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1.
Chinese Medical Journal ; (24): 70-78, 2021.
Article in English | WPRIM | ID: wpr-921266

ABSTRACT

BACKGROUND@#Acquired immune deficiency syndrome (AIDS)-related non-Hodgkin lymphoma (AR-NHL) is a high-risk factor for morbidity and mortality in patients with AIDS. This study aimed to determine the prognostic factors associated with overall survival (OS) and to develop a prognostic nomogram incorporating computed tomography imaging features in patients with acquired immune deficiency syndrome-related non-Hodgkin lymphoma (AR-NHL).@*METHODS@#A total of 121 AR-NHL patients between July 2012 and November 2019 were retrospectively reviewed. Clinical and radiological independent predictors of OS were confirmed using multivariable Cox analysis. A prognostic nomogram was constructed based on the above clinical and radiological factors and then provided optimum accuracy in predicting OS. The predictive accuracy of the nomogram was determined by Harrell C-statistic. Kaplan-Meier survival analysis was used to determine median OS. The prognostic value of adjuvant therapy was evaluated in different subgroups.@*RESULTS@#In the multivariate Cox regression analysis, involvement of mediastinal or hilar lymph nodes, liver, necrosis in the lesions, the treatment with chemotherapy, and the CD4 ≤100 cells/μL were independent risk factors for poor OS (all P < 0.050). The predictive nomogram based on Cox regression has good discrimination (Harrell C-index = 0.716) and good calibration (Hosmer-Lemeshow test, P = 0.620) in high- and low-risk groups. Only patients in the high-risk group who received adjuvant chemotherapy had a significantly better survival outcome.@*CONCLUSION@#A survival-predicting nomogram was developed in this study, which was effective in assessing the survival outcomes of patients with AR-NHL. Notably, decision-making of chemotherapy regimens and more frequent follow-up should be considered in the high-risk group determined by this model.


Subject(s)
Acquired Immunodeficiency Syndrome , Humans , Lymphoma, Non-Hodgkin , Neoplasm Staging , Nomograms , Prognosis , Retrospective Studies
2.
Korean Journal of Radiology ; : 2052-2061, 2021.
Article in English | WPRIM | ID: wpr-918191

ABSTRACT

Objective@#The role of preoperative overt hepatic encephalopathy (OHE) in the neurophysiological mechanism of cognitive improvement after liver transplantation (LT) remains elusive. This study aimed to explore changes in sub-regional thalamic functional connectivity (FC) after LT and their relationship with neuropsychological improvement using resting-state functional MRI (rs-fMRI) data in cirrhotic patients with and without a history of OHE. @*Materials and Methods@#A total of 51 cirrhotic patients, divided into the OHE group (n = 21) and no-OHE group (n = 30), and 30 healthy controls were enrolled in this prospective study. Each patient underwent rs-fMRI before and 1 month after LT. Using 16 bilateral thalamic subregions as seeds, we conducted a seed-to-voxel FC analysis to compare the thalamic FC alterations before and after LT between the OHE and no-OHE groups, as well as differences in FC between the two groups of cirrhotic patients and the control group. Correction for multiple comparisons was conducted using the false discovery rate (p < 0.05). @*Results@#We found abnormally increased FC between the thalamic sub-region and prefrontal cortex, as well as an abnormally decreased FC between the bilateral thalamus in both OHE and no-OHE cirrhotic patients before LT, which returned to normal levels after LT. Compared with the no-OHE group, the OHE group exhibited more extensive abnormalities prior to LT, and the increased FC between the right thalamic subregions and right inferior parietal lobe was markedly reduced to normal levels after LT. @*Conclusion@#The renormalization of FC in the cortico-thalamic loop might be a neuro-substrate for the recovery of cognitive function after LT in cirrhotic patients. In addition, hyperconnectivity between thalamic subregions and the inferior parietal lobe might be an important feature of OHE. Changes in FC in the thalamus might be used as potential biomarkers for recovery of cognitive function after LT in cirrhotic patients.

3.
Article in Chinese | WPRIM | ID: wpr-884555

ABSTRACT

Objective:To explore the application of failure mode and effects analysis (FMEA) in low-energy X-ray intraoperative radiotherapy (IORT), analyze its potential risks in IORT, and preliminarily explore the feasibility of FMEA in optimizing IORT management and reducing the occurrence of potential risks.Methods:An FMEA working group was established by the IORT team (1 radiologist, 1 radiology physicist, 2 surgeons, and 2 nurses) to apply the FMEA methodology to conduct a systematic risk assessment. The process modules were established, the potential failure modes and causes for each module were analyzed, the severity (SR), frequency of occurrence (OR) and likelihood of detection (DR) of failure modes were scored and the risk priority number (RPN) was calculated: RPN= SR × OR × DR. The possible errors and potential clinical impact of each part of the radiotherapy process were prospectively analyzed and understood, the causes and current measures were analyzed for each failure mode and preventive measures were proposed and risk management measures were taken accordingly.Results:The IORT process was divided into 8 modules with 14 failure modes. The highest OR value was unsatisfactory target area confirmation (7 points), the highest SR value was equipment failure to discharge the beam (10 points), the highest DR value was wrong key entry after dose calculation (7 points), the highest RPN values were unsatisfactory target area confirmation (210 points) and ineffective protection of endangered organs (180 points). Weaknesses were corrected according to priorities, workflows were optimized and more effective management methods were developed.Conclusion:FMEA is an effective method of IORT management and contributes to reducing the occurrence of potential risks.

