Deep learning algorithms for classification and detection of recurrent aphthous ulcerations using oral clinical photographic images.

Background/purpose: The application of artificial intelligence diagnosis based on deep learning in the medical field has been widely accepted. We aimed to evaluate convolutional neural networks (CNNs) for automated classification and detection of recurrent aphthous ulcerations (RAU), normal oral mucosa, and other common oral mucosal diseases in clinical oral photographs. Materials and methods: The study included 785 clinical oral photographs, which was divided into 251 images of RAU, 271 images of the normal oral mucosa, and 263 images of other common oral mucosal diseases. Four and three CNN models were used for the classification and detection tasks, respectively. 628 images were randomly selected as training data. In addition, 78 and 79 images were assigned as validating and testing data. Main outcome measures included precision, recall, F1, specificity, sensitivity and area under the receiver operating characteristics curve (AUC). Results: In the classification task, the Pretrained ResNet50 model had the best performance with a precision of 92.86%, a recall of 91.84%, an F1 score of 92.24%, a specificity of 96.41%, a sensitivity of 91.84% and an AUC of 98.95%. In the detection task, the Pretrained YOLOV5 model had the best performance with a precision of 98.70%, a recall of 79.51%, an F1 score of 88.07% and an AUC of Precision-Recall curve 90.89%. Conclusion: The Pretrained ResNet50 and the Pretrained YOLOV5 algorithms were shown to have superior performance and acceptable potential in the classification and detection of RAU lesions based on non-invasive oral images, which may prove useful in clinical practice.

Platelet-derived microparticles adoptively transfer integrin ß3 to promote antitumor effect of tumor-infiltrating T cells.

Approximately two-thirds of hepatocellular carcinoma (HCC) is considered a "cold tumor" characterized by few tumor-infiltrating T cells and an abundance of immunosuppressive cells. Cilengitide, an integrin αvß3 inhibitor, has failed in clinical trials as a potential anticancer drug. This failure implies that integrin αvß3 may play an important role in immune cells. However, the expression and potential role of integrin αvß3 in T cells of HCC patients remain unknown. Here, we established two HCC models and found that cilengitide had a dual effect on the HCC microenvironment by exerting both antitumor effect and immunosuppressive effect on T cells. This may partly explain the failure of cilengitide in clinical trials. In clinical specimens, HCC-infiltrating T cells exhibited deficient expression and activation of integrin ß3, which was associated with poor T-cell infiltration into tumors. Additionally, integrin ß3 functioned as a positive immunomodulatory molecule to facilitate T-cell infiltration and T helper 1-type immune response in vitro. Furthermore, T cells and platelet-derived microparticles (PMPs) co-culture assay revealed that PMPs adoptively transferred integrin ß3 to T cells and positively regulated T cell immune response. This process was mediated by clathrin-dependent endocytosis and macropinocytosis. Our data demonstrate that integrin ß3 deficiency on HCC-infiltrating T cells may be involved in shaping the immunosuppressive tumor microenvironment. PMPs transfer integrin ß3 to T cells and positively regulate T cell immune response, which may provide a new insight into immune therapy of HCC.

Reduction of portosystemic gradient during transjugular intrahepatic portosystemic shunt achieves good outcome and reduces complications.

BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is placed important role in the therapy of complications of portal hypertension, there is still no suitable criterion for a reduction in portosystemic gradient (PSG), which can both reduce PSG and maximize clinical results and minimize hepatic encephalopathy (HE). AIM: To compare the clinical outcomes and incidence of HE after one-third PSG reduction during TIPS in patients with variceal bleeding and refractory ascites. METHODS: A total of 1280 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2016 to January 2019 were analyzed retrospectively. Patients were divided into group A (variceal hemorrhage and PSG reduced by one third, n = 479); group B (variceal hemorrhage and PSG reduced to < 12 mmHg, n = 412); group C (refractory ascites and PSG reduced by one third, n = 217); and group D (refractory ascites and PSG reduced to < 12 mmHg of PSG, plus medication, n = 172). The clinical outcomes were analyzed. RESULTS: By the endpoint of follow-up, recurrent bleeding was no different between groups A and B (χ 2 = 7.062, P = 0.374), but recurrent ascites did differ significantly between groups C and D (χ 2 = 14.493, P = 0.006). The probability of total hepatic impairment within 3 years was significantly different between groups A and B (χ 2 = 11.352, P = 0.005) and groups C and D (χ 2 = 13.758, P = 0.002). The total incidence of HE differed significantly between groups A and B (χ 2 = 7.932, P = 0.016), groups C and D (χ 2 = 13.637, P = 0.007). There were no differences of survival rate between groups A and B (χ 2 = 3.376, P = 0.369, log-rank test), but did differ significantly between groups C and D (χ 2 = 13.582, P = 0.014, log-rank test). CONCLUSION: The PSG reduction by one third may reduce the risk of HE, hepatic function damage and achieve good clinical results.

Prognostic value of hysterosalpingography after salpingostomy in patients with hydrosalpinx.

To assess whether post-hysterosalpingography evaluation was associated with pregnancy rate and to identify independent risk factors for pregnancy success after salpingostomy in patients with hydrosalpinx. A retrospective analysis was conducted on the clinical data of 47 patients diagnosed with hydrosalpingography (HSG) in our hospital from 2015 to 2018. These patients received laparoscopic surgery and another salpingography within 2 months after surgery. According to the fallopian tube conditions evaluated by HSG before and after surgery, the patients could be divided into two groups. According to the pregnancy rate and postoperative HSG of patients with hydrosalpinx after laparoscopy, the total pregnancy rate of the tubal improved group was 65.62%, while that of the non-improved group was 20%, with statistical significance (p < 0.05). We found that hysterosalpingography after salpingostomy in patients with hydrosalpinx can provide reference for clinical treatment and improve the prognosis of patients.

Postoperative HSG improvement was an independent risk factor for pregnancy rate in patients with hydrosalpinx after laparoscopic surgery. Impact statementWhat is already known on this subject? Fallopian tube obstruction is an important cause of female infertility. Current studies have shown that most spontaneous pregnancies in patients with hydrosalpinx after salpingostomy occur within 18 months, however, pregnancy rates and outcomes vary from report to report.What do the results of this study add? Many studies have shown that hydrosalpinx reduces the success rate of natural pregnancy and embryo transfer, but the mechanism of hydrosalpinx affecting pregnancy remains unclear. This study explored the mechanism of successful pregnancy through hysterosalpingography after salpingostomy in patients with hydrosalpinx.What are the implications of these findings for clinical practice and/or further research? To evaluate the prognosis of patients with hydrosalpinx after laparoscopic salpingostomy by hysterosalpingography (HSG), and to reflect the improvement according to the postoperative pregnancy rate of the patients. To provide clinical personalized treatment plan.

Elevated fasting glucose level increases the risk of fatty liver disease: a 10-year study of 31,154 individuals.

OBJECTIVES: Dysglycemia promotes the occurrence of fatty liver disease (FLD). However, the process is unclear. This study aimed to analyze the median time-to-onset, cumulative prevalence and influencing factors for the occurrence of FLD in people undergoing routine screening and evaluation. METHODS: Data from Karamay Central Hospital (September 2008-April 2017) were analyzed. Survival analysis was performed to calculate the median time and cumulative prevalence of FLD associated with normal and elevated fasting blood glucose (FBG) levels. Cox proportional hazards model was used to determine risk factors. RESULTS: A total of 31,154 participants were included in the two cohorts of this study, including 15,763 men. The mean age was 41.1 ± 12.2 years. There were 2230 patients (1725 male) in the elevated FBG group, the median age was 53 years (range 21-85 years), the median time-to-onset of FLD was 5.2 years. The incidence of FLD was 121/1000 person-years, and the 1-, 3-, 5-, and 7-year prevalence rates were 4%, 30%, 49%, and 64%, respectively. The normal FBG group included 28,924 participants (14,038 male), the median age was 40 years (range 17-87 years), and the corresponding values were as follows: 8.3 years, 66/1000 person-years, and 3%, 16%, 28%, and 41%, respectively. The Cox proportional hazards analysis revealed that age, blood pressure, FBG, body mass index and triglycerides were independent influencing factors for FLD in individuals (P < 0.05). CONCLUSIONS: Elevated FBG levels increase the risk of FLD and should be treated promptly.

