ABSTRACT
BACKGROUND@#Pre-operative non-invasive histological evaluation of hepatocellular carcinoma (HCC) remains a challenge. Tumor perfusion is significantly associated with the development and aggressiveness of HCC. The purpose of the study was to evaluate the clinical value of quantitative liver perfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography (CT) scans in predicting histological grade of HCC.@*METHODS@#Totally, 52 patients with HCC were enrolled in this retrospective study and underwent triple-phase enhanced CT imaging. The blood perfusion parameters were derived from triple-phase CT scans. The relationship of liver perfusion parameters and corresponding histogram parameters with the histological grade of HCC was analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal ability of the parameters to predict the tumor histological grade.@*RESULTS@#The variance of arterial enhancement fraction (AEF) was significantly higher in HCCs without poorly differentiated components (NP-HCCs) than in HCCs with poorly differentiated components (P-HCCs). The difference in hepatic blood flow (HF) between total tumor and total liver flow (ΔHF = HFtumor - HFliver) and relative flow (rHF = ΔHF/HFliver) were significantly higher in NP-HCCs than in P-HCCs. The difference in portal vein blood supply perfusion (PVP) between tumor and liver tissue (ΔPVP) and the ΔPVP/liver PVP ratio (rPVP) were significantly higher in patients with NP-HCCs than in patients with P-HCCs. The area under ROC (AUC) of ΔPVP and rPVP were both 0.697 with a high sensitivity of 84.2% and specificity of only 56.2%. The ΔHF and rHF had a higher specificity of 87.5% with an AUC of 0.681 and 0.673, respectively. The combination of rHF and rPVP showed the highest AUC of 0.732 with a sensitivity of 57.9% and specificity of 93.8%. The combined parameter of ΔHF and rPVP, rHF and rPVP had the highest positive predictive value of 0.903, and that of rPVP and ΔPVP had the highest negative predictive value of 0.781.@*CONCLUSION@#Liver perfusion parameters and corresponding histogram parameters (including ΔHF, rHF, ΔPVP, rPVP, and AEFvariance) in patients with HCC derived from traditional triphasic CT scans may be helpful to non-invasively and pre-operatively predict the degree of the differentiation of HCC.
Subject(s)
Humans , Carcinoma, Hepatocellular/diagnostic imaging , Contrast Media , Liver Neoplasms/diagnostic imaging , Perfusion , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
Objective:To explore impact of serum level of interleukin(IL)-6 on long-term prognosis in patients un-dergoing intracoronary drug-eluting stent(DES)implantation.Methods:A total of 2017 patients,received success-ful DES implantation in our hospital from Feb 2010 to Feb 2013 were selected.According to IL-6 level change be-tween before and after surgery,they were divided into elevated IL-6 group(n=994)and decreased IL-6 group(n=1023),and both groups received postoperative follow-up of one,two and three years.Results:Compared with de-creased IL-6 group after one-year follow-up,there were significant rise in levels of high sensitive C reactive protein [(22.3 ± 6.0)ng/ml vs.(30.8 ± 7.0)ng/ml],low density lipoprotein cholesterol[(2.5 ± 0.9)mmol/L vs.(2.6 ± 1.0)mmol/L]and serum creatinine[(77.9 ± 34.9)μmol/L vs.(88.8 ± 35.6)μmol/L],and significant reduction in level of high density lipoprotein cholesterol[(1.1 ± 0.4)mmol/L vs.(1.0 ± 0.3)mmol/L]in elevated IL-6 group,P=0.001 all;compared with decreased IL-6 group after two-year follow-up,there were significant rise in target lesion revascularization rate(1.6% vs.3.1%)in elevated IL-6 group(P=0.021);compared with decreased IL-6 group after three-year follow-up,there were significant rise in target lesion revascularization rate(1.3% vs. 3.8%),cumulative incidence rate of MACE(9.8% vs.15.6%),accumulative mortality(1.6% vs.3.3%) and cardiogenic mortality(0 vs.1.1%)in elevated IL-6 group(P = 0.001). Conclusion:Compared with decreased IL-6 group,after coronary drug-eluting stent implantation,long-term prognosis of elevated IL-6 group is significantly poor.
