Purpose:To investigate the effect of dexmedetomidine combined with stellate ganglion block (SGB) on postoperative sleep quality in elderly patients undergoing hip arthroplasty. Methods:126 patients aged ≥ 65 years undergoing hip arthroplasty were allocated to three groups: control (Group C), dexmedetomidine (Group D), and dexmedetomidine plus SGB (Group DS). Group D received dexmedetomidine (loading dose 0.5µg/kg over 10 min, then 0.2µg/kg/h infusion until surgery end). Group DS received the same regimen plus SGB at C6 with 5mL of 0.375% ropivacaine. The primary outcome was postoperative sleep quality assessed by the Richards-Campbell Sleep Questionnaire (RCSQ) on the first three postoperative nights. Secondary outcomes included postoperative visual analogue scale (VAS) scores, number of patient-controlled analgesia (PCA) and sleep quality using Pittsburgh Sleep Quality Index (PSQI) scores at one month postoperatively. Results:On the first three postoperative nights (POD 1-3), the RCSQ scores were significantly higher in Groups D and DS compared with Group C (P < 0.001). Specifically, Group D had significantly lower RCSQ scores than Group DS at each postoperative time point (POD 1: mean difference = -6.912, 95% CI: -9.328 to -3.385; POD 2: mean difference = -8.425, 95% CI: -11.464 to -5.386; POD 3: mean difference -8.236, 95% CI: -12.144 to -5.406; P < 0.001). VAS scores on POD 1 and POD 2 were significantly lower in Group DS than in Groups D and C (P < 0.001). No significant differences in PSQI scores were found among the three groups at one month postoperatively (P > 0.05). Conclusion:In elderly patients undergoing hip arthroplasty, dexmedetomidine combined with SGB significantly improved subjective sleep quality during the first three postoperative nights, although this beneficial effect was not maintained at one month postoperatively.

Background:The probability of children experiencing emergence agitation (EA) in post-anesthesia care unit (PACU) undergoing adenoidectomy and tonsillectomy is up to 80%. This study investigated the effects of pre-anesthesia sedation of esketamine at 0mg/kg (Control group), 0.1mg/kg, 0.3mg/kg and 0.5mg/kg on EA in children. Methods:164 children aged 3-10 years, with American Society of Anesthesiologists (ASA) class I-II were included. Children were randomly divided into groups k0, k1, k3 and k5, and the intravenous anesthesia doses of esketamine were 0 mg/kg, 0.1 mg/kg, 0.3 mg/kg and 0.5 mg/kg, respectively. EA occurrence was assessed using the Pediatric Anesthesia Emergence Delirium Scale (PAED) and Watcha scale. Anesthesia time, operation time, tracheal catheter removal time, PACU stay time, hospital stay, postoperative face, legs, activity, crying, consolability scale (FLACC), analgesia needs, heart rate (HR), mean arterial pressure (MAP) at different times, and postoperative complications were also recorded in the four groups. Results:There were significant statistical differences in PAED scores [13.00 (7.75), 10.00 (6.00), 9.00 (4.00), 9.00 (2.00), p=0.002], Watcha scores [3.00 (1.00), 3.00 (1.00), 2.00 (1.00), 2.00 (1.00), p<0.001], occurrence of postoperative EA [25 (62.5%), 21 (56.8.8%), 10 (25.6%), 7 (18.9%), p<0.001], and severe postoperative EA [20 (50.0%), 11 (29.7%), 4 (10.3%), 3 (8.1%), p<0.001] among the groups k0, k1, k3 and k5. There were no significant differences in operation time, duration of anesthesia, postoperative analgesia and antiemetic needs, and residence time in the PACU among the 4 groups (p>0.05). The 0.5 mg/kg group significantly increased the time required for tracheal catheter removal (p<0.05). The differences in HR and MAP among the four groups were statistically significant (p<0.05). Conclusion:Intravenous administration of esketamine at dose of 0mg/kg, 0.1mg/kg, 0.3mg/kg, and 0.5mg/kg before anesthesia induction leads to differences in the PAED score and incidence of EA of children after adenoidectomy and tonsillectomy. 0.3 mg/kg esketamine appears to offer the optimal balance between efficacy and safety in reducing EA. Trial Registration Number:ChiCTR2300075038. The trial is publicly available and is registered at www.chictr.org.cn on August 23, 2023.

