Application of transient elastography combined with serological markers to distinguish early hepatic fibrosis of chronic hepatitis B / 中国现代医生

Objective To explore the clinical value of transient elastography(TE)combined with serological markers to distinguish early hepatic fibrosis of chronic hepatitis B(CHB).Methods Clinical data of 176 CHB patients admitted to Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University from January 2020 to November 2022 were retrospectively analyzed,and the included patients were divided into training group(n=123)and test group(n=53).Based on the data of the training group,the clinical features were screened by the least absolute shrinkage and selection operator algorithm,and the early liver fibrosis model was constructed by multivariate Logistic regression.The performance of the model was evaluated using test group data and receiver operating characteristic(ROC)curve.Finally,the stability and clinical efficacy of the model were evaluated using calibration curve and decision curve,respectively.Results The prediction model was constructed based on liver stiffness measurement,fat attenuation index,red blood cells and glutamic-oxaloacetic transaminase.The area under the curve of the model in training group and test group was 0.824 and 0.819,the sensitivity was 82.1%and 80.6%,and the specificity was 71.8%and 68.8%,respectively.The calibration curve showed good calibration performance in training group and test group,and the decision curve showed good clinical efficacy of the model in training group and test group.Conclusion A hybrid model of TE technology combined with serological markers provides a potential new way to identify early liver fibrosis in patients with CHB,which could aid in clinical monitoring and treatment.

Ultrasound-guided application of cervical plexus nerve block in radiofrequency ablation of thyroid and parathyroid benign lesions / 中华超声影像学杂志

Objective To investigate the efficacy of ultrasound-guided cervical plexus block in radiofrequency ablation of thyroid and parathyroid benign lesions . Methods One hundred and twenty-five patients with thyroid nodules or hyperparathyroidism , who were undergone ultrasound guided radiofrequency ablation ,were randomly assigned to receive either ultrasound-guided cervical plexus block or local infiltration anesthesia ,and the pain grading was evaluated by numerical rating scale ( NRS ) . The anesthetic dosage and the effect of thermal ablation surgery of ultrasound-guided cervical plexus block anesthesia and local anesthesia were compared . Results The anesthetic dosage in ultrasound-guided cervical plexus block was lower than that in local infiltration anesthesia( t = 17 .681 , P < 0 .05) . The pain grading of ultrasound-guided cervical plexus block was lower than that of local infiltration anesthesia( χ2 = 33 .738 , P < 0 .05) . Conclusions Ultrasound-guided cervical plexus nerve block has lower anesthetic dosage and pain grading in the radiofrequency ablation of thyroid and parathyroid benign lesions ,which may be widely applied in clinical .

Hyperbaric oxygen therapy and comprehensive orthopedic treatment for incomplete traumatic spinal cord injury on the Qinghai-Tibet Plateau: study protocol for an open-label randomized controlled clinical trial / 中国组织工程研究

BACKGROUND: Apoptosis secondary to ischemia and hypoxia is the main cause of spinal cord dysfunction. Because of the decrease in atmospheric pressure, patients living on the Qinghai-Tibet Plateau are in a hypoxic environment, which is very unfavorable for the recovery of spinal cord injury. Hyperbaric oxygen therapy can improve the postoperative function of patients with incomplete spinal cord injury, and its effect is better on the plateau than at normal altitudes.OBJECTIVE: To observe the effect of hyperbaric oxygen therapy on traumatic spinal cord injury in patients living on the Qinghai–Tibet Plateau.METHODS: This prospective, open-label, randomized controlled clinical trial was performed at the Department of Spine Surgery, Affiliated Hospital of Qinghai University, China. In total, 164 patients with incomplete traumatic spinal cord injury were equally and randomly assigned to a control group and a hyperbaric oxygen therapy group. Patients in the control group were treated with pedicle screw fixation and decompressive laminectomy. In addition to the surgical treatment performed in the control group, patients in the hyperbaric oxygen group underwent hyperbaric oxygen therapy at 0.2 MPa once a day for four treatment courses. Ten treatment sessions constituted one course, and each course was separated by a 5- to 7-day rest interval. The primary outcome was the modified Barthel index to assess activities of daily living. The secondary outcomes were the American Spinal Injury Association (ASIA) impairment scale grade, sensory score, and motor score. The study protocol was approved by the Ethics Committee of the Affiliated Hospital of Qinghai University, China (Approval number: QHC011K). Written informed consent was provided by a relative or legal representative of each patient after they had indicated that they fully understood the treatment plan. RESULTS AND CONCLUSION: The partial results demonstrated that after four treatment courses (55-61 days), the modified Barthel index and ASIA tactile, pain, and motor scores were higher in the hyperbaric oxygen group than in the control group. The ASIA grades were significantly different between the hyperbaric oxygen group and control group. The proportion of patients with ASIA grades D and E was higher in the hyperbaric oxygen group than in the control group. In this trial, we aim to determine the efficacy of hyperbaric oxygen therapy on the treatment of incomplete traumatic spinal cord injury in patients living on the plateau and to provide clinical evidence for treating incomplete traumatic spinal cord injury in these patients.