4.
Article in Chinese | WPRIM | ID: wpr-884507

ABSTRACT

Head and neck cancer presents with complex anatomy and high intratumoralheterogeneity. Radiotherapy is one of the main treatments. The therapeutic strategy and prognostic evaluation in head and neck cancer patients traditionally depend on TNM stage, lacking of individual information. Radiomics can extracts high-throughput image features relevant to the biology of tumors, which provides a non-invasive and quantitative method to evaluate the overall tumor heterogeneity and also offers a novel perspective for precision radiotherapy. The research progresses on the application and chanllenges of radiomics in the radiotherapy for head and neck cancer were summarized in this review.

5.
Acta Physiologica Sinica ; (6): 223-232, 2021.
Article in English | WPRIM | ID: wpr-878251

ABSTRACT

The present study was aimed to investigate the role of GluN2B-BDNF pathway in the cerebrospinal fluid-contacting nucleus (CSF-CN) in neuropathic pain. Intra-lateral ventricle injection of cholera toxin subunit B conjugated with horseradish peroxidase (CBHRP) was used to label the CSF-CN. Double-labeled immunofluorescent staining and Western blot were used to observe the expression of GluN2B and BDNF in the CSF-CN. Chronic constriction injury of sciatic nerve (CCI) rat model was used to duplicate the neuropathic pain. Pain behavior was scored to determine the analgesic effects of GluN2B antagonist Ro 25-6981 and BDNF neutralizing antibody on CCI rats. GluN2B and BDNF were expressed in the CSF-CN and their expression was up-regulated in CCI rats. Intra-lateral ventricle injection of GluN2B antagonist Ro 25-6981 or BDNF neutralizing antibody notably alleviated thermal hyperalgesia and mechanical allodynia in CCI rats. Moreover, the increased expression of BDNF protein in CCI rats was reversed by intra-lateral ventricle injection of Ro 25-6981. These results suggest that GluN2B and BDNF are expressed in the CSF-CN and alteration of GluN2B-BDNF pathway in the CSF-CN is involved in the modulation of the peripheral neuropathic pain.


Subject(s)
Animals , Brain-Derived Neurotrophic Factor , Hyperalgesia , Neuralgia , Rats , Rats, Sprague-Dawley , Sciatic Nerve
6.
Article in Chinese | WPRIM | ID: wpr-879822

ABSTRACT

OBJECTIVE@#To study the changes in hemodynamics during the induction stage of systemic mild hypothermia therapy in neonates with moderate to severe hypoxic-ischemic encephalopathy (HIE).@*METHODS@#A total of 21 neonates with HIE who underwent systemic mild hypothermia therapy in the Department of Neonatology, Dongguan Children's Hospital Affiliated to Guangdong Medical University, from July 2017 to April 2020 were enrolled. The rectal temperature of the neonates was lowered to 34℃ after 1-2 hours of induction and maintained at this level for 72 hours using a hypothermia blanket. The impedance method was used for noninvasive hemodynamic monitoring, and the changes in heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), cardiac output (CO), cardiac index (CI), and total peripheral resistance (TPR) from the start of hypothermia induction to the achievement of target rectal temperature (34℃). Blood lactic acid (LAC) and resistance index (RI) of the middle cerebral artery were recorded simultaneously.@*RESULTS@#The 21 neonates with HIE had a mean gestational age of (39.6±1.1) weeks, a mean birth weight of (3 439±517) g, and a mean 5-minute Apgar score of 6.8±2.0. From the start of hypothermia induction to the achievement of target rectal temperature (34℃), there were significant reductions in HR, CO, and CI (@*CONCLUSIONS@#The systemic mild hypothermia therapy may have a significant impact on hemodynamics in neonates with moderate to severe HIE, and continuous hemodynamic monitoring is required during the treatment.


Subject(s)
Cardiac Output , Child , Hemodynamics , Humans , Hypothermia , Hypoxia-Ischemia, Brain/therapy , Infant , Infant, Newborn , Vascular Resistance
7.
Chinese Journal of Radiology ; (12): 241-246, 2020.
Article in Chinese | WPRIM | ID: wpr-868282