BackgroundAtrial fibrillation (AF) is a prevalent cardiac arrhythmia, with ventricular rate control being a critical therapeutic target. However, the optimal range for ventricular rate control remains unclear. Additionally, the relationship between different levels of ventricular rate control and cardiac remodeling in patients with atrial fibrillation remains unclear.ObjectiveThis study aims to explore the relationship between different levels of heart rate control and cardiac remodeling in patients with early persistent atrial fibrillation.MethodsA bi-center prospective cohort study was conducted, enrolling patients with newly diagnosed persistent AF and rapid ventricular rates, yet with a normal cardiac size, from March 2019–May 2020 at the people's hospital of Chongqing Hechuan and the First Affiliated Hospital of Zhengzhou University. Patients were divided into four groups based on their average ventricular rate levels from 24 h Holter monitoring: Group I (40 ≤ average rate < 60 bpm), Group II (60 ≤ average rate <80 bpm), Group III (80 ≤ average rate < 100 bpm), and Group IV (average rate ≥ 100 bpm).The study tracked changes in left atrial diameter (LAD), left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF), and the severity of mitral regurgitation over one year.ResultsA total of 764 patients were enrolled. We found that there were no significant differences in cardiac remodeling among the groups of patients before the observation. However, after one-year follow-up observation, there were significant differences in the degree of cardiac remodeling among the groups (p < 0.001). Specifically, the severity of cardiac remodeling, including LVEDD, LAD, LVEF, and mitral regurgitation, showed the following trend: Group II < Group I < Group III < Group IV. Further regression analysis indicated that body mass index (BMI) might be related to changes in LAD. Additionally, the use of digoxin could affect changes in left ventricular ejection fraction. At the same time, the use of diltiazem, bisoprolol, as well as factors like hypertension, coronary artery disease, smoking, diabetes, and chronic obstructive pulmonary disease, might be closely associated with the worsening of mitral regurgitation.ConclusionThis study shows that in early persistent AF patients, different levels of heart rate control are related to varying degrees of cardiac remodeling. These results suggest that maintaining an average ventricular rate within the range of 60–80 beats per minute may be associated with milder cardiac remodeling. On the other hand, an average heart rate greater than 100 bpm appears to be associated with the most severe cardiac remodeling.Registration NumberChiCTR2400079978; Registered 17 January 2024–Retrospectively registered: https://www.chictr.org.cn/showproj.html?proj=198684.

BACKGROUND:Dexmedetomidine is commonly used in hysteroscopy surgery due to its analgesia and sedation without respiratory depression. Many studies have shown that dexmedetomidine can reduce the consumption of sevoflurane. However, the optimal end-tidal concentration of sevoflurane when it is co-administered with dexmedetomidine has not been established. The primary purpose of this study was to investigate the minimal alveolar concentration (MAC) of sevoflurane for cervical dilatation combined with different doses of dexmedetomidine in patients with hysteroscopy surgery.METHODS:One-hundred patients undergoing hysteroscopy surgery were enrolled in this clinical trial. All the patients were randomly assigned into four groups (C, D1 , D2 , D3 ) and received a loading dose of dexmedetomidine (0, 0.6, 0.8 and 1.0 μg/kg) over 10 min before anaesthesia induction, respectively. Anaesthesia was induced in each patient with 5% sevoflurane in 100% oxygen via a facemask. A laryngeal mask (LMA) was inserted when the patient had lost consciousness and the BIS value decreased below 40. The response to cervical dilatation stimulus (movement vs non-movement) by the insert of hysteroscope was recorded. The MAC of sevoflurane was measured by up and down sequential method of Dixon and Mood and centred isotonic regression analysis.RESULTS:The calculated MAC of sevoflurane using up-and-down method of Dixon and Mood in patients with hysteroscopy surgery was (1.90 ± 0.13)%, (1.23 ± 0.16)%, (1.03 ± 0.10)% and (0.93 ± 0.08)% in groups C, D1 , D2 and D3 , respectively.CONCLUSIONS:The administration of dexmedetomidine can significantly decrease the MAC of sevoflurane for hysteroscopy surgery. However, a ceiling effect of the reduction was observed when the dose of dexmedetomidine was higher than 0.8 μg/kg.

