Peak early diastolic strain rate improves prediction of adverse cardiovascular outcomes in patients with ST-elevation myocardial infarction.

BACKGROUND: The prognostic role of diastolic dysfunction measured by the circumferential peak early diastolic strain rate (PEDSR) on ST-elevation myocardial infarction (STEMI) is not completely established. OBJECTIVES: We aimed to investigate the prognostic value of diastolic function by measuring PEDSR within 1 week after STEMI. METHODS: The cardiac magnetic resonance (CMR) pictures of 420 subjects from a clinical registry study (NCT03768453) were analyzed and the composite major adverse cardiac events (MACEs) were followed up. RESULTS: The PEDSR of patients was significantly lower compared with that of control subjects (P < 0.001). Within the median follow-up period of 52 months, PEDSR of patients who experienced MACEs deceased more significantly than that of patients without MACEs (P < 0.001). After adjusting with clinical or CMR indexes, per 0.1/s reduction of PEDSR increased the risks of MACEs to 1.402 or 1.376 fold and the risk of left ventricular (LV) remodeling to 1.503 or 1.369 fold. When PEDSR divided by best cutoff point, significantly higher risk of MACEs (P < 0.001) and more remarkable LV remodeling (P < 0.001) occurred in patients with PEDSR ≤ 0.485/s. Moreover, when adding the PEDSR to the conventional prognostic factors such as LV ejection fraction and infarction size, better prognostic risk classification models were created. Finally, aging, tobacco use, remarkable LV remodeling, and a low LV ejection fraction were factors related with the reduction of PEDSR. CONCLUSIONS: Diastolic dysfunction has an important prognostic effect on patients with STEMI. Measurement of the PEDSR in the acute phase could serve as an effective index to predict the long-term risk of MACEs and cardiac remodeling.

[Advances in Research on the Mechanism of Association Between Periodontitis and Diabetes Mellitus].

Periodontitis and diabetes mellitus are both chronic diseases with a rather high prevalence and they are closely associated with each other. On one hand, diabetes mellitus poses as a risk factor for periodontitis. On the other hand, periodontitis has a negative impact on glucose control in diabetic patients. The two-way relationship has aroused a lot of research interest in recent years. Herein, approaching the issue by looking at the effect of periodontitis on diabetes, we summarized the mechanism of the traditional periodontal pocket-blood circulation pathway and reviewed the role of the oral-gut axis in the mechanism, which has been proposed in recent years. In addition, regarding the impact of diabetes on periodontitis, we summarized new findings concerning changes in oral microbiota, abnormal levels of cytokines and adipokines, oxidative stress, unbalanced osteogenic and osteoclastic activities, and the accumulation of advanced glycation end-products. We hope this paper will be helpful for further studies on the mechanism of association between periodontitis and diabetes.

Speech silence character as a diagnostic biomarker of early cognitive decline and its functional mechanism: a multicenter cross-sectional cohort study.

BACKGROUND: Language deficits frequently occur during the prodromal stages of Alzheimer's disease (AD). However, the characteristics of linguistic impairment and its underlying mechanism(s) remain to be explored for the early diagnosis of AD. METHODS: The percentage of silence duration (PSD) of 324 subjects was analyzed, including patients with AD, amnestic mild cognitive impairment (aMCI), and normal controls (NC) recruited from the China multi-center cohort, and the diagnostic efficiency was replicated from the Pitt center cohort. Furthermore, the specific language network involved in the fragmented speech was analyzed using task-based functional magnetic resonance. RESULTS: In the China cohort, PSD increased significantly in aMCI and AD patients. The area under the curve of the receiver operating characteristic curves is 0.74, 0.84, and 0.80 in the classification of NC/aMCI, NC/AD, and NC/aMCI+AD. In the Pitt center cohort, PSD was verified as a reliable diagnosis biomarker to differentiate mild AD patients from NC. Next, in response to fluency tasks, clusters in the bilateral inferior frontal gyrus, precentral gyrus, left inferior temporal gyrus, and inferior parietal lobule deactivated markedly in the aMCI/AD group (cluster-level P < 0.05, family-wise error (FWE) corrected). In the patient group (AD+aMCI), higher activation level of the right pars triangularis was associated with higher PSD in in both semantic and phonemic tasks. CONCLUSIONS: PSD is a reliable diagnostic biomarker for the early stage of AD and aMCI. At as early as aMCI phase, the brain response to fluency tasks was inhibited markedly, partly explaining why PSD was elevated simultaneously.

