Chinese thyroid imaging reporting and data system(C-TIRADS)combined with intranodular and perinodular stiffness for distinguishing benign and malignant thyroid nodules / 中国医学影像技术

Objective To explore the value of Chinese thyroid imaging reporting and data system(C-TIRADS)combined with intranodular and perinodular stiffness for distinguishing benign and malignant thyroid nodules.Methods Data of routine ultrasound and ultrasonic shear wave elastography(SWE)in 117 patients with thyroid nodules confirmed by fine needle aspiration cytology(FNAC)and/or surgical pathology were retrospectively analyzed.The nodules were classified according to C-TIRADS and SWE parameters of nodules and surrounding 2 mm glands measured with SWE technique,including Young's modulus of thyroid nodules(E)and perinodular glandular(Eshell)(the maximum[Emax/Eshellmax],the mean[Emean/Eshellmean]and the minimum[Emin/Eshellmin]as well as standard deviation[ESD/EshellSD]values).Then receiver operating characteristic(ROC)curve was drawn,and area under the curve(AUC)was calculated to assess the efficacy of C-TIRADS,SWE and the combination for differentiating benign and malignant thyroid nodules.Results Totally 117 thyroid nodules of 117 patients were enrolled,including 50 benign and 67 malignant ones.SWE parameters of malignant thyroid nodules were higher than those of benign ones(all P＜0.001).AUC of C-TIRADS for differentiating benign and malignant thyroid nodules was 0.736,with sensitivity of 79.10％,specificity of 68.00％and accuracy of 74.36％.AUC of Emax,Emean,Emin and ESD was 0.816,0.752,0.664 and 0.705,respectively,of Emax was the highest.AUC of Eshellmax,Eshellmean,Eshellmin and EshellSD was 0.834,0.804,0.693 and 0.697,respectively,of Eshellmax was the highest,which was not statistically difference with that of Emax(Z=1.044,P=0.297).AUC of C-TIRADS+Emax and C-TIRADS+Eshellmax was 0.835 and 0.843,respectively,being not significantly different(Z=0.574,P=0.566)but higher than that of C-TIRADS(AUC=0.736,Z=2.510,2.230,both P＜0.05),with diagnostic specificity and accuracy both higher than those of C-TIRADS(all P＜0.05).Conclusion C-TIRADS combined with intranodular and perinodular stiffness could be used to effectively distinguish benign and malignant thyroid nodules,which might improve diagnostic efficiency of C-TIRDAS.

Observation on changes of quadriceps tendon in type 2 diabetes mellitus patients based on ultrasonic elastography / 中国医学影像技术

Objective To observe the changes of quadriceps tendon in type 2 diabetes mellitus(T2DM)patients based on ultrasonic elastography.Methods Data of 80 T2DM patients(T2DM group)and 80 healthy subjects(control group)were retrospectively analyzed.The general information and ultrasound elastography parameters,including strain ratio(SR)of the ratio of the proximal,middle and distal segments of quadriceps tendon and ipsilateral anterior femoral fat pad were compared between groups,while the correlations of the above SR with the disease course of T2DM and glycosylated hemoglobin(HbA1c)were explored.Results Fasting blood glucose and HbA1c in T2DM group were both significantly higher than those in control group(both P＜0.05).Compared with control group,SR of the proximal,middle and distal segments of quadriceps tendon in T2DM group were all significantly higher(all P＜0.05),especially the distal and proximal segments(t=6.01,5.92).In T2DM group,SR of the proximal,middle and distal segments of quadriceps tendon were positively correlated with the disease course of T2DM(r=0.45,0.20,0.43,all P＜0.05)and HbA1c(r=0.44,0.40,0.33,all P＜0.05).Conclusion SR of quadriceps tendon in T2DM patients significantly increased and positively correlated with the course of disease and HbA1c.

