GD was 19.88%, higher in female patients (P < 0.05), who were older (P < 001). The overall percentage of GD increased with age (P < 0.05). The GD patients had higher uric acid (men), total cholesterol and apolipoprotein B (apo-B) serum concentrations (women; P < 0.05); women also had a higher prevalence of hypertriglyceridemia (P < 0.05). The age-corrected odds ratio of having GD by tertiles increased significantly with increasing uric acid (men) and with increasing total cholesterol, triglycerides and apo-B (women). At univariate continuous analysis GD was associated with insulin 120 min and uric acid in male patients; and with body mass index, insulin 120 min, apo-B, total cholesterol and triglycerides in female patients. On multivariate analysis it was found that among these factors only uric acid in men and apo-B in women were independently associated with GD in NAFLD. CONCLUSIONS: The prevalence of GD in NAFLD is more elevated than reported in the general population. The factors independently associated with GD in NAFLD are different from those reported in the general population and vary according to the gender.     

血清尿酸水平对2型糖尿病一级亲属代谢综合征的预测价值

目的：观察2型糖尿病一级亲属中血清尿酸水平是否与代谢综合征（MS）的组成成分有关,明确在2型糖尿病一级亲属这一高危人群中尿酸能否成为预测MS的独立因子。方法招募年龄在40～70岁的2型糖尿病一级亲属322人,其中男性119人,女性203人,检测身高、体质量、血压、肝功、肾功、血脂以及口服糖耐量试验,计算体质量指数（BMI）。根据中华医学会糖尿病学分会关于MS的诊断标准（2004）诊断MS。结果在全部人群中,血清尿酸水平与身高、体质量、BMI、餐后2h血糖（2hPBG）、收缩压（SBP）、舒张压（DBP）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）有关（r＝0.376、0.450、0.285、0.127、0.244、0.225、0.395、-0.184,P＜0.05）,尿酸水平为365～537μmol/L（男性）及283～411μmol/L（女性）的MS患病率（男性62.1%,女性32.7%）明显高于0～274,275～320μmol/L（男性,30.0%,26.7%）及0～188,189～230μmol/L（女性,7.8%,9.6%）,尿酸水平在MS人群中明显高于无MS人群[（315.83±83.97） vs （251.80±75.21）μmol/L,P＜0.01]。不论男性还是女性,尿酸平均水平随着MS组成个数的增加而增高（P＜0.05）。尿酸对MS的单因素logistic回归分析中,比值比（OR）及95%可信区间为男性1.008（1.002？1.013,P＝0.005）、女性1.010（1.004？1.016,P＝0.001）。多因素logistic回归分析尿酸对MS的作用则不显著。结论尿酸与MS大部分组成部分相关, MS患者有较高的尿酸水平,但尿酸可能不是预测MS独立因素。     

Factors associated with liver cancer prognosis after hepatectomy: A retrospective cohort study

This article was to investigate risk factors influencing liver cancer prognosis after hepatectomy.Patients undergoing hepatectomy after being diagnosed with liver cancer in Zhongshan Hospital Affiliated to Xiamen University were collected in the retrospective cohort study between January 2012 and December 2017, and divided into disease progression and non-progression groups based on their prognostic status. Univariate analysis was performed on the patients’ baseline and laboratory test data, with multivariate logistic regression further conducted to investigate the independent risk factors for liver cancer progression after hepatectomy.Among the 288 subjects, 159 had adverse outcomes (death or cancer recurrence). Hepatitis B and high levels of aspartate aminotransferase, gamma-glutamyltransferase, alkaline phosphatase (ALP), direct bilirubin, and total bilirubin as well as low level of lymphocyte (LYM) were found to be associated with disease progression in the univariate analysis, and were introduced into the multivariate logistic regression. The results indicated that patients with high ALP level (odds ratio [OR] = 1.004, 95%CI: 1.002–1.007, P = .003) and with a history of hepatitis B (OR = 2.182, 95%CI: 1.165–4.086, P = .015) had a higher risk of liver cancer progression compared with those of lower ALP level and those without hepatitis B respectively, whereas the elevated level of LYM (OR = 0.710, 95%CI: 0.516–0.978, P = .034) had favorable progression.The elevated ALP level and a history of hepatitis B may increase the risk of death or cancer recurrence, whereas high LYM level may decrease poor progression among liver cancer patients after hepatectomy. More importance should be attached to the improvement of the liver function and treatment of hepatitis B to enable a better outcome for the patients.     