Multi-disciplinary treatment of maxillofacial skeletal deformities by orthognathic surgery combined with periodontal phenotype modification: A case report.

BACKGROUND: Maxillofacial deformities are skeletal discrepancies that cause occlusal, functional, and esthetic problems, and are managed by multi-disciplinary treatment, including careful orthodontic, surgical, and periodontal evaluations. However, thin periodontal phenotype is often overlooked although it affects the therapeutic outcome. Gingival augmentation and periodontal accelerated osteogenic orthodontics (PAOO) can effectively modify the periodontal phenotype and improve treatment outcome. We describe the multi-disciplinary approaches used to manage a case of skeletal Class III malocclusion and facial asymmetry, with thin periodontal phenotype limiting the correction of deformity. CASE SUMMARY: A patient with facial asymmetry and weakness in chewing had been treated with orthodontic camouflage, but the treatment outcome was not satisfactory. After examination, gingiva augmentation and PAOO were performed to increase the volume of both the gingiva and the alveolar bone to allow further tooth movement. After orthodontic decompensation, double-jaw surgery was performed to reposition the maxilla-mandibular complex. Finally, implant placement and chin molding were performed to restore the dentition and to improve the skeletal profile. The appearance and function were significantly improved, and the periodontal tissue remained healthy and stable. CONCLUSION: In patients with dentofacial deformities and a thin periodontal phenotype, multi-disciplinary treatment that includes PAOO could be effective, and could improve both the quality and safety of orthodontic-orthognathic therapy.

Multidisciplinary non-surgical treatment of advanced periodontitis: A case report.

BACKGROUND: Patients with severe periodontitis often require multidisciplinary treatment to achieve healthy periodontal tissue, normal occlusion, and optimal aesthetics. In the present study, we aimed to evaluate the efficacy of multidisciplinary non-surgical treatment in a patient with stage IV/ grade C periodontitis, malocclusion, and dentition defects. CASE SUMMARY: A 47-year-old woman visited our periodontology department due to teeth mobility problems and difficulties chewing food. The patient had no history of drug allergies or systemic disease. Initial therapy involved scaling and root planning with a Gracey scaler and periodontal ultrasonic therapeutic apparatus using a periodontal endoscope (Perioscopy, Zest Dental Solutions, United States) to control the periodontal inflammation prior to treatment. Five months later, orthodontic treatment was then performed to treat occlusion and overall aesthetics. After completion, a Maryland bridge was used to restore Nos. 22, 31, and 41 teeth. Florida probing (Florida probe, United States) was performed every 2-3 mo to evaluate the periodontal condition throughout treatment. Overall, multidisciplinary non-surgical treatment resulted in satisfactory aesthetic results with healthy periodontal tissue and stable occlusion. CONCLUSION: In some patients with stage IV/grade C periodontitis, systematic and sequential non-surgical treatment can provide excellent therapeutic results.

The characteristic computed tomography findings of pulmonary B-cell non-Hodgkin's lymphoma and their role in predicting patient survival.

BACKGROUND: To assess the value of characteristic computed tomography (CT) findings in predicting the survival of patients with pulmonary B-cell non-Hodgkin's lymphoma (NHL). METHODS: Eighty-four patients who were histopathologically confirmed with pulmonary B-cell NHL between 2004 and 2018 were retrospectively enrolled. All patients underwent chest CT scan at the time of initial diagnosis in our hospital. Characteristic CT findings and clinicopathological features of the patients were analyzed, and Cox regression models were used to determine the relationship of CT findings with overall survival (OS) and progression-free survival (PFS). RESULTS: Air bronchogram occurred more frequently in patients with early-stage disease, primary pulmonary lymphoma (PPL) and the indolent histological type of lymphoma than in patients with advanced-stage disease, secondary pulmonary lymphoma (SPL), and the aggressive histological type (all P<0.05). The halo sign was observed most in the SPL group (19/48, 40%; P=0.004), while the presence of cross-lobe sign was higher in patients with PPL (13/36, 36%; P=0.010). Pleural involvement and hilar/mediastinal lymphadenopathy were observed more in patients with SPL and the aggressive histological type (33/48 and 27/48; 31/46 and 26/46, respectively; all P<0.05). Survival analyses showed that the number of lung lesions, cross-lobe sign, and pleural involvement were independent prognostic factors for PFS, while the halo sign and pleural involvement were significantly correlated with OS (all P<0.05). More aggressive, advanced-stage cases and male patients showed worse outcomes. CONCLUSIONS: The halo sign and pleural involvement are independent prognostic factors for OS, while the number of lung lesions, cross-lobe sign, and pleural involvement are correlated with PFS.

