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PubMed1999

[Classification of the adolescent idiopathic scoliosis and preoperative strategy].

The authors analysed 841 patients (83% girls and 17% boys) with adolescent idiopathic scoliosis. 678 patients (group I) were treated with the Harrington technique and 163 patients (group II) were treated using multisegmental instrumentation. Follow-up time in group I was on average 14.2 years, and 28 months in group II. Preoperative assessment of patients in group was based on clinical and radiological examination. Assessment of the spine was mainly based on coronal radiogram done in an upright position and lateral side-bending radiograms in a supine position. Traction and lateral X rays were rarely taken into account in this study. The fusion area was decided according to the end vertebrae of the structural curves. The caudal end of the fusion area was identified using Harrington's stable zone. The curves were classified in accordance with the SRS suggestions. Taking into account the apex of the curve, the deformations were classified into: cervico-thoracic, thoracic, thoraco-lumbar, lumbar and lumbo-sacral curves. In group II the triplanar (3D) character of the deformity was taken into account. In the coronal plane the upper and lower stable vertebra of the major structural curves were identified using the CSVL (Central Sacral Vertical Line) based on long films (70 cm x 110 cm) with and without traction. Lumbar curve was classified as mild, moderate, severe according to CSVL. In the axial plane vertebral rotation was assessed according to Nash and Moe method. A careful analysis of lateral radiograms in the upright standing position was performed. Lateral radiograms were performed also in maximal flexion and hyperextension of the spine to obtain a dynamic evaluation of the sagittal plane. Conoral radiograms with maximal rotation of the trunk to assess mobility of the caudad segments of the deformity. Classification of the scoliotic deformity based on its triplanar character included: thoracic curves (King III, IV, V types), double major (thoracic and lumbar), "false" double major curve (thoracic and lumbar) King type II, thoracolumbar/lumbar curves--the main curve is thoracolumbar lumbar/thoracolumbar curves--the main curve is lumbar--10 degrees the thoracolumbar component--King type I triple major curve--all curves have similar structural changes. Correct identification of the type of scoliosis, assessment of structural changes in the frontal, sagittal and axial plane (three dimensional 3D) and analysis of the size and correctiveness of the lumbar curve and all parameters which play a key role in rational preoperative planning. Redefining or at least maintaining lumbar lordosis is far more important than correction of thoracic kyphosis.

Adolescent↗

PubMed1999

Hospital cuts length of stay for vent patients by 34%.

By implementing an innovative set of ventilator protocols, case managers at Nash General Hospital in Rocky Mount, NC, have cut length of stay for ventilator patients by 34%, reduced the average duration of mechanical ventilation by 38%, and saved the hospital an average of $35,000 in charges per ventilator patient. Elements of the protocol include using pulse oximetry in place of autologous blood gases when possible, performing a chest X-ray and initiating tube feeding immediately after the patient is placed on the ventilator, taking sputum cultures to determine a baseline for organism growth and the need for antibiotics, and weaning the patient at certain oxygen levels. Ventilator collaborative team members are also examining the possibility of adding a kinetic therapy element to the protocols.

Case Management↗

PubMed2001

[Non-alcoholic steatohepatitis].

BACKGROUND: There is a growing interest in nonalcoholic steatohepatitis (NASH), a disease entity which is quite similar to alcoholic liver disease. MATERIAL AND METHODS: We present three patients with nonalcoholic steatohepatitis, and review current opinion on this disease entity. RESULTS: Non-alcoholic steatohepatitis is very often associated with the insulin resistance syndrome. There is also an association with hepatic iron overload. In one of our patients, biochemical improvement occurred after treatment with phlebotomy. Insulin resistance, resulting in fat accumulation, seems to be an important first step in the pathogenesis. Free fatty acids, iron, and other sources of oxidative stress probably result in cell damage. In some patients, these events result in necroinflammation mediated by various cytokines and immunoactive cells. The prognosis in pure steatosis is usually good. Presence of necroinflammation or fibrosis indicates a risk of progressive liver disease, including cirrhosis.

Adult↗

PubMed2001

[Effect of some ADH inhibitors on microsomal alcohol oxidizing system activity in vitro].

