The value of contrast-enhanced ultrasound combined with microflow imaging in predicting microvascular invasion of hepatocellular carcinoma before operation.

OBJECTIVE: To evaluate the preoperative predictive value of contrast-enhanced ultrasound (CEUS) combined with microflow imaging (MFI) in microvascular invasion (MVI) of hepatocellular carcinoma (HCC). METHODS: In our study, 80 patients with HCC were analyzed retrospectively. According to the gold standard of postoperative pathology, the patients were divided into MVI positive group (n = 39) and MVI negative group (n = 41). we were to analyze the correlation between CEUS and MVI in combination with MFI, to identify independent risk factors for the occurrence of MVI positive, and to analyze the predictive efficacy of every independent risk factor and their combination in preoperative prediction of MVI. RESULTS: In our study, 80 patients were enrolled, including 39 patients in the MVI-positive group and 41 patients in the MVI-negative group, with a MVI-positive rate of 48.8%. By univariate analysis and multivariate analysis, it was found that there were statistically significant differences in enhancement range extension, start time of wash out and CEUS-MFI between the two groups, which were independent risk factors for MVI-positive. The combination of three independent risk factors is more effective than single one in predicting MVI of HCC. CONCLUSIONS: CEUS combined with MFI is feasible for the preoperative prediction of MVI in HCC, and can provides meaningful help for individualized clinical treatment.

Clinical significance of cefazolin inoculum effect in serious MSSA infections: a systematic review.

Background: The cefazolin inoculum effect (CzIE) is a phenomenon whereby some MSSA isolates demonstrate resistance to cefazolin when a high bacterial inoculum is used for susceptibility testing. The clinical significance of this phenotypic phenomenon remains unclear. We conducted a systematic review to answer the following question: In patients with serious MSSA infection treated with cefazolin, does infection due to CzIE-positive MSSA isolates result in worse clinical outcomes than infection due to CzIE-negative MSSA isolates? Methods: Ovid MEDLINE, Embase, Cochrane CENTRAL, medRxiv and bioRxiv were searched from inception until 12 April 2023. Studies were included if they tested for CzIE in clinical isolates from MSSA infections in humans. Two independent reviewers extracted data and conducted risk-of-bias assessment. Main outcomes were treatment failure and mortality. Pooling of study estimates was not performed given the heterogeneity of patient populations and outcome definitions. Results: Twenty-three observational studies were included. CzIE presence amidst MSSA isolates ranged from 0% to 55%. There was no statistically significant mortality difference in two studies that compared MSSA infections with and without CzIE, with ORs ranging from 0.72 to 19.78. Of four studies comparing treatment failure, ORs ranged from 0.26 to 13.00. One study showed a significantly higher treatment failure for the CzIE group, but it did not adjust for potential confounders. Conclusions: The evidence on CzIE is limited by small observational studies. In these studies, CzIE did not predict higher mortality in MSSA infections treated with cefazolin. Our findings do not support CzIE testing in clinical practice currently.

A quantitative analysis of thyroid fine needle aspiration (FNA) using needles with different gauges.

OBJECTIVE: The aim of this study is to compare the results of three gauge (G) needles (22G, 23G and 25G) in terms of cell amount in thyroid fine needle aspiration (FNA). SUBJECTS AND METHODS: In the retrospective study, a total of 443 patients undergoing FNA for the first time between 2017 and 2018 were included in the study, and assigned to 3 groups with 22-gauge, 23-gauge and 25-gauge needles, respectively. RESULTS: The cell amount of a suspicion for the four diagnosis groups, including malignancy and malignant, benign nodules, follicular of undetermined significance (FLUS), and follicular neoplasia was mainly in the range of 0-10000, 0-300, 0-150, and 500-2500, respectively. The cut-off values of 22G needle 20000, 300, 1000, and 2500, while the cut-off values of 23G and 25G were 10000, 400, 1000, and 2500; 5000, 400, 1500, and 2000, respectively for the four diagnosis groups. CONCLUSION: Large-gauge needles resulted in more cellular specimens than small-gauge needles only in the cases of malignant tumors. Small-gauge needles resulted in a higher comfort level of the patients, and had no difference in cell number in nodules with abundant blood supply, compared with large-gauge needles.