BACKGROUND Hepatic artery thrombosis is the most common and severe vascular complication after liver transplantations. Transcatheter arterial thrombolysis is a viable alternative with high selectivity, low drug dosage, high local drug concentration, and minimal effect on systemic coagulation function. Intra-arterial contrast-enhanced ultrasound (IA-CEUS) is radiation-free and repeatable, can be performed bedside, and could be an alternative for continuous monitoring. We described the efficacy of IA-CEUS in assessing the effect of continuous transcatheter arterial thrombolysis in post-liver transplant hepatic artery thrombosis in a series of cases. MATERIAL AND METHODS Eight patients with diagnosis of hepatic artery thrombosis after liver transplantation between November 2016 and May 2023 were selected. All 8 patients underwent continuous transcatheter arterial thrombolysis, using urokinase. Dynamic IA-CEUS monitoring was performed for each patient during the thrombolysis treatment. Hepatic artery digital subtraction angiography was used to verify the results. RESULTS Two patients showed a hepatic artery perfusion defect. Six patients demonstrated good perfusion of artery. Three patients developed biloma. One patient developed a dissection aneurysm. One patient developed a pseudoaneurysm with catheter displacement in it. One patient developed retroperitoneal hematoma. None of the patients experienced contrast agent-related complications. CONCLUSIONS IA-CEUS was found to be safe and feasible as a new option for evaluating the efficacy of transcatheter arterial thrombolysis in post-liver transplant hepatic artery thrombosis.

Conformational and colloidal stabilities are responsible for the stability of hemoglobin. However, most hemoglobin A1c (HbA1c) control materials (e.g., reference materials, calibrators, and quality control materials) are unstable and noncommutable. This may be closely related to the breakdown of the balance between the conformational and colloidal stabilities of hemoglobin. Therefore, we developed a new combined formulation buffer to address the causes of conformational and colloidal instabilities and to maintain hemoglobin or HbA1c stability. For the commutability of HbA1c control materials, we purified hemoglobin to remove plasma proteins, phospholipids, and fats. On the basis of the above design, we prepared two medical concentrations of HbA1c control materials for the external quality assessment (EQA) program and then determined the certified values via the reference measurement method. Stability, homogeneity, value transfer, and commutability were evaluated. Moreover, the control material was distributed to 56 laboratories to assess proficiency testing. The HbA1c control materials showed good homogeneity and stability and reliable value transfer, and were commutable for routine clinical analyzers. In the EQA program, only one analyzer exceeded the acceptable bias range (± 6.0

Gastrin-releasing peptide precursor (ProGRP) is a bioactive precursor of GRP and might play an important role as an emerging tumor marker in early cancer diagnosis. It might also be abnormal in the nonmalignant disease and renal function abnormalities. The present study was undertaken to investigate the changes of ProGRP levels in patients with kidney injuries, especially with chronic kidney disease (CKD), determine the upper reference intervals and clinical diagnostic value of ProGRP in CKD, and thus help oncologists in interpreting ProGRP levels and making clinical judgments of malignances. 676 individuals were enrolled in this cross-sectional study and divided into five groups: healthy control (n=194), CKD (n=272), nephrotic syndrome (NS) (n=137), antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) (n=41), and urinary tract infection (UTI) (n=32). A total of 27 features including age, gender, and 25 laboratory markers were analyzed. Machine learning algorithms were built for the diagnostic models of CKD. Statistical analysis was performed by R software. It was shown that serum ProGRP level in CKD was significantly higher than that in healthy controls, UTI and NS (P < 0.01). The upper reference limit of ProGRP was 188.42 pg/ml for CKD, 245.40 pg/ml for CKD IV-V, and 97.25 pg/ml for NS. Compared with the healthy control, the level of serum ProGRP in CKD stages II, III, IV-V was significantly increased and elevated progressively with CKD grade (P < 0.01). Random Forest (RF) model works best among 4 building machine learning algorithms. 5 vital indicators, ProGRP, estimated glomerular filtration rate (eGFR), urea, albumin (ALB), and direct bilirubin (DBIL), were selected to establish RF model for diagnosing CKD with an area under the curve (AUC) of 0.96 (95% confidence interval [CI]: 0.94-0.97) and high sensitivity (0.89) and specificity (0.92). This study demonstrates that the level of ProGRP in patients with CKD, nephrotic syndrome or AAV, was significantly higher than that in the healthy population. The machine learning model of ProGRP with DBIL, eGFR, ALB, and urea, could provide good clinical value for CKD evaluation.

