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Background/Aims@#Existing hepatocellular carcinoma (HCC) prediction models are derived mainly from pretreatment or early on-treatment parameters. We reassessed the dynamic changes in the performance of 17 HCC models in patients with chronic hepatitis B (CHB) during long-term antiviral therapy (AVT). @*Methods@#Among 987 CHB patients administered long-term entecavir therapy, 660 patients had 8 years of follow-up data. Model scores were calculated using on-treatment values at 2.5, 3, 3.5, 4, 4.5, and 5 years of AVT to predict threeyear HCC occurrence. Model performance was assessed with the area under the receiver operating curve (AUROC). The original model cutoffs to distinguish different levels of HCC risk were evaluated by the log-rank test. @*Results@#The AUROCs of the 17 HCC models varied from 0.51 to 0.78 when using on-treatment scores from years 2.5 to 5. Models with a cirrhosis variable showed numerically higher AUROCs (pooled at 0.65–0.73 for treated, untreated, or mixed treatment models) than models without (treated or mixed models: 0.61–0.68; untreated models: 0.51–0.59). Stratification into low, intermediate, and high-risk levels using the original cutoff values could no longer reflect the true HCC incidence using scores after 3.5 years of AVT for models without cirrhosis and after 4 years of AVT for models with cirrhosis. @*Conclusions@#The performance of existing HCC prediction models, especially models without the cirrhosis variable, decreased in CHB patients on long-term AVT. The optimization of existing models or the development of novel models for better HCC prediction during long-term AVT is warranted.
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Objective To investigate the clinical value of multidisciplinary team collaboration (MDT)for the treatment of hip fractures in elderly patients.Methods A total of 157 elderly patients with hip fractures meeting inclusion and exclusion criteria were admitted into our department from 1st September 2015 to 31st December 2017.The patients were randomly divided into the traditional treatment group and the MDT group.The differences in treatment time,cost,postoperative outcomes and postoperative Harris hip function score were compared between the two groups.Results The preoperative length of stay,total hospitalization time and the time of antibiotic use after operation were shorter in the MDT treatment group than in the traditional treatment group (all P ＜0.05).Total costs of treatment and costs for bed,laboratory examinations,and nursing were lower in the MDT treatment group than in the traditional treatment group(all P＜0.05).The off-bed activity time after operation was earlier in the MDT treatment group with femoral neck fractures [(5.36 ± 1.56)d vs.(10.07±2.26)d,P =0.002]than in the traditional treatment group with intertrochanteric fracture patients [(30.26 ± 3.01) d vs.(42.28 ± 3.52) d,P =0.017].Harris hip function score was higher in the MDT treatment group than in the traditional treatment group at 3 and 6 months after surgery (P ＜ 0.05).Conclusions As compared with the traditional treatment mode,MDT treatment mode can shorten the preoperative stay in bed,the length of hospital stay after surgery and the off-bed activity time after operation,reduce hospitalization costs and postoperative complications,and can promote the recovery of hip joint function in elderly hip fracture patients.
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ObjectiveTo investigate the clinical effect of interferon (IFN) in the treatment of genotype B or C chronic hepatitis B (CHB) patients. MethodsPubMed, Web of Science, The Cochrane Library, CNKI, Wanfang Data, and VIP were searched for articles on IFN in the treatment of genotype B or C CHB patients published up to November, 2018. Two researchers performed screening, data extraction, and quality assessment of the articles independently, and then a meta-analysis was performed. ResultsA total of 20 articles were included. The results of the meta-analysis showed that compared with the genotype C CHB patients, the genotype B CHB patients had significantly higher HBV DNA clearance rate (odds ratio ［OR］=2.95, 95% confidence interval ［CI］: 2.22-3.91,P＜005), HBeAg clearance rate (OR=3.16, 95%CI: 2.38-4.20,P＜005), HBeAg seroconversion rate (OR=1.83, 95%CI: 1.44-2.33，P＜005), HBsAg clearance rate (OR=2.59, 95%CI: 1.05-6.38，P＜005), and alanine aminotransferase normalization rate (OR=2.31, 95%CI: 1.69-316，P＜005). The subgroup analysis showed that the clinical effect of IFN in genotype B or C CHB patients was not affected by the type of IFN. ConclusionThe antiviral effect of IFNs is affected by HBV genotype, and the patients with genotype B CHB have a better antiviral outcome than those with genotype C CHB. Therefore, HBV genotype is an important factor for predicting the clinical effect of IFN therapy.
