BACKGROUND/AIMS:Dysregulated cholesterol metabolism is a hallmark of hepatocellular carcinoma (HCC) that drives tumor initiation and progression. However, clinical targeting of cholesterol metabolism has yielded limited benefits due to stringent feedback in tumor cells. Identifying a central mediator capable of restoring cholesterol homeostasis within the cell's intrinsically fine-tuned regulatory framework is urgently needed. METHODS:We integrated a proteomic dataset from patients with cholesterol-dysregulated HCC into a global cholesterol metabolic regulatory network to identify potential therapeutic targets for disrupted cholesterol homeostasis. The prognostic significance of the candidate targets was further validated in an independent cohort through immunohistochemistry. Functional and mechanistic studies were conducted in vitro using HCC cell lines and in vivo using mouse models. The pharmacological efficacy of the candidate agent was evaluated in both subcutaneous and orthotopic HCC mouse models. RESULTS:ER lipid raft-associated 1 (ERLIN1), a pivotal regulator of cholesterol metabolism reprogramming, was identified as an independent favorable prognostic indicator in HCC. ERLIN1 constrains HCC progression both in vitro and in vivo by stabilizing the INSIG1-SCAP-SREBP2 axis and maintaining the metabolic balance of intracellular cholesterol. Under hypoxia, impaired factor-inhibiting hypoxia-1-dependent hydroxylation of ASB11 at asparagine residues 90 and 92 enhances ASB11-mediated ERLIN1 degradation. Pharmacological targeting of this axis using zoledronic acid (ZoA) attenuated HCC progression by weakening the ASB11-ERLIN1 interaction and restoring cholesterol homeostasis. CONCLUSIONS:ERLIN1 represents a druggable metabolic vulnerability in cholesterol-dysregulated HCC. Targeting the ASB11-ERLIN1 axis with the clinically approved ZoA reestablishes cholesterol homeostasis and offers a promising therapeutic strategy to overcome the current limitations of cholesterol-targeted HCC therapies.

RATIONALE AND OBJECTIVES:MRI-proton density fat fraction (MRI-PDFF) is widely applied in clinical practice for hepatic fat quantification. However, the conventional manual region of interest (ROI) method is time-consuming and operator-dependent, and the diagnostic accuracy of artificial intelligence (AI)-based models for hepatic steatosis assessment remains to be fully clarified. This study aimed to evaluate the diagnostic performance of an AI-based whole liver segmentation (WLS) model for histological hepatic steatosis grading, and to technically validate its segmentation performance and agreement with manual ROI-based PDFF measurement. MATERIALS AND METHODS:A total of 538 adults who underwent MRI-PDFF examinations were enrolled. A VBB-Net segmentation model was developed in a training cohort of 372 patients (418 examinations). Validation was performed in a consecutive cohort of 166 adults who underwent liver biopsy for suspected metabolic dysfunction-associated steatotic liver disease (MASLD). Histological steatosis grading (S0-S3) was used as the reference standard. RESULTS:The mean Dice coefficients were 0.94 ± 0.05 in the training cohort and 0.93 ± 0.04 in the validation cohort. Margins of error were 0.794% for AI-WLS-PDFF and 0.821% for ROI-PDFF. The AUROCs (95% CI) of AI-WLS-PDFF for diagnosing S0-S3 were 0.995 (95% CI: 0.989, 1.000), 0.951 (95% CI: 0.921, 0.980), and 0.928 (95% CI: 0.888, 0.968), respectively. AI-WLS-PDFF showed excellent agreement with ROI-PDFF (ICC, 0.996; 95% CI: 0.995, 0.997) with minimal bias (mean difference, -0.06%; 95% agreement limits: -1.59% to 1.47%). CONCLUSION:The AI-WLS-PDFF model showed high diagnostic performance for histological steatosis grading and excellent agreement with manual ROI-PDFF, supporting its potential as an automated approach for whole-liver PDFF quantification in patients with MASLD. The proposed cutoff values should be considered exploratory and require further validation.