ABSTRACT

Objective:To investigate the changes of liver spin-lattice relaxation time (T 1rho) values in the rotating frame in the progression and regression of carbon tetrachloride (CCl 4)-induced model rats with liver fibrosis and the diagnostic values for staging liver fibrosis. Methods:Eighty rats were prospectively enrolled and randomly divided into the CCl 4 group ( n=49), the regression group ( n=20) and the control group ( n=11). All rats were labeled and then examined using MRI at baseline. The liver fibrosis model was established by subcutaneous injection of 40% CCl 4 in hackles. The CCl 4 group underwent black-blood T 1rho imaging at the end of the 4th, 6th, 8th, 10th, 12th week post CCl 4 injection. The regression group underwent black-blood T 1rho imaging at the end of the 4th, 6th week post CCl 4 injection and the end of 1st, 2nd, 4th, 6th week post CCl 4 withdrawal (the injection was stopped at the end of the 6th week). The control group was injected with the same amount of corn oil at the same time point and underwent black-blood T 1rho imaging at the end of 4th, 6th, 8th, 10th, 12th week. The liver T 1rho values were measured in each group over time. Independent-samples t test was used to analyze the differences of liver T 1rho values in adjacent time points. The experimental mice were divided into no liver fibrosis group (S0), mild liver fibrosis group (S1, 2) and moderate or severe liver fibrosis group (S3, 4). The differences of liver T 1rho values were analyzed in different fibrosis stages by Kruskal-Wallis H test. The receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic ability of T 1rho values in staging liver fibrosis. The correlation between liver T 1rho values and fibrosis stages was analyzed using Spearman correlation coefficient. Results:Fifty-nine rats completed the whole experiment, including 28 rats in the CCl 4 group, 20 rats in the recovery group and 11 rats in the control group. In the CCl 4 group, the liver T 1rho values gradually increased, reached the maximum at the end of week 8, and then gradually decreased. There was statistically significance in liver T 1rho values at the adjacent time points ( P<0.05) except at the 4th to 6th week ( P=0.112) and 10th to 12th week ( P=0.487) in the CCl 4 group. In regression group, the liver T 1rho values gradually increased post CCl 4 injection and decreased post CCl 4 injection withdrawal. There was statistically significance in liver T 1rho values at the adjacent time points ( P<0.05) in regression group. There was no statistically significance in liver T 1rho values at the adjacent time points ( P>0.05) in control group. The T 1rho values in the no liver fibrosis group (S0, n=15), the mild liver fibrosis group (S1, 2, n=23) and the moderate or severe liver fibrosis group (S3, 4, n=21) were [36.3(34.4,41.4)], (47.2±8.4), (48.8±9.0) ms, respectively. The liver T 1rho values increased with the aggravation of the liver fibrosis, and there was a low positive correlation between them ( r=0.402, P=0.001). There were statistically significant differences in T 1rho values among the three groups ( P<0.01).The area under the curve values to distinguish no liver fibrosis (S0) from liver fibrosis (S1 to 4) and no or mild liver fibrosis (S0 to 2) from moderately or severe liver fibrosis (S3,4) were 0.825 (95% confidence intervals is 0.720 to 0.931) and 0.668 (95% confidence intervals is 0.540 to 0.796), separately. Conclusion:The liver T 1rho values are useful for evaluating the progression and regression of liver fibrosis. It has a moderate diagnostic value to assess the presence of liver fibrosis, but a low diagnostic value to differentiate no or mild liver fibrosis from moderately to severe liver fibrosis.

8.
Chinese Critical Care Medicine ; (12): 1538-1541, 2019.
Article in Chinese | WPRIM | ID: wpr-800024

ABSTRACT

Objective@#To explore the role of late gadolinium enhancement (LGE) and T1 mapping for detection of cardiac amyloidosis.@*Methods@#Nine cases of cardiac amyloidosis who had diagnosed by renal biopsy diagnosed type light-chain (AL) amyloidosis and acute heart failure suspected involvement of the heart in Tianjin First Central Hospital from May 2018 to March 2019 were enrolled, and at the same time 14 cases of non-obstructive hypertrophic cardiomyopathy patients, 12 cases of healthy physical examination at the same period were enrolled as the control. All patients underwent Philips 3.0-T including plain scan as cine, T2WI, native T1 mapping and enhanced scan as perfusion, LGE imaging, post T1 mapping. For LGE cardiac magnetic resonance imaging (CMRI), a bolus of 0.1 mL/kg of gadolinium-based contrast followed by a 20 mL saline flush was administered. After a 7-minutes delay, ECG-gated images were acquired in 3 long-axis and a stack of short-axis slices identical to those of cine images using a breath-hold gradient recalled echo phase-sensitive or magnitude only inversion recovery sequence. LGE and T1 mapping CMRI observation, including cardiac function index [left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), valvular regurgitation], cardiac morphological index [including left ventricular wall thickness, left ventricular weight (LVM)], myocardial histological characteristics and markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and accompanying signs (including pericardial effusion, pleural effusion) were performed.@*Results@#The predominant LGE pattern in amyloidosis was diffuse left ventricular sub endocardial enhancement (3/9), diffuse in left ventricular wall enhancement (3/9), and transmural delayed enhancement in left ventricular (2/9) and non-typical delayed enhancement (1/9). Myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 1 497.3±22.0 vs. 1 273.3±30.1, 1 329.3±42.6, both P < 0.05). Myocardial T1 was increased in AL amyloid before LGE. A post-contrast myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 476.7±44.2 vs. 516.1±41.5, 569.9±12.3, both P > 0.05). Three of 9 amyloidosis patients with review images showing T1 value and cardiac function was no significantly different with the first check (ms: 1 484.8±6.5 vs. 1 497.3±22.0, P = 0.11).@*Conclusions@#One-stop CMRI can improve the diagnosis of cardiac amyloidosis, LGE can display the myocardial scarring and fibrosis, and T1 mapping is sensitive to myocardial edema and diffuse fibrosis. LGE and T1 mapping can improve the diagnostic accuracy, which is very meaningful for diagnosis and follow-up of patients.