Pancreatic Neuroendocrine Neoplasms: CT Spectral Imaging in Grading.

RATIONALE AND OBJECTIVES: The purpose of this study was to define the CT spectral imaging characteristics of pancreatic neuroendocrine neoplasms (PNENs) and evaluate their potential for differential diagnosis of nonlow grade (non-LG) PNENs from low grade (LG) PNENs. MATERIALS AND METHODS: CT spectral imaging data of 54 pathologically proven PNENs were retrospectively reviewed. Patients were divided into two groups: 40 cases with grade 1 in LG PNENs group and 14 cases with grade 2 and grade 3 in non-LG PNENs group. RESULTS: Gender, calcification, inhomogeneity, invasiveness, PD dilatation, lymph node enlargement, size, normalized iodine (water) concentration in arterial phase (AP) (Iodine (ap)), normalized effective-Z (Zap), slope of normalized CT spectral curves in both AP, and portal venous phase were found to be significant variables for differentiating non-LG PNENs from LG PNENs (p < 0.05). Non-LG PNENs had larger size and lower Zap and Iodine (ap) than LG PNENs. The tumor size, Zap and Iodine (ap) had fair to good diagnostic performance with the area under receiver-operating-characteristic curve (AUC) 0.843, 0.733, and 0.728, respectively. Multivariate analysis with logistic regression had higher AUC (p<0.05) than all the single parameters except for size. CONCLUSION: There were significant differences in CT spectral imaging parameters between non-LG and LG PNENs. Tumor size was the most promising independent parameter and the combination of quantitative parameters with qualitative parameters is the best predictor in differentiating of non-LG PNENs from LG PNENs. CT spectral imaging can help determine the malignancy of PNENs, which can better assist in surgical planning.

[Clinical effects of scaling and root planing with an adjunctive periodontal endoscope for residual pockets: a randomized controlled clinical study].

OBJECTIVE: To evaluate the efficacy of scaling and root planing (SRP) with a periodontal endoscope in the treatment of residual pockets in patients with periodontitis after initial periodontal therapy. METHODS: Patients with residual pockets [probing depth (PD)≥5 mm] were included and randomly assigned to the endoscope group (SRP with a periodontal endoscope) or SRP group (SRP alone). The PD, attachment loss (AL), and bleeding on probing (BOP) of residual pockets were recorded before treatment and at 3 and 6 months after treatment. Data were analyzed with SPSS 20.0 software. RESULTS: Compared with the baseline values, the percentage of PD≥5 mm sites, PD, AL, and BOP (+)% in the endoscope group and SRP group at 3 and 6 months after treatment decreased (P<0.05). Compared with the values at 3 months after treatment, the percentage of PD≥5 mm sites, PD, AL, and BOP (+)% at 3 and 6 months after treatment decreased in the endoscope group (P<0.05), whereas no statistical difference in these values was observed in the SRP group (P>0.05). Compared with those in the SRP group, the percentage of PD≥5 mm sites and PD at 3 and 6 months after treatment and AL and BOP (+)% at 6 months after treatment in the endoscope group decreased (P<0.05). CONCLUSIONS: SRP with a periodontal endoscope shows a better effect in improving the PD, AL, and BOP of residual pockets (PD≥5 mm) in patients with periodontitis after initial periodontal therapy and has advantages in improving the long-term curative effect of this therapy.

COVID-19 and early-stage lung cancer both featuring ground-glass opacities: a propensity score-matched study.