Liver cancer, primarily hepatocellular carcinoma (HCC), is one of the deadliest cancers globally. However, effective predictive models for early recurrence and poor prognosis in HCC remain limited. This retrospective study analyzed 180 patients with HCC to explore the prognostic value of tertiary lymphoid structures (TLSs), peripheral blood immune parameters, and clinical factors. The findings revealed that TLSs significantly reduced early recurrence rates, although they were not associated with late recurrence. The interaction of peripheral blood immune parameters, particularly the neutrophil–monocyte ratio (NMR), was found to play a crucial role in predicting early recurrence. A novel clinical prediction model was developed by integrating the tumor-node-metastasis (TNM) staging system (8th edition), TLS status, and NMR data. This model demonstrated strong predictive accuracy for early HCC recurrence. These results underscore the multifaceted influence of TLSs and peripheral blood immunity on HCC prognosis. The proposed model offers a valuable tool for personalized patient management, particularly in identifying the risk of early recurrence.

Purpose:This study aimed to develop a radiomics model based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the preoperative prediction of two distinct histopathological vascular patterns in hepatocellular carcinoma (HCC): vessels encapsulating tumor clusters (VETC) and microvascular invasion (MVI). In addition, the study evaluated the prognostic significance of these vascular patterns in predicting postoperative outcomes in patients with HCC. Patients and Methods:A total of 306 patients with HCC who underwent radical resection at two medical centers were retrospectively included. Patients from Center 1 were randomly assigned to a training cohort and an internal validation cohort at a ratio of 7:3, while patients from Center 2 comprised the external validation cohort. Radiomics features were extracted from the arterial phase (AP), portal venous phase (PP), and delayed phase (DP) DCE-MRI images, including intratumoral, peritumoral, and fused intra-peritumoral regions. Radiomics models were constructed based on these features, and the optimal model was subsequently integrated with clinical variables to establish a combined clinical-radiomics model. Results:For predicting VETC and/or MVI (defined as VM patterns), the combined model achieved area under the curve (AUC) values of 0.857 in the training cohort, 0.761 in the internal validation cohort, and 0.723 in the external validation cohort. Calibration and decision curve analysis (DCA) indicated acceptable calibration performance and potential clinical utility of the combined model. Both pathological VM positivity and model-predicted VM positivity were significantly associated with early recurrence (ER) and shorter disease-free survival (DFS). Conclusion:The clinical-radiomics combined model based on DCE-MRI holds potential value as a noninvasive preoperative approach for evaluating VM patterns and postoperative prognosis in patients with HCC.

Background:Non-Small Cell Lung Cancer (NSCLC) patients with low tumor mutational burden (TMB) showed low sensitive to conventional fractionated radiotherapy in our previous study. This study aimed to evaluate the efficacy and safety of hypofractionated radiotherapy (HFRT) in locally advanced NSCLC patients with low-TMB compared to conventional fractionated radiotherapy (CFRT). Methods:We retrospectively analyzed clinical outcomes of 74 locally advanced NSCLC patients with low-TMB undergoing definitive radiotherapy from January 2017 to July 2023, with 31 patients received HFRT (received radiation doses of >2Gy and ≤5 Gy per fraction) and 43 received CFRT (received radiation doses of 1.8-2 Gy per fraction). Progression-free survival (PFS), overall survival (OS) and objective response rate (ORR) to radiotherapy was analyzed in the two groups. Univariate analysis was performed to assess the impact of clinical characteristics on PFS. We also analyzed PFS in subgroups receiving HFRT or CFRT combined with immunotherapy and chemotherapy. Results:Survival analysis revealed the median PFS of 13 months in the HFRT group was significantly better than the 10 months in the CFRT group (p = 0.024). The 6-month and 12-month PFS rates were 80.6% and 61.3% for the HFRT group, versus 81.4% and 39.5% for the CFRT group, respectively. Median OS was 27 months in the HFRT group and 20 months in the CFRT group (p = 0.079). There were no statistically significant differences in major adverse events between the HFRT and CFRT groups (all p>0.05). In the subgroup receiving combined immunotherapy and chemotherapy, the median PFS was 10 months in the HFRT group and 9 months in the CFRT group (p = 0.092). Conclusion:HFRT was superior to CFRT in prolonging PFS for patients with low-TMB locally advanced NSCLC. It was a safely and effective approach for these patients and was worth further prospective studies with larger sample sizes.