9.
Article in Chinese | WPRIM | ID: wpr-755921

ABSTRACT

Objective To summarize the computed tomographic (CT) manifestations of pulmonary aspergillosis after organ transplantation and compare different signs between pulmonary aspergillosis and bacterial pneumonia.Methods CT images of pulmonary aspergillosis (n =62) and bacterial pneumonia (n =68) in post-transplantation patients were reviewed.The signs were categorized with consolidation,mass,large nodule (≥1crn),small nodule and bud-in-tree pattern.Some detailed useful differentiating signs such as halo sign,air bronchogram sign,reversed halo sign,hypodensity sign and cavitation were also analyzed.Results CT patterns of pulmonary aspergillosis included consolidation,mass,large nodule,small nodule and bud-in-tree pattern.The most common was large nodule (75.8%),followed by consolidation (48.4%)and mass (29.0%).And small nodule (16.1 %) and bud-in-tree (12.9%) patterns were concurrent.For consolidation pattern,the proportion of bacterial pneumonia (69.1%) was the larger;For mass pattern,the proportion of pulmonary aspergillosis (29.0%) was the larger.For large nodule pattern,there was no difference.The detail sign of large nodule in two groups had no difference In detailed signs of consolidation pattern,air bronchogram sign was more often seen in bacterial pneumonia while cavitation was more frequently found in pulmonary aspergillosis.In detailed signs of mass pattern,pulmonary aspergillosis often has single lesion (66.7%),cavitation (83.3%)and air crescent sign (77.8%) is more common.The proportion of halo sign was 30.7%.Conclusions CT manifestations of pulmonary aspergillosis are diverse after organ transplantation.There is some difference and yet overlap with bacterial pneumonia.

10.
Chinese Journal of Radiology ; (12): 357-363, 2019.
Article in Chinese | WPRIM | ID: wpr-754930

ABSTRACT

Objective To assess the value of diffusion and perfusion properties of early renal allografts with intravoxel incoherent motion (IVIM) and arterial spin labeling (ASL) MR imaging. Methods Seventy‐six renal allograft recipients were included from May 2014 to December 2015 in First Center Hospital of Tianjin in this prospective study. All subjects underwent conventional, IVIM and ASL MRI. Recipients were divided into 3 groups based on the estimated glomerular filtration rate (eGFR) and chronic kidney disease: group 1, recipients with good allograft function (eGFR≥60 ml·min-1·1.73 m-2,n=44); group 2, recipients with mild to moderate impaired allograft function (30 ml·min-1·1.73 m-2≤eGFR<60 ml·min-1· 1.73 m-2,n=19); group 3, recipients with severe impaired allograft function (eGFR<30 ml·min-1·1.73 m-2, n=13). Apparent diffusion coefficient (ADC), pure diffusion coefficient (ADCslow), pseudo‐diffusion coefficient (ADCfast), perfusion fraction (PF), renal blood flow (RBF) in the cortex and medullar were measured. A paired t‐test was used to test the difference of cortical or medullary index values between the cortex and medulla in three groups. One‐way analysis of variance (ANOVA) and least significant difference (LSD) were used to test the difference of the index values among three groups. Pearson correlation coefficients were used to evaluate the correlation of all index values with eGFR. The receiver operating characteristic (ROC) curve was performed to assess the diagnostic efficacy of using IVIM and ASL index values to discriminate different renal functions. The ROC curve and binary logistic regression analyses were performed to assess the diagnostic efficacy of using IVIM and ASL alone or a combination of them to distinguish allografts with different renal functions. Results ADC, ADCslow, ADCfast values between cortex and medulla were significantly different in group 1 and 3, as well as PF in group 1 (P<0.05). ADC, ADCslow, ADCfast, PF, RBF in the cortex and ADC, PF in the medulla were significant different between group 2 and 1 (P<0.05);except PF in the medulla in group 3, other index values were significant different between group 3 and 2 (P<0.05).All index values exhibited a correlation with renal function as determined by eGFR for recipients(r were 0.603, 0.590,0.604,0.457,0.552,0.552,0.579,0.425,0.673 respectivily, P<0.01). ADC, ADCslow, ADCfast, PF, RBF in the cortex and ADC in the medulla showed a relatively high diagnostic efficacy to discriminate renal allografts with different functions. Cortical ADC showed a better diagnostic efficacy(Z=2.699,P=0.007) than cortical ADCslow when distinguishing group 1 from 2.The combination of IVIM and ASL MRI showed a better diagnostic efficacy to distinguish group 1 from 2 than IVIM and ASL MRI alone, with an AUC of 0.969, a sensitivity of 100.0% and a specificity of 93.2% (P<0.05). Conclusions IVIM and ASL MRI can evaluate the diffusion and perfusion properties of renal allografts. A combination of IVIM and ASL MRI can better distinguish different functional allografts.

11.
Article in Chinese | WPRIM | ID: wpr-754581

ABSTRACT

Cardiac involvement in amyloidosis has a relatively poor prognosis, and early diagnosis and treatment is very important to the prognosis of such involved patients. "One stop type" cardiac examination can be carried out by the cardiac magnetic resonance imaging (CMRI) and the evaluation of cardiac morphology and function can be complete. "One stop type" CMRI may show the thickness of myocardium in left ventricle, cardiac diastolic dysfunction, sub-endocardial enhancement (patch, diffuse and transmural types), rising of T1 value, too fast clarifying rate of contrast agent in blood pool, pericardial and/or pleural cavity effusion, that may help to elevate the efficiency of diagnosis. The CMRI presents myocardial tissue characteristics quite well, that may help for early diagnosis of myocardial amyloidosis, and clearly demonstrate the situation of heart involvement; to follow-up patients with repeat CMRI examinations can monitor drug therapeutic effect, direct and regulate treatment, judge prognosis, etc. so that CMRI possesses very high clinical application value.