Changes of thickness and elasticity of skeletal muscles in diabetic patients and relative impact factors / 中国医学影像技术

Objective To observe changes of thickness and elasticity of skeletal muscles in patients with type 2 diabetes mellitus(T2DM)and relative impact factors.Methods Totally 62 T2DM patients(T2DM group)and 60 healthy adults(HC group)were prospectively recruited.Shear wave elastography(SWE)technology was used to measure the maximum Young's modulus(Emax)of the rectus abdominis and gastrocnemius muscles under relaxed and contracted states in both groups.The thickness and elasticity modulus of the skeletal muscles under the two states were compared between groups.Multiple linear regression analysis was performed to screen impact factors of the elasticity modulus of the rectus abdominis and gastrocnemius muscles.Results No significant difference of muscle thicknesses of rectus abdominis,nor of gastrocnemius muscle was found between groups under relaxed and contracted states(all P＞0.05).Under both relaxed and contracted states,the Emax of the rectus abdominis and gastrocnemius muscle in T2DM group were all lower than those in HC group(all P＜0.05).Multiple linear regression analysis showed that in T2DM group,the elasticity modulus of the rectus abdominis and gastrocnemius muscle under both relaxed and contracted states decreased linearly with disease duration,fasting blood glucose(FBG)and glycosylated hemoglobin(HbA1c)(all P＜0.05).Conclusion The elasticity modulus of skeletal muscle decreased in T2DM patients,and the reducing scales linearly related to disease duration,FBG and HbA1c.

Diagnosis of Thyroid Tumors by Multimodal Ultrasound Imaging / 中国医学影像学杂志

Ultrasound is the imaging modality of choice for the diagnosis of thyroid diseases.The establishment of thyroid imaging reporting and data system based on conventional ultrasound plays a key role in the diagnosis of thyroid tumors.In recent years,new technologies such as elastography,superb microvascular imaging,ultrasonography and artificial intelligence have been widely used in the ultrasound diagnosis of thyroid diseases.The application of multimodal ultrasound technology has greatly improved the diagnostic accuracy of thyroid malignancies and provided a theoretical basis for the formulation of individualized diagnostic and treatment plans for thyroid cancer patients.

Research progress on the diagnosis, treatment evaluation and prognostic prediction of hepatocellular carcinoma using ultrasound elastography / 中华肝胆外科杂志

Ultrasound elastography is a non-invasive imaging technique that can measure tissue hardness and provide valuable information for diagnosis and treatment of hepatocellular carcinoma. It offers numerous advantages, including non-invasiveness, rapidity, safety, excellent repeatability, cost-effectiveness, and high patient acceptance. This article reviews the current research progress of ultrasound elastography in diagnosis, treatment evaluation, and prognosis prediction of hepatocellular carcinoma, aiming to help clinicians to tailor treatment strategy, reduce complications, and improve prognosis.

Application value of two-dimensional shear wave elastography and serological models in the staging of liver fibrosis in patients with chronic hepatitis B / 临床肝胆病杂志

ObjectiveTo investigate the value of two-dimensional shear wave elastography （2D-SWE） or serological models used alone or in combination in determining the stage of liver fibrosis in patients with chronic hepatitis B. MethodsA retrospective analysis was performed for the clinical data of 327 patients with chronic hepatitis B who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from August 2020 to August 2022 and underwent 2D-SWE and liver histopathological examination， including sex， age， serological markers， and 2D-SWE results. According to the degree of liver fibrosis， they were divided into S0-S1， S≥2， S≥3， and S=4 groups， and the serological models were calculated based on serological markers. A Spearman correlation analysis was used to investigate the correlation of 2D-SWE and serological models with liver fibrosis stage； the receiver operating characteristic curve was plotted with the results of liver histopathology as the standard to compare the efficiency of each parameter used alone or in combination in determining the stage of liver fibrosis； the Delong test was used to investigate the difference between different methods. ResultsLiver stiffness measurement measured by 2D-SWE was strongly correlated with the stage of liver fibrosis （r=0.741， P<0.001）， and as for the serological model， six markers （APRI， FIB-4， GPR， GP， RPR， and S index）， other than AAR， were positively correlated with the stage of liver fibrosis （all P<0.001）. 2D-SWE had an area under the ROC curve （AUC） of 0.878， 0.932， and 0.942， respectively， in the diagnosis of S≥2， S≥3， and S=4 liver fibrosis （all P<0.001）， with an optimal cut-off value of 6.9 kPa， 7.9 kPa， and 9.4 kPa， respectively. Among the serological models， APRI had the largest AUC of 0.788 and 0.875， respectively， in the diagnosis of S≥2 and S=4 liver fibrosis， and S index had the largest AUC of 0.846 in the diagnosis of S≥3 liver fibrosis. In the diagnosis of S≥2， S≥3， and S=4 liver fibrosis， 2D-SWE combined with APRI increased the AUC values to 0.887， 0.938， and 0.950， respectively， and 2D-SWE combined with S index increased the AUC values to 0.879， 0.935， and 0.941， respectively， while there were no significant differences between 2D-SWE and the above combinations （P>0.05）. Conclusion2D-SWE has a better diagnostic efficacy than the above seven serological models in determining liver fibrosis stage. The serological models have a certain diagnostic value， among which APRI and S index have a relatively high diagnostic value. There is no significant difference between 2D-SWE and 2D-SWE combined with serological models， and such combinations cannot significantly improve diagnostic efficiency. Therefore， further studies are needed to explore new combinations of diagnostic methods.