BACKGROUND: Radiological manifestations of coronavirus disease 2019 (COVID-19) featured ground-glass opacities (GGOs), especially in the early stage, which might create confusion in differential diagnosis with early lung cancer. We aimed to specify the radiological characteristics of COVID-19 and early lung cancer and to unveil the discrepancy between them. METHODS: One hundred and fifty-seven COVID-19 patients and 374 early lung cancer patients from four hospitals in China were retrospectively enrolled. Epidemiological, clinical, radiological, and pathological characteristics were compared between the two groups using propensity score-matched (PSM) analysis. RESULTS: COVID-19 patients had more distinct symptoms, tended to be younger (P<0.0001), male (P<0.0001), and had a higher body mass index (P=0.014). After 1:1 PSM, 121 matched pairs were identified. Regarding radiological characteristics, patients with a single lesion accounted for 17% in COVID-19 and 89% in lung cancer (P<0.0001). Most lesions were peripherally found in both groups. Lesions in COVID-19 involved more lobes (median 3.5 vs. 1; P<0.0001) and segments (median 6 vs. 1; P<0.0001) and tended to have multiple types (67%) with patchy form (54%). Early lung cancer was more likely to have a single type (92%) with oval form (66%). Also, COVID-19 and early lung cancer either had some distinctive features on computed tomography (CT) images. CONCLUSIONS: Both COVID-19 and early lung cancers showed GGOs, with similar but independent features. The imaging characteristics should be fully understood and combined with epidemiological history, pathogen detection, laboratory tests, short-term CT reexamination, and pathological results to aid differential diagnosis.

The aging-liked alterations in Cushing's disease: A neurite orientation dispersion and density imaging (NODDI) study.

PURPOSE: Glucocorticoid (GC) is probably related to biological aging, but the exact mechanism remains unknown. Cushing's disease (CD) could represent a unique human model for examining the effects of prolonged exposure to hypercortisolism and its relationship with aging. Thus, we studied the alterations of neurites in CD patients with Neurite orientation dispersion and density imaging (NODDI). METHODS: CD patients (n = 15) and healthy control subjects (n = 15) were included in this study. Orientation dispersion index (Odi), neurite density index (Ndi), partial fraction of free water (fiso), partial fraction of extracellular water (fec) were examined in a cross-sectional analysis. RESULTS: Significant altered NODDI parameters were found in CD patients. Some of these alterations were correlated with current age. Additionally, increased dendritic density was found in cerebellar of CD patients. CONCLUSION: Hypercortisolism relative reductions of the dendritic density were correlated with current age in several regions of CD patients. Our study enhances the understanding of the link between the aging and GC.

Comparison of direct stenting with conventional strategy on myocardial impairments in ST-segment elevation myocardial infarction: a cardiac magnetic resonance imaging study.

Direct stenting (DS) without pre-dilatation of the culprit lesion might improve myocardial perfusion and prognosis in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI); however, some studies report conflicting results. We investigated whether DS provides incremental myocardial benefits over conventional stenting (CS) in STEMI patients based on cardiac magnetic resonance imaging (CMR) measures. Reperfused patients who underwent CMR examinations within 1 week of STEMI onset were selected from a multicenter CMR registry of STEMI (NCT: 03768453). Patients were stratified into either a DS or CS group. Each group comprised 137 patients after 1:1 propensity score matching. Major adverse events (MACEs), including death, myocardial re-infarction, re-admission for heart failure, and stroke were noted during a median period of 44 months (interquartile range 32-58 months). DS was associated with larger (p = 0.007) and shorter (p = 0.005) stent sizes than CS. DS and CS achieved comparable angiographic TIMI-3 flow grades (p = 0.86) and myocardial blush grades (p = 0.70). There were no group differences regarding the incidence of CMR manifestations of microvascular dysfunction, including microvascular obstruction (MVO) (p = 0.89) and intramyocardial hemorrhage (p = 0.47), the extent of MVO (p = 0.21), infarction size (p = 0.83), or left ventricular ejection fraction (p = 0.57). Kaplan-Meier analysis revealed similar risks of MACEs (log rank p = 0.909), which occurred in 23.4% of DS and 26.3% of CS patients (p = 0.576). DS did not show any incremental benefits over CS on myocardial impairments as evaluated using CMR.Clinical Trial Registration: Clinicaltrials.gov, NCT: 03768453.

[Accuracy of paralleling technique in measuring the depth of approximal infrabony pocket].