The treatment of methanol intoxication usually focuses on prevention of methanol conversion to its toxic metabolites due to administration of ethanol or 4-methylpyrasole (4-MP). Nevertheless there is a need for new measures treatment of methanol intoxication. For this reason the influence of some alcohol dehydrogenase inhibitors on the activity of microsomal alcohol oxidising system (MAOS) with methanol as a substrate was assayed. In the present study MAOS activity was measured spectrophotometrically in vitro at physiological pH 7.4 and 37 degrees C, assaying the degree of methanol oxidation. The quantity of arising formaldehyde was measured according with the method of Nash. The source of enzyme was hepatic slices. Our results have shown that MAOS activity was inhibited to different extents by: 4-MP, isovaleric amide, cimetidine, DMSO, EDTA, o-phenantroline, pyrasole and theophylline at concentrations of 0.01 mmol/l, 0.10 mmol/l 1.00 mmol/l. And methylene blue, acetyl-L-carnitine and penicillamine increase MAOS activity in the process of methanol oxidation. In summary, 4-MP which plays an important role as an antidote in methanol intoxication was not an effective MAOS inhibitor. EDTA was found to be a highly effective inhibitor at all investigated concentrations.

Alcohol Dehydrogenase↗

PubMed2002

[Non-alcoholic steatohepatitis: a childhood case].

INTRODUCTION: A significant part of cryptogenic cirrhosis among adult patients shows that it can be the result of "burn-out" non-alcoholic steatohepatitis beginning in childhood. AIM: Describing the case of a 15-year-old boy the aim of the authors is to raise attention to the fact that doctors should think of the possibility of having a fatty liver in presence of certain etiological features. PATIENT: Although he was asymptomatic, the screening test revealed an elevated serum aspartate aminotransferase level. Abdominal ultrasound examination raised the possibility of a diffuse liver damage. The liver biopsy demonstrated the features of steatosis in the absence of alcohol abuse. RESULTS: On the basis of these results, NASH was diagnosed. The presence of a severe fatty liver at such an early age is quite unusual. In the background, the authors verified familial combined hyperlipidaemia and heterozygous mutation of the cystic fibrosis gene for delta F508 as genetic predisposing factor. The clinical condition was accelerated and worsened by the fact, that the patient has grown fat since his infancy. It did not prove possible to achieve a weight reduction with a fat- and cholesterol-poor diet, increased physical activity and medical treatment. However, there was significant improvement in the laboratory findings. CONCLUSIONS: The conclusion drawn from this case, on one hand, is that doctors should think of the possibility of a fatty liver in case of an elevated isolate serum transaminase level in connection with obese or over weight patients. On the other hand the role of other coexisting etiological features must emerge in the background of severe steatohepatitis.

Adolescent↗

PubMed2002

[Clinico-morphological changes of the liver in patients with dyslipoproteinemia].

At present the disorders of lipid metabolism and connected diseases are studied insufficiently. Some disorders with the basis of lipid metabolism disorders are combined into the lipid distress-syndrome. The clinical study of 60 patients with expressed dislipoproteidemia (48 female and 12 male) in the age 46-79 years were made by the clinical observation, estimation of biochemical indexes, lipid blood spectrum, viral hepatitis markers, ultrasonic and liver biopsy. Obtained results showed that the patients with dislipoproteidemia had the expressed liver disorders which were typical for the clinical-morphological characteristics of non-alcoholic steatohepatitis. In patients with cardio-vascular pathology, atherosclerosis and dislipoproteidemia in 90% of cases the detected liver dystrophy can be considered as pre-stage of NASH.

Aged↗

PubMed2001

Three-dimensional correction of scoliosis using TSRH instrumentation.