Research progress on cardiovascular hemodynamic assessment based on computational fluid dynamics / 中国胸心血管外科临床杂志

@#Hemodynamics plays a vital role in the development and progression of cardiovascular diseases, and is closely associated with changes in morphology and function. Reliable detection of hemodynamic changes is essential to improve treatment strategies and enhance patient prognosis. The combination of computational fluid dynamics with cardiovascular imaging technology has extended the accessibility of hemodynamics. This review provides a comprehensive summary of recent developments in the application of computational fluid dynamics for cardiovascular hemodynamic assessment and a succinct discussion for potential future development.

Application and progress of cardiac magnetic resonance quantitative technology in the evaluation of myocardial lesions / 中国医师杂志

Cardiovascular disease is the leading cause of death among Chinese residents, and non-invasive imaging technology has important value in the diagnosis and treatment of cardiovascular disease. Cardiac magnetic resonance (CMR) can characterize cardiac pathophysiological information from multiple dimensions, including cardiac structure, function, tissue characteristics, and microstructure, through multi parameter and multi sequence " one-stop" imaging. This article will focus on new technologies such as CMRT1 mapping, feature tracking, and diffusion tensor imaging, and explain their applications and progress in the diagnosis, efficacy monitoring, and prognosis prediction of various myocardial lesions such as non ischemic heart disease and ischemic heart disease.

Study on thoracic skeletal muscle characteristics of Danon disease and hypertrophic cardiomyopathy based on cardiovascular magnetic resonance imaging / 中国医师杂志

Objective:To apply cardiovascular magnetic resonance (CMR) to quantitatively evaluate the morphology and tissue characteristics of thoracic skeletal muscle (TSM) in patients with Danon disease and hypertrophic cardiomyopathy (HCM), in order to provide auxiliary differential diagnostic information.Methods:A retrospective study was conducted on 15 Danon disease patients (Danon disease group) who completed CMR examination, and 15 HCM patients (HCM group) and 15 healthy volunteers (control group) who were matched by gender and age were compared. TSM (pectoralis major, pectoralis minor, erector spinae, and subscapularis) area index (TSMAi), T1 relaxation time of four groups, and extracellular volume (ECV) of skeletal muscles of two groups (pectoralis major and subscapularis) were measured for all subjects. Single factor analysis of variance and KruskalWallis test were used to compare three sets of values.Results:The total TSMAi of the Danon disease group was lower than that of the HCM group and the control group [(15.37±3.28)cm 2/m 2 vs (23.02±3.88)cm 2/m 2 vs (22.33±4.67)cm 2/m 2, P<0.001], and the TSMAi of each TSM was also lower than that of the HCM group and the control group (all P<0.05). There was no statistically significant difference in TSMAi between the HCM group and the control group (all P>0.05). The native T1 values of the pectoralis major muscle in the Danon disease group and HCM group were higher than those in the control group (all P<0.05). The ECV of the pectoralis major muscle and subscapularis muscle in the Danon disease group were higher than those in the HCM group and control group, and the enhanced T1 values were lower than those in the HCM group and control group (all P<0.05); There was no statistically significant difference in ECV and the enhanced T1 values between the HCM group and the control group ( P>0.05). Conclusions:The application of CMR can effectively evaluate the changes in TSM morphology and tissue characteristics in Danon disease patients. Compared with HCM patients, Danon disease patients showed significant atrophy of TSM with increased extracellular volume. CMR provides a quantitative reference for TSM in the differential diagnosis of the two.

