U-shaped relationship between urea level and hepatic decompensation in chronic liver diseases

Background/Aims@#We aimed to determine the association between blood urea level and incident cirrhosis, hepatic decompensation, and hepatocellular carcinoma in chronic liver disease (CLD) patients. @*Methods@#The association between blood urea level and liver fibrosis/liver-related events were evaluated on continuous scale with restricted cubic spline curves based on generalized additive model or Cox proportional hazards models. Then, the above associations were evaluated by urea level within intervals. @*Results@#Among 4,282 patients who had undergone liver stiffness measurement (LSM) by transient elastography, baseline urea level had a U-shaped association with LSM and hepatic decompensation development after a median follow-up of 5.5 years. Compared to patients with urea of 3.6–9.9 mmol/L, those with urea ≤3.5 mmol/L (adjusted hazard ratio [aHR], 4.15; 95% confidence interval [CI], 1.68–10.24) and ≥10 mmol/L (aHR, 5.22; 95% CI, 1.86–14.67) had higher risk of hepatic decompensation. Patients with urea ≤3.5 mmol/L also had higher risk of incident cirrhosis (aHR, 3.24; 95% CI, 1.50–6.98). The association between low urea level and incident cirrhosis and hepatic decompensation was consistently observed in subgroups by age, gender, albumin level, and comorbidities. The U-shaped relationship between urea level and LSM was validated in another population screening study (n=917). Likewise, urea ≤3.5 mmol/L was associated with a higher risk of incident cirrhosis in a territory-wide cohort of 12,476 patients with nonalcoholic fatty liver disease at a median follow-up of 9.9 years (aHR, 1.27; 95% CI, 1.03–1.57). @*Conclusions@#We identified a U-shaped relationship between the urea level and liver fibrosis/incident cirrhosis/hepatic decompensation in patients with CLD.

Non-invasive tests of non-alcoholic fatty liver disease / 中华医学杂志(英文版)

For the detection of steatosis, quantitative ultrasound imaging techniques have achieved great progress in past years. Magnetic resonance imaging proton density fat fraction is currently the most accurate test to detect hepatic steatosis. Some blood biomarkers correlate with non-alcoholic steatohepatitis, but the accuracy is modest. Regarding liver fibrosis, liver stiffness measurement by transient elastography (TE) has high accuracy and is widely used across the world. Magnetic resonance elastography is marginally better than TE but is limited by its cost and availability. Several blood biomarkers of fibrosis have been used in clinical trials and hold promise for selecting patients for treatment and monitoring treatment response. This article reviews new developments in the non-invasive assessment of non-alcoholic fatty liver disease (NAFLD). Accumulating evidence suggests that various non-invasive tests can be used to diagnose NAFLD, assess its severity, and predict the prognosis. Further studies are needed to determine the role of the tests as monitoring tools. We cannot overemphasize the importance of context in selecting appropriate tests.

Application of transient elastography in nonalcoholicfatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Although it has become one of the leading causes of cirrhosis and hepatocellular carcinoma in the Western world, the proportion of NAFLD patients developing these complications is rather small. Therefore, current guidelines recommend noninvasive tests for the initial assessment of NAFLD. Among the available non-invasive tests, transient elastography by FibroScan® (Echosens, Paris, France) is commonly used by hepatologists in Europe and Asia, and the machine has been introduced to the United States in 2013 with rapid adoption. Transient elastography measures liver stiffness and the controlled attenuation parameter simultaneously and can serve as a one-stop examination for both liver steatosis and fibrosis. Liver stiffness measurement also correlates with clinical outcomes and can be used to select patients for varices screening. Although obesity is a common reason for measurement failures, the development of the XL probe allows successful measurements in the majority of obese patients. This article reviews the performance and limitations of transient elastography in NAFLD and highlights its clinical applications. We also discuss the reliability criteria for transient elastography examination and factors associated with false-positive liver stiffness measurements.