Factors associated with long-term survival after liver transplantation:A retrospective cohort study

AIM To identify predictive factors associated with long-term patient and graft survival( 15 years) in liver transplant recipients.METHODS Medical charts of all de novo adult liver transplant recipients(n = 140) who were transplanted in Hamburg between 1997 and 1999 were retrospectively reviewed.In total,155 transplantations were identified in this time period(15 re-transplantations).Twenty-six orthotopic liver transplant(OLT) recipients were early lost to followup due to moving to other places within 1 year after transplantation.All remaining 114 patients were included in the analysis.The following recipient factors were analysed:Age,sex,underlying liver disease,pre-OLT body mass index(BMI),and levels of alanine aminotransferase(ALT),bilirubin,creatinine and gammaglutamyltransferase(gamma-GT),as well as warm and cold ischemia times.Furthermore,the following donor factors were assessed:Age,BMI,cold ischemia time and warm ischemia time.All surviving patients were followed until December 2014.We divided patients into groups according to their underlying diagnosis:(1) hepatocellularcarcinoma(n = 5,4%);(2) alcohol toxic liver disease(n = 25,22.0%);(3) primary sclerosing cholangitis(n = 6,5%);(4) autoimmune liver diseases(n = 7,6%);(5) hepatitis C virus cirrhosis(n = 15,13%);(6) hepatitis B virus cirrhosis(n = 21,19%);and(7) other(n = 35,31%).The group "other" included rare diagnoses,such as acute liver failure,unknown liver failure,stenosis and thrombosis of the arteria hepatica,polycystic liver disease,Morbus Osler and Caroli disease.RESULTS The majority of patients were male(n = 70,61%).Age and BMI at the time point of transplantation ranged from 16 years to 69 years(median:53 years) and from 15 kg/m~2 to 33 kg/m~2(median:24),respectively.Sixty-six OLT recipients(58%) experienced a follow-up of 15 years after transplantation.Recipient's age(P = 0.009) and BMI(P = 0.029) were identified as risk factors for death by χ~2-test.Kaplan-Meier analysis confirmed BMI or age above the median as predictors of decreased long-term survival(P = 0.008 and P = 0.020).Hepatitis B as underlying disease showed a trend for improved long-term survival(P = 0.049,χ~2-test,P = 0.055;Kaplan-Meier analysis,Log rank).Pre-transplant bilirubin,creatinine,ALT and gamma-GT levels were not associated with survival in these patients of the pre-era of the model of end stage liver disease.CONCLUSION The recipients' age and BMI were predictors of longterm survival after OLT,as well as hepatitis B as underlying disease.In contrast,donors' age and BMI were not associated with decreased survival.These findings indicate that recipient factors especially have a high impact on long-term outcome after liver transplantation.     

Serum uric acid and its change with the risk of type 2 diabetes: A prospective study in China

ObjectiveTo assess the association of baseline uric acid levels and their changes from baseline to Year 1 with the risk of type 2 diabetes.Research design and methodsThis study cohort included 9471 subjects without a history of diabetes at baseline. The incident diabetes was diagnosed according to the American Diabetes Association standard.ResultsDuring a mean follow-up of 2.9 years, we identified 762 type 2 diabetes cases. Multivariate-adjusted hazard ratios (HRs) of diabetes across baseline tertiles of serum uric acid were 1.00, 1.15, and 1.32 (P for trend = 0.018), respectively. Participants with hyperuricemia compared with those without had a 1.20-fold (95% confidence interval [CI] 1.01−1.44) risk of diabetes. When uric acid was examined as a continuous variable, multivariable-adjusted HR of diabetes for each 1 mg/dL (60 μmol/L) increase in serum uric acid was 1.09 (95% CI 1.03−1.15). Compared with subjects with stable serum uric acid from baseline to Year 1 (±10%), those with uric acid gain ≥30% had a 30% (95% CI 1.01–1.79) increased risk of diabetes and those with uric acid loss ≥10% had a 21% (95% 0.62−0.99) decreased risk of diabetes. This positive association between baseline serum uric acid and diabetes risk was consistent among subjects younger and older than 45 years, non-obese and obese participants, and men.ConclusionsHigh level of baseline serum uric acid and serum uric acid gain from baseline to Year 1 are associated with an increased risk of type 2 diabetes among Chinese adults.     

The relationship between mean platelet volume and metabolic syndrome in patients with type 2 diabetes mellitus: A retrospective study

This study aimed to investigate the association between mean platelet volume (MPV) and metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (T2DM). Data for 1240 patients with T2DM admitted to the Department of Endocrinology at the First Affiliated Hospital of Guangxi Medical University between January 1, 2017 and June 1, 2020 were collected retrospectively via electronic medical records, including demographic information, complete blood count, lipid profile, and glucose metabolism indexes. MetS was defined according to the Chinese Diabetes Society. Among the 1240 patients enrolled, 873 (70.40%) had MetS. MPV was significantly higher in patients with MetS (P < .001). For individual MetS components, MPV was significantly higher in the presence of abdominal obesity (P = .013) and hypertriglyceridemia (P = .026), but did not differ in the presence of elevated blood pressure (P = .330) or low high-density lipoprotein cholesterol (P = .790). Moreover, MPV was independently associated with MetS after adjustment for sex, smoking, alcohol drinking, white blood cell count, fasting C-peptide, and body mass index (odds ratio 1.174, 95% confidence interval 1.059–1.302). The odds ratio for MetS in the highest tertile, compared with the lowest MPV tertile, was 1.724 (95% confidence interval 1.199–2.479, P for trend = .003) after multiple adjustment. In stratified analyses, the positive correlation of MPV with MetS was significant only in patients who were older, male, or overweight, or who had poor glycemic control. In conclusion, high MPV was positively associated with the presence of MetS in patients with T2DM, particularly older, male, or overweight patients, or those with poor glycemic control.