The prevalence, comorbidities, influencing factors, and identifying factors of non-obese fatty liver disease.

Objective: To analyze the prevalence, associated comorbidities, influencing factors, and identifying factors of non-obese fatty liver disease and to provide a reference for its prevention and treatment. Materials and methods: Firstly, to screen data obtained from the physical examinations of individuals conducted in the Second Affiliated Hospital of Xi'an Jiaotong University in 2021, subjects with complete data of abdominal ultrasonography, body mass index, age and sex were selected to analyze the prevalence of fatty liver disease and non-obese fatty liver disease. Secondly, to screen non-obese subjects who had data for triglycerides, fasting blood glucose, and so on, to analyze the complications, influencing factors, and identifying factors of non-obese fatty liver disease. Results: The prevalence of fatty liver disease was 27.8% (18,416/66,221), including 33.9% (11,921/35,131) in males and 20.9% (6,495/31,090) in females, revealing that the prevalence was significantly higher in males than in females (P < 0.001). There were 40,673 non-obese subjects screened in total, and the prevalence of non-obese fatty liver disease was 13.0% (5,307/40,673). The prevalence of non-obese fatty liver disease was 13.3% (2,208/16,572) in males and 12.9% (3,099/24,101) in females; the difference was not statistically significant (P = 0.17). The serum triglycerides level was elevated in 54.2% of subjects with non-obese fatty liver disease, and this was the most common abnormal metabolic index accompanying the disease. Logistic regression analysis showed that gender, age, body mass index, blood pressure, alanine aminotransferase, aspartate aminotransferase, fasting blood glucose, triglycerides, total cholesterol, and serum uric acid were independent risk factors for non-obese fatty liver disease (P < 0.001). For triglycerides, the area under the receiver operating characteristic curve in predicting non-obese fatty liver disease was the greatest (0.806). Conclusion: The prevalence of fatty liver disease and non-obese fatty liver disease determined by the physical examination of individuals was high, and the triglycerides is likely to be useful for the extensive screening of non-obese fatty liver disease.

Erratum: KLF10 inhibits cell growth by regulating PTTG1 in multiple myeloma under the regulation of microRNA-106b-5p: Erratum.

[This corrects the article DOI: 10.7150/ijbs.45999.].

Salivary cytokine profile in patients with oral lichen planus.

BACKGROUND/PURPOSE: Oral lichen planus (OLP) is a chronic inflammatory lesion of oral mucosal, and its pathogenesis involves immune cell-mediated aberrances. However, the findings conflict with each other. This research aimed to comprehensively detect the salivary cytokine profile of patients with OLP. MATERIALS AND METHODS: The cohort included 60 OLP patients (30 reticular and 30 erosive), and 30 healthy controls, matched in age and sex. Human Cytokine/Chemokine Magnetic Bead Panel Kit (HCYTMAG-60K-PX41) was used to detect salivary inflammation-related cytokines. Rank sum test, group t-test, and ANOVA were used for data analysis in different groups. Moreover, Spearman's rank correlation analysis was used to analyze the correlation between salivary cytokine levels and OLP lesion severity. RESULTS: The levels of TNF-α, G-GSF, IL-1α, IL-1ß and IL-8 were statistically significant higher in both erosive and reticular OLP patients than in the healthy group, while the IL-13 level was significantly lower. Particularly, the salivary TNF-α, GM-CSF, MIP-1α, MIP-1ß, IL-1ß, IL-6 and IL-8 levels were higher in erosive OLP group than other groups. Spearman's rank correlation analysis revealed that the salivary TNF-α, GM-CSF, MIP-1α, MIP-1ß, IL-1ß and IL-6 levels were positively correlated with OLP lesion severity. CONCLUSION: Imbalance of the Th1/Th2-mediated immune response contributes to OLP. Certain salivary cytokines, such as MIP-1α, MIP-1ß, GM-CSF, and IL-6, are positively correlated with OLP severity, and they have a high potential as biomarkers to diagnose and predict OLP prognosis.

