Although fuzzy set concepts have evolved,neutrosophic sets are attractingmore attention due to the greater power of the structure of neutrosophic sets.The ability to account for components that are true,false or neith...Although fuzzy set concepts have evolved,neutrosophic sets are attractingmore attention due to the greater power of the structure of neutrosophic sets.The ability to account for components that are true,false or neither true nor false is useful in the resolution of real-life problems.However,simultaneous variations render neutrosophic sets unsuitable in specific circumstances.To enable the management of these sorts of issues,we combine the principle of multi-valued neutrosophic uncertain linguistic sets and complex fuzzy sets to develop the principle of multivalued complex neutrosophic uncertain linguistic sets.Multi-valued complex neutrosophic uncertain linguistic sets can contain grades of truth,abstinence,and falsity,and uncertain linguistic terms,which are expressed as complex numbers whose real and imaginary parts are limited to the unit interval.Some important Dombi laws are elaborated along with Bonferroni mean operators,which offer a flexible general structure with modifiable factors.Bonferroni means aggregation operators perform a significant role in conveying the magnitude level of options and characteristics.To determine relationships among any number of attributes,we develop multi-valued complex neutrosophic uncertain linguistic Dombi-normalized weighted Bonferroni mean operators and discuss their important properties with some special cases.By using these laws,we can deploy themulti-attribute decisionmaking(MADM)technique using the novel principle of multi-valued complex neutrosophic uncertain linguistic sets.To determine the power and flexibility of the elaborated approach,we resolve some numerical examples based on the proposed operator.Finally,the work is validated with the help of comparative analysis,a discussion of its advantages,and geometric expressions of the elaborated theories.展开更多
Nowadays,the use of renewable energies,especially wind,solar,and biomass,is essential as an effective solution to address global environmental and economic challenges.Therefore,the current study examines the energy-ec...Nowadays,the use of renewable energies,especially wind,solar,and biomass,is essential as an effective solution to address global environmental and economic challenges.Therefore,the current study examines the energy-economic-environmental analysis of off-grid electricity generation systems using solar panels,wind turbines,and biomass generators in various weather conditions in Iran.Simulations over 25 years were conducted using HOMER v2.81 software,aiming to determine the potential of each region and find the lowest cost of electricity production per kWh.In the end,to identify the most suitable location,the Technique for Order Preference by Similarity to Ideal Solution(TOPSIS)method was employed to rank different stations based on simulation output parameters and some other influential factors.Considering the evaluation of various parameters,the stations in Yazd,Marand,and Dezful achieved the best results,while the stations in Ramsar,Shahrekord,and Gonbad presented the least favorable outcomes.In Yazd,the wind turbine is an economic priority,and a 100 kW wind turbine is utilized in the optimal system.In Yazd,where the simultaneous use of renewable energies is most prominent,the lowest pollutant production occurred with a quantity of 1174 kg/year.Annual energy losses are highest in Jask station and lowest in Yazd.展开更多
[Objectives]Metabolic obese normal weight(MONW)is becoming one of the pubic problems which are threatening human health.Whereas,MONW was facing a great challenge for limited attention,especially for the female in Chin...[Objectives]Metabolic obese normal weight(MONW)is becoming one of the pubic problems which are threatening human health.Whereas,MONW was facing a great challenge for limited attention,especially for the female in China.The aim of this research was to estimate the prevalence of MONW and its related risk components in South China.[Methods]A community-based cross-sectional study was performed on 3349 residents aged 18-93 years in The First Affiliated Hospital of Jinan University,Guangzhou,China,in 2019.Data was collected by physical examination data which included physical measurements and laboratory examinations.[Results]In all subjects,55%were females(M/F=1509/1840).The prevalence of MONW was 16.09%(0.04%for male,16.05%for female,P<0.001).The prevalence increased significantly with increasing age in both genders(P<0.001).The binary logistic regression analysis shows that among the risk factors with MONW,age,BMI,gender,systolic pressure,hypertension[Male:ORs=2.56,95%CI(1.23,5.32);Female:ORs=2.88,95%CI(1.76,4.71)]and hypertriglyceridemia[Male:ORs=3.23,95%CI(1.67,6.19);Female:ORs=2.57,95%CI(1.64,4.03)]were found to be statistically significant.The level of ALT in MONW group was(27.88±15.85)in male and(24.33±15.75)in female,which were significantly higher than those in the non-MetS group.