Background: It is crucial to evaluate liver fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD). Digital pathology, an automated method for quantitative fibrosis measurement, provides valuable support to pathologists by providing refined continuous metrics and addressing inter-observer variability. Although non-invasive tests (NITs) have been validated as consistent with manual pathology, the relationship between digital pathology and NITs remains unexplored. Methods: This study included 99 biopsy-proven MASLD patients. Quantitative-fibrosis (Q-Fibrosis) used second-harmonic generation/two-photon excitation fluorescence microscopy (SHG/TPEF) to quantify fibrosis parameters (q-FPs). Correlations between eight NITs and q-FPs were analyzed. Results: Using manual pathology as standard, Q-Fibrosis exhibited excellent diagnostic performance in fibrosis stages assessment with area under the receiver operating characteristic curves (AUCs) ranging from 0.924 to 0.967. In addition, magnetic resonance elastography (MRE) achieved the highest diagnostic accuracy (AUC: 0.781–0.977) among the eight NITs. Furthermore, MRE-assessed liver stiffness measurement (MRE-LSM) showed the strongest correlation with q-FPs, particularly adjusted by string length, string width, and the number of short and thick strings within the portal region. Conclusions: Both MRE and digital pathology demonstrated excellent diagnostic accuracy. MRE-LSM was primarily determined by collagen extent, location and pattern, which provide a new perspective for understanding the relationship between the change in MRE and histological fibrosis reverse.

Background & Aims: Only a minority of patients could benefit from systemic therapy owing to the high heterogeneity of HCC. Therefore, a deeper understanding of the pathogenesis of HCC is essential for precision therapy. Genomic and proteomic studies of HCC have enhanced our understanding of HCC. However, phosphoproteomic characterization of HCC remains poorly understood. Approach & Results: We conducted an in-depth analysis of a clinical cohort of HCC using high-coverage phosphoproteomic. Effective therapeutic targets were validated using liver cancer cell lines and HCC patient-derived xenograft (PDX) mouse models that correspond to the phosphoproteomic subtypes of HCC. Phosphoproteomic analysis classified HCC into three subtypes, A, B, and C, with increasing malignancy and correlation with clinical features, including patient prognosis, tumor staging, serum alpha fetoprotein (AFP) levels, tumor thrombus, and tumor size. Phosphoproteomic subtyping deeply reflected the biological characteristics and clinical features of HCC patients. The profiles of HCC dysregulated kinase activities inferred from the different phosphoproteomic subtypes, consistently identifying increased kinase activity related to cell proliferation. Subtype-C HCC patients showed the most significant dysregulation, indicating a potential therapeutic target. The corresponding drug, bosutinib, demonstrated efficacy in inhibiting the growth of subtype C tumors in liver cancer cell lines and HCC patient-derived xenograft (PDX) mouse models representative of the phosphoproteomic HCC subtypes. Conclusions: Our study provides a comprehensive exploration of the phosphoproteomic landscape of HCC, establishing new subtypes that match clinical features and identifying potential therapeutic targets for the most malignant C subtype.

Introduction: Liver cancer, predominantly hepatocellular carcinoma (HCC), ranks among the deadliest malignancies worldwide, and effective predictive models for early recurrence and poor prognosis are limited. Methods This study retrospectively analyzed 180 HCC patients and explored the prognostic value of tertiary lymphoid structures (TLSs), peripheral blood immune parameters, and clinical factors in HCC. Results The results showed that TLSs could significantly reduce early recurrence rates but that they were not related to late recurrence. The interaction of peripheral blood immune parameters, especially the neutrophil–monocyte ratio (NMR), plays a pivotal role in early recurrence prediction. A novel clinical prediction model was constructed by combining the tumor-node-metastasis (TNM) staging system (8th edition), TLS status, and NMR data, and the results demonstrated substantial predictive accuracy for early HCC recurrence. Conclusions These findings highlight the multifaceted impact of TLSs and peripheral blood immunity on HCC prognosis and provide a valuable tool for personalized patient management, particularly for identifying early recurrence risk.

