Volume 99 ·  Issue 07 ·  2019

The early diagnosis and staging of hepatic fibrosis is of great clinical significance. In recent years, the imaging technology of liver fibrosis has become a hot research topic, among which ultrasound elastography and magnetic resonance elastography are the most promising. In addition, artificial intelligence is increasingly used in the diagnosis of liver fibrosis. With the rapid development of artificial intelligence, the imaging method of digital quantitative analysis of liver fibrosis based on deep learning has also emerged. This new technology is expected to extract important features in multimodal images through efficient algorithms, realize non-invasive and efficient diagnosis and staging of liver fibrosis, and even evaluate the prognosis of patients. These imaging techniques can reduce or even replace liver biopsy of liver fibrosis, and have guiding significance for advancing the clinical diagnosis of liver fibrosis.

totally implantable venous access devices (TIVADs), also known as infusion ports, are long-term central venous fluid access. 1982 Niederhuber et al.^[1]Surgical incision port implantation was first reported at MD Anderson Cancer Center in the United States; 1992 Morris et al.^[2]Percutaneous puncture technique was used to implant intravenous fluid port under the guidance of X-ray fluoroscopy, which significantly improved the success rate of TIVAD implantation. Since then, this technique has been widely used.

To establish automatic liver fibrosis classification models by using traditional machine learning and deep learning methods and preliminaryly evaluate the efficiency.

Gray scale ultrasound images and corresponding elastic images of 354 patients, 247 males and 107 females, mean age (54±12) years undergoing partial hepatectomy in Zhongshan Hospital of Fudan University from November 2014 to January 2016 were enrolled in this study. By using traditional machine learning and deep learning methods, an automatic classification model of liver fibrosis stages (S0 to S4) were established through feature extraction and classification of ultrasound image data sets and the accuracy in different classification categories of each model were calculated, by using liver biopsy as the reference standard.

Pathological examination showed 73 cases in pathological stage S0, 40 cases in S1, 49 cases in S2, 41 cases in S3, and 151 cases in S4. The traditional machine classification model based on support vector machine (SVM) classifier and sparse representation classifier and the deep learning classification model based on LeNet-5 neural network, their accuracy rates in the two categories (S0/S1/S2 and S3/S4) were 89.8%, 91.8% and 90.7% respectively; the accuracy rates in the three categories (S0/S1 and S2/S3 and S4) were 75.3%, 79.4% and 82.8% respectively; the accuracy in the three categories (S0 and S1/S2/S3 and S4) were 79.3%, 82.7% and 87.2% respectively.

Computer-aided assessment of liver fibrosis progression in patients with chronic hepatitis B has a high accuracy, and can achieve a more detailed classification. This method is expected to be applied in the non-invasive evaluation of liver fibrosis in patients with hepatitis B in clinical work in the future.

To investigate the MRI and diffusion weighted imaging (DWI) features of focal peliosis hepatis.

The clinical data and MRI of 19 cases with focal peliosis hepatis confirmed by pathology from January 2012 to March 2018 in Zhongshan Hospital of Fudan University were retrospectively analyzed. The number, location, size, shape, signal intensity of plain scan of lesions, enhancement pattern of lesions, vessels within lesions, and perfusion disorders of hepatic parenchyma were analyzed. The apparent diffusion coefficient (ADC) values of the lesions and adjacent hepatic parenchyma were measured, then the differences between them were explored statistically. All 24 lesions were categorized into group A with tumor-related chemotherapy and group B without tumor-related chemotherapy. The differences of MR features between the two groups were explored statistically.

In all 24 lesions, 22 lesions were located in the right lobe, 2 lesions in the left lobe. The median size was 7.5-72.0 (24.4±17.2) mm.On T₁WI,21 lesions showed slightly hypointensity, 1 lesion showed slightly hyperintensity and 2 lesions were isointensity; all 24 lesions showed slightly hyperintensity on T₂WI, and isointensity or slightly hyperintensity on DWI. The mean ADC value was (1.511±0.415)×10^-3 mm²/s in the lesions and (1.769±0.690)×10^-3 mm²/s in the adjacent hepatic parenchyma, which showed no difference between the two groups (P>0.05). On dynamic MR images, 20 lesions showed gradually filling enhancement, 4 lesions showed markedly and persistent enhancement. Punctiform or filiform vessels were found in 9 lesions. Adjacent hepatic perfusion disorders showed in 8 lesions. The median lesion size was 7.5-38.5(17.6±9.8) mm in the tumor-related-chemotherapy group and 9.0-72.0(33.8±21.2) mm in the no chemotherapy group.There was significant difference between the two groups (P<0.05).