[Conclusions]The prevalence of MONW was pretty high.We considered MONW be significantly associated with the increase of ALT.Female gender,advanced age,and elevated ALT were independent risk factors for MONW.It was high time that the government should raise the public attention toward metabolic function in normal weight population.Effective prevention and treatment strategies for MONW and its risk factors should be developed targeting different ages and genders.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Vitamin D has an immuo...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Vitamin D has an immuomodulatory role in vaccine response and this may be mediated via its action on antigen presenting cells with the most potent effects on dendritic cells. </span><b><span style="font-family:Verdana;">Aim of work</span></b><span style="font-family:Verdana;">: was to determine if there is an association between circulating 25(OH)D concentrations and BCG vaccine cytokine response (interferon gamma) level. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: A cross sectional study included 80 infants aged 4 - 9 months from the pediatric outpatient clinic of Al-Zahraa university hospital (40 with normal weight and 40 with </span><span style="font-family:Verdana;">underweight). Participants were subjected to history taking, clinical examination, and laboratory investigations, particularly 25 hydroxy vitamin D [25(OH)D]</span><span style="font-family:Verdana;"> and BCG vaccine-induced interferon gamma (IFN-</span><i><span style="font-family:Verdana;">γ</span></i><span style="font-family:Verdana;">). </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: The study showed that the underweight group had a lower socioeconomic level and higher percentage of breastfeeding compared with the normal weight group. Most infants in our study received vitamin D supplementation (80% and 62.5% in normal and underweight groups, respectively). The average serum level of 25(OH)D was relatively high (>100 ng/ml) in both</span><a name="_Hlk34497752"></a><span style="font-family:Verdana;"> normal and underweight groups. The mean levels of IFN-</span><i><span style="font-family:Verdana;">γ</span></i><span style="font-family:Verdana;"> in response to BCG vaccine were not significantly different between the normal and underweight groups of infants in our study. Also, there was a statistically-significant moderate correlation between serum levels of 25(OH)D and BCG vaccine-induced IFN-</span><i><span style="font-family:Verdana;">γ</span></i><span style="font-family:Verdana;"> in both normal (r = 0.58) and underweight (r = 0.64) groups. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: A good vitamin D status was observed in all studied infants irrespective of their nutritional status and significant correlation with BCG vaccine induced IFN-</span><i><span style="font-family:Verdana;">γ</span></i><span style="font-family:Verdana;">.展开更多
Statistical Quality Control (SQC) is used to analyze and monitor quality characteristic measurements of normal neonatal weight in a maternity clinic in Banjarmasin in this paper. The objective of this study is to as...Statistical Quality Control (SQC) is used to analyze and monitor quality characteristic measurements of normal neonatal weight in a maternity clinic in Banjarmasin in this paper. The objective of this study is to assist medical practitioners in observing pregnant women to deliver their babies with normal weight. It is also assumed that pregnant women who delivered their babies in the clinic have been monitored during their nine-month pregnancy. Thus, they can manage their own pregnancy to deliver normal weight babies. The use of Statistical Process Control (SPC) tools, such as frequency histogram, probability plot, and the implementation of Shewhart, R, and S control charts as primary techniques, are presented to display the monitoring aspects of the process. In addition, Process Capability Analysis (PCA) is performed to ensure that the process outcomes are capable of meeting certain requirements or specifications. The Process Capability Ratio (PCR) for the process is also presented. This analysis is an essential part of an overall quality improvement program.展开更多