Active magnetic dipole emission by the Ge2Sb2Te5 nanodisk.

Active light manipulation plays a critical role in nanophotonics. In this Letter, we investigate the modulation properties of magnetic dipole (MD) emission based on the phase change material Ge2Sb2Te5 hollow nanodisk (GST-HND). The results show that the amorphous GST-HND supports a strong MD response with a radiative decay enhancement of 282 times and quantum efficiency of 100%. More importantly, by tuning the crystallization rate of GST, the active manipulation of MD radiation is achieved with a quantum efficiency modulation depth of up to 95% at a specific wavelength. Our work may provide significant instruction for the active tuning of optical nanodevices.

A Strategy for Selective Deletion of Autoimmunity-Related T Cells by pMHC-Targeted Delivery.

Autoimmune diseases such as rheumatoid arthritis are caused by immune system recognition of self-proteins and subsequent production of effector T cells that recognize and attack healthy tissue. Therapies for these diseases typically utilize broad immune suppression, which can be effective, but which also come with an elevated risk of susceptibility to infection and cancer. T cell recognition of antigens is driven by binding of T cell receptors to peptides displayed on major histocompatibility complex proteins (MHCs) on the cell surface of antigen-presenting cells. Technology for recombinant production of the extracellular domains of MHC proteins and loading with peptides to produce pMHCs has provided reagents for detection of T cell populations, and with the potential for therapeutic intervention. However, production of pMHCs in large quantities remains a challenge and a translational path needs to be established. Here, we demonstrate a fusion protein strategy enabling large-scale production of pMHCs. A peptide corresponding to amino acids 259-273 of collagen II was fused to the N-terminus of the MHC_II beta chain, and the alpha and beta chains were each fused to human IgG4 Fc domains and co-expressed. A tag was incorporated to enable site-specific conjugation. The cytotoxic drug payload, MMAF, was conjugated to the pMHC and potent, peptide-specific killing of T cells that recognize the collagen pMHC was demonstrated with tetramerized pMHC-MMAF conjugates. Finally, these pMHCs were incorporated into MMAF-loaded 3DNA nanomaterials in order to provide a biocompatible platform. Loading and pMHC density were optimized, and peptide-specific T cell killing was demonstrated. These experiments highlight the potential of a pMHC fusion protein-targeted, drug-loaded nanomaterial approach for selective delivery of therapeutics to disease-relevant T cells and new treatment options for autoimmune disease.

Characteristics of Peripheral Lymphocyte Subsets in Patients With Acute-On-Chronic Liver Failure Associated With Hepatitis B.