12.
Article in Chinese | WPRIM | ID: wpr-754501

ABSTRACT

Objective To evaluate the diagnostic value of cardiac magnetic resonance (MR) for acute heart failure (AHF) with unknown cause. Methods A retrospective study was conducted, eleven patients with AHF with unknown cause admitted to Tianjin First Center Hospital from September 2017 to August 2018 were enrolled, and all the patients underwent complete cardiac MR imaging (plain MR and delayed enhancement imaging) with satisfactory image quality fulfilled the diagnostic requirement. Additionally, all of them had no history of heart disease and lack of diagnostic laboratory tests (routine blood test, blood biochemistry and myocardial enzyme), electrocardiogram (ECG) changes and echocardiography abnormality. Besides, 10 patients had completed invasive coronary angiography or coronary CT angiography (CCTA); the results of laboratory tests, ECG abnormality, echocardiography and cardiac MR were recorded, and the values of echocardiography and cardiac MR examination in the diagnosis and exploring the cause of patients with AHF with unknown cause were analyzed. Results Nine of 11 patients with AHF with unknown cause had positive finding on cardiac MR examination; there were 3 patients with chronic myocardial infarction, 3 with dilated cardiomyopathy, 2 with cardiac involvement of amyloidosis and 1 with myocarditis. The left ventricular end systolic volume (LVESV) measured on cardial MR was significantly higher than that on echocardiography (mL: 120.68±57.47 vs. 108.84±50.49, P < 0.05), the left ventricular ejection fraction (LVEF) and myocardial valvular regurgitation measured on MR were less than those on echocardiography (LVEF: 0.36±0.09 vs. 0.43±0.10; regurgitation: 11 vs. 22, both P < 0.05); while, the differences of the end diastolic volume (LVEDV) and the number of patients with pericardial effusions between MR and echocardiography had no statistical significant differences [LVEDV (mL): 183.37±65.26 vs. 182.26±70.44; pericardial effusion: 6 cases vs. 6 cases, all P > 0.05]. Conclusion Cardiac MR could synthetically evaluate the heart by its morphology, function as well as accompanied sign (pericardial effusion) and cardiac tissue characteristics; eventually, it may provide valuable information concerning the selection of proper clinical therapeutic strategies and improvement of AHF patients' prognose.

13.
Chinese Critical Care Medicine ; (12): 269-280, 2019.
Article in Chinese | WPRIM | ID: wpr-753954

ABSTRACT

Objective To review the development of adult and pediatric liver transplantation in Tianjin First Center Hospital, and to enhance academic exchanges, improve technological innovation, and jointly promote the progress and maturity in the field of liver transplantation. Methods The development of liver transplantation in Tianjin First Center Hospital was analyzed. The clinical data of adult and pediatric liver transplantation from September 1998 to September 2018 were collected. The important events and technological innovation achievements of liver transplantation during the 20 years were summarized. Results The first clinical liver transplantation was attempted in Tianjin First Central Hospital in April 1980. The first long-term survival adult liver transplantation in China was completed in 1994 (11 years survival after the operation). The specialized team of liver transplantation was formally established in September 1998. The 20-year clinical exploration and progress reflected the characteristics of era changes and technological innovation during the rapid development of liver transplantation in China. Our center performed liver re-transplantation in January 1999, reduced-size pediatric liver transplantation in August 2000. In May 2001, we organized the formulation for the preventive and treatment plan for hepatitis B recurrence after liver transplantation. We performed combined liver and kidney transplantation in July 2002, split liver transplantation (SLT) in April 2004, the first domino liver transplantation (DLT) in August 2005. Pediatric living donor liver transplantation (LDLT) was initiated in October 2006, adult LDLT was carried out in August 2007. In September 2007, the first living donor combined liver and kidney transplantation from the same donor in Asia was performed. The first domino+living donor double grafts liver transplantation in the world was performed in January 2009. In March 2011, we performed laparoscopically assisted right hepatic lobe liver transplantation (LDLT) with middle hepatic vein. In May 2014, living donor laparoscopic left lateral lobe procurement was successfully established. In April 2016, simultaneous liver, pancreas and kidney multi-organ transplantation was completed. Domino donor-auxiliary liver transplantation was performed in February 2017. In December 2017, extracorporeal membrane oxygenation (ECMO)-supported liver transplantation in a patient with severe pulmonary hypertension was successfully completed. Liver transplantation combined with partial splenectomy was established in April 2018. Cross-domino liver transplantation (hypersensitive kidney transplantation with auxiliary liver transplantation+pediatric liver transplantation) was performed in May 2018. During the 20 years, the team has performed or assisted other centers in Beijing, Shanghai, Guangzhou and Shenzhen to carry out more than 10 000 cases of liver transplantations. A total of 7 043 cases of various types of liver transplantation were performed in the single center of the hospital (6 005 adult liver transplantations and 1 038 pediatric liver transplantations). Concerning adult liver transplantation, the cumulative 1-year, 3-year and 5-year survival rate from September 1998 to March 2003 were 83.1%, 73.0% and 69.0%, from April 2003 to March 2009 were 85.3%, 76.2% and 72.1% and from April 2009 to September 2018 were 87.5%, 79.2% and 75.1%, respectively. The cumulative 1-year, 3-year and 5-year survival rate for pediatric liver transplantation were 93.5%, 92.2% and 90.2%, respectively. The nucleoside (acid) analogue combined with low dose hepatitis B immunoglobulin (HBIG) was developed to prevent the recurrence of hepatitis B after liver transplantation, this plan has reduced the recurrence rate of hepatitis B and the 5-year re-infection rate of hepatitis B virus (HBV) after liver transplantation significantly. The risk assessment system for tumor recurrence after liver transplantation was established and individual treatment method was established based on this assessment system. Continuous exploration and improvement of liver transplantation for liver cancer, liver re-transplantation, liver transplantation with portal vein thrombosis, SLT, DLT and multi-organ combined transplantation have significantly improved the clinical efficacy of patients and the post-operative survival rate. Conclusions The liver transplantation team of Tianjin First Center Hospital has carried out a scientific and technological exploration on the key problems and technical difficulties of clinical liver transplantation. This work strongly has initiated and promoted the rapid development of liver transplantation in China. The restrictive barrier of hepatitis B recurrence after liver transplantation has been overcome. The risk prevention and control system of tumor recurrence after liver transplantation has been established. A series of innovative achievements that can be popularized have been achieved in the field of complex liver transplantation and expansion of donor liver source. The iterative progress and sustainable development of liver transplantation have been realized.