A metabolically healthy status,whether obese or not,is a transient stage with the potential to develop into metabolic disor-ders during the course of life.We investigated the incidence of metabolic disorders in 1078 m...A metabolically healthy status,whether obese or not,is a transient stage with the potential to develop into metabolic disor-ders during the course of life.We investigated the incidence of metabolic disorders in 1078 metabolically healthy Chinese adults from the Shanghai Changfeng Study and looked for metabolites that discriminated the participants who would develop metabolic disorders in the future.Participants were divided into metabolically healthy overweight/obesity(MHO)and meta-bolically healthy normal weight(MHNW)groups according to their body mass index(BMI)and metabolic status.Their serum metabolomic profile was measured using a ^(1)H nuclear magnetic resonance spectrometer(^(1)H-NMR).The prevalence of diabetes,hypertriglyceridemia,hypercholesterolemia and metabolic syndrome was similar between the MHNW and MHO participants at baseline.After a median of 4.2 years of follow-up,more MHO participants became metabolically unhealthy than MHNW participants.However,a subgroup of MHO participants who remained metabolically healthy(MHO→MHO)had a similar prevalence of metabolic disorders as the MHNW participants at the follow-up examination,despite a signifi-cant reduction in their serum concentrations of high-density lipoprotein(HDL)and an elevation in valine,leucine,alanine and tyrosine.Further correlation analysis indicated that serum intermediate-density lipoprotein(IDL)and very low-density lipoprotein cholesterol(VLDL-CH)might be involved in the transition from metabolically healthy to unhealthy status and could be valuable to identify the MHNW and MHO with increased metabolic risks.展开更多
Let n>1 and B be the unit ball in n dimensions complex space C^(n).Suppose thatφis a holomorphic self-map of B andψ∈H(B)withψ(0)=0.A kind of integral operator,composition Cesàro operator,is defined by T_(...Let n>1 and B be the unit ball in n dimensions complex space C^(n).Suppose thatφis a holomorphic self-map of B andψ∈H(B)withψ(0)=0.A kind of integral operator,composition Cesàro operator,is defined by T_(φ)ψ(f)(z)=∫^(1)0f[φ(tz)]Rψ(tz)dt/t,f∈(B)z∈B.In this paper,the authors characterize the conditions that the composition Cesàro operator T_φ,ψis bounded or compact on the normal weight Zygmund space Z_μ(B).At the same time,the sufficient and necessary conditions for all cases are given.展开更多
This study discusses about the optimization of spray characteristics of biodiesel fuel in a spray chamber.Three factors namely,fuel injection pressure,fuel temperature and fuel blends were chosen as the influencing fa...This study discusses about the optimization of spray characteristics of biodiesel fuel in a spray chamber.Three factors namely,fuel injection pressure,fuel temperature and fuel blends were chosen as the influencing factor for the set objective.Four levels were chosen in each factor and spray tip penetration,spray cone angle and Sauter mean diameter(SMD) were taken as the response variables.Experiments were designed by employing design of experiments method and Taguchi full factorial array was used to conduct the tests with different levels of the chosen factors.Multi Response Signal to Noise ratio(MRSN) was calculated for the response variables and the optimum combination level of factors was obtained simultaneously using Taguchi's parametric design.Confirmation experiments were conducted for the obtained optimum combination level of factors and the results were compared with the normal operating conditions and significant improvement were observed in the response variables.展开更多
Let p>0 andνbe a normal function on[0,1).In this paper,several equivalent characterizations are given for which composition operators are bounded or compact on the normal weight Dirichlet type space D_(ν)^(p)(D)i...Let p>0 andνbe a normal function on[0,1).In this paper,several equivalent characterizations are given for which composition operators are bounded or compact on the normal weight Dirichlet type space D_(ν)^(p)(D)in the unit disc.展开更多
A Finite Difference Method with four points weighted implicit scheme and Newton-Raphson iteration method are introduced to complete the flood routing in the tidal river. The problems related to normalization of cross-...A Finite Difference Method with four points weighted implicit scheme and Newton-Raphson iteration method are introduced to complete the flood routing in the tidal river. The problems related to normalization of cross-sectional area and optimization of weighting factor α are discussed and α = 0. 5 - 0. 7 is suggested. With such a α, high accuracy, stable and convergence results and flexible time step will be expected. The computational example of a tidal river in Liaoning Province shows the good agreement with the measuring data on prototype.展开更多
