A novel noninvasive algorithm for the assessment of liver fibrosis in patients with chronic hepatitis B virus infection.

Several noninvasive blood biomarkers have been established for the assessment of liver fibrosis in patients with chronic hepatitis B virus (HBV) infection, but their clinical performance remains inconclusive. Here, we compared the diagnostic performance of these biomarkers and developed a novel algorithm for assessing liver fibrosis. Six hundred and sixteen chronically HBV-infected and treatment-naïve patients who underwent liver biopsy were enrolled and randomly divided into training (N=410) and internal validation cohorts (N=206). One hundred and fifty-nine patients from another centre were recruited as an external validation cohort. Receiver operating characteristic (ROC) curves were used to analyse the performance of the gamma-glutamyltransferase-to-platelet ratio (GPR), red cell volume distribution width-to-platelet ratio (RPR), FIB-4 index, aspartate aminotransferase-to-platelet ratio index (APRI) and HBV DNA level against liver histology, and a novel algorithm was developed using the recursive partitioning and regression tree (RPART) method. In the training cohort, the area under the ROC curve of FIB-4 was significantly higher than that of APRI (P=.038) but was comparable to those of GPR, RPR and HBV DNA; however, the performance of the biomarkers was similar among the validation cohort. The established RPR-HBV DNA algorithm performed better in the training cohort than any individual blood biomarker, and the corresponding sensitivity, specificity, positive predictive value and negative predictive value were 63%, 90%, 72% and 80%, respectively. In the internal and external validation cohorts, the performance of the algorithm in assessing liver fibrosis was also superior to that of other biomarkers. These results suggest that the established RPR-HBV DNA algorithm might improve the diagnostic accuracy of liver fibrosis in treatment-naïve patients with chronic HBV infection, although additional studies are warranted to confirm these findings.

[Precision nutrition in the era of precision medicine].

Precision medicine has been increasingly incorporated into clinical practice and is enabling a new era for disease prevention and treatment. As an important constituent of precision medicine, precision nutrition has also been drawing more attention during physical examinations. The main aim of precision nutrition is to provide safe and efficient intervention methods for disease treatment and management, through fully considering the genetics, lifestyle (dietary, exercise and lifestyle choices), metabolic status, gut microbiota and physiological status (nutrient level and disease status) of individuals. Three major components should be considered in precision nutrition, including individual criteria for sufficient nutritional status, biomarker monitoring or techniques for nutrient detection and the applicable therapeutic or intervention methods. It was suggested that, in clinical practice, many inherited and chronic metabolic diseases might be prevented or managed through precision nutritional intervention. For generally healthy populations, because lifestyles, dietary factors, genetic factors and environmental exposures vary among individuals, precision nutrition is warranted to improve their physical activity and reduce disease risks. In summary, research and practice is leading toward precision nutrition becoming an integral constituent of clinical nutrition and disease prevention in the era of precision medicine.

The false thyroid capsule: new findings.

PURPOSE: The false thyroid capsule is an important anatomical structure involved in thyroidectomy, yet it is rarely studied. This study aimed to define the anatomy of the false thyroid capsule, and its clinical significance. METHODS: A prospective study was performed involving 151 patients with goitre who underwent thyroid lobectomy. The anatomy of the false thyroid capsule was carefully documented intra-operatively. RESULTS: The false thyroid capsule enclosed the inferior and middle thyroid veins and the superior thyroid vessels, forming a mesentery-like structure by attaching to the gland. Once the unilateral lobe had been removed, the thyroid mesentery could be seen to have a C-shaped edge. The recurrent laryngeal nerve, inferior thyroid artery and parathyroid glands were located beneath the C-shaped edge of the thyroid mesentery. CONCLUSION: The thyroid mesentery is a distinctive structure that can be used as a guide for surgical dissection.

[Modified method of determining phosphatidylglycerol in amniotic fluid to assess fetal maturity].

In this study the amniotic fluid of 111 cases were analyzed to assess fetal maturity by a modified method of determining phosphatidylglycerol. The L/S ratio was also determined in the amniotic fluid by thin layer chromatography at the same time. This method was found especially valuable where the L/S ratio was not less than 2.0 and the newborn infant did not have RDS. Here the fetal maturation was characterized by an early appearance of PG. Clinical evaluation showed that the rate of accuracy to assess fetal maturity of PG was 97.3%, significantly higher when compared with the 86.5% by L/S ratio (P less than 0.01). The false negative rate for PG was 5%. PG analysis in amniotic fluid as markers of surfactant seems to be of value as an additional index of prenatal evaluation of lung maturity. The modified method of PG assessment in amniotic fluid is a better method for estimating fetal maturity.

Selection of hormone-responsive advanced breast cancer with a cytoplasmic estrogen receptor assay. Analysis of 100 cases.

One hundred women with advanced breast cancer were treated with endocrine therapy alone and the clinical response was correlated with the estrogen receptor status of the tumor as determined by a fluorescent histochemical assay designed to estimate the percentage of cancer cells with high cytoplasmic estrogen binding activity. Using clinical response rates as the standards for measurement, this histochemical method showed an 84% sensitivity, a 74% specificity, a 76% positive predictive value and an 82% negative predictive value. These results indicate that the histochemical assay may serve as a supplementary means to identify hormone-responsive mammary carcinomas and as a research tool to study the biology of this group of tumors.

New sequential external counterpulsation for the treatment of acute myocardial infarction.

Over a period of 6 years, 52 patients with acute myocardial infarction (AMI) were treated with sequenced external counterpulsation (SECP). Of the 23 patients who experienced severe chest pain, 22 had complete relief within 30 min of SECP, and 31 of the 52 patients showed remarkable improvement in their electrocardiogram after the first hour of treatment. Fifteen patients were studied using the 35-lead ST segment elevation-mapping method. sigma ST and NST, indicators of infarct size, showed decreasing trends in seven patients treated with SECP for a period of 6 days, whereas sigma ST and NST of the control group of eight patients increased during the same period. Our hemodynamic data indicate that in four of five patients with AMI and left heart failure, the central venous pressure and cardiac output increased after SECP, whereas the pulmonary wedge pressure decreased. Measurements of the P-wave terminal force of lead V1 also demonstrated that the application of SECP can improve left ventricular function in a majority of patients with AMI.