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ObjectiveTo investigate the effect of alanine aminotransferase (ALT) level on liver stiffness measurement (LSM) in patients with hepatitis B cirrhosis. MethodsThe patients who were diagnosed with hepatitis B cirrhosis by liver biopsy in Beijing Friendship Hospital from January 2012 to May 2015 and did not receive antiviral therapy were enrolled. Their demographic characteristics, routine blood test results, biochemical parameters, hepatitis B virus (HBV) DNA level, alpha-fetoprotein level, LSM, abdominal ultrasound findings, and liver biopsy data were collected. LSM was compared between hepatitis B cirrhosis patients with different ALT levels. The one-way analysis of variance or rank sum test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data. Pearson correlation analysis and partial correlation analysis were performed. ResultsA total of 104 patients were recruited and divided into three groups according to their ALT levels (≤2×upper limit of normal ［ULN］, 2-5×ULN, and ≥5×ULN). There were no significant differences between the three groups in sex ratio, body mass index, HBeAg status, HBV DNA level, albumin level, and platelet count (all P＞0.05). The median values of LSM for the three groups were 15.4 kPa, 18.8 kPa, and 29.9 kPa, respectively, suggesting that LSM increased as the ALT level increased, and there was a significant difference in LSM between the three groups (χ2=10.07, P＜0.05). After adjusting for age, which was significantly different between the three groups, LSM was still found to be positively correlated with ALT level (r=0.220, 95% confidence interval: 0.101-0.468, P＜0.05). ConclusionIn patients with hepatitis B cirrhosis, LSM increased with the increasing ALT level, and the positive correlation remains after adjusting for age.
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Nonalcoholic fatty liver disease (NAFLD) is a chronic disease with complex lesions, and it is difficult to determine the clinical stage. Liver biopsy is still the gold standard for the diagnosis of NAFLD; however, its clinical application is limited by various factors. Therefore, noninvasive methods for the accurate diagnosis of NAFLD are research hotspots at present. Imaging examinations help to achieve qualitative and quantitative evaluations of hepatic steatosis and fibrosis and thus has a promising future in clinical practice. This article summarizes the research advances in the imaging diagnosis of nonalcoholic fatty liver disease in recent years.
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Objective@#To explore the diagnostic values of FibroTouch and FibroScan for liver fibrosis in patients with chronic hepatitis B(CHB).@*Methods@#This study enrolled patients with CHB who was accepted liver biopsy at Beijing Friendship Hospital, Capital Medical University between March 2014 to December 2017. FibroTouch and FibroScan were performed among these patients at same time. Liver stiffness measurement(LSM), optimal cut-off value, receiver operating characteristic(ROC) were compared.@*Results@#In our 103 patients, there were no significantly different between FibroTouch and FibroScan in LSM. The threshold of the optimal cut-off value for FibroTouch and FibroScan were 5.45 versus 5.55 kPa (≥S1), 7.10 versus 6.65 kPa (≥S2), 11.05 versus 9.20 kPa (≥S3), 15.50 versus 15.45 kPa (S4), respectively. The area under the ROC curve for the prediction of the stage1, stage2, stage2, stage 4 of liver fibrosis in these patients were 0.858 versus 0.765 (P=0.54), 0.812 versus 0.801 (P=0.68), 0.863 versus 0.878 (P=0.45), and 1.0 versus 0.99 (P=0.38) respectively.@*Conclusions@#FibroTouch and FibmScan have a good consistency in the evaluation of the degree of liver fibrosis in patients with CHB.
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Objective@#To investigate the methods for qualitative pathological assessment of dynamic changes in liver fibrosis/cirrhosis after antiviral therapy in patients with chronic hepatitis B (CHB), since antiviral therapy can partially reverse liver fibrosis and cirrhosis caused by hepatitis B and semi-quantitative, rather than qualitative, pathological assessment is often used for the research on liver fibrosis regression.@*Methods@#Previously untreated CHB patients with liver fibrosis and cirrhosis were enrolled, and liver biopsy was performed before treatment and at 78 weeks after the antiviral therapy based on entecavir. The follow-up assessment was performed once every half a year. Based on the proportion of different types of fibrous septum, we put forward the new qualitative criteria called P-I-R classification (predominantly progressive, predominantly regressive, and indeterminate) for evaluating dynamic changes in liver fibrosis. This classification or Ishak fibrosis stage was used to evaluate the change in liver fibrosis after treatment and Ishak liver inflammation score was used to evaluate the change in liver inflammation after treatment.@*Results@#A total of 112 CHB patients who underwent liver biopsy before and after treatment were enrolled, and among these patients, 71 with an Ishak stage of ≥3 and qualified results of live biopsy were included in the final analysis. Based on the P-I-R classification, 58% (41/71) were classified as predominantly progressive, 29% (21/71) were classified as indeterminate, and 13% (9/71) were classified as predominantly regressive; there were no significant differences between the three groups in alanine aminotransferase, aspartate aminotransferase, albumin, HBeAg positive rate, HBV DNA, and liver stiffness (P < 0.05). After treatment, the proportion of predominantly progressive, indeterminate, or predominantly regressive patients changed to 11% (8/71), 11% (8/71), and 78% (55/71), respectively. Among the 35 patients who had no change in Ishak stage after treatment, 72% (25/35) were classified as predominantly regressive and had certain reductions in the Laennec score, percentage of collagen area, and liver stiffness.@*Conclusion@#This new P-I-R classification can be used to assess the dynamic changes in liver fibrosis after antiviral therapy in CHB patients.