OBJECTIVE: To evaluate the results of TSRH instrumentation in the correction of coronal, sagittal and rotational deformity of scoliosis. METHODS: From January 1998 to December 1999, thirty-two consecutive patients (6 males, 26 females)with scoliosis underwent anterior or posterior spinal instrumentation and fusion using TSRH instrumentation. Of these cases, 21 were idiopathic scoliosis and 11 were congenital scoliosis. The average age at surgery was 16.4 years (range, 11 approximately 45 years). The mean Cobb angle at surgery was 71.2 degrees range, 44 degrees approximately 125 degrees) in the coronal plane, and 49. degrees range, 16 degrees aprroximately 67degrees in the sagittal plane. Rotational deformity (Nash-Moe) ranged from I to III degree. Preoperative apical translation averaged 4.8 cm (range, 3 approximately 9 cm). RESULTS: The average follow-up duration was 13.3 months (range, 10 approximately 24 months). At the final follow-up, the mean Cobb angle in the coronal plane was 26.6 (range, 10 degrees approximately 73 degrees), with a 63.8% of improvement. Sagittal alignment was well maintained with a mean Cobb angle of 28 degrees (range, 10 degrees approximatelky 45 degrees). The average correction of rotation of the apical vertebra was I degree. The average apical translation was 1.6 cm (range, 0.5 approximately 5.0 cm) representing a correction rate of 66, 7%. Complication was noted in two cases with an incidence of 3.1%, one case had superficial infection and the other one had lower hook dislocation. There was no neurologic deficit and pseudoarthrodesis in this series. CONCLUSION: TSRH instrumentation is an effective and convenient three-dimensional correction system with a lower rate of complication, which can not only correct the coronal and rotational deformity, but maintain the sagittal alignment as well.

Adolescent↗

PubMedDate not supplied

Experimental observations and clinical implications of fasting and diet supplementation in fatty livers.

Fatty accumulation per se does not appear to affect liver function; however, interest has recently renewed to fatty liver because of the clinical relevance of non alcoholic steato-hepatitis (NASH) and for the increased risk of post-transplant failure in grafted livers with steatosis. Clinical and experimental studies have doubtless demonstrated that oxidative stress ensues in steatotic livers. Mitochondria represent the preferential target of the oxidative injury associated to fatty degeneration and show reduced content of glutathione, higher levels of oxidative products and damages to enzymes involved in the process of ATP synthesis, which become more evident under stressing conditions. Although obese patients with fatty liver are advantaged by weight loss, clinical and experimental observations suggest that fatty livers poorly tolerate excessive food deprivation. These observations represent the rationale for treatment strategies based on the supplementation of antioxidants and energetic substrates rather than solely a diet restriction. This review focuses on data emerging from a series of investigations performed in rats with fatty livers induced by a choline-deficient diet, which resembles human steatosis due to an excessive intake of carbohydrates, and aims to give the cue for the development of therapeutic options able to preserve hepatic function after transplantation of steatotic organs.

Animals↗

PubMed1956

Susceptibility of malaria vectors to DDT in Greece; laboratory findings.

The authors describe an investigation, started in Greece in the autumn of 1953 and continued during the 1954 malaria-transmission season, to determine the variations in the susceptibility to DDT of the anophelines in different localities, with a view to establishing a point of departure which would make it possible to follow any future changes in susceptibility to this insecticide.The degree of susceptibility of the mosquitos to DDT was assessed numerically by both the technique of topical application of microdoses of the insecticide and the technique devised by Busvine & Nash. The villages of Elos and Asterion (Skála area), the Agoulinitsa area, and the Georgioupolis (Crete) area were chosen for the investigation.The findings disclosed considerable differences in the susceptibility to DDT in the above areas, but showed that, on the whole, the tendency for anophelines to acquire resistance to DDT seemed to be continuing in Greece.

Animals↗

PubMed2003

Serum levels of acute phase proteins in patients with nonalcoholic steatohepatitis.

BACKGROUND/AIMS: A simple and practical method of detecting the degree of the inflammatory response during the development of nonalcoholic steatohepatitis has not been developed to date. In this study the serum levels of acute phase proteins in patients with nonalcoholic steatohepatitis and whether these levels had any relationship with histopathological findings in the liver were evaluated. METHODS: The study included 18 patients with NASH diagnosed by liver biopsy (13 males and five females with a mean age of 44 years) and 16 healthy volunteers as a control group (11 males and five females, with a mean age of 40 years). The serum levels of C-reactive protein, C-reactive ceruloplasmin, ferritin, transferrin, alpha-1-acid glycoprotein, alpha-2-macroglobulin, alpha-1-antitripsin, albumin, haptoglobulin and lipoprotein (a) were determined by nephelometric method in both groups. In patients with nonalcoholic steatohepatitis, liver histopathology was assessed using a modified scoring system based on the classification defined by Brunt. RESULTS: Serum C-reactive, ferritin, alpha-2-macroglobulin and ceruloplasmin concentrations in patients with nonalcoholic steatohepatitis were significantly higher than those of the control group (p=0.0001, p=0.001, p=0.007, p=0.01 respectively), but serum transferrin, albumin, haptoglobin, alpha-1-acid glycoprotein, alpha-1-antitripsin and lipoprotein (a) levels were not different. There was no difference in C-reactive protein levels regarding the degree of hepatic steatosis and inflammation and the stage of liver fibrosis. Acute phase proteins had no correlation with liver histology. CONCLUSIONS: Measurement of serum C-reactive protein, ferritin, ceruloplasmin and alpha-2-macroglobulin levels may be useful in assessing patients at risk of nonalcoholic steatohepatitis and those with high C-reactive protein and ferritin but normal transferrin should be considered for liver biopsy.