14.
Chinese Critical Care Medicine ; (12): 1538-1541, 2019.
Article in Chinese | WPRIM | ID: wpr-824240

ABSTRACT

Objective To explore the role of late gadolinium enhancement (LGE) and T1 mapping for detection of cardiac amyloidosis. Methods Nine cases of cardiac amyloidosis who had diagnosed by renal biopsy diagnosed type light-chain (AL) amyloidosis and acute heart failure suspected involvement of the heart in Tianjin First Central Hospital from May 2018 to March 2019 were enrolled, and at the same time 14 cases of non-obstructive hypertrophic cardiomyopathy patients, 12 cases of healthy physical examination at the same period were enrolled as the control. All patients underwent Philips 3.0-T including plain scan as cine, T2WI, native T1 mapping and enhanced scan as perfusion, LGE imaging, post T1 mapping. For LGE cardiac magnetic resonance imaging (CMRI), a bolus of 0.1 mL/kg of gadolinium-based contrast followed by a 20 mL saline flush was administered. After a 7-minutes delay, ECG-gated images were acquired in 3 long-axis and a stack of short-axis slices identical to those of cine images using a breath-hold gradient recalled echo phase-sensitive or magnitude only inversion recovery sequence. LGE and T1 mapping CMRI observation, including cardiac function index [left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), valvular regurgitation], cardiac morphological index [including left ventricular wall thickness, left ventricular weight (LVM)], myocardial histological characteristics and markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and accompanying signs (including pericardial effusion, pleural effusion) were performed. Results The predominant LGE pattern in amyloidosis was diffuse left ventricular sub endocardial enhancement (3/9), diffuse in left ventricular wall enhancement (3/9), and transmural delayed enhancement in left ventricular (2/9) and non-typical delayed enhancement (1/9). Myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 1497.3±22.0 vs. 1273.3±30.1, 1329.3±42.6, both P < 0.05). Myocardial T1 was increased in AL amyloid before LGE. A post-contrast myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 476.7±44.2 vs. 516.1±41.5, 569.9±12.3, both P > 0.05). Three of 9 amyloidosis patients with review images showing T1 value and cardiac function was no significantly different with the first check (ms: 1484.8±6.5 vs. 1497.3±22.0, P = 0.11). Conclusions One-stop CMRI can improve the diagnosis of cardiac amyloidosis, LGE can display the myocardial scarring and fibrosis, and T1 mapping is sensitive to myocardial edema and diffuse fibrosis. LGE and T1 mapping can improve the diagnostic accuracy, which is very meaningful for diagnosis and follow-up of patients.

15.
Article in Chinese | WPRIM | ID: wpr-817824

ABSTRACT

OBJECTIVE: To investigate diagnosis of children's neuronal ceroid lipofuscinosis(NCL),especially the significance of gene diagnosis. METHODS: The clinical data of 5 cases of suspected NCL in our hospital from January 2013 to January 2017 were retrospectively analyzed. There were 3 boys and 2 girls,2 of whom were sister and brother. The age of onset ranged from 3 years and 4 months to 8 years and 1 month,averaged 5 years and 9 months. The first visit to our hospital ranged from 3 years and 6 months to 14 years,with an average of 8 years and 1 month. DNA of peripheral blood was extracted from 4 children with abnormal imaging and their parents and brothers,and the related genes were detected.RESULTS: Four cases of children were diagnosed with NCL,and 1 case was diagnosed with hysteria;gene detection showed:case 1:TPP1 gene c.887-17 A>G was a shearing variant,and c.646 G>A was a missense mutation;case 2:TPP1 gene c.1015_1016 del was frameshift mutation,and c.640 C>T was nonsense mutation;the nucleotide of case 3:CLN6 gene changed to c.158 T>C(p.L53 P)and c.889 C>T(p.P297 S). The parents of the 3 cases only carried one of the heterozygous variants,and the brother of case 3 had no mutation. Heterozygous mutation existed in case 4:CLN3 gene,c.1160_1169 delCAGCCTACGTinsGC,which was not detected in the mother,and there was the deletion of the paternal sample;there was loss of heterozygosity in the exon E3-E8 of the CLN3 gene,which was the true missing from mother.Five cases were followed up for 15-60 months and there was no death. CONCLUSION: Suspected NCL patients should be checked head MRI,electroencephalogram and gene. The gene mutation leads to NCL,such as TPP1(c.887-17 A>G,c.1015_1016 del),CLN3(c.1160_1169 delCAGCCTACGTinsGC),CLN6[(c.158 T>C(p.L53 P) and c.889 C>T(p.P297 S)],are reported for the first time. Genotype is very important for NCL classification and prognosis.

