Application of Global Leadership Initiative on Malnutrition criteria in patients with liver cirrhosis / 中华医学杂志(英文版)

BACKGROUND@#The Global Leadership Initiative on Malnutrition (GLIM) criteria were published to build a global consensus on nutritional diagnosis. Reduced muscle mass is a phenotypic criterion with strong evidence to support its inclusion in the GLIM consensus criteria. However, there is no consensus regarding how to accurately measure and define reduced muscle mass in clinical settings. This study aimed to investigate the optimal reference values of skeletal muscle mass index for diagnosing sarcopenia and GLIM-defined malnutrition, as well as the prevalence of GLIM-defined malnutrition in hospitalized cirrhotic patients.@*METHODS@#This retrospective study was conducted on 1002 adult patients with liver cirrhosis between January 1, 2018, and February 28, 2022, at Beijing You-An Hospital, Capital Medical University. Adult patients with a clinical diagnosis of liver cirrhosis and who underwent an abdominal computed tomography (CT) examination during hospitalization were included in the study. These patients were randomly divided into a modeling group (cohort 1, 667 patients) and a validation group (cohort 2, 335 patients). In cohort 1, optimal cut-off values of skeletal muscle index at the third lumbar skeletal muscle index (L3-SMI) were determined using receiver operating characteristic analyses against in-hospital mortality in different gender groups. Next, patients in cohort 2 were screened for nutritional risk using the Nutritional Risk Screening 2002 (NRS-2002), and malnutrition was diagnosed by GLIM criteria. Additionally, the reference values of reduced muscle mass in GLIM criteria were derived from the L3-SMI values from cohort 1. Multivariate logistic regression analysis was used to analyze the association between GLIM-defined malnutrition and clinical outcomes.@*RESULTS@#The optimal cut-off values of L3-SMI were 39.50 cm 2 /m 2 for male patients and 33.06 cm 2 /m 2 for female patients. Based on the cut-off values, 31.63% (68/215) of the male patients and 23.3% (28/120) of the female patients had CT-determined sarcopenia in cohort 2. The prevalence of GLIM-defined malnutrition in cirrhotic patients was 34.3% (115/335) and GLIM-defined malnutrition was an independent risk factor for in-hospital mortality in patients with liver cirrhosis ( Wald = 6.347, P  = 0.012).@*CONCLUSIONS@#This study provided reference values for skeletal muscle mass index and the prevalence of GLIM-defined malnutrition in hospitalized patients with liver cirrhosis. These reference values will contribute to applying the GLIM criteria in cirrhotic patients.

Sinogram interpolation combined with unsupervised image-to-image translation network for CT metal artifact correction / 南方医科大学学报

OBJECTIVE@#To propose a framework that combines sinogram interpolation with unsupervised image-to-image translation (UNIT) network to correct metal artifacts in CT images.@*METHODS@#The initially corrected CT image and the prior image without artifacts, which were considered as different elements in two different domains, were input into the image transformation network to obtain the corrected image. Verification experiments were carried out to assess the effectiveness of the proposed method using the simulation data, and PSNR and SSIM were calculated for quantitative evaluation of the performance of the method.@*RESULTS@#The experiment using the simulation data showed that the proposed method achieved better results for improving image quality as compared with other methods, and the corrected images preserved more details and structures. Compared with ADN algorithm, the proposed algorithm improved the PSNR and SSIM by 2.4449 and 0.0023 when the metal was small, by 5.9942 and 8.8388 for images with large metals, and by 8.8388 and 0.0130 when both small and large metals were present, respectively.@*CONCLUSION@#The proposed method for metal artifact correction can effectively remove metal artifacts, improve image quality, and preserve more details and structures on CT images.

Interpretation of the European Society for Clinical Nutrition and Metabolism micronutrient guideline (2022) / 中华临床营养杂志

Micronutrient (MN) deficiency is common in many acute and chronic diseases and should be monitored and managed. In February 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) released the MN guidelines. This guideline aimed to inform the evaluation, monitoring and treatment principles in MN management as part of daily clinical nutrition practice with standardized terminology to avoid confusion. Extensive literature review was conducted covering multiple databases including Medline, PubMed, Cochrane, Google Scholar, and CINAHL databases. For each kind of MN, information was summarized concerning main functions, optimal detection methods, susceptibility to inflammation, potential toxicity and recommended dose for supplementation via enteral or parenteral nutrition. Practical recommendations on MN supplementation and monitoring were provided to manage MN deficiency in high-risk diseases. This review was based on the contents in the guidelines with an emphasis on interpreting the critical issues.