Background and Aims: Acute-on-chronic liver failure (ACLF) is a rare, but dramatic clinical syndrome. There is substantial evidence suggesting that immunity-mediated inflammation plays an important role in HBV-ACLF. Our aim was to characterize the proportion and cell counts of peripheral blood lymphocyte subsets in acute-on-chronic liver failure patients caused by HBV infection. Methods: One hundred and seventeen patients were enrolled in this study, including those with HBV-related ACLF (HBV-ACLF; n = 70), and HBV related non-ACLF patients (HBV non-ACLF; n = 47). Demographics, clinical and laboratory data at hospital admission were retrospectively analyzed. The percentage and cell count of peripheral lymphocyte subsets were evaluated by flow cytometry. Comparison analysis was performed by t-test or non-parametric Mann-Whitney U-test. Actuarial probabilities of death were calculated by the Kaplan-Meier method. Results: Both circulating lymphocyte count and lymphocyte percentage were significantly reduced in patients with HBV-ACLF (P < 0.001). The CD8+ T cell, CD4+ T cell, and CD16+CD56+ NK cell counts were significantly decreased in HBV-ACLF. Consistently, flow cytometric analysis showed that CD8+ T cell counts were significantly decreased in non-survivors, while no significant differences were found in CD4+ T cell, CD19+ B cell, or CD56+CD16+ NK cell counts. Furthermore, the group with the lower CD8+ T cell count displayed a significantly higher mortality rate compared with the group with the higher CD8+ T cell count. Conclusions: The abnormal prevalence of lymphocyte subsets may be important in the pathogenesis of HBV-ACLF. The decrease in CD8+ T cell counts may be related to poor survival in HBV-ACLF patients.

Spatio-temporal heterogeneity of air pollution and its key influencing factors in the Yellow River Economic Belt of China from 2014 to 2019.

The Yellow River Economic Belt (YREB) plays an important role in China's socio-economic development and ecological security. However, this region has suffered from serious atmospheric pollution in recent years due to intense human activity. Identifying and qualifying the spatio-temporal characteristics of the region's air pollution and its driving forces would help in the formulation of effective mitigation policies. Here, the YREB's spatio-temporal characteristics of air quality were meticulously investigated using air pollution observation, synchronous meteorological, and socio-economic data from 103 cities, for the period of 2014-2019. Furthermore, the factors influencing air pollution were analyzed and qualified. Although air quality improved in the cities of the YREB following the implementation of the Air Pollution Action Plan, the region's quality index (AQI) remained higher than the national average. Annual variations of AQI in the YREB followed a U-shaped pattern, being high in autumn and winter and low in spring and summer; this U shape became shallower following improvements in air quality during autumn and winter. From 2014 to 2019, the annual average AQI values of cities in the eastern, middle, and western YREB dropped from 109.66, 111.70, and 94.65 to 92.00, 103.85, and 73.95, respectively. The air pollution trends of cities revealed obvious spatial agglomeration, and those cities with poor air quality were primarily the western cities of Shandong province, most cities in Henan province, and the eastern cities of Shanxi province. Due to the improvement of air quality in eastern cities, the pollution center of gravity moved gradually from Changzhi (113°3411"E, 36°040"N) to Linfen (110°5222″E, 36°2344″N). The results of the spatial Durbin model (SDM) indicated that air pollution had an apparent spillover effect in the YREB at the watershed scale, and that government technical expenditure, gross domestic product (GDP) per capita, population density, annual wind speed, and relative humidity all had significant negative overall effects on the AQI values of cities. The green cover rate, ratio of secondary industry, and temperature, meanwhile, all had significant positive total effects. Due to differences the natural conditions and stages of socio-economic development between the eastern, middle, and western cities of the YREB, the impact directions and functional strengths of their key factors differed greatly.

Anthropogenic emission inventory of multiple air pollutants and their spatiotemporal variations in 2017 for the Shandong Province, China.