16.
China Pharmacy ; (12): 1985-1989, 2019.
Article in Chinese | WPRIM | ID: wpr-817219

ABSTRACT

OBJECTIVE: To investigate the correlation of 5-hydroxytryptamine 2A receptor (5-HT2AR) rs6313 gene polymorphism with pain occurrence and opioid requirements in patients with lung cancer. METHODS: Totally 332 patients with lung cancer were selected from the Affiliated Hospital of Xuzhou Medical University during Dec. 2017-Jun. 2018 as lung cancer group. They were divided into pain group (177 cases) and painless group (155 cases) according to whether pain occurred. Totally 116 healthy persons who underwent physical examination in same period were selected as control group. The genotype of rs6313 locus of 5-HT2AR gene was detected by PCR-RFLP. The distribution of genotype was compared by χ2-test. The correlation of genotype with pain occurrence and degree, opioids requirements were investigated by Binary Logistic regression analysis, χ2-test and Kruskal-Wallis test. RESULTS: CC, CT, TT genotypes were detected in rs6313 locus of 5-HT2AR gene. The frequency of above genotypes were 20.7%, 47.4%, 31.9%, 20.6%, 50.3%, 29.0% as well as 16.4%, 50.8%, 32.8%, respectively in control group, painless group and pain group. Their frequencies and allele frequencies were in line with Hardy-Weinberg balance (P>0.05). There was no statistical significance in genotype and allele frequencies between lung cancer group and control group (P>0.05). TNM staging (Ⅲ-Ⅳ stage) was associated with pain in lung cancer patients [OR=3.661, 95%CI (1.972,6.797), P<0.001]. Gender, age, height, body weight, pathological typing and rs6313 locus genotype had no correlation with pain (P>0.05). The genotype of this locus was not related to the degree of pain and the requirements for opioids in patients with lung cancer (P>0.05). CONCLUSIONS: The polymorphism of 5-HT2AR gene rs6313 locus is no related to pain occurrence and opioid requirements in patients with lung cancer. Its polymorphism may not be the main cause of individual pain differences in lung cancer patients.

17.
Article in English | WPRIM | ID: wpr-716338

ABSTRACT

OBJECTIVE: The study aimed to evaluate the contributions of levator ani muscle (LAM) injury, vesical neck movement, urethral length and mobility, and urethral sphincter dysfunction observed on magnetic resonance imaging (MRI) towards stress urinary incontinence (SUI) after vaginal delivery. MATERIALS AND METHODS: Fifty primiparous women after 6 months of delivery (15 with SUI and 35 without) and 35 nulliparous as continent controls underwent MRI at rest and Valsalva maneuver. A published levator ani scoring system was used to characterize morphological changes of LAM. The severity of the injury was divided into three categories as none, minor, and major. A series of common parameters including levator plate angle, iliococcygeal angle, and levator hiatus were used to describe the functional conditions of LAM. Urethral mobility was defined based on the rotation of the urethra between Valsalva and rest status. Vesical neck movement was evaluated by its distance to the pubococcygeal line. Urethral sphincter dysfunction was defined as the widening of the proximal urethra and/or funneling at the urethrovesical junction during Valsalva. RESULTS: Primiparous incontinent (PI) women had additional major levator ani defects (33.3% vs. 17.1%) while less minor defects (0.7% vs. 31.4%) than primiparous continent (PC) women. Vesical neck downward movement in PI women was more obvious than PC women (28.5 mm vs. 24.2 mm, p = 0.006). Urethral mobility was more active in primiparous women than in nulliparous continent controls (57.4 vs. 52.4), whereas no difference was observed on urethral mobility in the primiparous group (p = 0.25). Urethral sphincter dysfunction and funneling were present in 80% of PI women versus 22.9% in PC women (p < 0.001). CONCLUSION: The MRI findings revealed that de novo SUI was associated with major LAM injury, vesical neck downward movement as well as urethral sphincter dysfunction. Vesical neck funneling on sagittal images can be treated as a valuable predictor for SUI. The intervention for the PI should focus on the elevation of vesical neck, rehabilitation of LAM as well as recovery of the urethral sphincter muscle.


Subject(s)
Female , Humans , Magnetic Resonance Imaging , Neck , Pelvic Floor Disorders , Pelvic Floor , Rehabilitation , Urethra , Urinary Incontinence , Valsalva Maneuver
18.
Article in English | WPRIM | ID: wpr-715446

ABSTRACT

OBJECTIVE: To investigate brain regional homogeneity (ReHo) changes of multiple sub-frequency bands in cirrhotic patients with or without hepatic encephalopathy using resting-state functional MRI. MATERIALS AND METHODS: This study recruited 46 cirrhotic patients without clinical hepatic encephalopathy (noHE), 38 cirrhotic patients with clinical hepatic encephalopathy (HE), and 37 healthy volunteers. ReHo differences were analyzed in slow-5 (0.010−0.027 Hz), slow-4 (0.027−0.073 Hz), and slow-3 (0.073−0.198 Hz) bands. Routine analysis of (0.010−0.080 Hz) band was used as a benchmark. Associations of abnormal ReHo values in each frequency band with neuropsychological scores and blood ammonia level were analyzed. Pattern classification analyses were conducted to determine whether ReHo differences in each band could differentiate the three groups of subjects (patients with or without hepatic encephalopathy and healthy controls). RESULTS: Compared to routine analysis, more differences between HE and noHE were observed in slow-5 and slow-4 bands (p 12, overall corrected p < 0.05). Sub-frequency band analysis also showed that ReHo abnormalities were frequency-dependent (overall corrected p < 0.05). In addition, ReHo abnormalities in each sub-band were correlated with blood ammonia level and neuropsychological scores, especially in the left inferior parietal lobe (overall corrected p < 0.05 for all frequency bands). Pattern classification analysis demonstrated that ReHo differences in lower slow-5 and slow-4 bands (both p < 0.05) and higher slow-3 band could differentiate the three groups (p < 0.05). Compared to routine analysis, ReHo features in slow-4 band obtained better classification accuracy (89%). CONCLUSION: Cirrhotic patients showed frequency-dependent changes in ReHo. Sub-frequency band analysis is important for understanding HE and clinical monitoring.