The MRI performance of focal peliosis hepatis had a certain characteristic. MRI combined with diffusion weighted imaging could help to make diagnoses.

To evaluate the feasibility of diffusion parameters obtained from mono-exponential and stretched exponential diffusion-weighted imaging models in staging of nonalcoholic fatty liver disease and compare the diagnosis ability of nonalcoholic steatohepatitis.

Thirty-two 12 -week-old male New Zealand rabbits, about 2.5 kg of each, were randomly divided into five groups. To obtained different severity groups of NAFLD, a variety of diet (from standard to high-fat, high cholesterol chow) were feed for different periods before liver diffusion imaging was performed by using 3.0 T MR imaging system (Discovery 750W GE health care), the value of ADC, stretched exponential model parameters distributed diffusion coefficient (DDC) and α (water molecular diffusion heterogeneity index) were measured. Liver specimens were obtained for pathological grading (NAFLD activity scoring system). The diffusion parameters of each group of NAFLD were compared by ANOVA, LSD-t test was utilized to pairwise comparison between different grades of NAFLD. Spearman rank correlation analysis was used to evaluate the correlation between ADC, DDC, α and different severity groups of NAFLD. ROC curve was compared to evaluate the diagnostic efficiency of MR parameters for NASH.

α was significant different between borderline and NASH groups (0.65±0.05 vs 0.72±0.07;P<0.05); ADC and DDC showed no statistical difference between borderline and NASH groups (ADC:(1.09±0.14)×10^-3 vs (1.04±0.24)×10^-3 mm²/s; DDC: (0.73±0.08)×10^-3 vs (0.66±0.19)×10^-3 mm²/s; P>0.05); ADC and DDC were negatively correlated with NAFLD, and the correlation coefficients were -0.552, -0.596, respectively (P<0.05). α was found to be positively correlated with advancement of NAFLD, the correlation coefficient was 0.729 ( P<0.05).In terms of the diagnostic efficiency of NASH, the AUC of ADC, DDC and α were 0.736, 0.784, 0.900, respectively, α was significantly greater than ADC in diagnosis of NASH ( P<0.05).

Stretched exponential model parameter α (water molecular diffusion heterogeneity index) could be utilized to identify NAFLD. α may provide more information and improve the staging of NASH compared with conventional diffusion parameters.

To explore the effect of cathepsin (Cat) S in primary biliary cholangitis (PBC).

The serum of PBC patients and Hepatitis B virus (HBV) patients were collected in Peking Union Medical College Hospital from August 2016 to July 2017 and the liver tissue of PBC were collected from March 2010 to July 2013. Indirect enzyme-linked immunosorbent assay (ELISA) was used to detect the serum concentrations of total-and pro-Cat S respectively in 24 PBC patients, 24 Hepatitis B patients and 24 healthy controls. The relation between the serum levels of Cat S and cholestasis biochemical indexes and the serum levels of immunoglobulin (Ig) M, G were analyzed. Immunofluorescence analysis of liver tissue was performed to detect macrophage infiltration and Cat S expression. The data was analyzed by student′s t-test, spearman correlation analysis, and receiver operating characteristic (ROC) curve was used to obtain an optimal cutoff value.

The serum levels of total-Cat S, pro-Cat S and active-Cat S in PBC group were significantly higher than those in healthy controls and HBV controls (P<0.05). There was a correlation between serum total-Cat S and ALP and GGT in patients with PBC (P<0.05). There was a moderate correlation between pro-Cat S and ALP and GGT (P<0.05) and total Cat S was associated with IgG (P<0.05). The area under ROC curve (AUC) of total-Cat S, pro-Cat S and active-Cat S was 0.85(P<0.01), 0.65(P<0.05) and 0.77(P<0.01), respectively. The optimal cut-off value was 11.30、7.81 and 5.93 pg/L, respectively, with the sensitivity of 0.81, 0.53 and 0.53 and specificity of 0.82, 0.81 and 0.96. Liver tissue immunofluorescence revealed macrophage infiltration in the liver of PBC patients. The average percentage of macrophages and Cat S co-expressed cells in mononuclear cells was 23.77%.

