Prevalence and predictors of nonalcoholic fatty liver disease in South Asian women with polycystic ovary syndrome

BACKGROUND Polycystic ovary disease(PCOS)may be a risk factor for nonalcoholic fatty liver disease(NAFLD)due to common pathogenetic pathways,including insulin resistance and obesity.Both PCOS and NAFLD are more severe in South Asian women.Data on NAFLD in South Asian women with PCOS are lacking.AIM To investigate prevalence and predictors of NAFLD and liver fibrosis in PCOS patients from South Asia.METHODS We conducted an observational routine screening program by means of transient elastography(TE)with associated controlled attenuation parameter(CAP).NAFLD was defined as CAP≥288 decibels per meter.Significant liver fibrosis(stage 2 and higher out of 4)was defined as TE measurement≥8.0 kilopascals.Elevated alanine aminotransferase(ALT)was defined as ALT>24 IU/L,as per upper limit of normal reported in South Asian women.Biochemical hyperandrogenism was defined as free androgen index>5.Predictors of NAFLD were determined by logistic regression analysis.RESULTS 101 PCOS patients(mean age 36.3 years)with no significant alcohol intake or viral hepatitis were included.Prevalence of NAFLD and significant liver fibrosis was 39.6% and 6.9%,respectively.Elevated ALT was observed in 40%and 11.5%of patients with and without NAFLD,respectively.After adjusting for duration of PCOS and insulin resistance measured by homeostasis model for assessment of insulin resistance,independent predictors of NAFLD were higher body mass index[adjusted odds ratio(aOR)1.30,95% confidence interval(CI):1.13-1.52],hyperandrogenism(aOR:5.32,95%CI:1.56-18.17)and elevated ALT(aOR:3.54,95%CI:1.10-11.47).Lifetime cardiovascular risk was higher in patients with NAFLD compared to those without NAFLD(0.31±0.11 vs 0.26±0.13).CONCLUSION Despite their young age,NAFLD diagnosed by TE with CAP is a frequent comorbidity in South Asian women with PCOS and is strongly associated with higher body mass index and hyperandrogenism.Non-invasive screening strategies could help early diagnosis and initiation of interventions,including counselling on weight loss,cardiovascular risk stratification and linkage to hepatology care where appropriate.

Bilateral effect of acupuncture on cerebrum and cerebellum in ischaemic stroke patients with hemiparesis:a randomised clinical and neuroimaging trial

Background Acupuncture involving the limb region may be effective for stroke rehabilitation clinically,but the visualised and explanatory evidence is limited.Our objectives were to assess the specific effects of acupuncture for ischaemic stroke(IS)patients with hemiparesis and investigate its therapy-driven modification in functional connectivity.Methods IS patients were randomly assigned(2:1)to receive 10 sessions of hand-foot 12 needles acupuncture(HA,n=30)or non-acupoint(NA)acupuncture(n=16),enrolling gender-matched and age-matched healthy controls(HCs,n=34).The clinical outcomes were the improved Fugl-Meyer Assessment scores including upper and lower extremity(ΔFM,ΔFM-UE,ΔFM-LE).The neuroimaging outcome was voxel-mirrored homotopic connectivity(VMHC).Static and dynamic functional connectivity(sFC,DFC)analyses were used to study the neuroplasticity reorganisation.Results 46 ISs(mean(SD)age,59.37(11.36)years)and 34 HCs(mean(SD)age,52.88(9.69)years)were included in the per-protocol analysis of clinical and neuroimaging.In clinical,ΔFM scores were 5.00 in HA group and 2.50 in NA group,with a dual correlation betweenΔFM andΔVMHC(angular:r=0.696,p=0.000;cerebellum:r=-0.716,p=0.000)fitting the linear regression model(R2=0.828).In neuroimaging,ISs demonstrated decreased VMHC in bilateral postcentral gyrus and cerebellum(Gaussian random field,GRF corrected,voxel p<0.001,cluster p<0.05),which fitted the logistic regression model(AUC=0.8413,accuracy=0.7500).Following acupuncture,VMHC in bilateral superior frontal gyrus orbital part was increased with cerebro-cerebellar changes,involving higher sFC between ipsilesional superior frontal gyrus orbital part and the contralesional orbitofrontal cortex as well as cerebellum(GRF corrected,voxel p<0.001,cluster p<0.05).The coefficient of variation of VMHC was decreased in bilateral posterior cingulate gyrus(PPC)locally(GRF corrected,voxel p<0.001,cluster p<0.05),with integration states transforming into segregation states overall(p<0.05).There was no acupuncture-related adverse event.Conclusions The randomised clinical and neuroimaging trial demonstrated acupuncture could promote the motor recovery and modified cerebro-cerebellar VMHC via bilateral static and dynamic reorganisations for IS patients with hemiparesis.

2019 Chinese Clinical Practice Guidelines for the Prevention of Mother-to-child Transmission of Hepatitis B Virus

To develop the evidence-based guidelines for managing mother-to-child transmission of hepatitis B virus in China, a multidisciplinary guideline development group was estab-lished. Clinical questions were identified from two rounds of surveys on the concerns of first-line clinicians. We conducted a comprehensive search and review of the literature. A grading of recommendations' assessment, development, and evaluation system was adopted to rate the quality of evidence and the strength of recommendations. Recommen-dations were formulated based on the evidence, overall balance of benefits and harms (at individual and population levels), patient/health worker values and preferences, re-sources available, cost-effectiveness, and feasibility. Even-tually, recommendations related to 13 main clinical concerns were developed, covering diagnostic criteria, treatment in-dications, antiviral therapy choice, timing to initiate and discontinue treatment, immunoprophylaxis strategy at birth, and how to deal with special situations, such as unintended pregnancy, assisted reproduction, and breastfeeding. The guidelines are intended to serve as guidance for clinicians and patients, to optimize the management of majority of pregnant women who are positive for hepatitis B surface antigen. Guideline registration: International Practice Guide Registration Platform (IPGRP-2018CN040).