Subject(s)
Ammonia , Benchmarking , Brain , Classification , Healthy Volunteers , Hepatic Encephalopathy , Humans , Liver Cirrhosis , Magnetic Resonance Imaging , Parietal Lobe
19.
Article in Chinese | WPRIM | ID: wpr-773785

ABSTRACT

OBJECTIVES@#To investigate the interventional effects of 16-week aerobic exercises on the elderly's arteriosclerosis and its mechanism.@*METHODS@#Twenty-seven elderly people with the average age of 62. 70 ±3. 26 joined a 16-week square dance/taijiquan exercise program that conducted 60 minutes each time, six times per week. Arterial stiffness and its related indexes such as systolic pressure(SBP), diastolic pressure(DBP), left brachial-ankle pulse wave velocity (L-baPWV), right brachial-ankle pulse wave velocity(R-baPWV), left ankle brachial index (L-ABI), right ankle brachial index(R-ABI), serum triglyceride(TG), total cholesterol(TC), high density lipoprotein cholesterol(HDL-c), low density lipoprotein cholesterol(LDL-c), superoxide dismutase(SOD), malondialdehyde(MDA) and glutathione peroxidase (GSH-Px) were detected at 3 time points including before exercise program, by the end of exercise for 8 weeks and 16 weeks.@*RESULTS@#① Compared with pre-exercise, the R-baPWV and R-ABI of the elderly people were decreased at the end of the 8 week, and the L-baPWV, RbaPWV, R-ABI and L-ABI were decreased significantly at the end of the 16 week. ②Compared with pre-exercise, SBP and DBP were declined markedly (<0.01, <0.05) at the end of the 8 week, SBP, DBP and pulse pressure were decreased significantly (<0.01, <0.05) at the end of the 16 week. ③Compared with pre-exercise, TC and LDL-c were declined markedly (<0.01) at the end of the 8 and the 16 week, and there was no difference of the level of TG and LDL-c between pre-exercise and post-exercise. ④There was no evident difference of serum level of SOD, GSH-Px, MDA between pre-exercise and post-exercise at the end of the 8 week. Compared with pre-exercise, the level of serum SOD, GSH-Px was increased evidently while the content of serum MDA was decreased significantly (<0.01).@*CONCLUSIONS@#Sixteen-week aerobic exercises could reduce baPWV and ABI levels, regulate blood pressure, blood lipids and lipid peroxides levels of the elderly evidently, thus improve the controlling quality of atherosclerosis.


Subject(s)
Aged , Ankle , Ankle Brachial Index , Arteriosclerosis , Therapeutics , Blood Pressure , Cholesterol , Blood , Exercise , Glutathione Peroxidase , Blood , Humans , Malondialdehyde , Blood , Middle Aged , Pulse Wave Analysis , Superoxide Dismutase , Blood , Triglycerides , Blood
20.
Article in Chinese | WPRIM | ID: wpr-704174

ABSTRACT

Objective To evaluate the role of suppressor of cytokine signaling 3 ( SOCS3) in the spinal cord of chronic sciatic constriction injury ( CCI) mice. Methods Part one:four Kunming mice were selected to receive the CCI operation by sciatic nerve ligation. Seven days after operation the mice were sac-rificed and L4~6 segments of the spinal cord were removed. The co-expression of SOCS3 with NeuN ( for neurons),GFAP (for astrocytes),or IBA1 (for microglia) in spinal were detected by immunohistofluores-cence. Part two:thirty-two Kunming mice were divided into 4 groups according to random number table:sham operation group (group SH),CCI group (group BP),CCI+Lenti-SOCS3 group (group BS),CCI +Lenti-vector group (group BV). Group BS were intrathcal injected of Lenti-SOCS3 (2 μl) and group BV were intrathcal injected of Lenti-vector (2 μl) on 7 d,8 d,9 d after operation. Paw withdrawal latency ( PWL) and paw withdrawal threshold ( PWT) were measured at 1 d before operation and 5,7,10,12,14 d after operation. Mice were then sacrificed and L4~6 segments of the spinal cord were removed for determina-tion of GFAP,IBA-1 by Western blot and IL-6,IL-1β,TNF-α by Elisa on 14 d. Results SOCS3 was dis-tributed in dorsal horn,and expressed in astrocytes and microglia,but hardly colocalized with neurons. Com-pared with group SH,the PWL and PWT of group BP and BV were significantly decreased after operation (all P<0. 05),and the expression of GFAP,IBA-1,IL-6,IL-1β and TNF-α was significantly increased (all P<0. 05). Compared with group BV,the PWL (5. 1±0. 9,7. 5±0. 8,7. 2±1. 4) and PWT (6. 1±1. 4,8. 9± 1. 1,8. 2±2. 1) of group BS was significantly increased on 10,12,14 d (all P<0. 05),and the expression of GFAP (1. 69±0. 45),IBA-1(1. 76±0. 25),IL-6 (181±8),IL-1β (151±7),TNF-α (216±9) was signifi-cantly downregulated (P<0. 05) . Conclusion SOCS3 alleviates neuropathic pain by inhibiting the glial ac-tivation and the expression of proinflammatory cytokines IL-6,IL-1β,TNF-α.

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