Xiaoyan Wang1 · Run Yang1 · Jingxiang Li1 · Yongqi Liang2 · Chenxi Jin1 · Yining Xu1 · Xianbo Wu2 · Mengchen Zou1
Received: 4 July 2025 / Accepted: 30 September 2025 / Published online: 15 October 2025 © The Author(s) 2025
Abstract
Background Excess weight is a progressive metabolic epidemic, and inflammation plays an important role in the progres-sion of disease. Insulin resistance (IR) is an important feature of obesity, but it does not reflect systemic inflammation. Cur-rently, there is a lack of effective clinical tools for early risk stratification and intervention in physically active people.
Methods This was a prospective cohort of 72,262 overweight but physically active persons in the UK Biobank. The TyG was combined with hsCRP, waist circumference (WC), or body mass index (BMI) as indices of IR. Adjusted Cox regression, interaction tests, restricted cubic splines (RCS) analysis, Kaplan-Meier analysis, and Harrell’s C-index were used to examine the relations and time-dependent predictive power.
Results During 12.7 years of follow-up, 1,477 participants developed metabolic dysfunction-associated fatty liver disease (MAFLD). RCS analysis suggested TyG-hsCRP had a nonlinear positive correlations with all-cause mortality. Compared to the lowest quartile group, the corrected hazard ratio (HR) (95% confidence interval [CI]) of new-onset MAFLD in maximum quartile groups for TyG-hsCRP was 1.94(1.62–2.32), for TyG-WC was 1.78(1.44–2.18), for TyG-BMI was 1.36(1.12–1.65), and for TyG was 1.41(1.15–1.72). The relation between C-index of TyG-hsCRP and MAFLD was higher than that of other TyG indices. Similar results were observed in all-cause mortality.
Conclusion TyG-hsCRP is superior to other indices for identifying risk of MAFLD and all-cause mortality in overweight but physically active people. Our findings suggest the importance of inflammatory metabolism and provide evidence for effectively early anti-inflammatory treatments.
Keywords Excess weight · Inflammation · Insulin resistance · Physically active
Communicated by Salvatore Corrao, M.D
Mengchen Zou
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Xianbo Wu
1 Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Road North, Guangzhou 510515, China
2 Department of Occupational Health and Medicine, School of Public Health, Southern Medical University, Guangzhou, China
Chunhai Tao1 , Xi Chen2*, Wenji Zheng1*, Zehao Zhang1 , Ruoyan Tao3 , Rui Deng1 and Qizhe Xiong1
1School of Statistics, Jiangxi University of Finance and Economics, Nanchang, China, 2School of Economics and Management, Nanchang University, Nanchang, China, 3School of Liberal Arts, Macau University of Science and Technology, Taipa, Macau SAR, China
OPEN ACCESS
EDITED BY
Kui Yi, East China Jiaotong University, China
REVIEWED BY
Yong Wang, Dongbei University of Finance and Economics, China Gang Peng, Southwestern University of Finance and Economics, China
*CORRESPONDENCE
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This article was submitted to Organizational Psychology, a section of the journal Frontiers in Psychology
RECEIVED 27 October 2022 ACCEPTED 05 December 2022 PUBLISHED 05 January 2023
CITATION
Tao C, Chen X, Zheng W, Zhang Z, Tao R, Deng R and Xiong Q (2023) How to promote the hierarchical diagnosis and treatment system: A tripartite evolutionary game theory perspective Frint Psychol. 13:1081562.
doi: 10.3389/fpsyg.2022.1081562
COPYRIGHT
© 2023 Tao, Chen, Zheng, Zhang, Tao, Deng and Xiong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the origina publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Due to the disorderly access to medical care and inefficient use of health resources, the advancement of the hierarchical diagnosis and treatment is more valued in promoting health system reform. Hence, this article integrates prospect theory into an evolutionary game model of the local government health departments, the medical institutions, and the patients in the system promotion of the hierarchical diagnosis and treatment. The simulation shows the specific influencing mechanism of the psychological perceived value of game subjects. Then by introducing the stochastic evolutionary game model, the system promotion under different medical cultures is also discussed in detail. The results indicate that for local government health departments, the amount and duration of financial subsidies are the key factors influencing the game system’s evolution. For medical institutions, participating in the hierarchical diagnosis and treatment system is relatively beneficial. For patients, the recovery rate in primary hospitals matters more than the cost of treatment. Changes in the risk sensitivity coefficient will cause the equilibrium of the game system to change. However, changes in the loss avoidance factor do not change the equilibrium and only have an impact on the speed of convergence. With the health departments’ intervention, patients in rural medical culture are more inclined to support the hierarchical diagnosis and treatment system than those in urban or town medical culture. Therefore, in order to promote the hierarchical diagnosis and treatment system, this article recommends that more attention should be paid to the regulatory role of health departments and the participation improvement of medical institutions and patients.
KEYWORDS
hierarchical diagnosis and treatment, evolutionary game theory, prospect theory, stochastic disturbance, medical cultures
刘晗 负压引流与创面修复
是不是 瘘了？
原创： 十六点五 中山二院糖尿病足中心
男性，24岁，3年前外院诊断“下丘脑生殖细胞瘤”，进行γ刀治疗后，长期应用“氢化可的松”早晚各2片维持，半年前不慎损伤左小腿下部外侧皮肤，之后长期不愈合，收入院。
含银的敷料是目前治疗糖尿病足的主流敷料，有各种剂型，包括泡沫状、胶冻态、液态、粉末态、膏态等等，生产的厂家的非常多，其中的质量良莠不齐，很难鉴别。
进一步的清创就到了骨骼，对于骨髓炎最彻底的治疗方法就是去除被细菌侵袭的骨，正常的骨骼一般是浅黄色，如果发白或者变黑，往往就提示这段骨头可能活性比较差，另外，还有一种是面积比较大的骨暴露，一般的肉芽组织很难爬上去，因此，对于坏死的骨头及较大面积的骨暴露，一般需要清除。
皮下组织中的脂肪组织在足部分布广泛，而皮下脂肪中血管分布非常少，在相对或绝对缺血的糖尿病足中，脂肪组织边缘的是否出血不是其是否存活的可靠指标。
这是一个我们在《糖尿病足切开设计（1）》中提到过，这次从不同角度谈谈足趾的保全。
伤口世界平台生态圈，以“关爱人间所有伤口患者”为愿景，连接、整合和拓展线上和线下的管理慢性伤口的资源，倡导远程、就近和居家管理慢性伤口，解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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