目的 观察小儿行腹腔镜手术时,靶控输注不同浓度瑞芬太尼对气腹刺激时七氟烷抑制肾上腺素能反应的最低肺泡有效浓度(MACBAR)的影响.方法 选择拟行腹腔镜疝修补术的3～7岁患儿75例,分为3组,瑞芬太尼靶浓度分别为0 ng/mL(R0组)、1 ng/mL(R1组)及2 ng/mL(R2组).采用序贯法测定各组七氟烷MACBAR.结果 R0、R1及R23组七氟烷MACBAR分别为(3.29±0.17)％、(2.12±0.10)％、(1.29±0.11)％,差异有统计学意义(P＜0.05).结论 不同瑞芬太尼血浆靶浓度可不同程度降低小儿腹腔镜手术时七氟烷的MACBAR.

What is known and objective Remifentanil can effectively decrease the sevoflurane concentration to block sympathetic adrenergic response to CO2 pneumoperitoneum stimulus,and liver dysfunction will significantly reduce the MAC(BAR) (minimum alveolar concentration for blocking adrenergic response) of sevoflurane. However, the effects of different remifentanil concentrations on the MAC(BAR) of sevoflurane in patients with liver dysfunction are unclear. The aim of this study was to observe the effects of different remifentanil concentrations by intravenous target-controlled infusion on the MAC(BAR) of sevoflurane in patients with grade B liver dysfunction under carbon dioxide pneumoperitoneum stimulus. Methods Seventy-five patients with grade B liver dysfunction undergoing elective laparoscopic surgery were selected, and randomly divided into three groups with remifentanil plasma target concentrations of 0 (group R-0), 1 (group R-1) and 2 (group R-2) ng/ml. Anaesthesia was induced by intravenous injection of propofol 2-3 mg/kg, remifentanil 2 mu g/kg and cisatracurium 0.15 mg/kg. All groups were inhaled different concentrations of sevoflurane. The determination of sevoflurane MAC(BAR) in each group was used a method of sequential-allocation technique, and venous blood samples were taken before and after the creation of carbon dioxide pneumoperitoneum to determine plasma adrenaline and noradrenaline concentrations. Results and discussions The MAC(BAR) of sevoflurane in groups R-0, R-1 and R-2 was 4.83%, 3.00% and 2.10%, respectively. The MAC(BAR) of sevoflurane was significantly difference among the three groups. When a similar effect of MAC(BAR) had achieved in each group, no significant differences were found in the changes of plasma adrenaline and noradrenaline concentrations before and after the creation of pneumoperitoneum. What is new and conclusion Target-controlled infusion of different concentrations of remifentanil can reduce sevoflurane MAC(BAR) during pneumoperitoneum stimulation in patients with liver dysfunction in some degree. However, the changes of plasma adrenaline and noradrenaline concentrations are consistent in the three groups when patient's stress response was inhibited at the same degree.

To investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy. Seventy-five children with 3-7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R0, group R1, and group R2 according to different remifentanil plasma target concentration (0, 1, and 2 ngml-1), respectively. The MACBAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points. A total of 52 child patients were used among the anticipated 75 patients. In groups R0, R1, and R2, the MACBAR of sevoflurane was (3.29 ± 0.17) %, (2.12 ± 0.10) % and (1.29 ± 0.11) %, respectively, and a significant difference was found among the three groups (P<0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences. Remifentanil by target-controlled infusion can effectively reduce the MACBAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MACBAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations. The trial was registered at http://www.chictr.org.cn ( ChiCTR1800019393 , 8, Nov, 2018).

吸入麻醉药MACBAR(minimal alveolar concentration of blocking adrengic response)是指行吸入麻醉时,当50％的患者血流动力学变化和肾上腺素能反应受到抑制时,该吸入麻醉药的肺泡气内麻醉药浓度.研究表明吸入麻醉药的MACBAR受不同药物配伍,患者自身生理及病理、年龄、体温、体内酸碱平衡、实验者测定方法、并存疾病等多种因素的影响,本文就临床麻醉工作中常用药物对吸入麻醉药七氟烷MACBAR的影响作一综述.