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<p><b>OBJECTIVE</b>To perform a comparative assessment of the performance of FibroTouch and FibroScan in patients with hepatitis B.</p><p><b>METHODS</b>A total of 211 patients with hepatitis B, including cases of chronic hepatitis B (CHB) and of compensated cirrhosis, were enrolled for study between June and November of 2013. The patients underwent FibroScan testing (group 1) and FibroTouch testing (group 3), after which the operator examined a time motion ultrasound image from the FibroScan test and located a specific liver portion for focused FibroTouch testing (group 2). The consistency between the two tests' results was investigated by Pearson's correlation analysis, and the difference of liver stiffness between CHB patients and compensated cirrhosis patients was investigated by the two independent samples t-test or Mann-Whitney U test.</p><p><b>RESULTS</b>The values of liver stiffness were 5.30 (4.30,8.65) in group 1,6.10 (4.70,8.90) in group 2, and 5.70 (4.50, 8.00) in group 3 (all P < 0.05); the Pearson correlation coefficients were all more than 0.8 (P < 0.05) and there was no statistically significant difference found between the results from FibroScan and FibroTouch.The values of liver stiffness were significantly different between the CHB patients and the compensated cirrhosis patients (P < 0.05). The rates of successful detection were 100% for FibroTouch and 97% for FibroScan.</p><p><b>CONCLUSION</b>FibroTouch and FibroScan have good consistency in the evaluation of the degree of liver fibrosis. FibroTouch has a higher rate of successful detection than FibroScan.</p>
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Humans , Elasticity Imaging Techniques , Hepatitis B, Chronic , Pathology , Liver Cirrhosis , DiagnosisABSTRACT
Currently,thrombolytic therapy is the most effective treatment for acute ischemic stroke.Intravenous recombinant tissue plasminogen activator administered within 3 hours of symptom onset is the only medication approved by U.S.Food and Drug Administration for the treatment of acute ischemic stroke.However,because the time window for intravenous thrombolytic therapy is very short,only a very few patients can reach the hospital for intravenous thrombolytic therapy within 3 hours of onset.Therefore,how to extend the time window of thrombolytic therapy for more patients to have accessed to it and benefit from it have been the concern of researchers.This article reviews about the recent advances in research on extending the time window of thrombolytic therapy.
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Objective To observe the variation of dynamic 64-slice CT perfusion imaging of rats with traumatic brain injury and discuss the relating pathophysiological basis.Methods A total of 80 adult male SD rats were randomly divided into three groups according to random number table,ie,normal control group,sham injury group and injury group.The injury group was divided into eight subgroups at time points of 2,6,12,24,48,72,120 and 168 hours.The detection of CT perfusion imaging,water content and blood-brain barrier permeability was done in the injured rats at all time points.The pathological changes were also observed to calculate their correlation with CT perfusion parameters of the injured region.Results The relative value of the blood perfusion was decreased significantly to the mimimum within 24 hours after injury.Within 2-12 hours,relative cerebral fluid(rCBF)and relative cerebral blood volume(rCBV)remained in a low perfusion state,with just a little increase.Relative mean transit time(rMTT)was prolonged and permeability surface(PS)increased.rCBF and rCBV were increased gradually with time,which was reversed till at 24 hours after injury and the injured side was in a high perfusion state,with the highest value of PS.The perfusion reached peak at 48 hours after injury and then became normal gradually.The water content was increased at 2 hours after injury and reached its peak at 48 hours.The permeability of blood-brain barrier(BBB)began to increase at 2 hours after injury and reached the peak at 24 hours.rCBF and rCBV were positively correlated with change of brain edema and PS was positively correlated with BBB permeability.Conclusion The dynamic 64-slice spiral CT perfusion imaging reflects the variation of BBB and edema and can be used as noninvasive imaging method for predicting the degree of brain perfusion and edema.
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[Objective]Comparison of the content of general flavone and elements in the different parts of Stenoloma chusanum(L.)Ching.[Methods]Total flavone was determined by vis spectrophotometer.Elements were determined by inductively coupled plasma-atomic emission spectrometry(ICP-AES).[Results]The contents of general flavone in the different parts of Stenoloma chusanum(L.)Ching are respectively 11.89%,4.47%,3.46% and 11.75%.And there are some differences in the contents of elements between the different parts.[Conclusion]There are abundant elements and general flavone in the different parts of Stenoloma chusanum(L.)Ching.As the result reveals that Stenoloma chusanum(L.)Ching is very valuable.