The complexity of blood and its matrix in high-performance liquid chromatography (HPLC) glycated hemoglobin (HbA1c) assays is closely related to column performance. However, the available prefilters with a single structure or surface membrane materials are not ideal for column protection, and coupled with the complexity of blood samples, leads to rapid degradation of column performance. Therefore, we have developed a new microprefilter with a three-stage filtration design and depth filter material to protect the column. All filter materials used in the preparation of microprefilters were characterized, screened, and optimized, and then manufactured on the basis of optimized filter materials, which are depth filter material microprefilters. Based on the material and structural design, microprefilters were capable of filtering particulate matter from test samples on a step-by-step basis to avoid the plugging effect that occurs when all sizes of substances are gathered together. Moreover, all newly developed microprefilters can be tested more times, up to 600 times. Microprefilters with small-pore-size final filtration membranes of polyethersulfone, hydrophilic polytetrafluoroethylene, and mixed cellulose showed excellent column protection in terms of column efficiency, HbA1c retention time, number of column tests, and column backpressure, and prolonged column lifetime by as much as 20–30

BACKGROUND Hepatic artery occlusion (HAO) after liver transplantation (LT) is a devastating complication, resulting in early graft loss and reduced overall survival. Ultrasound is an established assessment method for HAO in patients following LT, especially those with complex hepatic artery reconstruction. AIM To investigate the ultrasound characteristics and analyze the risk factors associated with HAO in patients after LT. METHODS We retrospectively analyzed the ultrasound characteristics and the clinic risk factors associated with HAO in 400 adult LT patients who were enrolled and treated at the Third People's Hospital of Shenzhen between November 2016 and July 2022. Fourteen patients diagnosed with acute HAO (A-HAO) by surgery and fifteen diagnosed with chronic HAO (C-HAO) were included. A control group of 33 patients without HAO complications during the same period were randomly selected using a random number table. All patients underwent an ultrasonography examination. Parameters including resistance index (RI), peak systolic velocity (PSV), and portal vein velocity (PVV) were compared across the groups. Additionally, basic clinical data were collected for all patients, including gender, age, primary diagnosis, D-dimer concentration, total operation time, cold ischemia time, hot ischemia time, intraoperative blood loss and transfusion, intraoperative urine volume, infusion, model for end-stage liver disease (MELD) score, and whether complex hepatic artery reconstructions were performed. Furthermore, risk factors influencing HAO formation after LT were analyzed. RESULTS Compared to the non-HAO group, PVV and RI were higher in the A-HAO group, while PSV was lower. Conversely, both PSV and RI were lower in the C-HAO group compared to the non-HAO group. The proportion of patients undergoing complex hepatic artery reconstructions and the gamma-glutamyltransferase (GGT) level before occlusion were significantly higher in the A-HAO group compared to the non-HAO group. However, there were no distinct differences between the two groups in D-dimer, MELD score, pre-occlusion alanine transaminase and aspartate transaminase levels, or intraoperative conditions. CONCLUSION Ultrasound features of the hepatic artery before occlusion are significantly associated with postoperative HAO development. Additionally, complex hepatic artery reconstructions, defined as revascularization of the graft requiring additional anastomosis between donor hepatic arteries, constitute a risk factor for A-HAO. Besides, abnormal pre-occlusion GGT elevation is an important biochemical indicator. Therefore, ultrasound examination serves as an important tool for screening HAO, especially in patients with the identified risk factors.

ObjectivesThis study aims to investigate the use of high‐frequency sonography as a tool for detecting inflammatory and destructive changes in the hand and foot joints of patients with early and long‐term RA.MethodsThis study employs a prospective cohort design involving 162 patients diagnosed with Rheumatoid arthritis (RA) who meet the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria. Patients were divided into two groups based on disease duration: Group 1 (n = 74) included patients with a disease duration of up to 2 years, or early РА (ERA;), Group 2 (n = 88) consisted of patients with a disease duration exceeding 2 years, or long‐term persistent РА (LtRA). All patients underwent a clinical assessment of their joints, as well as radiography and arthrosonography, at the beginning of the study and again at 6 and 12 months later.ResultsIn the general group of patients, ultrasound examination revealed signs of synovitis in the joints of the hands more frequently (66%) compared with clinical examination (56% by a number of swollen joints [NSJ] and 55% by a number of painful joints [NPJ], P < .01). After 6 months of treatment, 12% of the patients achieved full US remission and 24% achieved partial US remission.ConclusionsWithin the scope of comprehensive RA diagnostics, arthrosonography of the joints of the hands and feet, utilizing a combination of greyscale and power Doppler, may surpass radiography in detecting early RA. This method allows for a more accurate assessment of disease activity and progression rates.