An amendment to this paper has been published and can be accessed via the original article.

目的 比较不同剂量地佐辛对腹腔镜气腹刺激时七氟烷抑制患者肾上腺素能反应的最低肺泡有效浓度的影响.方法 纳入腹腔镜择期手术患者100例,随机分为四组(D0,D1,D2,D3)各25例.麻醉诱导前,D0组静脉推注10 ml生理盐水,D,～D3组分别静推含0.1、0.2及0.3 mg/kg地佐辛的生理盐水稀释液10 ml.麻醉诱导时,四组患者均静脉推注丙泊酚2～4 mg/kg及瑞芬太尼1 μg/kg,待意识消失后静注罗库溴铵0.6mg/kg完成气管插管.调节七氟烷吸入浓度分别使四组患者呼末七氟烷浓度迅速达到其预设值,维持稳定20 min后开始建立气腹,观察并记录气腹刺激前后血压及心率变化,采用序贯法测定七氟烷MACBAR,并测定气腹刺激前后血浆肾上腺素及去甲肾上腺素浓度.结果 D0组七氟烷MACBAR(4.78 ±0.19)％明显高于D,组(3.85 ±0.16)％、D2组(3.60 ± 0.15)％和D3组(3.59 ±0.14)％,差异有统计学意义(P＜0.05),但D2组和D3组差异无统计学意义(P＞0.05).四组患者气腹刺激前后血浆肾上腺素及去甲肾上腺素浓度变化,差异无统计学意义(P＞0.05).结论 地佐辛可显著降低七氟烷的MACBAR,但当单次静脉注射剂量大于0.2 mg/kg时,对七氟烷MACBAR降低的影响甚微,且同等程度应激反应被抑制时不同剂量地佐辛并不会对血中肾上腺素及去甲肾上腺素的变化水平产生影响.

目的 观察CO2气腹刺激时正常肝功能与B级肝功能患者的七氟烷MACBAR(抑制50％患者血流动力学反应和肾上腺素能反应的肺泡气麻醉药浓度)是否存在差异.方法 选择肝胆外科需行择期腹腔镜手术的正常肝功能和B级肝功能患者各25例,两组麻醉诱导均静脉推注丙泊酚2～4mg/kg、瑞芬太尼2μg/kg及顺式阿曲库铵0.15mg/kg.气管插管后机械通气,两组均吸入预设浓度的七氟烷,呼末七氟烷浓度维持稳定20min后建立气腹,观察气腹刺激前后血流动力学变化,采用序贯法测定七氟烷MACBAR,并测定气腹刺激前后血浆肾上腺素及去甲肾上腺素浓度.结果 正常肝功能组七氟烷MACBAR(5.33±0.21)％明显高于B级肝功能组(4.83±0.14)％,差异有统计学意义(P<0.05),两组患者气腹刺激前后肾上腺素及去甲肾上腺素浓度变化差异无统计学意义(P>0.05).结论 肝功能障碍将会明显降低七氟烷的MAC BAR,但相同程度抑制应激反应时肝功能状态并不影响血中肾上腺素和去甲肾上腺素的变化水平.

RATIONALE AND OBJECTIVES:As an extension of the conventional diffusion weighted imaging, diffusion kurtosis imaging (DKI) is based on the non-Gaussian diffusion model that can inherently account for restricted water diffusion within the complex microstructure of most tissues. This study aimed to investigate association of liver DKI derived parameter with stage of liver fibrosis.MATERIALS AND METHODS:Fifty-six healthy New Zealand white rabbits were enrolled into this study, among which 48 rabbits were randomly given carbon tetrachloride to model liver fibrosis, and 8 rabbits treated with normal saline served as control subjects. All rabbits underwent liver DKI followed by biopsy to stage fibrosis (stages F0-F4) on 6th, 8th, 10th, and 12th weekends after initiation of modeling fibrosis. Mean kurtosis (MK), fractional anisotropy (FA), and mean diffusion (MD) were derived from DKI data. Statistical analysis was to evaluate association of DKI derived parameter with stage of fibrosis.RESULTS:FA (r = 0.512) and MK (r = 0.567) increased, and MD (r = -0.574) decreased with increasing stage of fibrosis from F0 to F4 (all p values < 0.05). Significant differences were found in all parameters between F0 and F3 or F4, F1 and F4, F0 and F1-4, and F0-1 and F2-4 (all p values < 0.05). FA and MD could distinguish between F0 from F2, MD, and MK could distinguish F1 from F3, F0-2 from F3-4, and F1-2 from F3-4, and MK and FA could distinguish F2 from F4, and F0-3 from F4 (all p values < 0.05). According to receiver operating characteristic analysis, MK could best predict stage ≥F1, ≥F2, ≥F3, and F4, and discriminate F1-2 from F3-4 with areas under receiver operating characteristic curve of 0.766-0.930.CONCLUSION:DKI derived parameters can help stage fibrosis.