Acute-Phase Proteins↗

PubMed2002

[Lipoxygenase-mediated N-demethylation of pesticides in vitro].

OBJECTIVE: In order to explore the pathway of dealkylation of pesticides other than cytochrome P450 monocoxygenases, lipoxygenase (LOX)-mediated demethylation of aminocarb and some other pesticides were measured. METHOD: Formaldehyde generated in the reaction was estimated by Nash reaction to express the rate of demethylation of pesticides mediated by soy lipoxygenase (SLO). RESULTS: N-demethylation of aminocarb mediated by SLO was found to depend on the incubation time, concentration of the enzyme, concentration of aminocarb and hydrogen peroxide. Under optimal conditions, Vmax value of 18 nmol of formaldehyde.min-1.nmol-1 of lipoxygenase was observed. The reaction exhibited Km values of 3.4 mmol/L for aminocarb and 235 mumol/L for hydrogen peroxide. A strong inhibition of the reaction by nordihydroguaiaretic acid, gossypol, and phenidone clearly implicated the lipoxygenase involvement as the protein catalyst. A significant decline in the formaldehyde accumulation in the presence of either reduced glutathione or dithiothreitol suggested generation of a free radical species as an initial oxidation intermediate during the demethylation of aminocarb by SLO. The inhibition of formaldehyde generation by butylated hydroxyanisole(BHT) and butylated hydroxy toluene(BHA) further supported this contention. In addition to aminocarb, seven other pesticides were also found to undergo N-demethylation, albeit at relatively low rates. CONCLUSION: Certain pesticides may oxidatively undergo dealkylation via the lipoxygenase pathway in animals and plants.

Butylated Hydroxyanisole↗

PubMed2003

[Activity of catalase after administration of some ADH and MEOS inhibitors: in vitro investigation in rat liver homogenates].

In the first pass methanol biotransformation three enzymatic systems: alcohol dehydrogenase (ADH), microsomal alcohol oxidising system (MEOS) linked with cytochrome P-450 and catalase are involved. Because of the toxicity of methanol, which is directly caused by its toxic metabolites, the major task in clinical toxicology is to inhibit each of these enzymes to protect human life. The aim of this investigation was to check the influence of some effective inhibitors of ADH and MEOS: 4-methylpyrazole, cimetidine, EDTA and 1,10-phenantroline on the activity of catalase with methanol as a substrate and the comparison with 3-amino-1,2,4-triasole. Catalase activity in rat hepatic homogenates was measured spectrophotometrically in vitro at physiological pH 7.4 and temp. 37 degrees C, assaying the degree of methanol oxidation according to Handler and Thurman. The quantity of arising formaldehyde was measured according with the method of Nash. Our results have shown that catalase activity was inhibited to different extents by all investigated compounds at concentrations of 10(-3) mol/l, 2 x 10(-4) mol/l, 10(-4) mol/l, 2 x 10(-5) mol/l, 10(-5) mol/l. 1,10-Phenantroline was found to be a highly effective inhibitor in comparison with aminotriasole. 4-Methylpyrazole, EDTA, 1,10-phenantroline and aminotriasole are catalase competitive inhibitors and cimetidine is non-competitive inhibitor. 4-Methylpyrazole has shown higher affinity to the enzyme than aminotriasole.

Alcohol Dehydrogenase↗

PubMed2004

[The trace element status in patients with chronic hepatic diseases].

