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Bramlage K.S.,Cincinnati Childrens Hospital Medical Center | Bansal V.,National Health Group | Xanthakos S.A.,Cincinnati Childrens Hospital Medical Center | Kohli R.,Cincinnati Childrens Hospital Medical Center
Indian Journal of Pediatrics | Year: 2012

The world's population is increasingly overweight and obese. According to the World Health Organization (WHO) as of 2010, 43 million children under the age of five were overweight. Once considered to be limited to developed countries, overweight and obese children are now found in low- and middle-income countries, though most commonly in urban areas. Furthermore the WHO now cites the conditions of overweight and obesity as being associated with more deaths around the globe than those associated with being underweight. With this increased prevalence of overweight and obese children has come a host of other medical problems including nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). This review will focus on NAFLD and NASH, their definitions, epidemiology, diagnosis and treatment. The authors will also discuss NAFLD in the Indian subcontinent, and the future of NAFLD and NASH. © 2012 Dr. K C Chaudhuri Foundation.

Pan C.-W.,Soochow University of China | Sun H.-P.,Soochow University of China | Zhou H.-J.,National Health Group | Ma Q.,3rd Peoples Hospital of Xiangcheng District | And 3 more authors.
Medical Decision Making | Year: 2016

Objective. To determine health-state utility (HSU) values for type 2 diabetes (T2D) patients with various clinical conditions in China, and to examine how these conditions are correlated with HSU values. Methods. A consecutive sample of T2D patients was recruited from a tertiary hospital in Suzhou, China. HSU values of T2D patients were measured using the EQ-5D-5L, a new version of the EQ-5D. T2D patients' clinical data were collected from the survey and the clinical examination; sociodemographic data were obtained from the survey. Ordinary least square (OLS) models were employed to estimate the impact of clinical conditions on HSU values controlling for sociodemographic conditions. Nonparametric biased-corrected and accelerated (BCA) bootstrap was used to calculate the 95% confidence intervals (CIs). Results. A total of 289 T2D patients provided data. The mean HSU value of the sample was 0.876 (standard deviation: 0.14), with a median of 0.895 (range: -0.063 to 1). Using the OLS model and BCA bootstrap, the impact of significant conditions on HSU values and 95% CIs are as follows: neuropathy (-0.057, [-0.093, -0.017]), heart disease (-0.074, [-0.122, -0.018]), cerebrovascular disease (-0.160, [-0.287, -0.030]), and increasing diabetes duration (-0.004, [-0.007, -0.001]). Conclusion. The HSU values estimated can be used to assess the cost-effectiveness of health care interventions for T2D patients in China. © 2015 The Author(s).

Liu J.-J.,Clinical Research Unit | Sum C.F.,Diabetes Center | Tavintharan S.,Diabetes Center | Yeoh L.Y.,Khoo Teck Puat Hospital | And 5 more authors.
Atherosclerosis | Year: 2014

Objective: Type 2 diabetes (T2DM) among the young population has become a serious concern globally, presumably due to the rising trend of obesity. Compared to other forms of diabetes, young-onset T2DM experiences more cardiovascular events and other vascular complications although the underlying mechanisms remain largely unknown. Increased arterial stiffness is a hallmark of vasculopathy. We aim to study the clinical and metabolic determinants of arterial stiffness in a cohort of multi-ethnic Asians with young-onset T2DM. Methods: 179 subjects with T2DM onset age below 30 years old were selected in this cross sectional study. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV). Results: PWV was correlated with age, duration of diabetes, systolic blood pressure, alanine aminotransferase, urinary albumin-to-creatinine ratio (ACR) and eGFR in bivariate correlation analysis. However, PWV was only significantly correlated with body mass index (BMI), waist circumference, urinary ACR and eGFR after adjustment for age. Overweight individuals with young-onset T2DM had significantly higher PWV levels compared to their lean counterparts (7.3 ± 2.4 m/s vs 6.4 ± 2.3 m/s, p = 0.072 and p < 0.0001 without and with adjustment for age, respectively). Multivariable regression models revealed that age, BMI, eGFR and usage of insulin were independently associated with PWV. These 4 variables explained 35.5% variance in PWV levels. Conclusion: Age, BMI, renal function and insulin usage are the main determinants of PWV levels in Asians with young-onset T2DM. Notably, obesity is a modifiable determinant of arterial stiffness independent of high blood pressure, dyslipidemia and hyperglycemia in this population. © 2014 Elsevier Ireland Ltd.

Attal R.,Innsbruck Medical University | Maestri V.,Innsbruck Medical University | Doshi H.K.,National Health Group | Onder U.,Innsbruck Medical University | And 3 more authors.
Bone and Joint Journal | Year: 2014

Using human cadaver specimens, we investigated the role of supplementary fibular plating in the treatment of distal tibial fractures using an intramedullary nail. Fibular plating is thought to improve stability in these situations, but has been reported to have increased soft-tissue complications and to impair union of the fracture. We proposed that multidirectional locking screws provide adequate stability, making additional fibular plating unnecessary. A distal tibiofibular osteotomy model performed on matched fresh-frozen lower limb specimens was stabilised with reamed nails using conventional biplanar distal locking (CDL) or multidirectional distal locking (MDL) options with and without fibular plating. Rotational stiffness was assessed under a constant axial force of 150 N and a superimposed torque of ± 5 Nm. Total movement, and neutral zone and fracture gap movement were analysed. In the CDL group, fibular plating improved stiffness at the tibial fracture site, albeit to a small degree (p = 0.013). In the MDL group additional fibular plating did not increase the stiffness. The MDL nail without fibular plating was significantly more stable than the CDL nail with an additional fibular plate (p = 0.008). These findings suggest that additional fibular plating does not improve stability if a multidirectional distal locking intramedullary nail is used, and is therefore unnecessary if not needed to aid reduction. © 2014 The British Editorial Society of Bone & Joint Surgery.

Luo L.,Tsinghua University | Xia W.,Peking Union Medical College | Nie M.,Peking Union Medical College | Sun Y.,Peking Union Medical College | And 4 more authors.
Molecular Biology Reports | Year: 2014

The estrogen receptor 1 (ESR1) and Chromosome 6 Open Reading Frame 97 (C6orf97) gene polymorphisms were earlier reported to be associated with osteoporosis in the European cohort. The aim of this study was to investigate the association of four single nucleotide polymorphisms (SNP) with bone mineral density (BMD), fracture, vertebral fracture, bone turnover or 25-hydroxyvitamin D [25(OH)D] in 1,753 randomly selected postmenopausal women in China. Vertebral fracture, BMD of lumbar spine (2-4), femoral neck and total hip were measured respectively. Serum N-terminal procollagen of type 1 collagen (P1NP), β-isomerized type I collagen C-telopeptide breakdown products (β-CTX) and 25(OH)D3 were also determined. Binary logistic regression revealed significant associations between fracture risk with rs1999805 (P = 0.041, OR 1.633, 95%CI 1.020-2.616) and rs6929137 (P = 0.005, OR 1.932, 95%CI 1.226-3.045) in recessive model. Significant association was also observed between vertebral fracture risk and rs1038304 (P = 0.039, OR 0.549, 95%CI 0.311-0.969) in recessive model. Liner regression analyses showed that only the CC group of rs4870044 was significantly associated with total hip in dominant model (P = 0.034). Our findings suggest that ESR1 and C6orf97 gene polymorphism is associated with fracture and vertebral fracture risk in Chinese postmenopausal women. © Springer Science+Business Media 2014.

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