The expression of Cat S in serum of patients with PBC is significantly higher than that of healthy controls and HBV patients, and is related to IgG and serum ALP, r-GT levels. Liver tissue macrophages were co-expressed with Cat S. Cat S may participate in the process of antigen presentation in the pathogenesis of PBC.

Exosomes are considered to mediate intercellular communication by delivering biomolecules like mRNA, miRNA into recipient cells. The purpose of this study was to evaluate the effects of exosomes secreted by fibroblasts from women with stress urinary incontinence (SUI-EXO) on endothelial cells angiogenesis.

Primary fibroblasts were acquired from periurethral vaginal wall tissues and exosomes were prepared by ultracentrifugation of fibroblasts cells conditioned medium. The expression levels of pro-angiogenic and anti-angiogenic genes were assessed using qRT-PCR analysis. Migration of endothelial cells was measured by transwell assay, and the effects of SUI-EXO on angiogenesis were evaluated by performing a tube formation assay in vitro.

SUI-EXO was successfully isolated from fibroblasts cells conditional medium and transferred to endothelial cells efficiently. When the endothelial cells were treated with SUI-EXO, the expression levels of pro-angiogenic genes in fibroblasts were downregulated, and the expression levels of anti-angiogenic genes were upregulated significantly (P<0.01). Endothelial cells exhibited a decreased migratory capacity after treatment with SUI-EXO compared to exosomes from health women (64.6±8.7 vs 114.5±14.2,P<0.01), and tube formation of endothelial cells was also significantly inhibited in the SUI-EXO treated group as determined by the increase of the tube length (87.6±13.3 vs 168.5±28.3,P<0.01).

This study suggests that SUI-EXO plays related roles in regulating endothelial cells angiogenesis and SUI-EXO maybe involve in the pathogenesis of SUI.

To study the association between polymorphisms in CYP19A1 rs2899470, GSTM1, GSTT1, and GSTP1 rs1695 and the development of endometriosis.

Between October 2015 and October 2017, 262 endometriosis patients and 275 control subjects were recruited from the Affiliated Hospital of Inner Mongolia Medical University. Genotyping was conducted using polymerase chain reaction-coupled with restriction fragment length polymorphism and multiplex allele specific polymerase chain reaction.

Individuals carrying the TT genotype of CYP19A1 rs2899470 expressed a higher risk of endometriosis than that carrying the GG genotype (P<0.01), and the adjusted OR was 2.33 (95%CI 1.27-4.33). In addition, individuals with the CYP19A1 rs2899470 the TT genotype aggravated the condition of endometriosis (OR=2.27, 95%CI 1.05-4.90). However, GSTM1, GSTT1 and GSTP1 rs1695 polymorphisms did not affect the pathogenesis of endometriosis.

Our results suggested that CYP19A1 rs2899470 polymorphism is associated with the risk of endometriosis and the risk of disease.

To explore the possible role of Irisin in antipsychotic drug-induced insulin resistance and abdominal obesity in patients with schizophrenia and to provide a theoretical basis for the prevention of antipsychotic drug-induced obesity.

Fifty-five patients with first-episode schizophrenia, from the First Affiliated Hospital of Zhengzhou University, between January 2016 and December 2017, were admitted as well as fifty healthy controls during the same period. Serum Irisin levels were measured by enzyme-linked immunosorbent assay (ELISA). Fasting blood glucose (FBG), fasting insulin (INS), homeostasis model assessment of insulin resistance (HOMA-IR) and triglyceride (TG), total cholesterol (TCHO), highdensity lipoprotein (HDL), low density lipoprotein (LDL) were detected.

The average Irisin level ((233±228) mmol/L) was higher than that in the normal control group ((124±89) mmol/L) (P<0.05).Repeated measurement analysis of variance showed that the average levels of the height, waist, FBG, INS, TCHO, TG, HDL, LDL, BMI, HOMA-IR and Irisin at the end of the 12^th and 24^th week′s treatment were higher than baseline (P<0.05). After correlation analysis, the level of Irisinat baseline was positively correlated with HOMA-IR (r=0.383, P<0.05). At the 12^th week, the level of Irisin was positively correlated with waist circumference, and HOMA-IR (r=0.360, r=0.475, all P<0.05). Multiple linear regression analysis showed that at the 12^th week′s treatment, compared with the baseline period, changes of Irisin was positively correlated with waist circumference and HOMA-IR, respectively (β=0.453, β=0.420, both P<0.05).