Objective: To investigate whether the value of T2 and magnitude images of ESWAN (enhanced T2 weight angiography) and the serum ferritin could determine liver fibrosis and evaluate the liver fibrosis stage. Materials and Methods: Sixty four new zealand white rabbits in this study, eight rabbits were as normal control group and fifty six rabbits were used to model liver fibrosis with CCL4 by intraperitoneal injection. The rabbits underwent MRI scan on 6th, 8th, 10th and 12th week after beginning of modeling the liver fibrosis. The values of T2 and magnitude images were obtained and got the liver METAVIR stage, and acquired the value of serum ferritin by ELISA. Results: The values of T2 and magnitude were decreased with increasing stage of fibrosis (r=-0.588, -0.388 respectively; all P<0.05) while the value of serum ferritin was increased (r=0.409, P<0.05). The value of T2 could distinguish normal group from F2, F3 and F4 respectively, F1 from F4, F1 from F2-4 (all P<0.05), and the AUC≥0.74. The value of magnitude imagine could distinguish the normal group from F4, F1 from F4 and F1-3 from F4 (all P<0.05), and the AUC≥0.822. The value of serum ferritin could differentiate normal group from F3, F4 respectively (all P<0.05), and the AUC≥0.873. Conclusions: The value of T2and magnitude and serum ferritin could quantificationally determine the presence and the severity of fibrosis.

ObjectiveTo determine whether T2∗ value of liver or that of spleen is better associated with the presence and Child–Pugh class of hepatitis B related cirrhosis.Materials and methodsFifty-nine cirrhotic patients with hepatitis B and 21 healthy participants were enrolled in this study and underwent 3.0-T magnetic resonance imaging with T2∗-weighted sequence. Mean T2∗ values of liver and spleen were calculated. Statistical analysis was performed to compare the association of T2∗ value of liver and that of spleen with cirrhosis and its Child–Pugh class.ResultsT2∗ values of liver and spleen might be indicators to discriminate cirrhotic patients from healthy individuals (all P < 0.05) with areas under receiver operating characteristic curve (AUCs) of 0.755 versus 0.719. T2∗ values of liver and spleen decreased with increasing Child–Pugh class of cirrhosis (r = −0.507 vs. −0.435, all P < 0.05). T2∗ value of liver could distinguish Child–Pugh class A from C and A-B from C (P = 0.016 and 0.011) with AUCs of 0.735 and 0.710, respectively; and that of spleen could distinguish class A-B from C (P = 0.046) with an AUC of 0.664.ConclusionT2∗ value of liver is better associated with cirrhosis and its Child–Pugh class than are those of the spleen.

