Although cadmium (Cd) is correlated with elevated levels of hepatic amino transferases, its influence on the degree of liver steatosis and fibrosis are unknown yet. We aimed to investigate the associations between the serum level of Cd and degree of liver steatosis/fibrosis. Clinical data were obtained from Korean National Health and Nutrition Examination Surveys IV–VII. Alanine aminotransferase (ALT) elevation was defined as ≥ 33 IU/L for men and ≥ 25 IU/L for women. Significant steatosis was defined as a hepatic steatosis index ≥ 36, while significant fibrosis was defined as a fibrosis index (FIB-4) ≥ 2.67 and as an aspartate aminotransferase and platelet ratio index ≥ 0.7. Adjusted odds ratios and 95% confidence intervals were calculated after adjustment. The levels of serum Cd were assessable in 15,783 subjects. The serum cadmium concentrations were significantly associated with ALT elevation, significant liver steatosis and fibrosis. Multivariate logistic regression analysis demonstrated serum Cd level in the forth quartile had a positive correlation with ALT elevation, hepatic steatosis index ≥ 36, FIB-4 ≥ 2.67 and aspartate aminotransferase-to-platelet ratio ≥ 0.7 using the first quartile of serum Cd level as the reference, (adjusted odds ratios 1.90, 1.26, 1.73, and 2.53, respectively; P values <.001). The serum level of Cd was associated with liver steatosis and fibrosis. The evaluation of serum Cd may help for assessing an unexplained liver steatosis and fibrosis, and further prospective studies are needed to confirm our findings.

Background: An injured calcaneofibular ligament (CFL) is a major cause of ankle instability (AI). Previous research has demonstrated that the thickness of the calcaneofibular ligament (CFLT) is correlated with higher-grade sprains and ankle instability. However, inflammatory hypertrophy is distinct from ligament thickness; accordingly, we considered that the calcaneofibular ligament cross-sectional area (CFLCSA) as a potential morphological parameter to analyze inflammatory CFL. We hypothesized that the CFLCSA was a key morphologic parameter in AI diagnosis. Methods:We gathered the CFL data of 26 AI patients and 25 control subjects who had undergone ankle magnetic resonance imaging (A-MRI), and it had revealed no evidence of AI. Ankle level T1-weighted coronal A-MRI images were acquired. Using our image analysis program (INFINITT PACS), we analyzed the CFLT and CFLCSA at the CFL on the A-MRI. The CFLCSA was measured as the whole ligament cross-sectional area of the CFL that was most hypertrophied in the transverse A-MR images. The CFLT was measured at the thickest level of CFL.Results: The mean CFLT was 3.49±0.82 mm in the control group, and 4.82±0.76 mm in the AI group.The mean CFLCSA was 33.31±7.02 mm 2 in the control group, and 65.33±20.91 mm 2 in the AI group.The AI patients had significantly greater CFLT (P<0.001) and CFLCSA (P<0.001) than the control group participants. A receiver operating characteristic (ROC) curve analysis in the evaluation of the diagnostic tests showed that the optimal cut-off score of the CFLT was 4.06 mm, with 76.9% sensitivity, 76.0% specificity, and an area under the curve (AUC) of 0.89 (95% CI, 0.79-0.99). The optimal cut-off threshold of the CFLCSA was 43.85 mm 2 , with 92.3% sensitivity, 92.0% specificity, and AUC of 0.94 (95% CI, 0.86-1.00).Conclusions: Even though the CFLT and CFLCSA were both significantly associated with AI, the CFLCSA was a more sensitive diagnostic test.