Liver biopsy and clinical features of liver injury of unknown origin： An analysis of 94 cases / 临床肝胆病杂志

ObjectiveTo summarize the liver biopsy and clinical features of patients with liver injury of unknown origin， and to investigate the value of ultrasound-guided percutaneous liver biopsy in the diagnosis of liver injury of unknown origin. MethodsA retrospective analysis was performed for the clinical data and ultrasound-guided percutaneous liver biopsy results of 94 patients with liver injury of unknown origin who were admitted to Zhongshan Hospital， Xiamen University， from January 2018 to February 2023. According to the proportion of the patients with different final diagnoses， the patients were divided into autoimmune liver disease （AILD） group， metabolic associated fatty liver disease （MAFLD） group， drug-induced liver injury （DILI） group， alcoholic liver disease （ALD） group， and unknown group. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the Bonferroni analysis or the Dunnett’ T3 test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups； the Fisher’s exact test was used for comparison of categorical data between multiple groups. ResultsAll 94 patients with liver injury of unknown origin underwent ultrasound-guided percutaneous liver biopsy after admission， among whom 90 patients （95.7%） had a confirmed diagnosis based on liver biopsy and clinical features. There were 43 patients （45.7%） with AILD， 21 （22.3%） with MAFLD， 15 （16.0%） with DILI， 6 （6.4%） with ALD， 1 （1.1%） with AILD and MAFLD， 1 （1.1%） with hemochromatosis， 1 （1.1%） with Budd-Chiari syndrome， 1 （1.1%） with congenital hepatic fibrosis， and 1 （1.1%） with idiopathic portal hypertension， while 4 patients （4.3%） still had an unknown etiology after liver biopsy. There were significant differences between the patients with top five diagnoses in age （F=4.457， P<0.05） ， body mass index （BMI） （F=3.245， P<0.05）， aspartate aminotransferase （AST） （H=11.128， P<0.05）， gamma-glutamyl transpeptidase （GGT） （H=24.789， P<0.05）， alkaline phosphatase （ALP） （H=26.013， P<0.05）， IgG （H=19.099， P<0.05）， IgM （H=21.263， P<0.05）， AMA-M2 positive rate （P<0.05）， and ANA positive rate （P<0.05）. Compared with the MAFLD group， the AILD group had significantly higher age， AST， GGT， and ALP and a significantly lower BMI； compared with the MAFLD group and the DILI group， the AILD group had significant increases in IgG and IgM； the AILD group had significant increases in the positive rates of AMA-M2 and ANA compared with the other four groups. ConclusionAILD， MAFLD， and DILI are the most common causes in patients with liver injury of unknown origin. Ultrasound-guided percutaneous liver biopsy plays an important role in determining the cause of liver injury of unknown origin， but it is still needed to make a comprehensive analysis based on clinical history， different types of liver injury， laboratory markers， and imaging data.

Research progress on roles and mechanisms of DNA hydroxymethylation in health effects induced by arsenic exposure / 环境与职业医学

Arsenic, a naturally occurring metal-like chemical element, is one of the 10 chemicals of major public concerns listed by the World Health Organization as harmful to the environment and human health. It can enter the human body through breathing, intaking food, drinking water, skin exposure, and other ways, and long-term exposure to arsenic can cause cancer of multiple organs and impaired function of multiple systems. Epigenetic mechanisms play an important role in arsenic-induced health effects, and research suggested that the carcinogenicity of arsenic may be associated with epigenetic changes. Previous studies focused on the effects of arsenic on DNA methylation modification. In recent years, research showed that 5-hydroxymethylcytosine (5-hmC), an intermediate of active demethylation of DNA, can act as a sensitive epigenetic mark and play a crucial role as a "bridge" between arsenic exposure and health effects. Based on the latest research progress on the role of DNA hydroxymethylation in the health effects associated with arsenic exposure, this article briefly described the relationship between the health effects of arsenic exposure and DNA hydroxymethylation, summarized the possible mechanisms of DNA hydroxymethylation in the health effects associated with arsenic exposure, and provided a scientific basis for preventing and treating the health effects associated with arsenic exposure.