Magnetic resonance left ventricular hemodynamic analysis: a normal value study of two methods / 中国医师杂志

Objectives:To analyze the consistency of evaluating left ventricular hemodynamics (HDF) based on single plane and multi plane cine sequences of magnetic resonance mitral valve orifice.Methods:A prospective study was conducted on 48 healthy adults, and two methods were used to measure the mitral valve diameter and calculate HDF parameters. The first method was to measure the diameter of the mitral valve opening in the left ventricular three chamber cine sequence; The second method is to measure the mitral valve diameter using cine sequences of two chamber, three chamber, and four chamber hearts, and then take the average value. Paired t-tests were used to compare the differences in HDF measured by two methods, and Pearson correlation coefficient ( r), intra group correlation coefficient ( ICC), and Bland-Altman analysis were used to test the consistency and reproducibility of the two methods. Results:The root mean square (RMS) of longitudinal HDF calculated using single plane and multi plane mitral valve diameters were [(17.28±4.41)% vs (17.21±4.61)%] ( P=0.379) for the entire cardiac cycle, [(21.45±5.54)% vs (21.49±5.68)%] ( P=0.646) for systolic phase, and [(12.78±4.10)% vs (12.54±4.24)%] ( P=0.106) for diastolic phase, respectively. The difference in the calculation results of HDF parameters related to ventricular function was not statistically significant (all P>0.05), and there was good consistency ( r=0.924-0.996, ICC=0.924-0.995). The two HDF parameters related to atrial function were sensitive to the measurement method of mitral valve orifice diameter [RMS of longitudinal HDF during active atrial emptying: (3.26±1.51)% vs (3.32±1.55)%, P=0.006; longitudinal HDF pulse during active atrial emptying: (-2.60±1.28)% vs (-2.76±1.30)%, P<0.001]. Conclusions:The ventricular function related HDF parameters obtained from the analysis of mitral valve orifice diameter using single plane and multi plane methods have good consistency, and can be evaluated using relatively simple single plane methods for left ventricular HDF.

The consistency study of quantitative coronary flow fraction and cardiac magnetic resonance imaging in evaluating myocardial ischemia in patients with coronary heart disease / 中国医师杂志

Objective:To evaluate the correlation and consistency between quantitative coronary flow fraction (QFR) and cardiac magnetic resonance imaging (CMR) in assessing myocardial ischemia in patients with coronary heart disease (CAD).Methods:A retrospective analysis was conducted on the data of coronary heart disease patients who underwent load CMR examination and coronary angiography at the Beijing Anzhen Hospital, Capital Medical University from August 2017 to March 2022. CMR examination includes cardiac cine, load/rest myocardial perfusion imaging, and delayed enhancement sequence. According to the results of CMR examination, the patient′s left ventricular myocardial segments were divided into normal segment group and abnormal segment group (further divided into ischemic segment group and infarcted segment group). On the basis of coronary angiography, an artificial intelligence based platform (AngioPlus system) was applied to calculate the preoperative coronary artery QFR value of patients undergoing percutaneous coronary intervention treatment. Kappa test was used to evaluate the consistency of QFR and CMR in diagnosing abnormal myocardium; Mann Whitney U test was used to compare the differences in QFR between groups; The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of QFR in diagnosing abnormal myocardium; Spearman correlation analysis was used to clarify the relationship between myocardial infarction area and QFR value of the supplying coronary artery in patients.Results:Among the 70 CAD patients enrolled, there were 60 males and 10 females, aged (54.1±11.1)years. At the vascular level, the consistency between QFR and CMR in diagnosing myocardial injury (including ischemia and infarction) is moderate (Kappa value=0.514). The sensitivity and specificity of detecting abnormal myocardial segments in CAD patients were 57% and 91%, respectively. The area under the curve (AUC) value of QFR predicting abnormal myocardium in CAD patients was 0.769, and the optimal cutoff value was QFR=0.865. At this time, the sensitivity and specificity of QFR predicting myocardial injury in CAD patients were 67.2% and 84.3%, respectively. The difference in vascular QFR between the normal segment group, ischemic segment group, and infarcted segment group was statistically significant ( P<0.001), with the infarcted segment group having significantly lower QFR values than the other two groups (all P<0.01). The range of myocardial infarction was negatively correlated with the QFR value of the supplying coronary artery ( r=-0.45, P<0.001). At the patient level, the consistency between QFR and CMR in diagnosing myocardial injury (including ischemia and infarction) was moderate (Kappa value=0.445), with a sensitivity of 74% and a specificity of 81% for diagnosing myocardial injury in CAD patients. Conclusions:Compared with CMR, QFR has better specificity in detecting myocardial injury in CAD patients. The QFR value of the infarcted segment group is significantly lower than that of the ischemic group and the normal group. The area of myocardial infarction is negatively correlated with the QFR value of the supplying coronary artery.