ObjectiveTo investigate the diagnostic value of contrast-enhanced ultrasound liver imaging reporting and data system（CEUS LI-RADS）and European CEUS guidelines for liver malignant tumors in high-risk patients with hepatocellular carcinoma（HCC）.MethodsThe imaging data of 89 high-risk patients with suspected HCC treated in Shenzhen Third People's Hospital from August 2020 to January 2022 were retrospectively analyzed. They were 74 males and 15 females, and aged between 22 and 77（50.8±11.3）years. Pathological diagnosis was used as the gold standard, and receiver operating characteristic（ROC）curve analysis was adopted to calculate the areas under the ROC curve（AUC）of CEUS LI-RADS and European CEUS guidlines. And the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV）and accuracy of CEUS LR-5+LR-M and European CEUS guidelines for diagnosing liver malignancies were calculated.ResultsOf the 92 lesions, 77 lesions were classified as LR-5+LR-M by CEUS, and 77 lesions were diagnosed liver malignant tumors by European CEUS guidelines, and 75 lesions were pathologically confirmed to be malignant tumors of the liver. The AUC values of CEUS LI-RADS and European CEUS guidelines were 0.875 and 0.797, respectively, through no statistical difference（Z=1.71, P=0.088）. Taking LR-5 and LR-M lesions as positive results, the sensitivity, specificity and PPV, NPV and accuracy were 97.3%（95%CI: 90.7%~99.7%）and 94.7%（95%CI: 86.9%~98.5%, Chi-square=8.12, P=0.004）, 76.5%（95%CI: 50.1%~93.2%）and 64.7%（95%CI: 38.3%~85.8%）, 94.8% and 92.2%, 86.7% and 73.3%, and 93.5%（95%CI: 86.3%~97.6%）and 89.1%（95%CI: 80.9%~94.7%, Chi-square=20.63, P<0.001）in CEUS LR-5+LR-M and European CEUS guidelines for diagnosing liver malignancies, respectively.ConclusionCEUS LI-RADS shows comparable diagnostic performance as European CEUS guidelines, but the sensitivity and accuracy of CEUS LI-RADS are significantly higher.

患者男,57岁.既往慢性乙型肝炎30余年.实验室检查肝功能异常,甲胎蛋白(alpha-fetoprotein,AFP)28.59 ng/mL,糖链抗原 199 72.5 U/mL.超声检查:肝左外叶包膜下见大小为22 mm×15 mm的高回声结节,局限性隆起,边界清,CDFI可见周边环状血流信号.超声造影(contrast-enhanced ul-trasound,CEUS):动脉期造影剂由粗大血管汇入,环状向心性增强;门脉期呈整体高增强;3 min 30 s时造影剂开始退出呈稍低增强,诊断血管瘤可能.增强MR:动脉期边缘见明显强化,内部呈轻度不均匀强化,门脉期、平衡期环形强化,肝胆期呈低摄取,提示肝细胞癌(hepatocellular carcinoma,HCC)可能性大.