Irisin may be involved in the process of metabolic regulation and bean early predictor of antipsychotic drug-induced insulin resistance and abdominal obesity.

To analyze the expression microarray data in the public databases of intracranial aneurysms (IA) using bioinformatics, and to provide important information for the study of disease mechanisms.

Gene co-expression network was constructed by weighted gene co-expression network analysis (WGCNA) based on the dataset (GSE75436) and pivot genes were identified. Using the online tool DAVID (Database for Annotation, Visualization, and Integrated Discovery) to perform GO function enrichment and KEGG path analysis on modules highly related to IA.

Three IA-related modules were screened out, and 14 pivot genes (COL3A1, SPARC, CDH11, COL5A1, HOPX, CLEC11A, GALNT10, ADAMTS2, CEMIP, KIAA1755, COL11A1, ZIC2, CDKN2A, and LINC00460) in the brown module were identified; the analysis of GO showed that the brown module was mainly enriched in extracellular matrix organization, extracellular matrix organization, cell adhesion and other biological processes; the analysis of KEGG indicated that the brown module involved in ECM-receptor interaction, Focal adhesion, protein digestion and absorption, PI3K-Akt signaling pathway.

Based on WGCNA, we identified modular and pivotal genes that are critical to the development of IA, and they may become potential biomarkers and/or therapeutic targets.

To compare the differences of cognitive function, daily living ability and neuropsychiatric symptoms in patients with sporadic type of Alzheimer′s disease (AD) under different care modes, and find the most favorable care mode for delaying the progress of disease.

One hundred and twenty cases of AD patients were divided into three groups: Spouse Care Group, Adult Child Care Group and Nursing Home Group. Medical history collection and scale evaluation were carried out by trained specialists on 3 groups of patients and caregivers. Assessment included socio-demographic data, including name, gender, age, course of the disease, the year of education and the way of care, Mini mental state examination (MMSE), Activity of Daily Living (ADL), Alzheimer′s Disease Assessment Scale-Cognitive section (ADAS-Cog), Neuropsychiatric Inventory (NPI), and the Relevant Outcome Scale for Alzheimer′s disease (ROSA). All the evaluations were completed upon enrollment. The differences in cognitive function, daily living ability and neuropsychiatric symptoms were compared among the three groups.

There was no significant difference in age, gender, education duration and course of disease between the three groups (P>0.05). The MMSE average scores of Spouse Care Group, Adult Child Care Group and Nursing Home Group were 19±7, 15±6, 13±7 respectively. The ADAS-Cog median scores of Spouse Care Group, Adult Child Care Group and Nursing Home Group were 17.32(9.78, 26.50), 30.00(16.10, 38.55), 33.15 (16.28, 50.68). The NPI median total scores of Spouse Care Group, Adult Child Care Group and Nursing Home Group were 5.00(1.00, 13.00), 9.00(4.00, 20.00), 19.50(8.50, 28.50) respectively. The ADL average scores of Spouse Care Group, Adult Child Care Group and Nursing Home Group were 21±9, 25±9, 35±11. The difference of MMSE, ADAS-Cog, ADL and NPI was statistically significant among the three groups (P<0.05). No significant difference was found in care burden among the three groups (P>0.05).

The AD patients with spouse care tend to suffer from mild diseases severitys, no matter in terms of cognitive function, daily living ability or neuropsychiatric symptoms. Close, familiar and comprehensive care plays an important role in delaying the progress of AD.

To modify Western Ontario and McMaster University Osteoarthritis Index (WOMAC) for more accurate evaluation of patients with knee osteoarthritis in China,and its reliability and validity were measured.

The WOMAC was modified through reviewing relevant literatures and practical survey.Total of 120 patients were enrolled in this study. The subjects completed the WOMAC,the modified WOMAC and Medical Outcomes Study 36-item Short Form(SF-36), and 113 of the questionnaires were valid for analysis [27 males (23.9%), 86 females (76.1%), aged (59±10) years]. Intraclass correlation coefficient and Cronbach α reliability coefficient were used to analyze the modified WOMAC′s reliability; exploratory factor analysis was adopted to analyze the validity of WOMAC and the modified WOMAC; Spearman rank correlation coefficient was used to make a correlation analysis among SF-36, WOMAC and the modified WOMAC.