The epidemiology of nonalcoholic fatty liver disease goes hand-in-hand with the obesity pandemic.The pathogenesis of fatty liver has shifted from an hepatocentric view to an adipocentric view,in which the overloaded a...The epidemiology of nonalcoholic fatty liver disease goes hand-in-hand with the obesity pandemic.The pathogenesis of fatty liver has shifted from an hepatocentric view to an adipocentric view,in which the overloaded adipose tissue spills out lipids that spread to ectopic tissues and organs such as the liver,elicits inflammation,and changes its adipokines profile promoting insulin resistance and the metabolic syndrome.Up to 40%of nonalcoholic fatty liver disease(NAFLD)patients are not obese and up to 20%are actually lean.Furthermore roughly 10%of lean subjects have NAFLD.In fact,adiposopathy can occur in patients with normal weight,and it is associated with expansion of metabolically active visceral fat and a qualitatively different adipose tissue that becomes overwhelmed after challenged by a mildly positive energy balance.This defines the concept of personal fat threshold that when exceeded results in metabolic dysfunction.Overweight/obese persons have higher probability of exceeding that threshold,explaining why adiposopathy/metabolic syndrome/NAFLD is more frequent in the obese.In this article,the epidemiology,pathogenesis,and management of patients with lean NAFLD are reviewed with an emphasis on reconciling the concepts of NAFLD in its relationship with adiposity and of NAFLD in lean individuals.展开更多
文摘Although fuzzy set concepts have evolved,neutrosophic sets are attractingmore attention due to the greater power of the structure of neutrosophic sets.The ability to account for components that are true,false or neither true nor false is useful in the resolution of real-life problems.However,simultaneous variations render neutrosophic sets unsuitable in specific circumstances.To enable the management of these sorts of issues,we combine the principle of multi-valued neutrosophic uncertain linguistic sets and complex fuzzy sets to develop the principle of multivalued complex neutrosophic uncertain linguistic sets.Multi-valued complex neutrosophic uncertain linguistic sets can contain grades of truth,abstinence,and falsity,and uncertain linguistic terms,which are expressed as complex numbers whose real and imaginary parts are limited to the unit interval.Some important Dombi laws are elaborated along with Bonferroni mean operators,which offer a flexible general structure with modifiable factors.Bonferroni means aggregation operators perform a significant role in conveying the magnitude level of options and characteristics.To determine relationships among any number of attributes,we develop multi-valued complex neutrosophic uncertain linguistic Dombi-normalized weighted Bonferroni mean operators and discuss their important properties with some special cases.By using these laws,we can deploy themulti-attribute decisionmaking(MADM)technique using the novel principle of multi-valued complex neutrosophic uncertain linguistic sets.To determine the power and flexibility of the elaborated approach,we resolve some numerical examples based on the proposed operator.Finally,the work is validated with the help of comparative analysis,a discussion of its advantages,and geometric expressions of the elaborated theories.
文摘Nowadays,the use of renewable energies,especially wind,solar,and biomass,is essential as an effective solution to address global environmental and economic challenges.Therefore,the current study examines the energy-economic-environmental analysis of off-grid electricity generation systems using solar panels,wind turbines,and biomass generators in various weather conditions in Iran.Simulations over 25 years were conducted using HOMER v2.81 software,aiming to determine the potential of each region and find the lowest cost of electricity production per kWh.In the end,to identify the most suitable location,the Technique for Order Preference by Similarity to Ideal Solution(TOPSIS)method was employed to rank different stations based on simulation output parameters and some other influential factors.Considering the evaluation of various parameters,the stations in Yazd,Marand,and Dezful achieved the best results,while the stations in Ramsar,Shahrekord,and Gonbad presented the least favorable outcomes.In Yazd,the wind turbine is an economic priority,and a 100 kW wind turbine is utilized in the optimal system.In Yazd,where the simultaneous use of renewable energies is most prominent,the lowest pollutant production occurred with a quantity of 1174 kg/year.Annual energy losses are highest in Jask station and lowest in Yazd.
基金Projects of Administration of Traditional Chinese Medicine of Guangdong Province of China(20182022,20182023,20191083)General Program of the National Natural Science Foundation of China(82074305)Laboratory Construction of Traditional Chinese Medicine of Guangdong Province of China(89017020).