The nasopharynx is the initial site of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and neutrophils play a critical role in preventing viral transmission into the lower airways or lungs during the early phases of infection. However, neutrophil dynamics, functional signatures, and predictive roles in the nasopharynx of coronavirus disease 2019 (COVID-19) patients have not yet been elucidated. In this study, we carried out RNA sequencing of nasopharyngeal swabs from a cohort of COVID-19 patients with mild, moderate, severe outcomes and healthy donors as controls. Over 32.7% of the differentially expressed genes associated with COVID-19 severity were neutrophil-related, including those involved in migration, neutrophil extracellular traps formation, and inflammasome activation. Multicohort single-cell RNA sequencing analysis further confirmed these findings and identified a population of neutrophils expressing Vacuolar-type ATPase (V-ATPase) and the chemokine receptor CXCR4 in the nasopharynx. This population of neutrophils preferentially expressed pro-inflammatory genes relevant to phagosomal maturation as well as local reactive oxygen species and reactive nitrogen species production in the nasopharynx of patients with severe outcomes. A four-gene panel defined as a neutrophil signature associated with COVID-19 progression (NSAP) was identified as an early diagnostic predictor of severe COVID-19, which potentially distinguished severe patients from mild cases with influenza, respiratory syncytial virus, dengue virus, or hepatitis B virus infection. NSAP is mainly expressed on CXCR4high neutrophils and exhibits a significant association with the cell fraction of this neutrophil population. This study highlights novel potential therapeutic targets or diagnostic tools for predicting patients at a higher risk of severe outcomes.

慢性乙型肝炎(chronic hepatitis B,CHB)患者乙型肝炎病毒表面抗原(hepatitis B surface antigen,HBsAg)和乙型肝炎病毒表面抗体(hepatitis B surface antibody,HBsAb)共存的矛盾现象在临床并不少见,其产生机制一直以来都是研究热点.近年来研究发现HBsAg新增N-糖基化突变、HBV准种多样性、宿主遗传基因的突变和免疫组库表达的差异可能与HBsAg和HBsAb的共存有关.该文就CHB患者HBsAg和HBsAb共存机制的最新研究作一综述.

Background and aims: Chronic hepatitis B virus (CHB) infection remains a major global health burden and the non-invasive and accurate diagnosis of significant liver fibrosis (≥F2) in CHB patients is clinically very important. This study aimed to assess the potential of the joint use of ultrasound images of liver parenchyma, liver stiffness values, and patients’ clinical parameters in a deep learning model to improve the diagnosis of ≥F2 in CHB patients. Methods Of 527 CHB patients who underwent US examination, liver elastography and biopsy, 284 eligible patients were included. We developed a deep learning-based data integration network (DI-Net) to fuse the information of ultrasound images of liver parenchyma, liver stiffness values and patients’ clinical parameters for diagnosing ≥F2 in CHB patients. The performance of DI-Net was cross-validated in a main cohort (n =155) of the included patients and externally validated in an independent cohort (n = 129), with comparisons against single-source data-based models and other non-invasive methods in terms of the area under the receiver-operating-characteristic curve (AUC). Results DI-Net achieved an AUC of 0.943 (95% confidence interval [CI]: 0.893-0.973) in the cross-validation, and an AUC of 0.901 (95% CI: 0.834-0.945) in the external validation, which were significantly greater than those of the comparative methods (AUC ranges: 0.774-0.877 and 0.741-0.848 for cross- and external validations, respectively, P s < 0.01). Conclusion The joint use of ultrasound images of liver parenchyma, liver stiffness values, and patients’ clinical parameters in a deep learning model could significantly improve the diagnosis of ≥F2 in CHB patients.

OBJECTIVES:We aimed to evaluate the safety of the ultrasound contrast agent sulfur hexafluoride microbubbles in a large group of patients referred for routine contrast-enhanced ultrasound (CEUS).METHODS:A retrospective assessment was made of all patients that received sulfur hexafluoride microbubbles intravenously for CEUS at 24 centers between January 2006 and April 2019. Patient demographic details, examination type, and the dose of sulfur hexafluoride microbubbles administered were recorded with specific adverse events (AEs) documentation tools at each center. All AEs were recorded as serious or non-serious. Non-serious AEs were classified by intensity as mild, moderate, or severe according to ACR criteria. The frequencies of AEs across patient subgroups were compared using the chi-square test.RESULTS:A total of 463,434 examinations were evaluated. Overall, 157 AEs (153 [0.033%] non-serious; 4 [0.001%] serious) were reported after sulfur hexafluoride microbubbles administration, giving an AE frequency of 0.034% (157/463,434). Among the non-serious AEs, 66 (0.014%) were mild, 70 (0.015%) moderate, and 17 (0.004%) severe in intensity. The liver was the most common examination site, presenting an AE frequency of 0.026%. The highest AE frequency (0.092%) was for patients undergoing CEUS for vascular disease. There were no significant gender differences in either the total number or the severity of non-serious AEs (chi-square = 2.497, p = 0.287). The onset of AEs occurred within 30 min of sulfur hexafluoride microbubbles administration in 91% of cases.CONCLUSION:The frequency of AEs to sulfur hexafluoride microbubbles is very low and severe reactions are rare, confirming that sulfur hexafluoride microbubbles are appropriate for routine CEUS applications.KEY POINT:• The frequency of AEs to sulfur hexafluoride microbubbles is very low and severe reactions are rare.

