[Clinical value of multiparameteric quantitative ultrasound for assessing high-risk steatohepatitis].

Objective: To investigate the clinical value of multiparameteric quantitative ultrasound combined with a non-invasive prediction model for assessing high-risk steatohepatitis. Methods: One hundred and ninety-four cases with metabolic-associated fatty liver disease (MAFLD) who underwent liver biopsy in Huashan Hospital, Fudan University, from June 2021 to September 2022 were selected. Shear wave elastography (SWE), shear wave dispersion (SWD) imaging, and attenuation imaging (ATI) examinations were conducted in all patients before biopsy. High-risk steatohepatitis was defined as a total activity score of ≥4 in patients with steatohepatitis, hepatocellular ballooning, and liver lobular inflammation based on pathological hepatic steatosis, inflammatory activity, and fibrosis scoring system (SAF), and fibrosis stage≥F2. Binary logistic regression analysis was used to identify the factors influencing high-risk steatohepatitis. A predictive model for diagnosing high-risk steatohepatitis was constructed using R language. The DeLong test was used to compare the area under the curve between groups. Measurement data was compared between groups using the t-test or rank-sum test, and count data were compared between groups using the χ2 test. Results: There were 46 cases (23.7%) with high-risk steatohepatitis. The quantitative ultrasound parameters included elastic modulus (OR=2.958, 95%CI: 1.889-4.883, P<0.001), dispersion coefficient (OR=1.786, 95%CI: 1.424-2.292, P<0.001) and attenuation coefficient (OR=42.642, 95%CI: 3.463-640.451, P=0.004). Serological indexes of fasting blood glucose (OR=1.196, 95%CI: 1.048-1.392, P=0.011), alanine aminotransferase (OR=1.012, 95%CI: 1.006-1.019, P<0.001), aspartate aminotransferase (OR=1.027, 95%CI: 1.014-1.042, P<0.001), γ-glutamyl transferase (OR=1.008, 95%CI: 1.001-1.017, P=0.041) and HDL cholesterol (OR=0.087, 95%CI: 0.016-0.404, P=0.003) were the factors influencing its progression. The AUCs of elastic modulus, dispersion coefficient, attenuation coefficient, multiparametric ultrasound model, serological index model, and ultrasound combined with serology model for the diagnosis of high-risk steatohepatitis were 0.764, 0.758, 0.634, 0.786, 0.773 and 0.825, respectively. The results of the DeLong test showed that the ultrasound combined with the serological model was significantly better than the serological index model and the elastic modulus, dispersion coefficient, and attenuation coefficient alone (P=0.024, 0.027, 0.038 and <0.001). Conclusion: The combination of multiparametric quantitative ultrasound is helpful for the non-invasive diagnosis of high-risk steatohepatitis and possesses great clinical significance.

[The application value of shear wave dispersion and shear wave elastography combined with serological indicators in the evaluation of liver fibrosis].

Objective: To explore the application value of shear wave dispersion (SWD) and shear wave elastography (SWE) combined with serological indicators in the evaluation of liver fibrosis. Methods: A total of 219 patients with liver disorders who underwent liver biopsy were prospectively collected in Huashan Hospital, Fudan University from January 2021 to September 2022, including 130 males and 89 females, aged from 18 to 76 (42±12) years. All patients underwent SWD and SWE examinations before liver biopsy. Serological indicators including alanine aminotransferase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP)) and γ-glutamyl transpeptadase (GGT) were also collected. Based on pathological diagnosis of liver fibrosis stage (from S0 to S4), the distribution of dispersion slope and liver elastic modulus at different fibrosis stages were analyzed in all patients. All patients were divided 7: 3 into training set (156 cases) and validation set (63 cases) in chronological order. In training set, factors influencing liver fibrosis≥S2 stage and S4 stage were analysed using binary logistic regression. The predictive models were established for diagnosing liver fibrosis≥S2 stage and S4 stage by using R language, and the models were evaluated by the area under curve (AUC) and calibrated for validation. Results: The dispersion slope and elastic modulus increased with the severity of fibrosis, with statistically significant differences in different fibrosis stages (both P<0.001). In training set, dispersion slope, elastic modulus, ALT, AST, and GGT were influential factors in liver fibrosis≥S2 stage and S4 stage(both P<0.05), and prediction models were constructed based on these indicators. In training set, the AUCs of the predictive model, SWD and SWE for diagnosingliver fibrosis≥S2 stage were 0.743 (95%CI: 0.665-0.821), 0.709 (95%CI: 0.628-0.790) and 0.725 (95%CI: 0.647-0.804), respectively; for diagnosing liver fibrosis S4 stage, the AUCs were 0.988 (95%CI: 0.968-1.000), 0.908 (95%CI: 0.852-0.963) and 0.974 (95%CI: 0.945-1.000), respectively. In validation set, the AUC of the predictive model, SWD and SWE for diagnosing liver fibrosis≥S2 stage were 08.735 (95%CI: 0.612-0.859), 0.658 (95%CI:0.522-0.793) and 0.699 (95%CI:0.570-0.828), respectively; for diagnosing liver fibrosis S4 stage, the AUC were 0.976 (95%CI: 0.937-1.000), 0.872 (95%CI: 0.757-0.988) and 0.948 (95%CI: 0.889-1.000), respectively. The calibration curves of the prediction models were consistent in the training and validation sets. Conclusion: The predictive model of SWD and SWE combined with serological indicators is helpful in the diagnosis of stage of liver fibrosis non-invasively.