Exploring the hemodynamic changes of the ascending aorta before and after interventricular septal myocardial resection in obstructive hypertrophic cardiomyopathy by CMR 4D Flow technology / 中国医师杂志

Objective:To investigate the hemodynamic changes in the ascending aorta (AAo) before and after interventricular septal myocardial resection in obstructive hypertrophic cardiomyopathy (HOCM) using cardiac magnetic resonance four-dimensional blood flow (CMR 4D Flow) technology.Methods:HOCM patients who underwent interventricular septal myocardial resection at Guangdong Provincial People′s Hospital from May 2021 to September 2022 were prospectively included. Age and gender matched healthy volunteers (control group) were included during the same period. Both the control group and HOCM patients underwent CMR examination (including cine sequence and 4D Flow sequence) before and 6 months after surgery. CMR 4D flow technology was used to evaluate changes in AAo preoperative and postoperative blood flow patterns (eddy currents, spiral flow), maximum energy loss (EL max), and average energy loss (EL avg). HOCM patients underwent laboratory tests, including N-terminal pro-brain natriuretic peptide (N-pro BNP) and high-sensitivity troponin T (hsTnT). At the same time, the correlation between postoperative energy loss in HOCM patients and the degree of improvement in laboratory biomarkers was explored. Results:A total of 15 HOCM patients and 15 healthy volunteers were included. (1) In terms of blood flow patterns, the preoperative spiral flow degree of HOCM patients was significantly higher than that of the control group ( P=0.001), but the postoperative difference was not statistically significant ( P=0.059). The degree of eddy currents in HOCM patients before and after surgery was higher than that in the control group (all P<0.05). (2) In terms of energy loss, the preoperative EL max [21.17(14.30-28.10)mW vs 10.17(7.66-13.07)mW, P<0.001] and EL avg [4.87(3.46-5.77)mW vs 2.27(2.19-2.27)mW, P=0.023] of HOCM patients were higher than those of the control group, but there was no statistically significant difference between the postoperative and control groups (all P>0.05). Compared with preoperative, the postoperative EL max [12.33(8.70-17.41)mW] and EL avg [3.10(2.25-4.40)mW] of AAo in HOCM patients were significantly reduced (mean P=0.001). (3) Correlation analysis showed that there was a positive correlation ( r=0.587, P=0.021) between the EL max of AAo and the degree of improvement in hsTNT after interventricular septum myocardial resection, but no significant correlation ( r=0.229, P=0.413) with the degree of improvement in NT-pro BNP. Conclusions:The degree of postoperative AAo blood flow disorder in HOCM patients is reduced, and EL max and EL avg are significantly reduced. The EL max of postoperative AAo is positively correlated with the degree of improvement in hsTNT, suggesting that EL max may be applicable for prognostic evaluation of patients.