MRI appearences of pilomyxoid astrocytoma at unusual sites in children / 实用放射学杂志

Objective To investigate the MRI manifestations of pilomyxoid astrocytoma (PMA)at unusual sites and differential diagnosis in children.Methods The clinical and MRI data from 6 cases of PMA with atypical locations confirmed by surgery and pathology were analyzed retrospectively.Results 2 cases located at cerebral hemisphere,1 case at tegmentum mesencephali,1 case at medulla and 2 cases at cerebellar hemisphere.There were 4 cases of solid tumor and 2 case belonged to cystic-solid mass.5 cases were round or oval and 1 case was shallow lobulated.In addition,there were 2 cases with hemorrhage and 2 cases with peritumoral edema.T1WI showed hypointensity,isointense or slightly hyperintense while T2WI and fluid attented inversion recovery (FLAIR)exhibited isointensity or hyperintensity.After contrast administration,there were 3 cases of obvious multi-ring enhancement,of which 1 case showed astral enhancement of the mural nodules and the other 3 cases showed mild homogeneous or inhomogeneous enhancement.4 cases showed non-enhanced areas in the solid parts.No signs of leptomeningeal dissemination were found in all 6 cases.Conclusion The PMA at unuaual sites in children is primarily solid or cystic-solid,and the image manifestations of plain scan are varied.After enhancement,the tumors show obviously multi-circular enhancement and mild homogeneous or inhomogeneous enhancement could be observed,no enhancement areas are visible in the solid parts.It is noteworthy to distinguish this astrocytoma from other lesions.

Exploration of science management mode for high-value medical consumables / 中国医学装备

Objective:To investigate and explore the science management mode for high- value medical consumables in order to solve the problem of management deficiency in purchase and using of high-value medical consumables.Methods: To strengthen the management for high value consumables on 5 aspects: systematized institution, normalized processes, standardized operation, scientific evaluation and informationalized management.Results:The normalized, standardized and programmed management mode for high-value medical consumables has been established and improved throughout the whole process monitoring and management of total life cycle for the consumables. This research normalized the management for these consumables and formed a new science management mode.Conclusion: The exploration and implementation of new management method and path for medical high-value consumables can effectively improve the level of hospital material management, reduce management loopholes, decrease the cost of high-value consumables and increase work efficiency.

MRI differetial diagnosis of posterior fossa cyst with hydrocephalus in children / 实用放射学杂志

Objective To study MRI diagnosis and differential diagnosis of posterior fossa cyst with hydrocephalus in children. Methods MRI performances and clinical data of 56 children with cyst in the posterior fossa and hydrocephalus were analyzed and classified.Results 12 cases of Dandy-Walker malformation(DWM)showed absence of the vermis at different degrees and the enlarged fourth ventricle widely communicating with the large posterior fossa cyst,accompanied by elevation of the tentorium cerebella and hydrocephalus,in which 1 case combined with callosal agenesis,1 case with subependymal gray matter heterotopia and 1 case with subependymal gray matter heterotopia and small occipital encephalocele.9 cases of Blake's pouch cyst(BPC)showed mildly dilatation of the fourth ventricle,and the cyst was below the cerebellar and hydrocephalus.Neither cerebellar hypoplasia nor elevation of the tentorium cerebella was observed. The postirior wall of the cyst was observed on sagittal T 2WI in 5 cases.The choroid plexus of the fourth ventricular moving to the top wall of the cyst were seen on thin sagittal T 2WI in 1 case.35 cases of arachnoid cyst(AC)showed aggregation of cerebrospinal fluid,and the fourth ventricular and aqueductal stenosis at different degrees and hydrocephalus.Conclusion MRI has evident advantages at diagnosis and differential diagnosis of cystic malformations of the posterior fossa with hydrocephalus,especially on sagittal MRI.

Imaging manifestations and clinical analysis of mycoplasma pneumonia combined with pulmonary embolism in children / 实用放射学杂志

Objective To explore the clinical and imaging features of pulmonary embolism (PE)in children with mycoplasma pneumonia (MP).Methods The clinical features,imaging manifestations and laboratory data of 6 children with MP complicated by PE were reviewed retrospectively.Results 6 cases of children were admitted with chief complaints of fever and cough,the D-dimer levels were increased obviously.Consolidation was observed in 4 cases in the right lower lobe combined with pleural effusion and in 2 cases in the left lobe,which showed homogeneous enhancement.Filling defect of pulmonary artery was observed in 1 case,and other 5 cases showed sparse pulmonary vascular in consolidation area.D-dimer returned to normal level and consolidation was absorbed after anticoagulation therapy.Conclusion MP combined with PE in children is rare,and the positive detection rate of pulmonary artery angiography is low.PE should be considered when MP continues to deterioration after anti-infection treatment,even though there is no typical imaging findings of PE.