Purpose To investigate whether liver lobe based T2* values measured on gradient recalled echo T2*-weighted imaging are associated with the presence and Child-Pugh class of hepatitis B-related cirrhosis. Methods Fifty-six patients with hepatitis B-related cirrhosis and 23 healthy control individuals were enrolled in this study and underwent upper abdominal T2*-weighted magnetic resonance imaging. T2* values of the left lateral lobe (LLL), left medial lobe (LML), right lobe (RL) and caudate lobe (CL) were measured on T2*-weighted imaging. Statistical analyses were performed to determine the association between liver lobe based T2* values and the presence and Child-Pugh class of cirrhosis. Results The T2* values of the LLL, LML and RL decreased with the progression of cirrhosis from Child-Pugh class A to C (r = -0.231, -0.223, and -0.395, respectively; all P < 0.05), except that of the CL (r = -0.181, P > 0.05). To a certain extent, Mann-Whitney U tests with Bonferroni correction for multigroup comparisons showed that the T2* values of the LLL, LML and RL could distinguish cirrhotic liver from healthy liver (all P < 0.05), whereas the T2* values of the CL could not (P > 0.05). Receiver operating characteristic analysis demonstrated that the T2* value of the RL could best distinguish cirrhosis from healthy liver, with an area under the receiver operating characteristic curve (AUC) of 0.713 among T2* values of the liver lobes, and that only the T2* value of the RL could distinguish Child-Pugh class C from A-B, with an AUC of 0.697 (all P < 0.05). Conclusion The T2* value of the RL can be associated with the presence and Child-Pugh class of hepatitis B-related cirrhosis.

OBJECTIVE:To determine the associations of liver lobe-based magnetic resonance diffusion-weighted imaging findings using multiple b values with the presence and Child-Pugh class of cirrhosis in patients with hepatitis B. METHODS:Seventy-four cirrhotic patients with hepatitis B and 25 healthy volunteers underwent diffusion-weighted imaging using b values of 0, 500, 800 and 1000 sec/mm2. The apparent diffusion coefficients of individual liver lobes for b(0,500), b(0,800) and b(0,1000) were derived from the signal intensity averaged across images obtained using b values of 0 and 500 sec/mm2, 0 and 800 sec/mm2, or 0 and 1000 sec/mm2, respectively, and were statistically analyzed to evaluate cirrhosis. RESULTS:The apparent diffusion coefficients for b(0,500), b(0,800) and b(0,1000) inversely correlated with the Child-Pugh class in the left lateral liver lobe, the left medial liver lobe, the right liver lobe and the caudate lobe (r=-0.35 to -0.60, all p<0.05), except for the apparent diffusion coefficient for b(0,1000) in the left medial liver lobe (r=-0.17, p>0.05). Among these parameters, the apparent diffusion coefficient for b(0,500) in the left lateral liver lobe best differentiated normal from cirrhotic liver, with an area under the receiver operating characteristic curve of 0.989. The apparent diffusion coefficient for b(0,800) in the right liver lobe best distinguished Child-Pugh class A from B-C and A-B from C, with areas under the receiver operating characteristic curve of 0.732 and 0.747, respectively. CONCLUSION:Liver lobe-based apparent diffusion coefficients for b(0,500) and b(0,800) appear to be associated with the presence and Child-Pugh class of liver cirrhosis.

Liver fibrosis is a common feature of all kinds of chronic liver disease. During the process from liver fibrosis to cirrhosis and to hepatocellular carcinoma, it is well-known that the liver fibrosis can be reversed after the antifibrotic treatment only in a specific phase. Early diagnosis of liver fibrosis and evaluation of the severity of this disease can be helpful in seizing the appropriate timing for the antifibrotic treatment. Because abnormal iron deposition occurs in liver in patients with chronic liver disease and magnetic resonance T2*-weighted imaging and susceptibility weighted imaging can detect this abnormality, and can be used to assess the severity of liver fibrosis and diagnose liver cirrhosis and hepatocellular carcinoma. In recent years, some progresses in T2*-weighted imaging and susceptibility weighted imaging in chronic liver disease have been made, we aimed to review the progresses in this paper.

The aim of this study was to investigate how patterns of lymph nodes recurrence after radical surgery impact on survival of patients with pT1-3N0M0 thoracic esophageal squamous cell carcinoma. One hundred eighty consecutive patients with thoracic esophageal squamous cell carcinoma underwent radical surgery, and the tumors were staged as pT1-3N0M0 by postoperative pathology. Lymph nodes recurrence was detected with computed tomography 3-120 months after the treatment. The patterns of lymph nodes recurrence including stations, fields and locations of recurrent lymph nodes, and impacts on patterns of survival were statistically analyzed. There was a decreasing trend of overall survival with increasing stations or fields of postoperative lymph nodes involved (all P<0.05). Univariate analysis showed that stations or fields of lymph nodes recurrence, and abdominal or cervical lymph nodes involved were prognostic factors for survival (all P<0.05). Cox analyses revealed that the field was an independent factor (P<0.05, odds ratio = 2.73). Lymph nodes involved occurred predominantly in cervix and upper mediastinum (P<0.05). In conclusion, patterns of lymph node recurrence especially the fields of lymph nodes involved are significant prognostic factors for survival of patients with pT1-3N0M0 thoracic esophageal squamous cell carcinoma.

