Ultrasound-Based Multimodal Imaging Predicting Ischemic-Type Biliary Lesions After Living-Donor Liver Transplantation.

BACKGROUND: Ischemic-type biliary lesions (ITBL) are accepted as the most incomprehensible biliary complications after living-donor liver transplantation (LDLT). Early predicting the development of ITBL in pediatric patients permits more preventive strategies. However, few studies have focused on the early prediction of ITBL. OBJECTIVE: This study aimed to establish a nomogram including ultrasound-based multimodal imaging to predict ITBL in children with biliary atresia (BA) within 2 years after receiving LDLT. METHODS: The records of 94 BA children with at least one year of follow-up after LDLT were reviewed retrospectively. They were randomly divided into a training cohort for constructing a nomogram (n=64) and a validation cohort (n=30). In the training cohort, patients diagnosed as ITBL were included in the ITBL group and those without any vascular and biliary complication were included in the non-ITBL group. Multivariate Cox regression was used for the establishment of the nomogram in predicting the risk of ITBL within 2 years post-LDLT. The discrimination and calibration of the nomogram were internally and externally validated. The performances of the nomogram and the individual components were compared by the area under the curve (AUC) of receiver operating characteristic (ROC) curve. RESULTS: In the training cohort, 18 BA children were included in the ITBL group and 46 were in the non-ITBL group. Last pediatric end-stage liver disease (PELD) score, gamma-glutamyl transpeptidase (GGT), resistive index (RI), and liver stiffness measurement (LSM) were the independent predictors for the development of ITBL within 2 years post-LDLT. The nomogram incorporating these independent predictors showed good discrimination and calibration by the internal and external validation. Its performance was better than any individual component in predicting the prognosis (P < 0.05). CONCLUSION: The established nomogram may be used to predict the risk of ITBL within 2 years post-LDLT in BA children.

A Nomogram Predicting the Prognosis of Children With Biliary Atresia After Hepatoportoenterostomy.

Background: Although Kasai portoenterostomy (KPE) is performed timely for most children with biliary atresia (BA), the native liver survival (NLS) is still poor due to the progressive liver fibrosis. Many children have to receive liver transplantation (LT) within 2 years after KPE. Early prediction of the prognosis permits the implementation of prophylactic treatments for BA children. However, studies about the prediction are limited. Objective: The purpose of this study is to establish a nomogram to predict the prognosis of BA children within 2 years after KPE. Methods: The follow-up data of 151 BA children were retrospectively reviewed, and were randomly divided into a training cohort for constructing a nomogram (n = 103) and a validation cohort (n = 48). In the training cohort, patients were divided into Group A and Group B according to whether death or LT were observed within 2 years post-KPE. Multivariate Cox regression based on the baseline characteristics, liver function indicators and LSM (liver stiffness measurement) values at KPE and 3 months after KPE was utilized for the establishment of the nomogram in predicting the prognosis of BA within 2 years after KPE. The discrimination and calibration of the nomogram were internally and externally validated. Results: Fifty-six BA children were included in Group A and 47 were included in group B. Age at KPE, METAVIR score F4, LSM at 3 months, first onset of cholangitis within 3 months, and jaundice clearance time were the independent predictors for the prognosis of BA children within 2 years after KPE (all P < 0.05). The developed nomogram based on these independent predictors showed good discrimination and calibration by the internal and external validation. Its performance was better than each predictor in predicting the prognosis (all P < 0.05). Conclusions: The established nomogram based on the indicators from the first 3 months after KPE may be useful for predicting the prognosis of BA children within 2 years post-KPE and helpful for the consideration of LT.

[Relationship between the grading of periventricular echodensities and periventricular white matter cystic lesions in preterm infants].

OBJECTIVE: To understand the relationship of the grading of periventricular echodensities (PVE) with the morbidity and the occurrence time of periventricular white matter cystic lesions in preterm infants. METHODS: A retrospective, single-centre cohort study of 120 preterm infants with PVE diagnosed by ultrasonography between February 2005 and May 2008 was performed. The infants had a median gestational age of 32 weeks and a median birth weight of 2 230 g. RESULTS: Fifty-two infants (43%) were diagnosed as having PVE I, 42 infants (35%) having PVE II, and 26 infants (22%) having PVE III. The grading of PVE was closely related to birth weight, but not with gestational age. The total morbidity of periventricular white matter cystic lesions was 24% (29/120). The morbidity of the cystic lesions in PVE III patients (65%) was significantly higher than that in PVE II patients (21%) (<0.01). The PVE III patients developed the cystic lesions earlier than the PVE II patients. CONCLUSIONS: The grading of PVE is closely related to the morbidity and the occurrence time of periventricular white matter cystic lesions in preterm infants.

[Ultrasonographic findings of intussusception complicated by intestinal necrosis in children].

OBJECTIVE: The information on the ultrasonographic features of pediatric intussusception complicated by intestinal necrosis is limited at present. This study aimed to investigate the ultrasonographic findings of this disorder in children in order to provide references for selecting a right means of reduction in clinical practice. METHODS: The ultrasonographic findings of 48 children with intussusception complicated by intestinal necrosis and who underwent operative reduction between 2004 and 2006 were reviewed retrospectively. RESULTS: The type of intussusception was closely correlated to the development of intestinal necrosis and the ileo-ileo-colonic intussusception was the most common one resulting in intestinal necrosis. The bowel wall of the invaginated segment was obviously thickened and the center of the invaginated segment was often accompanied with swollen lymph node and appendix caecalis. The intussusceptional fluidify, the expanding of distal segment accompanied with the thickened bowels wall, and weakening or disappearance of enterokinesia were the appearances of necrosis of most of bowel walls. The secondary intussusception was an important factor resulting in intestinal necrosis, and sound image of primary lesion was found in some patients. Seroperitoneum was a common manifestation in all of infants with intussusception complicated by intestinal necrosis. CONCLUSIONS: There are some obvious sonographic characteristics of intussusception complicated by intestinal necrosis in children. The means of intussusception reduction may be selected according to ultrasonographic characteristics.