Imaging manifestations and clinical analysis of mycoplasma pneumonia combined with pulmonary embolism in children / 实用放射学杂志

Objective To explore the clinical and imaging features of pulmonary embolism (PE)in children with mycoplasma pneumonia (MP).Methods The clinical features,imaging manifestations and laboratory data of 6 children with MP complicated by PE were reviewed retrospectively.Results 6 cases of children were admitted with chief complaints of fever and cough,the D-dimer levels were increased obviously.Consolidation was observed in 4 cases in the right lower lobe combined with pleural effusion and in 2 cases in the left lobe,which showed homogeneous enhancement.Filling defect of pulmonary artery was observed in 1 case,and other 5 cases showed sparse pulmonary vascular in consolidation area.D-dimer returned to normal level and consolidation was absorbed after anticoagulation therapy.Conclusion MP combined with PE in children is rare,and the positive detection rate of pulmonary artery angiography is low.PE should be considered when MP continues to deterioration after anti-infection treatment,even though there is no typical imaging findings of PE.

Imaging findings of Langerhans cell histiocytosis in limbs of children:comparison with clinical and pathological findings / 中华放射学杂志

Objective To study the imaging findings, clinical and pathological characteristics of langerhans cell histiocytosis(LCH)in limbs of children, and to improve the imaging diagnostic accuracy of LCH . Methods Imaging findings and clinical data of 12 patients with limbs LCH were analyzed retrospectively. X-ray examination was performed in 10 cases, while 9 cases underwent CT and 7 cases underwent MRI examination. All imaging findings were analyzed. Results Seven lesions were solitary, including 4 lesions in the tibia, 2 in the radius and 1in the ulna. Five cases had limbs lesion in multiple sites, which included 12 bone lesions in total, with 6 lesions in the femur, 3 in the humerus (1 case involved the epiphysis), 2 in the tibia and 1in the radius. The X-ray or CT images of the lesions showed osteolytic destruction and swelling of the bone, which was commonly associated with the reaction of periosteum. Eleven cases were with peripheral soft tissue swelling, and one case had soft tissue mass. The lesions showed low signal on T1WI and high signal or mixed signal on T2WI. Six cases were diagnosed as LCH at the first time and the other 6 cases were diagnosed as infectious lesions. Twelve cases were regularly followed up after the treatment, and the prognosis of the patients with single lesion was better. Conclusions LCH of limbs usually involves diaphyseal and metaphyseal bone. The imaging features include osteolytic destruction and swelling of the bone, with peripheral soft tissue swelling or mass of the soft tissue. Although LCH of limbs has some specific imaging features, it is difficult to differentiate it from malignant bone tumors. Multi-imaging modalities such as radiography, CT and MRI imaging may suggest the diagnosis and provide important information for evaluating prognosis.

Oxidized meosporous carbon nanospheres as carriers for paclitaxel / 药学实践杂志

Objective To prepare oxidized mesoporous carbon nanospheres and investigate potential application as drug delivery carriers for paclitaxel .Methods Physicochemical properties such as morphology ,diameter ,pore diameter and pore volume were characterized .Drug‐loading capacity was measured and drug release behavior in vitro was investigated by dialysis method .In vitro antitumour effect was evaluated by CCK‐8 methods .Results The synthesized oxidized mesoporous carbon nanospheres had an average diameter of 140 nm ,Zeta potential of -36 mV ,high specific surface area of 704.63 m2/g ,high drug‐loading capacity of 45 .6% .Conclusion Oxidized mesoporous carbon nanospheres have promising application in anti‐cancer drug delivery system .

Diagnosis of horseshoe lung with multi-slice helical CT / 中华放射学杂志

Objective To study the multi-slice helical CT (MSCT) features of horseshoe lung and to improve its diagnostic ability. Methods The clinical and imaging data were retrospectively reviewed in 5 patients. All of them underwent plain MSCT scan, and 4 patients also had enhanced MSCT scan and threedimensional reconstruction. Results In horseshoe lung, the basal segments of the right and left lungs were fused together by a isthmus of pulmonary parenchyma, across the midline behind the pericardium and before the esophagus, descending aorta and spine. All patients were companied with bronchopulmonary dysplasia,anomalous origin of the central bronchi, anomalous arterial supply. Anomalous pulmonary venous return to inferior vena cava and congenital cardiovascular malformations were also found in 4 cases. Conclusion MSCT and three-dimensional reconstruction are valuable for identification of horseshoe lung.