文摘[Objectives]Metabolic obese normal weight(MONW)is becoming one of the pubic problems which are threatening human health.Whereas,MONW was facing a great challenge for limited attention,especially for the female in China.The aim of this research was to estimate the prevalence of MONW and its related risk components in South China.[Methods]A community-based cross-sectional study was performed on 3349 residents aged 18-93 years in The First Affiliated Hospital of Jinan University,Guangzhou,China,in 2019.Data was collected by physical examination data which included physical measurements and laboratory examinations.[Results]In all subjects,55%were females(M/F=1509/1840).The prevalence of MONW was 16.09%(0.04%for male,16.05%for female,P<0.001).The prevalence increased significantly with increasing age in both genders(P<0.001).The binary logistic regression analysis shows that among the risk factors with MONW,age,BMI,gender,systolic pressure,hypertension[Male:ORs=2.56,95%CI(1.23,5.32);Female:ORs=2.88,95%CI(1.76,4.71)]and hypertriglyceridemia[Male:ORs=3.23,95%CI(1.67,6.19);Female:ORs=2.57,95%CI(1.64,4.03)]were found to be statistically significant.The level of ALT in MONW group was(27.88±15.85)in male and(24.33±15.75)in female,which were significantly higher than those in the non-MetS group.[Conclusions]The prevalence of MONW was pretty high.We considered MONW be significantly associated with the increase of ALT.Female gender,advanced age,and elevated ALT were independent risk factors for MONW.It was high time that the government should raise the public attention toward metabolic function in normal weight population.Effective prevention and treatment strategies for MONW and its risk factors should be developed targeting different ages and genders.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:""><span style="font-family:Verdana;"> Vitamin D has an immuomodulatory role in vaccine response and this may be mediated via its action on antigen presenting cells with the most potent effects on dendritic cells. </span><b><span style="font-family:Verdana;">Aim of work</span></b><span style="font-family:Verdana;">: was to determine if there is an association between circulating 25(OH)D concentrations and BCG vaccine cytokine response (interferon gamma) level. </span><b><span style="font-family:Verdana;">Methods</span></b><span style="font-family:Verdana;">: A cross sectional study included 80 infants aged 4 - 9 months from the pediatric outpatient clinic of Al-Zahraa university hospital (40 with normal weight and 40 with </span><span style="font-family:Verdana;">underweight). Participants were subjected to history taking, clinical examination, and laboratory investigations, particularly 25 hydroxy vitamin D [25(OH)D]</span><span style="font-family:Verdana;"> and BCG vaccine-induced interferon gamma (IFN-</span><i><span style="font-family:Verdana;">γ</span></i><span style="font-family:Verdana;">). </span><b><span style="font-family:Verdana;">Results</span></b><span style="font-family:Verdana;">: The study showed that the underweight group had a lower socioeconomic level and higher percentage of breastfeeding compared with the normal weight group. Most infants in our study received vitamin D supplementation (80% and 62.5% in normal and underweight groups, respectively). The average serum level of 25(OH)D was relatively high (>100 ng/ml) in both</span><a name="_Hlk34497752"></a><span style="font-family:Verdana;"> normal and underweight groups. The mean levels of IFN-</span><i><span style="font-family:Verdana;">γ</span></i><span style="font-family:Verdana;"> in response to BCG vaccine were not significantly different between the normal and underweight groups of infants in our study. Also, there was a statistically-significant moderate correlation between serum levels of 25(OH)D and BCG vaccine-induced IFN-</span><i><span style="font-family:Verdana;">γ</span></i><span style="font-family:Verdana;"> in both normal (r = 0.58) and underweight (r = 0.64) groups. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: A good vitamin D status was observed in all studied infants irrespective of their nutritional status and significant correlation with BCG vaccine induced IFN-</span><i><span style="font-family:Verdana;">γ</span></i><span style="font-family:Verdana;">.
文摘Statistical Quality Control (SQC) is used to analyze and monitor quality characteristic measurements of normal neonatal weight in a maternity clinic in Banjarmasin in this paper. The objective of this study is to assist medical practitioners in observing pregnant women to deliver their babies with normal weight. It is also assumed that pregnant women who delivered their babies in the clinic have been monitored during their nine-month pregnancy. Thus, they can manage their own pregnancy to deliver normal weight babies. The use of Statistical Process Control (SPC) tools, such as frequency histogram, probability plot, and the implementation of Shewhart, R, and S control charts as primary techniques, are presented to display the monitoring aspects of the process. In addition, Process Capability Analysis (PCA) is performed to ensure that the process outcomes are capable of meeting certain requirements or specifications. The Process Capability Ratio (PCR) for the process is also presented. This analysis is an essential part of an overall quality improvement program.
基金supported by the Shanghai Municipal Science and Technology Major Project(2017SHZDZX01)the Science and Technology Commission of Shanghai Municipality(16JC1400500).