[Analysis of morphologic changes of lamina cribrosa in primary open angle glaucoma using enhanced depth imaging optical coherence tomography].

OBJECTIVE: To analyze the morphologic changes of the lamina cribrosa (LC) in primary open angle glaucoma (POAG) patients using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: This was a case-control study. Serial horizontal and vertical B-scans of the optic nerve head were obtained from one eye of 52 POAG patients and 50 age- and sex-matched healthy subjects by EDI-OCT. The number and location of focal LC defects as well as their relationship with retinal nerve fiber layer(RNFL) defects were investigated in glaucomatous eyes and compared with healthy controls. The LC thickness was measured at the center of mid-superior, central, and mid-inferior horizontal B-scans. The intra- and interobserver reproducibility were evaluated by intraclass correlation coefficient (ICC). A repeated measure ANOVA was used to analyze regional differences of the LC thickness. Independent t-test was conducted to compare LC thickness between POAG and healthy controls. A Pearson correlation was calculated for variation in LC thickness relative to global mean RNFL thickness. Spearman rank correlation was calculated to test the strength of the relationship between LC thickness and visual field mean deviation (MD). RESULTS: Twenty-six focal LC defects were found in 20 eyes (38.5%) with glaucoma versus none in the healthy controls. There were 13 (50.0%) focal LC defects in the inferotemporal sector, 6 (23.1%) defects in the inferior sector, 4 (15.4%) in the superotemporal sector, and 3 (11.5%) in the superior sector. Twenty-five of 26 focal LC defects (96.2%) corresponded to the RNFL defects. The intra- and interobserver ICCs of LC thickness measurement ranged from 0.90 to 0.95 and 0.84 to 0.90, respectively. The thicknesses of the superior midperipheral, central, and inferior midperipheral LC in POAG eyes were 180.7±26.3, 196.7±24.0, and 184.1±23.5 µm, respectively. In healthy controls, the laminar thicknesses were 203.2±21.0, 225.2±22.7, and 202.6±16.5 µm, respectively. In both groups, the midperipheral LC was significantly thinner than the central LC (P<0.01). The mean LC thickness was (187.2±19.4) µm in POAG eyes. It was significantly thinner than that in healthy controls (210.3±17.4 µm) (t=5.06, P<0.01). The superior midperipheral, central, and inferior midperipheral regions of the LC were also significantly thinner in POAG than in controls (t=3.52 to 4.96, P<0.01). In POAG patients, mean LC thickness was found to significantly correlate with both global mean RNFL thickness (r=0.45, P<0.01) and visual field MD (rs=-0.58, P<0.01). CONCLUSIONS: The LC thickness was thinner in POAG than in healthy eyes, and correlated with the severity of POAG. Focal LC defects occurred frequently in POAG eyes, and might be associated with RNFL defect. EDI-OCT is a useful tool for the evaluation of LC deformation in glaucoma.(Chin J Ophthalmol, 2016, 52: 422-428).

Alterations in Structural Polysaccharides during Liquefaction of Tomato Locule Tissue.

The locule tissue of tomato (Lycopersicon esculentum, Mill.) undergoes extensive liquefaction during ripening. In this study, the solubility, molecular mass, and glycosyl composition of locule pectic and alkali-soluble polysaccharides were examined with the aim of identifying features contributing to the unique properties of this tissue. Ethanol-insoluble solids were prepared from de-seeded locule tissue from tomato fruit at the immature green (IMG), mature green, and breaker stages of development. Ethanol-insoluble pectins were extracted sequentially in H2O, 50 mM trans-1,2-diaminocyclohexane-N,N,N[prime],N[prime]-tetraacetic acid, 50 mM Na2CO3, and 4 M KOH. At the IMG stage, nearly 85% of the locule pectins were solubilized by water, trans-1,2-diaminocyclohexane-N,N,N[prime],N[prime]-tetraacetic acid, and Na2CO3 solutions. Solubility increased only slightly with further locule development. The noncovalently associated polymers were of high molecular mass throughout liquefaction. Polymers extracted in mild alkali were of considerably lower molecular mass. Locule pectins in IMG fruit were heavily glycosylated with galactose, arabinose, and xylose. All pectin classes exhibited similar deglycosylation trends during liquefaction. Locule hemicelluloses were rich in glucose, xylose, and arabinose. These polymers collectively showed molecular mass downshifts with minimal compositional changes during liquefaction. The KOH-soluble material also included xylose-rich acidic polymers not matching the neutral sugar profile of the noncovalently associated pectic polymers.