ABSTRACT
<p><b>BACKGROUND</b>Atrial fibrillation (AF) is the most frequent tachyarrhythmia in patients with a permanent pacemaker. Angiotensin II receptor antagonists have a protective effect against the occurrence of AF in patients with heart diseases. This study aimed to assess the effectiveness of olmesartan in the prevention of new-onset AF and AF burden in atrioventricular block (AVB) patients with dual-chamber (DDD) pacemaker implantation.</p><p><b>METHODS</b>This was a single-center, prospective, randomized, single-blind, controlled clinical study. A total of 116 AVB patients, who received DDD pacemakers implantation with the percentage of ventricular pacing (VP%) ≥40% from April 22, 2011 to December 24, 2012, were prospectively randomized to olmesartan group (20 mg per day; n = 57) or control group (n = 59). Patients were followed up using pacemaker programming, 12-lead electrocardiography in the intrinsic sinus rhythm, laboratory examinations, and transthoracic echocardiography at 24 months. Atrial high rate events (AHREs) were defined as 180 beats/min over a minimum of 5 min. AF burden was calculated by the number of hours with AHREs divided by the number of measurement hours.</p><p><b>RESULTS</b>Ten (17.5%) patients in the olmesartan group and 24 patients (40.7%) in the control group occurred new-onset AF, and the difference between two groups was statistically significant (P = 0.04). AF burden was lower in olmesartan group than that in control group (8.02 ± 3.10% vs. 13.66 ± 6.14%, P = 0.04). There were no significant differences in mean days to the first occurrence of AHREs and mean cumulative numbers of AHREs between two groups (P = 0.89 and P = 0.42, respectively). Moreover, olmesartan group had smaller values of maximal P-wave durations and P-wave dispersion (PD) after 24 months follow-up compared with the control group (109.5 ± 7.4 ms vs. 113.4 ± 7.1 ms, P = 0.00; and 40.6 ± 4.5 ms vs. 43.3 ± 4.4 ms, P = 0.02, respectively). Left ventricular end-diastolic diameter and left ventricular ejection fraction were not significantly different between two groups (both P > 0.05).</p><p><b>CONCLUSION</b>This study suggested that 24-month of olmesartan therapy could reduce new-onset AF and AF burden in patients with DDD pacemakers.</p><p><b>CLINICAL TRIAL REGISTRATION</b>ChiCTR-TRC-12004443; http://www.chictrdb.org.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angiotensin Receptor Antagonists , Therapeutic Uses , Atrial Fibrillation , Drug Therapy , Atrioventricular Block , Drug Therapy , Imidazoles , Therapeutic Uses , Single-Blind Method , Tetrazoles , Therapeutic UsesABSTRACT
The platelet antibodies mainly include platelet-specific and related antibodies, which belong to irregular antibodies. They are produced by autoimmune, drug-induced or isoimmunization (such as pregnancy, blood transfusion and so on), the irregular IgG and/or IgM antibodies produce and lead to platelet transfusion refractoriness (PTR), post-transfusion purpura (PTP) and isoimmune neonatal thrombocytopenic purpura (INTP), idiopathic thrombocytopenic purpura and so on. It is very necessary to screen and identify the irregular antibodies before blood transfusion or parturition. Except some serological detections should be done first, flow cytometry and molecular biological techniques such as PCR and PCR-SSP are applied to detect the difficult-matching patients' genotypes and fetal genotypes in order to further predict fetal INTP and to provide the right blood for difficult-matching patients, therefore, some measures must be taken early for prevention and treatment of immune thrombocytopenic purpura. In this review, the production, typing and laboratory tests of irregular antibodies, as well as the pathogenesis and clinical symptoms of diseases caused by irregular antibodies, and the current progress are summarized.