Endovascular recanalization for non-acute internal carotid artery occlusion using a new angiographic classification / 中华放射学杂志

Objective:To evaluate the safety and feasibility of endovascular recanalization for non-acute internal carotid artery occlusion (NA-ICAO), and to propose a new angiographic classification.Methods:From April 2015 to October 2019, 95 consecutive patients with symptomatic NA-ICAO who received endovascular recanalization were retrospectively analyzed in Beijing Tiantan Hospital, Capital Medical University. All the patients were divided into four groups according to DSA: type Ⅰ, petrous segments were distally reconstituted by collateral vessels; type Ⅱ, cavernous segments were distally reconstituted by collateral vessels; type Ⅲ, ophthalmic segments were distally reconstituted by collateral vessels; type Ⅳ, communicating segments were distally reconstituted by collateral vessels. Study data including clinical characteristics, surgical details, lesion classification, recanalization rate and perioperative complications. For the counting data, the χ 2 test was used to compare between groups. For the quantitative data, the ANOVA was used for the normal distribution data, otherwise the Kruskal-Wallis H test was used. The primary safety outcome was any stroke or death within 30 days. Results:Among the 95 patients, 67 (70.53%) had successful recanalization. The recanalization rates of type Ⅰ－Ⅳ were 92.31% (36/39), 81.82% (18/22), 47.83% (11/23) and 18.18% (2/11) respectively (χ2=29.557, P<0.001). And the complication rates of the four types were 5.13% (2/39), 13.64% (3/22), 21.74% (5/23) and 9.10% (1/11) respectively. The incidence of perioperative ischemic stroke was 2.11% (2/95). No other serious stroke and death occurred. Conclusions:Endovascular recanalization may be feasible and safe for carefully selected patients with NA-ICAO and therefore represents an alternative treatment. The patients with type Ⅰ and Ⅱ lesions had higher recanalization rates, while the patients with type Ⅳ lesions had significantly lower recalculation rate. The new angiographic classification is conducive to the selection of suitable patients and difficulty in grading.

Symptomatic M1 stenosis of middle cerebral artery: the correlation between stenosis ratio and CT perfusion / 中华神经科杂志

Objective To quantitatively analyze the correlation between stenosis ratio and cerebral perfusion in patients with solely symptomatic M1 stenosis of middle cerebral artery.Methods All the patients with solely symptomatic M1 stenosis of middle cerebral artery were selected to this study from consecutive 203 patients with elective stenting of symptomatic intracranial artery stenosis.Brain CT, CT perfusion (CTP) and DSA examinations were performed in all cases.The CTP parameters of mean transit time (MTT), cerebral blood flow (CBF) and cerebral blood volume (CBV) were measured in regions of interest (ROIs) including bilateral frontal lobe, anterior watershed, opercula of the insula (including parsopercluaris and part of insula), temporal lobe, posterior watershed and occipital lobe.Compared with the unaffected side as control, the change of CTP and their relative CTP parameters in these ROIs at affected side were analyzed.Based on DSA data, the ratio of M1 stenosis was measured manually and blindly, the source of collateral branch of compensative artery was estimated and the blood flow was graded.Correlation between the ratio of M1 stenosis and the CTP parameters including the absolute and the relative values was investigated.Results Twenty patients were selected into this study; their average M1 stenosis ration of the affected side was 70.5% ± 10.6% (53% to 91%).Compared with the unaffected side, MTT and CBF were no significant change but CBV increased in the affected frontal lobe; MTT prolonged, CBF was normal and CBV increased in the affected anterior watershed and opercula of the insula; MTT prolonged, CBF and CBV had no significant difference in the affected temporal lobe; MTT prolonged, CBF decreased and CBV had no significant difference in the affected posterior watershed; MTT, CBF and CBV were normal in occipital lobe.Tissue perfusion gradually decreased from the front to the backward in all the M1 stenosis affected cerebral regions and the posterior watershed area was the only region at hemodynamic failure stage.Leptomeningeal vessels of the anterior cerebral artery were the major sources of compensative arteries shown in the DSA in all cases.The ratio of M1 stenosis was positively correlated (r =0.66, P =0.002) with the rCBV in posterior watershed and there is no significant correlation between the ratio and any other CTP parameters in any regions.Conclusions Associated with distribution of collateral compensative artery,tissue perfusion showed obvious spatial distribution at different level in different cerebral region.M1 stenosis ratio is positively correlated with rCBV in hemodynamic failure regions, and there is no correlation with tissue perfusion in hemodynamic compromise regions.