The application of cardiac magnetic resonance imaging in immune checkpoint inhibitor associated myocarditis / 中国医师杂志

Immunocheckpoint inhibitors have been widely used in the treatment of various tumors. Although the incidence rate of immunocheckpoint inhibitor related myocarditis caused by them is low, the mortality is high. Cardiac magnetic resonance imaging is the gold standard for evaluating cardiac morphology and function, and it has important clinical application value in the grading diagnosis, risk stratification, adverse prognosis prediction, and treatment monitoring of immune checkpoint inhibitor associated myocarditis.

Evaluation of the Mechanical Behavior of the Patellar and Semitendinosus Tendons Using Supersonic Shear-wave Imaging (SSI) Elastography and Tensile Tests / Avaliação do comportamento mecânico dos tendões patelar e semitendinoso utilizando a elastografia por ondas de cisalhamento (SSI) e testes de tração

Abstract Objective To analyze the mechanical properties of the patellar (PT) and semitendinosus (ST) tendons from fresh-frozen human cadavers from a tissue bank using supersonic shear-wave imaging (SSI) elastography and tensile tests. Methods We tested seven PT and five ST samples on a traction machine and performed their simultaneous assessment through SSI. The measurements enabled the comparison of the mechanical behavior of the tendons using the stress x strain curve and shear modulus (μ) at rest. In addition, we analyzed the stress x μ relationship under tension and tested the relationship between these parameters. The statistical analysis of the results used unpaired t-tests with Welch correction, the Pearson correlation, and linear regression for the Young modulus (E) estimation. Results The μ values for the PT and ST at rest were of 58.86 ± 5.226 kPa and 124.3 ± 7.231 kPa respectively, and this difference was statistically significant. The correlation coefficient between stress and μ for the PT and ST was very strong. The calculated E for the PT and ST was of 19.97 kPa and 124.8 kPa respectively, with a statistically significant difference. Conclusion The ST was stiffer than the PT in the traction tests and SSI evaluations. The μ value was directly related to the stress imposed on the tendon. Clinical relevance The present is an evaluation of the mechanical properties of the tendons most used as grafts in knee ligament reconstruction surgeries.

Resumo Objetivo Analisar as propriedades mecânicas dos tendões patelar (TP) e semitendinoso (ST) obtidos de cadáveres humanos congelados enquanto ainda frescos, provenientes de banco de tecidos, utilizando elastografia por ondas de cisalhamento (supersonic shearwave imaging, SSI, em inglês) e testes de tração. Métodos Sete amostras de TP e cinco de ST foram testadas em máquina de tração e simultaneamente avaliadas por SSI. As medidas geradas possibilitaram comparar o comportamento mecânico dos tendões por curva stress x strain e módulo de cisalhamento (μ) em repouso. Também foi analisada a relação stress x μ sob tensão, e testada a relação entre esses parâmetros. Os resultados foram submetidos a análise estatística pelos testes t não-pareado com correção de Welch, correlação de Pearson e regressão linear para estimativa do módulo de Young (E). Resultados O μ dos TP e ST em repouso foi, respectivamente, de 58,86 ± 5,226 kPa e 124,3 ± 7,231 kPa, com diferença estatisticamente significativa. O coeficiente de correlação entre stress e μ dos TP e ST foi classificado como muito forte. O E calculado dos TP e ST foi, respectivamente, de 19,97 kPa e 124,8 kPa, com diferença estatisticamente significativa. Conclusão O ST foi mais rígido do que o TP nos testes de tração e nas avaliações por SSI. O μ esteve diretamente relacionado com o stress a que o tendão é submetido. Relevância clínica Avaliar as propriedades mecânicas dos tendões mais utilizados como enxerto nas cirurgias de reconstrução ligamentar do joelho.