Application of SMOTE_ENN Combined with AdaBoost in Clinical Prediction Model / 中国卫生统计

Objective To explore the prediction effect of SMOTE_ENN mixed sampling combined with AdaBoost algorithm in unbalanced clinical data classification model.Methods Grid search was used and different sampling ratios were set.Combined with real data,four mixed sampling methods of ROS_RUS,SMOTE_RUS,SMOTE_Tomek and SMOTE_ENN were applied to build models based on DT,SVM and AdaBoost classification algorithms,respectively,and their performances were compared.Selecting Recall,F1 value,AUC three evaluation indicators,50%discount cross-validation repeated three times to take the average.Another two UCI data sets are selected to validate the model externally.Results Among the 12 classification models,the performance of SMOTE_ENN mixed sampling combined with AdaBoost was the best,the values of Recall,F1 and AUC were 0.747,0.751 and 0.776 respectively,and the best sampling rate was 50%SMOTE oversampling combined with 70%ENN undersampling.Conclusion SMOTE_ENN mixed sampling combined with AdaBoost model can effectively improve the clinical outcome prediction efficiency of unbalanced data of HT patients,and the best proportional sampling can effectively solve the problem that there is no clear sampling rate in previous resampling.After further verification of the open UCI data set,the model can be popularized and applied.

Application of low tube current combined with lower contrast agent in the head and neck dual-source CT angiography / 中华老年医学杂志

Objective To investigate the application value of low kilovolt technique combined with lower contrast in the head and neck angiography by the second-generation dual source CT.Methods From October 2013 to January 2015,120 patients undergoing head and neck computed tomography angiography (CTA) were randomly divided into groups A,B,C,D.Each group was given a different tube current and different dose of contrast agent and saline solution 50 ml.Group A received current 100 mA and contrast agent 50 ml,group B received current 100 mA and contrast agent 40 ml,group C received current 80 mA and contrast agent 50 ml,and group D received current 80 mA and contrast agent 40 ml.CT values of aortic arch,bilateral common carotid artery bifurcation,double sided M1 segment of middle cerebral artery,basilar artery enhanced degree of the straight sinus were measured in each group.Residual artifacts caused by contrast agent in brachiocephalic vein and subclavian vein were observed.5-score method was used to assess the quality of reconstructed image,and the radiation exposure dose was calculated.Results The mean effective dose was reduced by 29％ in group C as compared with group A [(0.53±0.17) mGy vs.(0.74±0.04) mGy].There was no significant difference in developing strength in cerebral arteries angiography between group C and group A (P=0.247),but the inage noise was slightly larger in group C than group A,without significant differences (P=0.203).The average effective dose in group A was almost the same as that in group B [(0.74 ± 0.04) mGy vs.(0.73 ± 0.05) mGy].Structure display of cerebral arteries on CT volume rendering (VR) and multiplane reformation (MPR) images had no significant differences between group A and group B (P=0.114).The average effective dose in group C was almost the same as that in group D[(0.53 ± 0.17) mGy vs.(0.53 ±0.01) mGy].Structure display of cerebral arteries on CT volume rendering (VR) and muhiplane reformation (MPR) images had no significant differences between group C and group D (P=0.109).The mean effective dose was reduced by 28％ in group D as compared with group B[(0.53±0.01)mGy vs.(0.73±0.05) mGy].There was no significant difference in developing strength in cerebral arteries angiography between group C and group A (P=0.236),but the image noise was sligbtly larger in group C than group A (P =0.212).Conclusions Application of low tube current combined with low concentration of contrast agent in the head and neck dual-source CT angiography is feasible in clinical diagnosis,with good clinical value.It can not only get better image quality,but also meet the needs of clinical diagnosis.

Research on CT and MRI findings of Hemiballism-hemichorea induced by hyperglycemia / 中国医学装备

Objective:To summarize the clinicopathologia and imaging features of Hemiballism-hemichorea induced by hyperglycemia and increase the understanding of the disease and improve the accuracy of diagnosis. Methods:The imaging images and clinical manifestation of 5 cases Hemiballism-hemichorea induced by hyperglycemia were analyzed retrospectively. The disease pathogenesis and mechanism relating to the Characteristic neuroradiological findings was obtained by literature review. Results:The common clinical manifestation of Hemiballism-hemichorea induced by hyperglycemia is unilateral limb involuntary movements. CT scans typically show an area of hyperdensity in the basal ganglia and The characteristic finding on the T1-weighted MRI is high signal intensity in the contralateral putamen. Conclusion: Hemiballism-hemichorea induced by hyperglycemia is an unusual but important differential diagnosis in patients with particular neuroradiological findings as prompt diagnosis and treatment of hyperglycemia has an excellent prognosis. The correct diagnosis could be received through integrated the patient's past medical history, presentation, laboratory and imaging inspection into account.