Shandong is the most populous and highly industrialized province in eastern China, and the resultant poor air quality is a cause for widespread concern. This study combines bottom-up and top-down approaches to develop a high-resolution anthropogenic emission inventory of air pollutants for 2017. The inventory was developed based on updated emission factors and detailed activity data. The emissions of sulfur dioxide (SO2), nitrogen oxides (NOx), particulate matter with aerodynamic diameters smaller than 2.5 and 10 µm (PM2.5 and PM10, respectively), carbon monoxide (CO), volatile organic compounds (VOCs), and ammonia (NH3) were estimated to be 1387.8, 2488.6, 5281.7, 3193.0, 9250.7, 2254.7, and 1210.6 kt, respectively. Power plants were the largest contributors of SO2 and NOx emissions accounting for 43.7% and 41.9% of the total emissions, respectively. CO emissions mainly originated from industrial processes (40.1%), mobile sources (24.8%), and fossil fuel burning (21.2%). The major sources of PM10 and PM2.5 emissions were industrial processes and fugitive dust, contributing 83.0% and 86.9% of their total emissions, respectively. Industrial processes (60.0%) contributed the largest VOC emissions, followed by mobile sources (16.8%) and solvent use (14.5%). Livestock and N-fertilizers were major emitters of NH3, accounting for 69.9% and 21.2% of the total emissions, respectively. Emissions were spatially allocated to grid cells with a resolution of 0.05 ° × 0.05 ° based on spatial surrogates, using Geographic Information System (GIS). Heavy pollutant emissions were mainly concentrated in the central and eastern areas of Shandong, while high NH3-emissions occurred in the western region. Most pollutant emissions from industrial sectors occurred in June and July, while low emissions were recorded between January and February. Range uncertainties in emission inventory were quantified using Monte Carlo simulations. Our inventory provides effective information to understand local pollutant emission characteristics, perform air quality simulations, and formulate pollution control measures.

Short-term and long-term safety and efficacy of tenofovir alafenamide, tenofovir disoproxil fumarate and entecavir treatment of acute-on-chronic liver failure associated with hepatitis B.

BACKGROUND & AIMS: There is limited evidence on the efficacy and safety of nucleos(t) ide analogues (NAs) in the treatment of HBV-ACLF. Our objective was to evaluate the outcomes among TAF, TDF and ETV, three first-line antivirals against chronic hepatitis B, in patients with HBV-ACLF. METHODS: Patients with HBV-related ACLF were recruited and received daily TAF (25 mg/d), TDF (300 mg/d) and ETV (0.5 mg/d). They were prospectively followed-up. The primary endpoint was overall survival at week 12 and week 48, the secondary endpoints were virological response and biochemical response. RESULTS: Forty gender and age matched eligible subjects were recruited and divided into three groups: TAF group, TDF group and ETV group. By week 48, 8 (80%) patients in TAF group, 6 (60%) patients in TDF group and 17 (85%) patients in ETV group survived without liver transplantation (P = 0.251). After 4 weeks of NAs treatment, all three groups showed paralleling reduction of HBV DNA levels. All three groups presented similar biochemical responses at week 4, patients treated with TAF showed a priority in total bilirubin reduction, albumin and cholesterol maintenance. Additionally, although there was no significant difference in changes of serum urea, serum creatinine, serum cystatin C and estimated GFR among the three groups by treatment week 4, TDF showed unfavorable renal safety even in short -term treatment. The treatment using NAs was well-tolerated and there was no serious drug-related adverse event reported. CONCLUSIONS: TAF, TDF and ETV are of similar efficacy and safety in short-term and long-term treatment of HBV-ACLF. TRIAL REGISTRATION: This study is ongoing and is registered with ClinicalTrials.gov , NCT03640728 (05/02/2019).

Overview of bile acid signaling in the cardiovascular system.