OBJECTIVE: To assess the accuracy of paralleling technique in measuring the depth of approximal infrabony pocket after periodontal flap surgery by comparing the measured and actual depths. METHODS: The study population included 26 patients with infrabony defects who had undergone periodontal flap surgery, bone graft surgery, and guided tissue regene-ration. The measured and actual depths of approximal infrabony pocket after periodontal flap surgery were compared. The 26 infrabony defects were categorized into the following groups according to tooth position: anterior teeth, premolar, and molar groups, and according to type of infrabony pocket: one-walled, two-walled, and three-walled infrabony pocket groups. Paired t-test was used to detect the difference between the two values. RESULTS: Depth measurements of the approximal infrabony pocket depth of the anterior teeth and premolar were not significantly different (P>0.05), whereas those of the molar group were significantly different (P<0.05). In addition, depth measurements in one-walled and two-walled infrabony pocket groups showed no significant differences (P>0.05), whereas those in the three-walled infrabony pocket group were significantly different (P<0.05). CONCLUSIONS: Paral-leling technique can accurately measure the depth of approximal infrabony pockets of anterior teeth and premolar teeth that are one- or two-walled. However, this method cannot accurately measure the approximal infrabony pockets of molar teeth and three-walled infrabony pockets as indicated by significant differences in their depth measurements.

Reversible and the irreversible structural alterations on brain after resolution of hypercortisolism in Cushing's disease.

The adverse effects of hypercortisolism on the human brain have been highlighted in previous studies of Cushing's disease (CD). However, the reversibility of brain damage after the resolution of hypercortisolism remains unclear. Thus, we studied the potential volumetric reversibility in biochemically remitted CD patients. Cross-sectional analysis demonstrated the active CD patients (n = 61) had the smallest gray matter (GM) volumes (553.33 ±â€¯45.90 CM3) among four groups. While the GM volumes of short-term remitted CD patients (586.62 ±â€¯46.89 CM3, n = 28) and long-term remitted CD patients (596.58 ±â€¯45.95 CM3, n = 35) were between those of the active CD patients and healthy control subjects (628.14 ±â€¯46.88 CM3, n = 74). Moreover, significant positive correlations between remitted time and GM volumes were only found in short-term remitted CD patients. On the contrary, the alterations of white matter (WM) in CD patients seem to be independent of concomitant hypercortisolism, persisting after remission. A preliminary longitude analysis also demonstrated similar results. Volumetric reversibility of GM, but not WM is highly prevalent in short-term after resolution of hypercortisolism in Cushing disease. Our study enhances our understanding of the reversible and the irreversible structural alterations in the human brain due to hypercortisolism.

Clinical features and outcomes of pulmonary lymphoma: A single center experience of 180 cases.

BACKGROUND: Pulmonary lymphoma arises primarily from the lung, which is extremely rare, or be secondarily involved by lymphoma. The clinical features, management, and prognostic factors have not been clearly identified. METHODS: Sixty-three patients with primary pulmonary lymphoma (PPL) and 117 patients with secondary pulmonary lymphoma (SPL) treated in our institution between June 2003 and December 2017 were retrospectively reviewed. RESULTS: MALT (67%) was the most common pathological subtype of PPL, while DLBCL (48%) was the most common subtype of SPL. Compared to the patients with PPL, the presence of B symptoms, advanced disease stage, intermediate-high or high risks of IPI and NCCN-IPI, elevated inflammatory parameters, and elevated cytokine levels were all observed in patients with SPL. Consolidation was the most frequent radiological finding in PPL cases, while nodules were the most frequent finding in SPL. With a median follow-up of 35 months (range 2-176), the estimated 3-year OS rates were 95%, 100%, 70% and 50% in indolent PPL, indolent SPL, aggressive PPL, and aggressive SPL, respectively. In indolent pulmonary lymphoma, none of the prognostic factors we studied significantly influenced survival of the patients. In aggressive pulmonary lymphoma, univariate analysis showed that NCCN-IPI was related to OS in PPL. Multivariate analysis showed that ß2-MG was an independent prognostic factor for OS in SPL. CONCLUSIONS: Primary and secondary pulmonary lymphoma differ in their clinical features and outcome. Furthermore, ß2-MG is the independent prognostic factor for OS in patients with aggressive SPL.

PITUITARY STALK THICKENING IN A LARGE COHORT: TOWARD MORE ACCURATE PREDICTORS OF PITUITARY DYSFUNCTION AND ETIOLOGY.