Despite of the achievements of pharmacology it is very actually to improve the diagnosis and therapy of different chronic hepatic diseases. The purpose of the investigation is to study trace element (TE) status in patients with chronic hepatic diseases for estimating the possibility of therapy efficiency improvement. 102 patients with chronic hepatic diseases, aged from 19 to 60 were clinically and laboratory investigated. Group 1 (36 patients) suffered from alcoholic liver cirrhosis, group 2 (35 patients) had chronic alcoholic steatohepatitis and group 3 (31 patients) had non-alcoholic steatohepatitis (NASH). Multielement blood plasma analysis by ICP-MS and ICP-OES was perfomed in the Center of Biotic Medicine (Moscow). The results showed the significant changes in TE status in patients with chronic hepatic diseases that proves the expediency of studying both the essential and toxic element in such patients to improve the diagnosis and to optimize the treatment. Patients with chronic hepatic diseases are characterized by changing of such elements as Al, Ca, Cu, K, Se, Zn, that leads to necessity of using them for diagnosis.

Adult↗

PubMed2004

A distributed non-point source pollution model: calibration and validation in the Yellow River Basin.

The applicability of a non-point source pollution model--SWAT(soil and water assessment tools) in a large river basin with high sediment runoff modulus(770 t/km2 in the Yellow River) was examined. The basic database, which includes DEM, soil and landuse map, weather data, and land management data, was established for the study area using GIS. A two-stage "Brute Force" optimization method was used to calibrate the parameters with the observed monthly flow and sediment data from 1992 to 1997. In the process of calibration automated digital filter technique was used to separate direct runoff and base flow. The direct runoff was firstly calibrated, and the base flow, then the total runoff was matched. The sediment yield was calibrated to match well. Keeping input parameters set during the calibration process unchanged, the model was validated with 1998--1999's observed monthly flow and sediment. The evaluation coefficients for simulated and observed flow and sediment showed that SWAT was successfully applied in the study area: relative error was within 20%, coefficient of determination and Nash-Suttcliffe simulation efficiency were all equal to or above 0.70 during calibration and validation period.

Calibration↗

PubMed1992

Mutagenesis of the amino terminus of the alpha subunit of the G protein Go. In vitro characterization of alpha o beta gamma interactions.

Heterotrimeric guanine nucleotide-binding proteins are composed of alpha and beta gamma subunits and couple a variety of cell-surface receptors to intracellular enzymes or ion channels. The heterotrimer dissociates into alpha and beta gamma subunits when the alpha subunit is activated by guanine nucleoside triphosphates. Several lines of evidence show that the amino terminus of the alpha subunit is important for the interaction with the beta gamma subunit (Neer, E. J., Pulsifer, L., and Wolf, L. G. (1988) J. Biol. Chem. 263, 8996-9000; Fung, B. K.-K., and Nash, C. R. (1983) J. Biol. Chem. 258, 10503-10510). We have mutagenized the amino terminus of alpha o to dissect the relative contributions of amino-terminal myristoylation and specific amino acid sequences to subunit interaction. Wild-type and mutant alpha o cDNAs were translated in vitro in a rabbit reticulocyte lysate. All proteins were able to bind guanosine 5'-(gamma-thio)triphosphate and to achieve the necessary conformation for protection from tryptic digestion. Two assays of alpha o beta gamma interactions were used: sucrose density gradients to look for stable heterotrimer formation and ADP-ribosylation by pertussis toxin to detect weak or transient alpha o beta gamma interactions. Our results indicate that myristoylation is essential for stable heterotrimer formation, but that nonmyristoylated proteins are also capable of interacting with the beta gamma subunit. Amino acids 7-10 have an important role in alpha o beta gamma interactions whether alpha o is myristoylated or not. Deletion of this region diminishes the ability of alpha o to interact with the beta gamma subunit, but substitutions at this position indicate that other amino acids can be tolerated without affecting subunit interaction.

Adenosine Diphosphate Ribose↗

PubMedDate not supplied

[Hepatitis-C infection and hepatic steatosis].