Clinical value of virtual touch tissue quantification and PGA index in evaluation of alcoholic liver fibrosis / 中南大学学报(医学版)

OBJECTIVE@#To explore the clinical value of virtual touch tissue quantification (VTQ) technique and the PGA index [prothrombin time (P), γ-glutamyl transpeptadase (GG) and apolipoprotein A1 (ApoAl)] in evaluating the degree of liver fibrosis in alcoholic patients.
@*METHODS@#A total of 64 patients with long-term alcohol history were enrolled for this study. The liver ultrasonography elasticity was examined by VTQ techniques, the VTQ value was assessed in the liver target region, and then the PGA index was calculated. According the liver biopsy biological results, a golden standard, the patients were divided into a non-fibrosis group (n=11), a fibrosis group (n=10), a significant fibrosis group (n=14) and a cirrhosis group (n=29). The diagnostic value of VTQ and PGA index were compared in alcoholic patients following the classification of liver fibrosis.
@*RESULTS@#The elastography VTQ values were (1.38±0.33), (1.49±0.30), (1.76±0.22) and (2.28±0.53) m/s; while the PGA indexes were 2.09±0.94, 2.30±1.06, 3.57±1.09, and 2.21±1.99 in the non-fibrosis group, the fibrosis group, the significant fibrosis group and the cirrhosis group, respectively. The VTQ value and PGA index were positively correlated with the classification of liver fibrosis (VTG: r=0.719, PGA: r=0.683; both P<0.01).
@*CONCLUSION@#The alcoholic liver fibrosis can be assessed by noninvasive VTQ technology and PGA index. As a real-time ultrasound elastography technique, VTQ is more accurate than the PGA index. Combination of the two methods is helpful for early diagnosis and treatment in the patients with alcoholic liver fibrosis.

Correlation of Smad protein expressions with liver fibrosis in patients with chronic HBV infections / 中华临床感染病杂志

Objective To evaluate the association of Smad2/3,Smad4 and P-Smad3 protein expressions in tissue with liver fibrosis in patients with chronic HBV infections.Methods Liver biopsy was performed to determine the liver fibrosis grades in 131 cases of chronic HBV infections.Immunohistochemistry and semiquantitative analysis were applied to detect the expression of Smad2/3,Smad4 and P-Smad3 proteins in liver tissues.Results Smad2/3,Smad4 and P-Smad3 were detected mainly in fibrous septum,portal areas,myofibroblasts,sinus and cytoplasm in the liver tissue.The expression of Smad2/3,Smad4 and P-Smad3 was increased with the development of fibrosis ( r =0.81,0.58and 0.68,P =0.000),and a strong positive correlation was observed among three proteins (r =0.75,0.87and 0.84,P =0.000).Conclusion The expression of Smad2/3,Smad4 and P-Smad3 is correlated with liver fibrosis in chronic HBV infection,which suggests that the up-regulation of Smad proteins may be involved in the progression of liver fibrosis.

Experimental study on relationship of Hyaluronic Acid and transforming growth factor-?_1 with different TCM syndromes of liver fibrosis / 中华中医药杂志

Objective:To observe the relationship of Hyaluronic Acid and transforming growth factor-?1 with different TCM syndromes of liver fibrosis. Methods:All rats of model groups were treated by CCl4 to establish the liver fibrosis model. Besides CCl4,the rats of liver-stagnation and spleen-deficiency group were treated by stimulating tails with forceps clip and gastric infusion of rhubarb decoction,and the rats of qi-deficiency and blood-stasis group were treated by the method of swimming-fatigue. Then every group was intervened by the relevant medicine. After all treatments,the HA and TGF-?1 in serum were examined. Results:The HA and TGF-?1 of model groups were significantly higher than those of the control group(P