Objective: To summarize the characteristics of patients with pituitary stalk thickening, analyze the association between pituitary stalk width and hypopituitarism, and develop a diagnostic model to differentiate neoplastic and inflammatory origins. Methods: A total of 325 patients with pituitary stalk thickening in a tertiary teaching hospital between January 2012 and February 2018 were enrolled. Basic characteristics and hormonal status were evaluated. Indicators to predict etiology in patients with histologic diagnoses were analyzed. Results: Of the 325 patients, 62.5% were female. Deficiency in gonadotropin was most common, followed by corticotropin, growth hormone, and thyrotropin. The increase in pituitary stalk width was associated with a risk of central diabetes insipidus (odds ratio [OR], 3.57; P<.001) and with a combination of central diabetes insipidus and anterior pituitary deficiency (OR, 2.28; P = .029). The cut-off pituitary stalk width of 4.75 mm had a sensitivity of 69.2% and a specificity of 71.4% for the presence of central diabetes insipidus together with anterior pituitary deficiency. Six indicators (central diabetes insipidus, pattern of pituitary stalk thickening, pituitary stalk width, neutrophilic granulocyte percentage, serum sodium level, and gender) were used to develop a model having an accuracy of 95.7% to differentiate neoplastic from inflammatory causes. Conclusion: Pituitary stalk width could indicate the presence of anterior pituitary dysfunction, especially in central diabetes insipidus patients. With the use of a diagnostic model, the neoplastic and inflammatory causes of pituitary stalk thickening could be preliminarily differentiated. Abbreviations: APD = anterior pituitary dysfunction; AUC = area under the curve; CDI = central diabetes insipidus; GH = growth hormone; MRI = magnetic resonance imaging; OR = odd ratio; PHBS = posterior hypophyseal bright spots; PST = pituitary stalk thickening; PSW = pituitary stalk width.

Computerized cognitive training for Chinese mild cognitive impairment patients: A neuropsychological and fMRI study.

BACKGROUND: Computerized multi-model training has been widely studied for its effect on delaying cognitive decline. In this study, we designed the first Chinese-version computer-based multi-model cognitive training for mild cognitive impairment (MCI) patients. Neuropsychological effects and neural activity changes assessed by functional MRI were both evaluated. METHOD: MCI patients in the training group were asked to take training 3-4 times per week for 6 months. Neuropsychological and resting-state fMRI assessment were performed at baseline and at 6 months. Patients in both groups were continuously followed up for another 12 months and assessed by neuropsychological tests again. RESULTS: 78 patients in the training group and 63 patients in the control group accomplished 6-month follow-up. Training group improved 0.23 standard deviation (SD) of mini-mental state examination, while control group had 0.5 SD decline. Addenbrooke's cognitive examination-revised scores in attention (p = 0.002) and memory (p = 0.006), as well as stroop color-word test interference index (p = 0.038) and complex figure test-copy score (p = 0.035) were also in favor of the training effect. Difference between the changes of two groups after training was not statistically significant. The fMRI showed increased regional activity at bilateral temporal poles, insular cortices and hippocampus. However, difference between the changes of two groups after another 12 months was not statistically significant. CONCLUSIONS: Multi-model cognitive training help MCI patients to gained cognition benefit, especially in memory, attention and executive function. Functional neuroimaging provided consistent neural activation evidence. Nevertheless, after one-year follow up after last training, training effects were not significant. The study provided new evidence of beneficial effect of multi-model cognitive training.

Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China (2017 Edition).

BACKGROUND: Hepatocellular carcinoma (HCC) (about 85-90% of primary liver cancer) is particularly prevalent in China because of the high prevalence of chronic hepatitis B infection. HCC is the fourth most common malignancy and the third leading cause of tumor-related deaths in China. It poses a significant threat to the life and health of Chinese people. SUMMARY: This guideline presents official recommendations of the National Health and Family Planning Commission of the People's Republic of China on the surveillance, diagnosis, staging, and treatment of HCC occurring in China. The guideline was written by more than 50 experts in the field of HCC in China (including liver surgeons, medical oncologists, hepatologists, interventional radiologists, and diagnostic radiologists) on the basis of recent evidence and expert opinions, balance of benefits and harms, cost-benefit strategies, and other clinical considerations. KEY MESSAGES: The guideline presents the Chinese staging system, and recommendations regarding patients with HCC in China to ensure optimum patient outcomes.

[Time lapse between endodontic and periodontal treatments of combined periodontal-endodontic lesion: a systematic review].