Elastografia hepática na avaliação complementar da insuficiência cardíaca / Liver elastography for complementary assessment of heart failure

A elastografia hepática (EH) avalia as consequências sistêmicas da insuficiência cardíaca (IC). Este método pode auxiliar na avaliação prognóstica dos portadores de IC. A IC pode afetar de forma secundária a função de vários órgãos e sistemas, notadamente o hepático, mediante congestão venosa. O objetivo deste artigo é mostrar, através de uma revisão narrativa, a importância da EH na avaliação complementar da IC. As consequências hepáticas na doença cardíaca, por vezes, se mostram silenciosas, sem grandes alterações no exame físico e/ou em exames laboratoriais. Nesse contexto, a EH demonstrou ser um método não invasivo recomendável para a mensuração do dano hepático causado pela IC. (AU)

Liver elastography (LE) assesses the systemic consequences of heart failure (HF). This method may help in the prognostic assessment of patients with HF. HF can secondarily affect the function of various organs and systems, especially the liver, through venous congestion. The purpose of this article is to provide a narrative review of the importance of LE in the complementary evaluation of HF. The hepatic consequences of cardiac disease are sometimes silent, without significant changes in physical examination and/or laboratory tests. In this context, LE has emerged as a recommended non-invasive method to measure liver damage caused by HF. (AU)

Noninvasive assessment of liver fibrosis can predict clinical outcomes at late follow-up after a sustained virological response in HCV patients?

Abstract Objectives The primary objective was to evaluate Liver-Related Events (LREs), including hepatic decompensation (ascites, hemorrhagic varices and encephalopathy) and Hepatocellular Carcinoma (HCC), as well as changes in liver stiffness during the follow-up period among patients who achieved a Sustained Virological Response (SVR) after treatment for chronic Hepatitis C Virus (HCV) infection. Methods A total of 218 patients with HCV were treated, and those who achieved an SVR were followed up for 3-years. Transient Elastography (TE) using FibroScan® was performed at various time points: before treatment, at the end of treatment, at 6-months post-treatment, at 1-year post-treatment, at 2-years post-treatment, and at 3-years post-treatment. Results At 6-months post-treatment, a Liver Stiffness Measurement (LSM) cutoff of > 19 KPa was identified, leading to a 14.5-fold increase in the hazard of negative outcomes, including decompensation and/or HCC. The analysis of relative changes in liver stiffness between pre-treatment and 6-months posttreatment revealed that a reduction in LSM of -10 % was associated with a -12 % decrease in the hazard of decompensation and/or HCC, with this trend continuing as the LSM reduction reached -40 %, resulting in a -41 % hazard of decompensation and/or HCC. Conversely, an increase in the relative change during this period, such as an LSM increase of +10 %, led to a + 14 % increase in the hazard of decompensation. In cases where this relative change in LSM was +50 %, the hazard of decompensation increased to +92. Conclusion Transient elastography using FibroScan® can be a good tool for monitoring HCV patients with SVR after treatment to predict LREs in the long term.

Miocarditis inducida por vacuna COVID-19 Spikevax - sospecha temprana para un manejo exitoso: reporte de caso

Resumen Introducción: la vacunación masiva se ha llevado a cabo a nivel mundial para controlar la propagación de infección por COVID-19, siendo las vacunas más utilizadas las de Pfizer-BioNTech y Moderna. La miocarditis post vacunación COVID-19 por vacuna Spikevax (previamente conocida como vacuna Moderna) es una entidad infrecuente, aún se sigue conociendo más acerca del cuadro y sus características clínicas, y poco se sabe acerca del seguimiento a largo plazo más allá de los 90 días. Presentación de caso: hombre de 21 años, estudiante universitario, sin antecedentes previos conocidos, que presentó cuadro agudo de dolor opresivo centro-torácico. Tuvo un inicio abrupto, curso in-crescendo, asociado a disnea y escalofríos. Se instauró tratamiento antiinflamatorio con colchicina 0,5mg cada 12 horas, y los síntomas se resolvieron a las 24 horas de inicio de antiinflamatorio. El diagnóstico de miocarditis se confirmó mediante resonancia magnética cardiaca y las imágenes de seguimiento mostraron la resolución del cuadro. El paciente permaneció asintomático, y recibió alta temprana. En su seguimiento a 90 días no se observaron secuelas residuales. Conclusiones: la miocarditis posterior a la vacunación COVID-19 se observa predominantemente en varones jóvenes a los pocos días de la vacunación. La fisiopatología de la miocarditis aún no es bien conocida. La cinética de la troponina I cardiaca en el caso presentado, asociado a los síntomas iniciales y las imágenes cardiacas confirmaron la presencia y posterior resolución de la miocarditis. El pronóstico es bueno y se requiere de sospecha temprana.