BACKGROUND & AIMS:Liver fibrosis is an intrinsic wound-healing response to chronic injury and the major cause of liver-related morbidity and mortality worldwide. However, no effective diagnostic or therapeutic strategies are available, owing to its poorly characterized molecular etiology. We aimed to elucidate the mechanisms underlying liver fibrogenesis. METHODS:We performed a quantitative proteomic analysis of clinical fibrotic liver samples to identify dysregulated proteins. Further analyses were performed on the sera of 164 patients with liver fibrosis. Two fibrosis mouse models and several biochemical experiments were used to elucidate liver fibrogenesis. RESULTS:We identified cathepsin S (CTSS) up-regulation as a central node for extracellular matrix remodeling in the human fibrotic liver by proteomic screening. Increased serum CTSS levels efficiently predicted liver fibrosis, even at an early stage. Secreted CTSS cleaved collagen 18A1 at its C-terminus, releasing endostatin peptide, which directly bound to and activated hepatic stellate cells via integrin α5β1 signaling, whereas genetic ablation of Ctss remarkably suppressed liver fibrogenesis via endostatin reduction in vivo. Further studies identified macrophages as the main source of hepatic CTSS, and splenectomy effectively attenuated macrophage infiltration and CTSS expression in the fibrotic liver. Pharmacologic inhibition of CTSS ameliorated liver fibrosis progression in the mouse models. CONCLUSIONS:CTSS functions as a novel profibrotic factor by remodeling extracellular matrix proteins and may represent a promising target for the diagnosis and treatment of liver fibrosis.

Background The molecular subtypes of hepatocellular carcinoma (HCC) with the worst prognosis are characterized by immune disorders dominated by myeloid cell infiltration, but how to accurately screen these patients for accurate diagnosis and treatment is not clear. In this study, based on HCC proteomic data from two independent centers, we found that Myeloid cell nuclear differentiation antigen (MNDA) could be used as a marker of myeloid lymphocyte especially M2 myeloid cell infiltration, and further analyzed the mechanism and potential clinical value of MNDA in promoting poor prognosis of HCC. Methods We investigated the proteomic molecular subtype of HCC and discovered a significant elevation of the myeloid cell nuclear differentiation antigen (MNDA) in the most aggressive subtype. The association between MNDA and the prognosis of HCC was examined using multi-omics data. Gene expression analysis, multiple immunofluorescence and western blot were used for detecting the localization of MNDA in HCC. Cellular co-culture experiments were conducted for exploring the functions of MNDA in vitro while intravenous injections were used in in vivo study. To elucidate its oncogenic mechanisms, we used RNA-seq combined with mass spectrometry analysis and cellular experiments to identify the related signaling pathway. Results MNDA demonstrated significantly elevated expression in the most aggressive subtype of HCC and exhibited a positively correlation with M2 infiltration and HCC metastasis. Moreover, MNDA also functioned as an independent prognostic predictor and has a good synergistic effect with existing prognostic clinical indicators (such as AFP, tumor size, MVI, etc.). We also found that MNDA was primarily expressed in tumor M2 macrophages and contributed to the enhancement of M2 macrophage polarization by upregulating the expression of the enhancers of M2 polarization. Furthermore, MNDA knockdown inhibited the secretion of M2 macrophage-derived pro-metastasis proteins via the exosome pathway to suppress HCC metastasis both in vivo and in vitro. Conclusions MNDA exerts a protumor role by promoting M2 macrophages polarization and HCC metastasis, and can serve as a potential biomarker and therapeutic target for HCC.

目的 观察和总结移植肝中央静脉周围炎型排斥反应的临床和组织病理学特点,并结合文献复习进一步明确其临床病理学意义.方法 回顾性分析4例肝移植受者(移植后均称为"受者")的5次移植肝穿刺活检组织标本,并收集其临床资料、实验室检查和随访数据.所有标本均经HE染色、Masson三色染色、Gordon-Sweets网状纤维染色和D-PAS染色的特殊染色;同时进行了包括HBsAg、HBcAg、CK7、MUM1、IgG4、CD3、CD20、CD4、CD8和C4d在内的多种免疫组织化学染色.结果 4例受者原发病分别为酒精性脂肪性肝硬化(n=1),肝细胞癌合并肝豆状核变性(n=1),原发性胆汁性胆管炎肝硬化(n=1),慢性乙型病毒性肝炎肝硬化(n=1).所有受者移植肝活检组织中均观察到肝小叶中央静脉周围肝细胞的急性坏死,1例单纯中央静脉周围炎型的受者发病早于其它3例伴汇管区排斥的受者.免疫组化上,浸润炎细胞主要为CD8+T淋巴细胞和MUM1+浆细胞,C4d染色呈无或低表达.4例受者确诊后均接受了增加免疫抑制剂剂量和类固醇激素冲击治疗,治愈1例,好转1例,复发1例,死亡1例.结论 中央静脉周围炎型排斥反应是CD8+T细胞介导的细胞免疫为主的排斥反应,且可能与排斥反应复发有关,需要临床更积极的治疗.术前机体免疫状态与中央静脉周围炎型急性排斥反应发生有关.