Bile acids (BAs) are classically known to play a vital role in the metabolism of lipids and in absorption. It is now well established that BAs act as signaling molecules, activating different receptors (such as farnesoid X receptor, vitamin D receptor, Takeda G-protein-coupled receptor 5, sphingosine-1-phosphate, muscarinic receptors, and big potassium channels) and participating in the regulation of energy homeostasis and lipid and glucose metabolism. In addition, increased BAs can impair cardiovascular function in liver cirrhosis. Approximately 50% of patients with cirrhosis develop cirrhotic cardiomyopathy. Exposure to high concentrations of hydrophobic BAs has been shown to be related to adverse effects with respect to vascular tension, endothelial function, arrhythmias, coronary atherosclerotic heart disease, and heart failure. The BAs in the serum BA pool have relevant through their hydrophobicity, and the lipophilic BAs are more harmful to the heart. Interestingly, ursodeoxycholic acid is a hydrophilic BA, and it is used as a therapeutic drug to reverse and protect the harmful cardiac effects caused by hydrophobic elevated BAs. In order to elucidate the mechanism of BAs and cardiovascular function, abundant experiments have been conducted in vitro and in vivo. The aim of this review was to explore the mechanism of BAs in the cardiovascular system.

Obesity interacts with hyperuricemia on the severity of non-alcoholic fatty liver disease.

BACKGROUND: A series of evidence revealed that body mass index was an important confounding factor in the research of uric acid and ischemic heart disease/hypertension. The objective of this study was to investigate whether obesity status can modify the association between serum uric acid and the severity of liver damage in NAFLD, and the possible interactive effect of hyperuricemia and obesity. METHODS: We conducted a cross-sectional study in a total of 557 ultrasound diagnosed-NAFLD. The hepatic steatosis and liver fibrosis were quantitatively evaluated by transient elastography. Hyperuricemia was defined as serum uric acid > 420 µmol/L in men, > 360 µmol/L in women and obesity was defined as body mass index ≥ 25 kg/m2. The adjusted OR values of hyperuricemia and obesity were analyzed by multivariate logistic regression analysis, and the additive model was used to investigate the possible interactive effect. RESULTS: Multivariate regression analysis showed that hyperuricemia was associated with serious hepatic steatosis (1.74[1.09-2.79]) and elevated ALT (2.17[1.38-3.41]), but not with advanced fibrosis (1.61[0.91-2.85]). The association was further investigated in different BMI group. Hyperuricemia was associated with higher odds of serious hepatic steatosis (2.02[1.14-3.57]) and elevated ALT (2.27[1.37-3.76]) only in obese NAFLD, not in non-obese subjects. Similarly, patients with hyperuricemia had higher odds of advanced fibrosis in obese subjects (2.17[1.13-4.18]), not in non-obese subjects (0.60[0.14-2.70]). Furthermore, there was an additive interaction between hyperuricemia and obesity on the odds of serious hepatic steatosis (AP: 0.39[0.01-0.77]) and advanced fibrosis. (AP: 0.60[0.26-0.95]). CONCLUSIONS: Hyperuricemia and obesity had a significantly synergistic effect on the hepatic steatosis and fibrosis. Thus, management of uric acid may need to be targeted in obese NAFLD.

Accuracy of Endoscopic Diagnosis of Helicobacter pylori Based on the Kyoto Classification of Gastritis: A Multicenter Study.

BACKGROUND: There is lack of clinical evidence supporting the value of the Kyoto classification of gastritis for the diagnosis of Helicobacter pylori (H. pylori) infection in Chinese patients, and there aren't enough specific features for the endoscopic diagnosis of past infections, which is of special significance for the prevention of early gastric cancer (GC). METHODS: This was a prospective and multicenter study with 650 Chinese patients. The H. pylori status and gastric mucosal features, including 17 characteristics based on the Kyoto classification and two newly-defined features unclear atrophy boundary (UAB) and RAC reappearance in atrophic mucosa (RAC reappearance) were recorded in a blind fashion. The clinical characteristics of the subjects were analyzed, and the diagnostic odds ratio (DOR), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), area under the receiver operating characteristics curve (ROC/AUC), and 95% confidence intervals were calculated for the different features, individually, and in combination. RESULTS: For past infection, the DOR of UAB was 7.69 (95%CI:3.11-19.1), second only to map-like redness (7.78 (95%CI: 3.43-17.7)). RAC reappearance showed the highest ROC/AUC (0.583). In cases in which at least one of these three specific features of past infection was considered positive, the ROC/AUC reached 0.643. For current infection, nodularity showed the highest DOR (11.7 (95%CI: 2.65-51.2)), followed by diffuse redness (10.5 (95%CI: 4.87-22.6)). Mucosal swelling showed the highest ROC/AUC (0.726). Regular arrangement of collecting venules (RAC) was specific for no infection. CONCLUSIONS: This study provides evidence of the clinical accuracy and robustness of the Kyoto classification of gastritis for the diagnosis of H. pylori in Chinese patients, and confirms UAB and RAC reappearance partly supplement it for the diagnosis of past infections, which is of great benefit to the early prevention of GC.