文摘A metabolically healthy status,whether obese or not,is a transient stage with the potential to develop into metabolic disor-ders during the course of life.We investigated the incidence of metabolic disorders in 1078 metabolically healthy Chinese adults from the Shanghai Changfeng Study and looked for metabolites that discriminated the participants who would develop metabolic disorders in the future.Participants were divided into metabolically healthy overweight/obesity(MHO)and meta-bolically healthy normal weight(MHNW)groups according to their body mass index(BMI)and metabolic status.Their serum metabolomic profile was measured using a ^(1)H nuclear magnetic resonance spectrometer(^(1)H-NMR).The prevalence of diabetes,hypertriglyceridemia,hypercholesterolemia and metabolic syndrome was similar between the MHNW and MHO participants at baseline.After a median of 4.2 years of follow-up,more MHO participants became metabolically unhealthy than MHNW participants.However,a subgroup of MHO participants who remained metabolically healthy(MHO→MHO)had a similar prevalence of metabolic disorders as the MHNW participants at the follow-up examination,despite a signifi-cant reduction in their serum concentrations of high-density lipoprotein(HDL)and an elevation in valine,leucine,alanine and tyrosine.Further correlation analysis indicated that serum intermediate-density lipoprotein(IDL)and very low-density lipoprotein cholesterol(VLDL-CH)might be involved in the transition from metabolically healthy to unhealthy status and could be valuable to identify the MHNW and MHO with increased metabolic risks.
基金supported by the National Natural Science Foundation of China(No.11571104)the Hunan Provincial Innovation Foundation for Postgraduate(No.CX2018B286)。
文摘Let n>1 and B be the unit ball in n dimensions complex space C^(n).Suppose thatφis a holomorphic self-map of B andψ∈H(B)withψ(0)=0.A kind of integral operator,composition Cesàro operator,is defined by T_(φ)ψ(f)(z)=∫^(1)0f[φ(tz)]Rψ(tz)dt/t,f∈(B)z∈B.In this paper,the authors characterize the conditions that the composition Cesàro operator T_φ,ψis bounded or compact on the normal weight Zygmund space Z_μ(B).At the same time,the sufficient and necessary conditions for all cases are given.
文摘This study discusses about the optimization of spray characteristics of biodiesel fuel in a spray chamber.Three factors namely,fuel injection pressure,fuel temperature and fuel blends were chosen as the influencing factor for the set objective.Four levels were chosen in each factor and spray tip penetration,spray cone angle and Sauter mean diameter(SMD) were taken as the response variables.Experiments were designed by employing design of experiments method and Taguchi full factorial array was used to conduct the tests with different levels of the chosen factors.Multi Response Signal to Noise ratio(MRSN) was calculated for the response variables and the optimum combination level of factors was obtained simultaneously using Taguchi's parametric design.Confirmation experiments were conducted for the obtained optimum combination level of factors and the results were compared with the normal operating conditions and significant improvement were observed in the response variables.
基金supported by the National Natural Science Foundation of China(Grant No.11942109).
文摘Let p>0 andνbe a normal function on[0,1).In this paper,several equivalent characterizations are given for which composition operators are bounded or compact on the normal weight Dirichlet type space D_(ν)^(p)(D)in the unit disc.
文摘A Finite Difference Method with four points weighted implicit scheme and Newton-Raphson iteration method are introduced to complete the flood routing in the tidal river. The problems related to normalization of cross-sectional area and optimization of weighting factor α are discussed and α = 0. 5 - 0. 7 is suggested. With such a α, high accuracy, stable and convergence results and flexible time step will be expected. The computational example of a tidal river in Liaoning Province shows the good agreement with the measuring data on prototype.
文摘The epidemiology of nonalcoholic fatty liver disease goes hand-in-hand with the obesity pandemic.The pathogenesis of fatty liver has shifted from an hepatocentric view to an adipocentric view,in which the overloaded adipose tissue spills out lipids that spread to ectopic tissues and organs such as the liver,elicits inflammation,and changes its adipokines profile promoting insulin resistance and the metabolic syndrome.Up to 40%of nonalcoholic fatty liver disease(NAFLD)patients are not obese and up to 20%are actually lean.Furthermore roughly 10%of lean subjects have NAFLD.In fact,adiposopathy can occur in patients with normal weight,and it is associated with expansion of metabolically active visceral fat and a qualitatively different adipose tissue that becomes overwhelmed after challenged by a mildly positive energy balance.This defines the concept of personal fat threshold that when exceeded results in metabolic dysfunction.Overweight/obese persons have higher probability of exceeding that threshold,explaining why adiposopathy/metabolic syndrome/NAFLD is more frequent in the obese.In this article,the epidemiology,pathogenesis,and management of patients with lean NAFLD are reviewed with an emphasis on reconciling the concepts of NAFLD in its relationship with adiposity and of NAFLD in lean individuals.