Hepatocellular carcinoma (HCC) takes the predominant malignancy of hepatocytes with bleak outcomes owing to high heterogeneity among patients. Personalized treatments based on molecular profiles will better improve patients' prognosis. Lysozyme (LYZ), a secretory protein with antibacterial function generally expressed in monocytes/macrophages, has been observed for the prognostic implications in different types of tumors. However, studies about the explicit applicative scenarios and mechanisms for tumor progression are still quite limited, especially for HCC. Here, based on the proteomic molecular classification data of early-stage HCC, we revealed that the LYZ level was elevated significantly in the most malignant HCC subtype and could serve as an independent prognostic predictor for HCC patients. Molecular profiles of LYZ-high HCCs were typical of those for the most malignant HCC subtype, with impaired metabolism, along with promoted proliferation and metastasis characteristics. Further studies demonstrated that LYZ tended to be aberrantly expressed in poorly differentiated HCC cells, which was regulated by STAT3 activation. LYZ promoted HCC proliferation and migration in both autocrine and paracrine manners independent of the muramidase activity through the activation of downstream protumoral signaling pathways via cell surface GRP78. Subcutaneous and orthotopic xenograft tumor models indicated that targeting LYZ inhibited HCC growth markedly in NOD/SCID mice. These results propose LYZ as a prognostic biomarker and therapeutic target for the subclass of HCC with an aggressive phenotype.

目的 总结AIDS合并肝细胞癌(hepatocellular carcinoma,HCC)病例的临床病理特征.方法 回顾性分析2009年1月至2021年12月首都医科大学附属北京佑安医院诊治的7例AIDS合并HCC患者的临床和病理资料,总结其临床病理特点,并与同期HIV阴性的HCC患者(n=33)做对比分析.结果 7例AIDS合并HCC中,3例共感染HBV,3例共感染HCV,1例合并脂肪性肝病.与HIV阴性HCC患者比较,HIV阳性组共感染HCV多见(P=0.022),肿瘤灶多发(P=0.003),门脉分支侵犯多见(P=0.011);另外,HIV阳性HCC肿瘤低分化,免疫组化高表达GPC3、Ki-67和P53(P=0.024、0.016、<0.001).结论 AIDS合并HCC患者多共感染HBV或HCV,病理分级高,肿瘤多灶和门脉侵犯常见.对于共感染患者应同时重视基础肝病和抗HIV治疗,规范复查、定期监测.

Background: Postoperative brain edema is a common complication in patients with high-grade glioma after craniotomy. Both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are applied to diagnose brain edema. Usually, MRI is considered to be better than CT for identifying brain edema. However, MRI is not generally applied in diagnosing acute cerebral edema in the early postoperative stage. Whether CT is reliable in detecting postoperative brain edema in the early stage is unknown. Objective: This study aimed at investigating the agreement and correlation between CT and MRI for measuring early postoperative brain edema. Methods: Patients with high-grade glioma who underwent craniotomy in the Beijing Tiantan hospital from January 2017 to October 2018 were retrospectively analyzed. The region of interest and operative cavity were manually outlined, and the volume of postoperative brain edema was measured on CT and MRI. Pearson correlation testing and the intraclass correlation coefficient (ICC) were used to evaluate the association and agreement between CT and MRI for detecting the volume of postoperative brain edema. Results: Twenty patients were included in this study. The interrater agreement was perfect for detecting brain edema (CT: κ=1, ICC=0.977, P<0.001; MRI: κ=0.866, ICC=0.963, P<0.001). A significant positive correlation and excellent consistency between CT and MRI were found for measuring the volume of brain edema (rater 1: r=0.97, ICC=0.934, P<0.001; rater 2: r=0.97, ICC=0.957, P<0.001). Conclusion: Substantial comparability between CT and MRI is demonstrated for detecting postoperative brain edema. It is reliable to use CT for measuring brain edema volume in the early stage after surgery.