The mechanism by which hepatitis C virus (HCV) causes chronic, progressive liver damage is unknown. Factors other than the virus itself have been implicated. The role of liver steatosis has been recently studied. Hepatic steatosis is a common histologic finding occurring in >50% of patients with chronic hepatitis C. Both host and viral factors have been demonstrated to play an important role in its development. In patients infected with genotype 1, steatosis appears due to co-existence of Non-alchoholic steatohepatitis (NASH) with HCV and associated with increased body mass index (BMI). Some recent observations suggest that steatosis may be of viral origin and related to genotype 3. This fact raises the possibility of a direct effect of specific viral sequences on the pathogenesis of lipid accumulation. Furthermore, hepatic steatosis attributed to genotype 3 correlates directly with serum and intrahepatic titers of HCV RNA. Resolution of steatosis after successful antiviral therapy as well as steatosis being a sign of recurrent HCV infection in patients with genotype 3 add convincing evidence that steatosis is viral-related. The pathogenic mechanism induced by genotype 3 is speculative. Correlation between steatosis, intrahepatic HCV RNA, and core protein expression suggest a direct effect. Further support is provided by the finding that HCV core protein induces steatosis in transgenic mice. Another possibility relates to interaction with hepatic triglyceride turnover. In conclusion, for patients infected with genotype 1 BMI plays a role in the pathogenesis of steatosis, while in those infected with genotype 3 steatosis may be due to a virus-specific cytopathic effect. Regardless of etiology, the contribution of both to liver fibrosis progression appears to be accepted.

Fatty Liver↗

PubMed2005

CYP17 polymorphism as a risk factor of tamoxifen-induced hepatic steatosis in breast cancer patients.

Oral administration of tamoxifen, an endocrine therapy for breast cancer, often induces hepatic steatosis (THS, tamoxifen-induced hepatic steatosis) as a complication, which can progress to non-alcoholic steatohepatitis (NASH). The development of this complication is strongly associated with three clinical risk factors; specifically, insulin resistance, central obesity, and hypertriglyceridemia, however a genetic predisposition to THS has yet to be investigated. The aim of this study is to determine whether genetic polymorphism of the P450c17alpha enzyme coded for by the CYP17 gene, responsible for regulating serum estrogen, has an association with THS. After obtaining informed consent from 180 eligible breast cancer patients treated with tamoxifen, DNA was collected and analyzed by restriction fragment length polymorphism assay and classified into alleles defined as A1 and A2. The absence or presence and extent of THS was evaluated by calculating the liver/spleen (L/S) ratio based on Hounsfield units with a CT scanner. Administration of tamoxifen led to THS (L/S ratio <0.9) in 57 (31.7%) of 180 patients while the remaining 123 (68.3%) patients did not develop THS. A significant difference in the distribution of CYP17 genotypes was observed between patients who developed THS and those who did not (P=0.021). A significantly higher frequency of the A2 allele was seen in the THS group (odds ratio, 1.90; 95% confidence interval, 1.21-2.99). Our study provides the first evidence that CYP17 polymorphism participates in the development of THS, and sheds light on the genetic causes of this side effect and genetic differences between tamoxifen-treated individuals.

Adult↗

PubMed2005

[Relationship between the severity of liver damage and the serum leptin level for nonalcoholic fatty liver disease].

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of conditions that are mainly characterized histologically by macrovesicular hepatic steatosis. There are two histologic patterns of NAFLD: simple steatosis alone and steatohepatitis. The factors leading from simple steatosis to nonalcoholic steatohepatitis (NASH) are still obscure. The datas from several studies have suggested that leptin could be involved in the progression from hepatic steatosis to steatohepatitis including the fibrosis. We evaluated serum leptin levels in patients with NAFLD to determine whether any relationships existed between the leptin levels and the severity of hepatic inflammation or fibrosis. METHODS: We studied 62 patients with NAFLD who were diagnosed at the Hallym University Sacred Heart Hospital from July 2001 to May 2004. We measured the serum leptin level in all cases and liver biopsy samples were obtained from 31 cases. The liver biopsy specimens were graded according to methods described by Brunt. Spearman rank correlations were used to detect the associations between the serum leptin and the various anthropometric and biochemical variables. The relationship between the histologic severity and the serum leptin level was evaluated with logistic regression analysis. RESULTS: Serum leptin levels correlated with insulin, c-peptide, ALT and homeostasis model assessment insulin resistance, but not with BMI, age and gender. Serum leptin level also correlated with hepatic fibrosis, but not with hepatic steatosis or inflammation. However, the serum leptin level was not a significant independent predictor of the grade of hepatic steatosis, inflammation and fibrosis on the univariate analysis. CONCLUSIONS: The serum leptin level was not an independent predictor of the severity of liver damage in NAFLD.

Adolescent↗