The combined use of cardioangiography and ultrasonography in interventional therapy for congenital heart disease in children / 介入放射学杂志

Objective To assess the respective value and limitation of cardioangiography and ultrasonography in interventional therapy for congenital heart disease in children,and to discuss the clinical significance of the combined use of both examinations. Methods A total of 162 children with congenital heart disease,screened by ultrasonography,were enrolled in this study.The disorders included VSD(n=50),PDA(n=96)and PS(n=16).Before the interventional therapy all the cases accepted cardioangiography and ultrasonography examinations,and the diameter of the abnormal passage was measured.The difference in the diameter between two examinations was compared and statistically analyzed by using paired t test.All the cases accepted both examinations after the interventional therapy to check the location of the occluder and the result of balloon dilatation.Results Both cardiovascular angiography and ultrasonography could make a definite diagnosis of congenital bean disease in children,and could well display the location and shape of the abnormalities.The diameter of VSD(n=50)measured by cardioangiography and ultrasonography was(4.93±2.73)mm and(5.66±2.77)mm respectively,with no significant statistical difference existing between two methods(P＞0.05).The diameter at the narrowest site of PDA(n=96)measured by cardioangiography and ultrasonography was(3.22±1.45)mm and(3.96±1.42)mm respectively,with a significant difference existing between two methods(P＜0.05).In 16 PS cases,the diameter of valvular ring determined on cardioangiogram and on ultrasonogram wag(16.16±4.26)mm and(17.94±5.50)mm respectively,with no significant difference between two groups(P＞0.05).During the operation of VSD,the monitoring ultrasonography revealed that the valvular opening and closing was interfered by the occluder in 9 cases,so the occluder was re-adjusted till it was fixed to proper position. After the interventional therapy for VSD and PDA,cardioangiography detected a small residual shunt in 7 cases,which completely disappeared 24 hours later on ultrasonography.After balloon dilation in all 16 children with PS the right ventricle-pulmonary artery pressure difference was reduced by more than 50%and the pressure figure reached the standard of clinical Cure.The interventional procedure was successfully completed in all patients except for three cases. Conclusion In treating children of congenital heart disease with interventional procedures,the determination of the lesion's diameter and the selection of the occluder should be based on cardioangiographic measurement,although ultrasonography is more helpful in making preoperative screening and postoperative evaluation.

The effect of hemodialysis in aged patients with chronic renal failure / 中国基层医药

Objective To evaluate the effects of hemodialysis in aged patients with chronic renal failure,decrease complications,to improve their survival rate.Methods The clinical datas of aged patients suffering from CRF who received maintenance hemodialysis were summarized and analyzed about the survival,the cause of death and common complications.Results The commonest causes of death in aged patients with maintenance hemodialysis were cardiovascular events,infection and malnutrition.The common complications were cardiac insufficiency,infection.Conclusion Providing individual enough HD and treatment,improving nutritional situation,anemia and controlling infection may contribute to the reduction of the complications and the increasing of survival rate.

Determination of Methyl-parathion Using Luminol-based Chemiluminescence Flow Injection Method / 分析化学

A simple, fast flow injection chemiluminescence (CL) method for the determination of methyl-parathion has been developed. It is based on the reaction of methyl parathion with luminol-H2O2 in the alkaline medium (pH：11.5～12.0), sensitized by water-soluble macromolecule Polyethylene glycol 400. Under the optimal conditions, the CL intensity was linear to the concentration in the range of 5.0×10-8～1.0×10-5　g/mL (r=0.9996), with a detection limit (3σ) of 2.0×10-8　g/mL. Relative standard deviation was less than 4% (n=11) and the recovery was between 82%～93%. This method has been successfully applied to the determination of trace residue of methyl-parathion in grain sample.

Determination of sildenafil citrate content by capillary zone electrophoresis / 第二军医大学学报

Objective: To establish capillary zone electrophoresis method for determination of sildenafil citrate (Viagra) content in its troche. Methods： Using tetrandrine as internal standard(IS), the electrophoretic separation was achieved with 25 mmol/L borate (pH=7.89) running buffer. And a voltage of 14 kV was applied to the 40 cm×75 μm(i.d) capillary. The analytes were introduced into capillary by siphon (1 s) and determined with on-column monitoring at 214 nm. Results：The determination could be completed within 4 min and the minimum concentration of detection was 5 μg/ml.The analytical results of sildenafil citrate samples demonstrated a good linear relationship within the range of 24-480 μg/ml.The relative standard deviations (RSD) of intra-day was less than 1.58% and that of inter-day was less than 2.46%.The present recoveries were between 95%-105％. Conclusion：The CZE method is accurate, simple, rapid and reliable, so it can be applied to the determination of sildenafil citrate content.