目的 回顾性分析肝窦阻塞综合征(SOS)的临床及影像学特点.方法 本研究对15例SOS的临床症状、实验室检查及影像学表现进行统计分析.13例患者行多排CT(MDCT)检查;3例患者进行了MDCT和MRI检查.回顾性研究得到了医院伦理委员会的批准.结果 本组病例最常见的肝功能异常指标为总胆红素和直接胆红素、γ-谷氨酰转移酶和凝血酶原时间.增强后肝实质出现三种形态的强化方式:弥漫性分布3例,斑片状强化在肝内呈弥漫分布,主要出现在静脉期及延迟期,延迟期强化不均匀,其中1例呈弥漫的"羽毛"状强化表现;肝主静脉周围分布10例,斑片状强化呈融合状,分布在肝脏3支大静脉周围,呈"爪样"或"三叶草"状,同时外周可见散在的不规则斑片状强化,延迟期强化不均匀;肝脏外周强化为主2例,斑片状强化主要分布在肝脏周围,中央部仅见少量散在强化.其他伴随影像包括肝脏增大、胆囊壁增厚、腹腔积液、侧支循环.结论 结合肝内特异性分布的斑片状强化和异常的肝功能检查,可以提高SOS的准确诊断.

患者 女,61岁,因"间断呕吐、乏力1年余,加重3d"于2021年6月18日收入首都医科大学附属北京佑安医院中西医结合中心.1年余前无明显诱因间断出现恶心呕吐,为胃内容物,乏力,无发热、腹痛、腹泻等不适,症状持续数小时至1d,可自行好转.曾怀疑心脏病变,于外院行冠状动脉造影未见明显异常,被诊断为不稳定型心绞痛,并给予药物治疗(具体不详),但仍有间断呕吐发作.

Objective To analyze the clinical manifestations and pathological features of congenital non-hemolytic jaundice, and to explore the guiding significance of TCM syndromes and liver biopsy pathology for clinical diagnosis.Methods Thirty-two patients with non-viral and non-hemolytic jaundice with abnormal serum bilirubin as the main manifestation who were admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine and Beijing You’an Hospital from April 2014 to October 2019 were collected. The patients were divided into indirect bilirubin（IBIL） elevated group and direct bilirubin（DBIL） elevated group, and their pathological features, TCM syndromes, liver function and gene changes were retrospectively analyzed.Results IBIL elevated group: Crigler-Najjar syndrome type Ⅱ（CNS-Ⅱ） serum IBIL was higher than Gilbert syndrome（P＜0.05）, 2 out of 7 cases of CNS-Ⅱ developed fibrosis, and UGT1 A1 gene detection revealed new Base mutation point c.1471 G＞A. DBIL elevated group: Dubin-Johnson syndrome-specific histological manifestations were brown-black pigment particles in the cytoplasm of liver cells, and progressive familial intrahepatic cholestasis type 2（PFIC2） histological manifestations were obvious cholestasis and bridging fibrosis. In TCM syndromes, the proportion of Yanghuang in the elevated IBIL group and the elevated DBIL group was 44.44% and 40.00%, respectively, and the proportion of Yinhuang in the two groups was 55.56% and 60.00%, respectively. The proportion of Yinhuang in the two groups was more than that of Yanghuang, but there was no statistical difference between the groups（P＞0.05）.Conclusion Ultrasound-guided percutaneous liver biopsy is an important method for diagnosing specific types of congenital non-hemolytic jaundice. The pathological results of liver tissue are of great significance for diagnosis. In terms of TCM syndromes, the proportion of Yinhuang is more than that of Yanghuang, which has certain guiding significance for TCM treatment.