OBJECTIVE: This study aims to evaluate the time lapse between the endodontic and periodontal treatments of the combined periodontal-endodontic lesion to guide the clinical treatment. METHODS: A systemic literature search was performed in articles published from 1980 to March 2017 using the electronic databases, including PubMed, EMbase, Cochrane, Web of Science, CNKI, CBM, and Wanfang Databases. RESULTS: After screening, two randomized controlled trials, two prospective case series studies, and eight case reports were ultimately included. All clinical studies and case reports were treated with root canal therapy and periodontal nonsurgical or periodontal surgical treatment, with root canal therapy as the initial treatment step. Changes in the periodontal probing depth and attachment loss were reported in all clinical studies and case reports. CONCLUSIONS: An observational period between the endodontic and periodontal nonsurgical treatments may not be required. However, given that the quality of several included studies was limited, and the number of randomized controlled trials was small, a large number of randomized controlled trials are needed to verify this result.

Liver fibrosis detection and staging: a comparative study of T1ρ MR imaging and 2D real-time shear-wave elastography.

PURPOSE: To compare the results of T1ρ MR imaging and 2D real-time shear-wave elastography (SWE) for liver fibrosis detection and staging. METHODS: Twenty-nine rabbit models of CCl4-induced liver fibrosis were established and six untreated rabbits served as controls. T1ρ MR imaging and 2D real-time SWE examination were performed at 2, 4, 6, 8, 10, and 12 weeks. T1ρ values and liver stiffness (LS) values were measured. Fibrosis was staged according to the METAVIR scoring system. Correlation test was performed among T1ρ values, LS values, and fibrosis stage. Receiver operating characteristic (ROC) analysis was performed for assessing diagnostic performance of T1ρ and SWE in detection of no fibrosis (F0), substantial fibrosis (≥ F2), severe fibrosis (≥ F3), and cirrhosis (F4). RESULTS: There was moderate positive correlation between fibrosis stage and T1ρ values (r = 0.566; 95% CI 0.291-0.754; P < 0.0001), and LS value (r = 0.726; 95% CI 0.521-0.851; P = 0.003). T1ρ values showed moderate positive correlations with LS values [r = 0.693; 95% confidence interval (CI) 0.472-0.832; P < 0.0001]. Areas Under ROC (AUROCs) were 0.861 (95% CI 0.705-0.953) for SWE and 0.856 (95% CI 0.698-0.950) for T1ρ (P = 0.940), 0.906 (95% CI 0.762-0.978) for SWE and 0.849 (95% CI 0.691-0.946) for T1ρ (P = 0.414), 0.870 (95% CI 0.716-0.958) for SWE and 0.799 (95% CI 0.632-0.913) for T1ρ (P = 0.422), and 0.846 (95% CI 0.687-0.944) for SWE and 0.692 (95% CI 0.517-0.835) for T1ρ (P = 0.137), when diagnosing liver fibrosis with ≥ F1, ≥ F2, ≥ F3, and F4, respectively. There was moderate positive correlation between inflammatory activity and T1ρ values (r = 0.520; 95% CI 0.158-0.807; P = 0.013). CONCLUSION: T1ρ imaging has potential for liver fibrosis detection and staging with good diagnostic capability similar to that of ultrasonography elastography.

Volumetric magnetic resonance imaging analysis in patients with short-term remission of Cushing's disease.

OBJECTIVE: The data on patients with short-term remission of Cushing's disease (CD) might provide information that is not available from previous long-term remission studies. We aimed to investigate structural changes in the brain in these patients and to examine whether these changes were associated with clinical characteristics. DESIGN: A cross-sectional study was performed. METHODS: Thirty-four patients with CD (14 with CD in short-term remission and 20 with active CD) and 34 controls matched for age, sex and education underwent clinical evaluation and magnetic resonance imaging brain scans. Biometric measurements, disease duration and remission duration data were collected. Grey matter volumes in the whole brain were examined using voxel-based morphometry (VBM). RESULTS: No differences were observed in the grey matter volumes of the medial frontal gyrus (MFG) and cerebellum between the patients with remitted CD and healthy controls, whereas patients with active CD had smaller grey matter volumes in these two regions compared with controls and patients with remitted CD. Furthermore, significant correlations were found between remission time and grey matter values in these regions in short-term remission patients with CD. Additionally, greater grey matter volumes in the bilateral caudate of short-term remission patients with CD were observed. CONCLUSIONS: Trends for structural restoration were found in CD patients with short-term remission. This finding was associated with the number of days elapsed since curative surgery and the current age of the patients. This study enhances our understanding of potential reversibility after the resolution of hypercortisolism in CD patients.