ABSTRACT
Background: The presence and extent of severity of esophageal varices (EV) in patients with liver cirrhosis (LC) are predicted using noninvasive clinical, biochemical, and imaging parameters. The aim of this study was to investigate the accuracy of noninvasive predictors of EV, such as the platelet count-to-spleen diameter ratio (PSR), platelet count-to-spleen volume ratio (PSVR), spleen size (SZ), and a combination of these markers in determining the severity of EV in patients with cirrhosis. Methods: We recruited 82 inpatients with LC from the Department of Gastroenterology at the First Affiliated Hospital of Guangxi Medical University between January 2018 and December 2019 for this diagnostic investigation. All patients underwent endoscopy, ultrasound, computed tomography, and routine laboratory investigations. For the study, we evaluated and compared the diagnostic accuracy of PSR, PSVR, SZ, and their combinations. Results: There were significant differences in the area under the receiver operating characteristic (ROC) curve (AUC) in the prediction of severe and moderate/severe EV for all the variables. PSR+PSVR had the highest AUC at 0.735 (95% CI: 0.626-0.826) and 0.765 (95% CI: 0.659-0.852) for predicting severe and moderate/severe EV, respectively. There were statistically significant differences in the AUCs (95% CI) for PSR, PSVR, and PSR+PSVR in predicting the existence of EV. As per the overall model quality chart, the combination of PSR+PSVR was the best indicator for detecting the presence of EV (AUC, 0.696; 95% CI: 0.584-0.792). Conclusion: In our study, we found that these noninvasive parameters could predict the extent of severity of EV in patients with LC. We anticipate the use of a combination of PSR + PSVR to emerge as the superior indicator as studies progress.
ABSTRACT
In this study, we aim to understand the morphology and structure of upper lip orbicularis oris muscle, and to provide clinical evidence for evaluating the effect of repair operation in cleft lip. Subjects included 106 healthy people and 36 postoperative patients of unilateral cleft lip. The upper lip orbicularis oris muscle was scanned using ultrasound in natural closure and pout states. Our results showed that the hierarchical structure of upper lip tissue was demonstrated clearly in ultrasonic images. After reconstruction of unilateral cleft lip, the left and right philtrum columns were still obviously asymmetric, their radian displayed clearly and showed better continuity. In the place of cleft lip side equivalent to philtrum columns, orbicularis oris muscle showed discontinuity and unclear hierarchical structure, which was replaced by hyperechoic scar tissue. The superficial layer would become thicker when pouting. In reconstructed unilateral cleft lip, the superficial layer was thinner than that of healthy controls. In normal upper lip orbicularis oris muscle, the superficial layer thickness was no less than 2.89 mm in philtrum dimple and no less than 3.92 mm in philtrum column, and the deep layer thickness was no less the 1.12 mm. Otherwise, the layer thickness less than above reference values may be considered as diagnostic criteria for dysplasia of upper lip orbicularis oris muscle. In conclusions, ultrasound imaging is able to clearly show the hierarchical structure of upper lip orbicularis oris muscle, and will be beneficial in guiding the upper lip repair and reconstruction surgery.