目的 探讨2种磁共振模态下氢质子密度脂肪分数(1H proton density fat fraction,PDFF)评价非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者脂肪变定量诊断和分级价值.方法 单中心、前瞻性入组2015年3月-2020年1月之间首都医科大学附属北京佑安医院脂肪肝门诊符合NAFLD诊断标准患者173例,进行MRI-PDFF、MRS-PDFF检查,其中55例患者行肝脏病理学检查.依据肝脏病理脂肪含量将肝脂肪变分为S0～S3共4级,结合脂肪变、小叶炎症和气球样变进行NAFLD活动度评分(NAFLD activity score,NAS).2种PDFF分别与身体质量指数、肝脏生化、血脂、受控衰减指数(controlled attenuation parameter,CAP)进行相关性分析.应用ROC曲线评估MRI-PDFF和MRS-PDFF对NAS的预测效能.结果 173例患者测得MRS-PDFF和MRI-PDFF范围分别为0.55％～45.36％,2.85％～68.90％.PDFF水平与ALT、LDL-C、TG、TC、尿酸水平呈正相关,与HDL-C水平则呈现负相关,(P均＜0.05)与APRI指数和FIB-4指数未显示相关.(P均＜ 0.05)55例肝穿病理结果提示脂肪变分级S1级20例,S2级16例,S3级19例,无S0级脂肪变患者.NAS评分0～3分14例,4分9例,＞4分32例,MRS-PDFF和MRI-PDFF与肝脂肪变分级呈线性相关.MRI-PDFF和MRS-PDFF用于预测诊断非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)(NAS＞4分)AUC分别为0.884和0.866.结论 2种模态PDFF均可用来诊断肝脏脂肪变程度,预测NASH具有价值,且2者诊断效能相近.

Objective:To investigate the effect of music therapy on depression and anxiety status in maintenance hemodialysis (MHD) patients.Methods:The study was a single-center, open, and randomized controlled trial. The patients with regular hemodialysis of more than 3 months and the Beck depression inventory (BDI) scores ≥10 in China Rehabilitation Research Center from March 1 to April 24, 2021 were selected. Random envelope method was used to divide the enrolled patients into music group and control group. The music therapist selected the treatment music and established the preset repertoire library in the music therapy programs, and the total duration of music was about 2 hours. The music group received listening music therapy of 1.0 to 1.5 hours 3 times a week during routine hemodialysis treatment, while the control group only received routine hemodialysis treatment. All the enrolled patients completed treatment of 8 weeks. The BDI and state-trait anxiety inventory (STAI) were used to assess the psychological status of MHD patients before and after treatment.Results:A total of 64 MHD patients were enrolled, aged (59.19±11.61) years old, among whom 38 patients (59.38%) were males. There were 32 patients in the music group and 32 patients in the control group. BDI scores [2 weeks (9.81±6.25) scores, 8 weeks (8.30±8.49) scores, F=49.75, P<0.001] and STAI scores [2 weeks (49.30±7.27) scores, 8 weeks (47.07±7.39) scores, F=13.09, P<0.001] in the music group decreased significantly after 2 weeks of treatment and remained stable for 8 weeks. After treatment, the BDI scores in the music group were significantly lower than those in the control group [2 weeks (9.81±6.25) scores vs (14.13±7.33) scores, t=-2.53, P=0.014; 8 weeks (8.30±8.49) scores vs (12.56±5.67) scores, t=-2.34, P=0.023], and STAI scores in the music group were significantly lower than those in the control group [2 weeks (49.30±7.27) scores vs (54.00±8.36) scores, t=-2.06, P=0.043; 8 weeks (47.07±7.39) scores vs (51.34±8.87) scores, t=-2.06, P=0.044]. Conclusion:Music therapy can improve depression and anxiety of MHD patients quickly and effectively.

目的 探讨肝淀粉样变与肝窦阻塞综合征(SOS)的临床和影像学鉴别点.方法 选取病理诊断的7例肝淀粉样变性和15例肝窦阻塞综合征,并对两组患者的临床症状、实验室检查和影像表现进行统计学分析来确定鉴别点.结果 两组患者的年龄、性别构成和临床症状无统计学差异.实验室检查:1)两组患者在甲胎蛋白、异常凝血酶原、CA-199、CEA间无统计学差异;2)淀粉样变患者的血小板升高率(85.7％对6.7％,P＜0.001)和蛋白尿发生率(42.9％对0％,P=0.02)高于SOS,差异有统计学意义;3)总胆红素升高率(42.9％对100％,P＜0.001)和凝血酶原时间异常率(57.1％对100％,P=0.02)低于SOS,差异有统计学意义.肝淀粉样变与SOS间差异有统计学意义的影像表现包括:脾脏增大(14.3％对80％,P=0.01)、侧支循环(0％对46.7％,P=0.04)、肝静脉狭窄或栓子(0％对80％,P＜0.001)、三叶草或爪状强化(0％对46.7％,P=0.04),皆P＜0.05.结论 肝淀粉样变与肝窦阻塞综合征的实验室检查及影像表现存在一定的差异性,鉴别应两者相结合做出准确的诊断.