For the four dimensions: pain, stiffness, function and life quality in the modified WOMAC, the intraclass correlation coefficient values were 0.861-0.910 and Cronbach α values were 0.751-0.936. In the content validity analysis, the number of extracted common factors for the four dimensions: pain,stiffness,function and life quality in the modified WOMAC were 1,1,2 and 1 respectively. The total variance interpretation rate was 65.684%, 84.367%, 67.252% and 67.572%, respectively. In the construct validity analysis, 4 common factors were extracted for WOMAC and the modified WOMAC respectively. The total variance interpretation rate was 70.100% and 67.213%, respectively. Both WOMAC and the modified WOMAC had a significant correlation with SF-36.

The modified WOMAC is more suitable for Chinese living habits, but it still needs to be further evaluated with larger samples.

To compare the outcome of either flexor hallucis longus transfer or turn-down of proximal Achilles tendon tissue repair in treating chronic Achilles tendon rupture.

The clinical data of 21 patients who underwent repair of Myerson type Ⅲ chronic Achilles tendon rupture at Peking University Sports Medicine Research Institute from May 2012 to March 2015 were retrospectively analyzed. Among them, 11 cases were treated with flexor hallucis longus (FHL) transfer, and 10 cases were treated with gastrocnemius turn-down flaps repair. The American Orthopedic Foot & Ankle Society (AOFOS) hindfoot score and Tegner motor function score before and after surgery were recorded and compared between the two groups. Data comparison between groups was performed with t test.

The patients in the both group were followed up for an average of (21±7) months. The postoperative AOFOS hindfoot score in the long flexor and gastrocnemius groups were both significantly higher than those before surgery, and the differences were statistically significant (97.7±2.6 vs 72.0±8.1 and 96.0±5.5 vs 78.5±6.4, t=10.70, 6.42, both P<0.05).The postoperative Tegner scores of the two groups were also significantly higher than those before surgery (4.2±1.4 vs 0.7±0.4 and 4.1±0.8 vs 0.6±0.5,t=7.29, 9.35, both P<0.05). There were no significant differences in postoperative AOFOS hindfoot scores and Tegner motor function scores between the two groups (both P>0.05).

The flexor hallucis longus transfer and turn-down of proximal Achilles tendon tissue repair can both get satisfactory results in treating chronic Achilles tendon rupture.

Repeated and persistent coronary spasm can lead to acute myocardial infarction, malignant arrhythmias, and even sudden cardiac death. In this patient, the onset and evolution of coronary spasm were completely recorded by ambulatory electrocardiogram, accompanied by the occurrence of malignant arrhythmia and Aspen syndrome, and ICD was implanted. Clinically rare.

Autoimmune glial fibrillary acidic protein (GFAP) astrocytosis is a newly discovered astrocytic disease caused by GFAP autoantibodies. This patient was a 44-year-old male with headache, ataxia, involuntary movement and epilepsy. The MRI of the head showed extensive white matter lesions in bilateral cerebral hemispheres with vascular enhancement. The cerebrospinal fluid was positive for GFAP antibody, and the pathological change was perivascular inflammation. He was diagnosed as GFAP astrocytosis, and the symptoms improved after immunotherapy. This case is accompanied by eosinophilia, which is rarely reported at present.

This article reports a case of bronchial artery embolism complicated by myocardial infarction.

With the constant development and the improvement of people's living standards, obesity has become a public health problem of global concern. Body mass index (BMI), which uses the ratio of weight to height to define obesity and its degree, cannot truly reflect the distribution of adipose tissue in human body. This may be an important reason for the controversy between the current research results of obesity and sepsis prognosis. This phenomenon is also called the "obesity paradox" of sepsis. Is the "obesity paradox" of sepsis real? What are the factors that affect the "obesity paradox"? It is necessary to carry on some dialectical thinking on the "obesity paradox" of sepsis. This article will discuss the above issues in depth.

In the state of chronic viral infection and malignant tumor, effector T cells undergo alterations such as depletion, disability, and senescence. Unlike normal effector T cells, these T cells lose normal immune response function, resulting in the occurrence of immune escape. Understanding the phenotypes and regulatory mechanisms of these T cells in different states, through immunotherapy studies targeting these T cells alone or in combination, will bring new ideas for clinical chronic infection and tumor treatment. In this paper, the research progress of T cell depletion, T cell disability, T cell senescence and their different functional states and immunotherapy are reviewed.