目的 探讨超声弹性成像技术无创性评估抗结核药物性肝损害的临床价值及预测抗结核药物性肝损害发生风险.方法 选取2020年1月至12月就诊于深圳市第三人民医院的56例结核病住院患者,分为抗结核药物性肝损害组(n=26),无抗结核药物性肝损害组(n=30),另外纳入30例健康体检者为对照组(n=30),所有受检者接受二维超声、声触诊弹性成像(STE)、声触诊弹性定量(STQ)及肝功能血生化检测.采用ROC曲线分析超声弹性成像诊断抗结核药物性肝损害的诊断效能,采用Logistic单因素及多因素回归分析筛选抗结核药物性肝损害的独立危险预测因素.结果 ①脾长、肝脏STE测值、肝脏STQ测值在抗结核药物性肝损害组中均高于对照组和抗结核无药物性肝损害组.②肝脏STE测值、肝脏STQ测值和脾脏STE测值诊断抗结核药物性肝损害的灵敏度分别为88.46％、80.77％、69.23％,特异度分别为96.77％、86.89％、73.68％;曲线下面积分别为0.978、0.894、0.739.③多因素Logistic回归分析显示肝脏STE测值是抗结核药物性肝损害的独立预测因素.结论 超声弹性成像尤其是肝脏STE测值对抗结核药物性肝损害的诊断和风险预测具有临床价值.

目的 评估流式荧光法(FFIA)、间接免疫荧光法(IIF)及酶联免疫吸附法(ELISA)检测抗双链DNA(dsDNA)抗体用于系统性红斑狼疮(SLE)诊断的临床价值,为临床实践寻找适宜的检测策略.方法 选取我院就诊的SLE患者92例,非SLE自身免疫性疾病患者127例及50例健康体检者,分别采用FFIA、IIF和ELISA检测血清中抗dsDNA抗体,计算各方法检测灵敏度和特异性,采用Kappa检验评估结果一致性,采用受试者工作特征曲线(ROC曲线)比较各方法用于区分SLE和非SLE自身免疫性疾病的效能.结果 用FFIA、IIF、ELISA检测抗dsDNA抗体,SLE组阳性率分别为44.6％、50.0％和62.0％,均高于疾病对照组和健康对照组(P<0.0001).IIF与FFIA、ELISA具有高度的一致性,Kappa值分别为0.64和0.72.FFIA与ELISA检测结果具有中等的一致性,Kappa值为0.56.以串联的方式FFIA-IIF或ELISA-IIF联合检测,可提高SLE诊断的灵敏度,分别达到59.8％和67.4％,其特异性分别为92.1％和89.3％,阴阳性与诊断符合率分别提高到81.0％和81.8％.ROC曲线分析显示,FFIA的AUC最大,达到0.768,ELISA和ⅡF的AUC分别为0.748和0.711.结论 FFIA、ELISA和IIF检测抗dsDNA抗体具有较好的一致性,用于SLE诊断的准确性高.ELISA-IIF或FFIA-IIF(串联)联合检测,可作为临床实践中适用于SLE诊断的抗dsDNA抗体检测模式.

目的:探讨彩色多普勒超声与常规CT应用于颈部淋巴结结核的诊断价值.方法:将我院2019年5月至2021年6月期间102例高度疑似颈部淋巴结结核患者纳入研究,所有患者均接受彩色多普勒超声及常规CT检查,以淋巴结穿刺或最终手术病理组织检查为金标准,观察所有患者疾病检出情况(灵敏度、特异度、准确度、误诊率、阴性及阳性检出率).结果:102例疑似颈部淋巴结结核患者中,经病理检查确诊99例阳性,3例阴性,其中经彩超检查灵敏度(96.97％)、特异度(66.67％)、准确度(96.08％)、阴性检出率(40.00％),均高于常规CT 检查(88.89％、33.33％、87.25％、8.33％、),误诊率(3.92％),低于常规 CT 检查(12.75％)(P＜0.05),阳性检出率(98.97％)与常规CT检查(97.78％)对比均差异无统计学意义(P＞0.05).结论:彩色多普勒超声对比常规CT应用于颈部淋巴结结核,可有效提高疾病检测灵敏度、特异度、准确度及阴性检出率,降低误诊率,但不影响检阳性检出情况.