OBJECTIVE:To determine whether right liver lobe volume (RV) and spleen size measured utilizing magnetic resonance (MR) imaging could identify the presence and severity of cirrhosis in patients with hepatitis B. METHODS:Two hundred and five consecutive patients with clinically confirmed diagnosis of cirrhosis due to hepatitis B and 40 healthy control individuals were enrolled in this study and underwent abdominal triphasic enhanced scans using MR imaging. Spleen maximal width (W), thickness (T) and length (L), together with RV and spleen volume (SV), were measured utilizing MR imaging. Spleen multidimensional index (SI) was obtained by multiplying previously acquired parameters W×T×L. Then statistical assessment was performed to evaluate the ability of these parameters, including RV, SV, RV/SV and SI, to identify the presence of cirrhosis and define Child-Pugh class of this disease. RESULTS:SV and SI tended to increase (r = 0.557 and 0.622, respectively; all P<0.001), and RV and RV/SV tended to decrease (r = -0.749 and -0.699, respectively; all P<0.001) with increasing Child-Pugh class of cirrhosis. All the parameters, including RV, SV, RV/SV and SI, might be the indicators used to discriminate the patients with liver cirrhosis from the control group, and to distinguish these patients between Child-Pugh class A and B, between B and C, and between A and C (area under receiver operating characteristic curve [AUC] = 0.609-0.975, all P<0.05). Among these parameters, RV/SV was the best noninvasive factor for the discrimination of liver cirrhosis between Child-Pugh class A and B (AUC = 0.725), between A and C (AUC = 0.975), and between B and C (AUC = 0.876), while SI was the best variable to distinguish the cirrhosis patients from the control group (AUC = 0.960, P<0.05). CONCLUSION:RV/SV should be used to identify the severity of cirrhosis, while SI can be recommended to determine the presence of this disease.

OBJECTIVE: To explore spleen hemodynamic alteration in liver fibrosis with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and to determine how to stage liver fibrosis with spleen DCE-MRI parameters. MATERIALS AND METHODS: Sixteen piglets were prospectively used to model liver fibrosis staged by liver biopsy, and underwent spleen DCE-MRI on 0, 5th, 9th, 16th and 21st weekend after modeling this disease. DCE-MRI parameters including time to peak (TTP), positive enhancement integral (PEI), maximum slope of increase (MSI) and maximum slope of decrease (MSD) of spleen were measured, and statistically analyzed to stage this disease. RESULTS: Spearman's rank correlation tests showed that TTP tended to increase with increasing stages of liver fibrosis (r = 0.647, P<0.001), and that PEI tended to decrease from stage 0 to 4 (r = -0.709, P<0.001). MSD increased slightly from stage 0 to 2 (P>0.05), and decreased from stage 2 to 4 (P<0.05). MSI increased from stage 0 to 1, and decreased from stage 1 to 4 (all P>0.05). Mann-Whitney tests demonstrated that TTP and PEI could classify fibrosis between stage 0 and 1-4, between 0-1 and 2-4, between 0-2 and 3-4, or between 0-3 and 4 (all P<0.01). MSD could discriminate between 0-2 and 3-4 (P = 0.006), or between 0-3 and 4 (P = 0.012). MSI could not differentiate between any two stages. Receiver operating characteristic analysis illustrated that area under receiver operating characteristic curve (AUC) of TTP was larger than of PEI for classifying stage ≥1 and ≥2 (AUC = 0.851 and 0.783, respectively). PEI could best classify stage ≥3 and 4 (AUC = 0.903 and 0.96, respectively). CONCLUSION: Spleen DCE-MRI has potential to monitor spleen hemodynamic alteration and classify liver fibrosis stages.