Abstract Introduction: mass vaccination has been carried out worldwide to control the spread of COVID-19 infection, with the most commonly used vaccines being Pfizer-BioNTech and Moderna. Myocarditis after COVID-19 vaccination by Spikevax vaccine (previously known as Moderna vaccine) is an infrequent entity, that we still know more about the clinical picture and characteristics, and that little is known about long-term follow-up beyond 90 days. Case report: 21-year-old male, college student, with no known previous history, presented with acute onset of oppressive central thoracic pain. It had an abrupt onset, in-crescendo course, associated with dyspnea and chills. Anti-inflammatory treatment with colchicine 0.5mg every 12 hours was started, and symptoms resolved within 24 hours of starting anti-inflammatory medication. The diagnosis of myocarditis was confirmed by cardiac magnetic resonance imaging and follow-up imaging showed resolution of the condition. The patient remained asymptomatic, and he was discharged early. His 90-day follow-up showed no residual sequelae. Conclusions: myocarditis following COVID-19 vaccination is predominantly seen in young males within days after vaccination. The pathophysiology of myocarditis is not yet well understood. Cardiac troponin I kinetics in the case presented, associated with the initial symptoms and cardiac imaging confirmed the presence and subsequent resolution of myocarditis. The prognosis is good and early suspicion is required.

Cardiac Myxomas: A Single?Center Case Series of 145 Patients Over a 32?Year Period Study

Background:Myxomas are the most common primary cardiac tumors that develop mostly at the atrial chambers of the heart and represent 0,25% of all cardiac diseases. Methods: This is a retrospective study aiming to analyze epidemiological and intraoperative data from cardiac myxoma cases in the hospital of the last 32 years. The study population was 145 cardiac surgical patients and was divided into 4 certain 8?year periods. 87,6% of cases had the myxoma located at left atrium and 97,2% of all patients fully recovered. 4,1% of patients relapsed and underwent a redo operation. Results: Mean CPB time and mean ICU length of stay increased during the 8?year periods (p < 0,001, P < 0,001, P = 0,002 and P = 0,003 respectively). In-hospital length of stay decreased to 5 days in the most recent period (p < 0,001). Cases significantly increased to 54 in the last 8?year period (p = 0,009). Conclusion: Improvement on cardiac imaging and a better accessibility may drive patients to earlier and safer diagnosis of myxomas preventing any deterioration of their condition. Improvement on postoperative care can also reduce in-hospital length of stay. Surgical excision is the treatment of choice and guaranteed survival at 97,2% of patients.

Advances in the application of elastography in noninvasive diagnosis of liver fibrosis in nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease, and liver fibrosis is closely associated with the prognosis in NAFLD; therefore, accurate assessment of liver fibrosis is of great importance. Liver biopsy is the gold standard for the diagnosis of NAFLD, but its clinical application is limited by invasiveness. Elastography technique based on ultrasound and magnetic resonance imaging has gradually been applied in the diagnosis of liver fibrosis associated with NAFLD. This article elaborates on the principles of the two techniques, compares their respective advantages and disadvantages, and introduces the advances in application in combination with artificial intelligence.

Research Progress in Noninvasive Early Diagnosis of Hepatocellular Carcinoma / 肿瘤防治研究

Liver cancer is a common tumor that seriously threatens human life and health. Given that the early onset of liver cancer is insidious and lacks specific symptoms, hence it is difficult to screen through routine examination. Thus, clinical diagnosis of liver cancer is mostly in the advanced stage. However, advanced liver cancer has few treatment options, poor prognosis and high relapse rate, thereby causing a high mortality rate. Therefore, early diagnosis of liver cancer is particularly important. Currently, non-invasive screening of liver cancer widely used in clinical setups lacks sufficient sensitivity and specificity, hence, a more reliable diagnostic method needs to be found urgently. This article reviews the research progress of noninvasive early diagnosis of liver cancer to provide a reference for raising the early diagnosis rate of liver cancer.