Objective:To investigate the clinical value of combined sound touch elastography (STE) and ultrasonography (US) score in staging liver fibrosis in chronic hepatitis B (CHB) patients.Methods:A total of 153 CHB patients who underwent liver biopsy were enrolled into liver fibrosis groups (F1-F4 groups) according to the METAVIR grading standard, and 53 healthy volunteers were included as a control group (F0 group). All subjects received STE/STQ, two-dimensional ultrasound, and liver function biochemical index detection. Logistic regression was used to analyze whether STE/STQ and US quantitative scores were in the same order of magnitude. Receiver operating curve (ROC) analysis of STE, STQ, STE combined with US, and STQ combined with US in the diagnosis of liver fibrosis at each stage was performed.Results:There were statistical differences in the liver STE value and liver STQ value among the F0-F4 groups [liver STE value: (5.71±0.68) kPa vs (6.64±0.96) kPa vs (8.00±1.59) kPa vs (10.14±1.82) kPa vs (13.94±2.83) kPa, F=166.28, P=0.002; liver STQ value: (5.98±1.09) kPa vs (7.01±1.42) kPa vs (8.40±2.54) kPa vs (10.14±1.99) kPa vs (14.91±3.09) kPa, F=123.77, P=0.003]. The spleen STE value only had statistical difference between the liver cirrhosis (F4) group and other groups [(25.69±5.31) kPa vs (16.30±4.29) kPa, (17.04±3.37) kPa, (17.00±3.79) kPa, and (17.41±5.31) kPa; P<0.05]. The ratio of?μUS/μSTE was close to 1, which means that STE and US quantitative scores were at the same level. According to the area under the ROC (AUROC), STE combined with US quantitative scoring showed the best diagnostic performance: ≥F1 stage liver fibrosis (AUROC: 0.944); ≥F2 stage liver fibrosis (AUROC: 0.955); ≥F3 stage liver fibrosis (AUROC: 0.976). For F4 liver cirrhosis, STQ combined with US quantitative scoring had the best diagnostic performance (AUROC: 0.979).Conclusion:STE combined with US quantitative scoring shows the best diagnostic ability in different stages of liver fibrosis, while STQ combined with US quantitative scoring has the best performance in diagnosing liver cirrhosis.

目的 探讨肝移植术后下肢深静脉血栓(deep vein thrombosis,DVT)的超声影像特征和DVT形成的危险因素.方法 选取深圳市第三人民医院行肝移植手术患者141例,术前均采用超声检查下肢静脉,记录有无DVT,术后1、7、14 d复查DVT发生情况.分析性别、年龄、高血压、糖尿病、肿瘤史、长期饮酒史、 胆固醇浓度、甘油三酯浓度、高密度脂蛋白浓度、低密度脂蛋白浓度、D-二聚体浓度、下肢深静脉穿刺置管史、总手术时间、无肝期时间、术中出血量及输血量、终末期肝病模型(model for end-stage liver disease,MELD)评分对肝移植术后DVT形成的可能风险因素.结果 移植术前均未检出DVT,术后检出DVT 33例,DVT总体发生率为23.4％.均发生于术后7 d内.单因素回归分析显示,无DVT者与DVT者总胆固醇浓度、高密度脂蛋白浓度、D-二聚体浓度、术中出血量及输血量、MELD评分、肿瘤史、下肢深静脉穿刺置管比较差异均有统计学意义(均P<0.05).Logistic多因素回归分析显示,下肢深静脉穿刺史、高MELD评分及高D-二聚体浓度是肝移植术后DVT形成的危险因素(均P<0.05).结论 超声可以明确诊断肝移植术后下肢DVT形成,总胆固醇浓度、高密度脂蛋白浓度、D-二聚体浓度、术中出血量及输血量、MELD评分、肿瘤史、下肢深静脉穿刺置管史是DVT形成的重要因素,对有以上高危因素的患者应重点进行超声监测.