Factors affecting the success of fallopian tube recanalization in treatment of tubal obstructive infertility.

OBJECTIVE: To examine potential risk factors associated with the success rate following fallopian tube recanalization (FTR) in infertile women with obstruction of the proximal fallopian tube. METHODS: We retrospectively studied patients who underwent FTR for tubal obstructive infertility between January 2016 and December 2018 at the Third Affiliated Hospital of Guangzhou Medical University. FTR was performed using a catheter and guidewire system to clear tubal obstruction. Predictive factors potentially associated with the success rate were assessed by logistic regression. RESULTS: A total of 762 patients were included. Multivariable analysis showed that age (odds ratio [OR] = 2.38, 95% confidence interval [CI]: 1.24-4.58), infertility type (OR = 2.82, 95% CI: 1.36-6.21), history of ectopic pregnancy (OR = 7.87, 95% CI: 4.05-15.81), history of abdominal surgery (OR = 4.30, 95% CI: 2.22-8.60), history of artificial abortion curettage (OR = 4.08, 95% CI: 2.12-8.03), and duration of infertility (OR = 2.03, 95% CI: 1.06-3.85) were independently associated with postoperative tubal patency. CONCLUSIONS: Our findings suggest that risk factors, such as age ≥35 years, secondary infertility, duration of infertility ≥5 years, and histories of ectopic pregnancy, abdominal surgery, and artificial abortion curettage, affect the success rate of FTR. These factors may also predict surgical success in treating tubal obstructive infertility.

Modified sandwich embolization technique for postpartum hemorrhage caused by uterine artery pseudoaneurysm: a case series.

PURPOSE: Uterine artery pseudoaneurysm (UAP) is rare but can cause life-threatening postpartum hemorrhage (PPH). To evaluate a novel sandwich embolization technique as a treatment for PPH caused by UAP. METHODS: This retrospective study included 10 patients with PPH caused by UAP who were treated using a modified sandwich embolization technique at the Radiology Department, Third Affiliated Hospital of Guangzhou Medical University between April 2009 and September 2018. Baseline clinical characteristics, intraoperative data (including treatment effectiveness) and postoperative data (including re-bleeding events and complications) were extracted from the medical records. RESULTS: Uterine arterial angiography showed cystic shadowing of the vascular wall during the arterial phase in all patients. Spraying of contrast agent into the pseudoaneurysm was observed for large UAPs, and the pseudoaneurysm disappeared in the venous phase. The pseudoaneurysm blood supply was from the uterine artery in 9 patients (90%) and the uterine, superior vesical, internal pudendal and nameless little arteries in 1 patient (10%). Bleeding symptoms were completely relieved in all patients after sandwich embolization. Eight patients experienced painful contractions in the perioperative period, but there were no other postoperative complications. During the 1-year postoperative follow-up, 9 patients (90%) had no re-bleeding symptoms/signs. One patient (10%), who had a pseudoaneurysm supplied by the uterine, superior vesical, internal pudendal and nameless little arteries, experienced re-bleeding 20 days after surgery and was treated by hysterectomy. CONCLUSION: Modified sandwich embolization is an effective treatment for PPH caused by UAP.