Objective The longitudinal effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on the liver are unknown. This study aimed to characterize dynamic changes in liver function test abnormalities in patients with COVID-19 at the acute phase and recovery phase. Methods A prospective cohort study involved patients with COVID-19 who were admitted to Shenzhen Third People’s Hospital between January 11, 2020, and April 27, 2020. Patients underwent liver function tests at hospitalization and at the outpatient visit at the 1-month, 3-month, 6-month, and 12-month follow-ups. Results Among 461 patients, 28.4% of patients had any kind of liver function tests abnormality at admission, manifested as elevated ALT (13.0%), AST (17.6%), and GGT (15.8%) levels. The trajectory analysis indicated a marked improvement in liver function after discharge, with any kind of liver function test abnormalities of 25.1% at 1 month, 13.2% at 3 months, 16.7% at 6 months, and 13.2% at 12 months after discharge. Persistent liver function abnormalities were observed in patients with pre-existing conditions during follow-up. A significantly higher prevalence of ultrasound determined fatty liver disease was found in those patients with more frequent LFT abnormalities at follow-up. Conclusion In this study of patients with COVID-19, liver damage in COVID-19 was usually temporary and could return to normal at the end of the 12-month follow-up.

Background The long-term clinical status of coronavirus disease 2019 (COVID-19) in recovered patients remains largely unknown. This prospective cohort study evaluated clinical status of COVID-19 and explored the associated risk factors. Methods At the outpatient visit, patients underwent routine blood tests, physical examinations, pulmonary function tests, 6-min walk test, high-resolution computed tomography (CT) of the chest, and extrapulmonary organ function tests. Results 230 patients were analyzed. Half (52.7%) reported at least one symptom, most commonly fatigue (20.3%) and sleep difficulties (15.8%). Anxiety (8.2%), depression (11.3%), post-traumatic symptoms (10.3%), and sleep disorders (26.3%) were also reported. Diffusion impairments were found in 35.4% of the patients. Abnormal chest CT scans were present in 63.5% of the patients, mainly reticulation and ground-glass opacities. Further, a persistent decline in kidney function was observed after discharge. SARS-CoV-2-specific antibodies of IgA, IgG, and IgM were positive in 56.4%, 96.3%, and 15.2% of patients, respectively. Multivariable logistic regression showed that disease severity, age, and sex were closely related to patient recovery. Conclusions One year after hospital discharge, patients recovered from COVID-19 continued to experience both pulmonary and extrapulmonary dysfunction. While paying attention to pulmonary manifestations of COVID-19, follow-up studies on extrapulmonary manifestations should be strengthened.

目的 探究乙型肝炎患者二维超声、声触诊弹性成像(STE)、血清学指标变化及其与肝纤维化分期的相关性.方法 选择2019年1月至2021年4月在深圳市第三人民医院就诊的120例乙型肝炎患者作为研究组,根据患者肝纤维化病理结果分为轻度纤维化组(S1期)43例,中-重度纤维化组(S2、S3期)46例和肝硬化组(S4期)31例,另选择同期在我院体检的健康者41例作为对照组.比较研究组和对照组受检者的二维超声结果以及研究组不同肝纤维化程度患者间的STE弹性值、天冬氨酸转氨酶/血小板比值指数(APRI)、纤维化4指数(FIB-4)的差异,并采用Spearman相关性分析法分析STE弹性值、APRI值和FIB-4值与肝纤维化分期的相关性.结果 二维超声结果显示,研究组患者的脾长度、脾厚度、脾静脉内径、肝门静脉内径明显长(高)于对照组,差异均有统计学意义(P<0.05);研究组患者中,轻度纤维化组、中重度纤维化组、肝硬化组患者的STE弹性值、APRI值和FIB-4值依次升高,且不同纤维化分期患者STE弹性值、APRI值和FIB-4值比较差异均有统计学意义(P<0.05);经Spearman相关性分析结果显示,STE弹性值(r=0.754,P<0.001)、APRI值(r=0.348,P=0.004)和FIB-4值(r=0.469,P<0.001)与肝脏纤维化分期均呈正相关.结论 二维超声、STE和血清学指标与乙型肝炎患者肝纤维化分期具有一定的相关性,可用于临床诊断分析.