Bariatric surgery presents a significant alleviation for non-alcoholic fatty liver disease (NAFLD), which relies in part on achieving substantial weight loss in post-surgical period. We aimed to understand the effect of bariatric surgery on NAFLD remission via metabolomics and to validate the results in a general population-based cohort. In a pilot study, ten patients with NAFLD who underwent bariatric surgery were enrolled. The remission of hepatic steatosis was assessed by MRI-derived proton density fat fraction (PDFF) before and 3-month after surgery. Temporal associations of body mass index (BMI) reduction, alteration in metabolomic biomarkers, and NAFLD remission were quantified by using cross-lagged models, which were then validated in a general population-based cohort (n = 1258). At 3-month after surgery, BMI reduction of 6.9 (SD 1.9) kg/m2 and MRI-PDFF reduction of 9.6

BACKGROUND:Distinguishing bariatric surgical effects on reversing nonalcoholic fatty liver disease (NAFLD) remain unclear. To assess discrepancies in histological response and changes in magnetic resonance imaging-proton density fat fraction (MRI-PDFF) after bariatric surgery. METHODS:This prospective multicenter cohort included 138 NAFLD patients who underwent bariatric surgery and were followed up for 1 year. We obtained paired liver biopsy samples (n = 40), paired proteomic data (n = 23), and sequential MRI-PDFF at 3-, 6-, and 12-month (n = 80, 65, 52, respectively) follow-ups. RESULTS:At 1 year, a ≥2-point improvement in NAFLD activity score (NAS) was observed in 80.0% of patients; nonalcoholic steatohepatitis (NASH) improved without fibrosis worsening in 42.1%; fibrosis improved without NASH worsening in 78.8% (95% confidence interval [CI]: 66.0-91.2, 26.8-58.2, and 63.0-91.3) (all P <0.001). MRI-PDFF discriminated the presence and grading of hepatic steatosis (area under the curve [AUC], 0.94 and 0.95, respectively), indicating liver fat remission (<3.3% or 5.0% at 1 year) in 72.2% or 90.4% of patients (95% CI: 58.4%-83.5% or 78.9%-95.5%; all P <0.001). A ≥78.8% relative decline in MRI-PDFF within 1 year differentiated NAS improvement from non-NAS improvement (AUC, 0.912; 95% CI: 0.79-1.00). Compared to non-NASH remission, NASH remission was associated with significant pre- or postoperative regulation of protein expression levels. CONCLUSIONS:These findings can help evaluate the expected histological response, and aid in understanding the proteomic features resulting from the beneficial surgical effects on NAFLD and its advanced stages in patients with obesity.

Background:: The performance of automatic liver segmentation and manual sampling MRI strategies needs be compared to determine interchangeability. Objective:: To compare automatic liver segmentation and manual sampling strategies (manual whole liver segmentation and standardized manual region of interest) for performance in quantifying liver volume and MRI-proton density fat fraction (MRI-PDFF), identifying steatosis grade, and time burden. Methods:: Fifty patients with obesity who underwent liver biopsy and MRI between December 2017 and November 2018 were included. Sampling strategies included automatic and manual whole liver segmentation and 4 and 9 large regions of interest. Intraclass correlation coefficient (ICC), Bland–Altman, linear regression, receiver operating characteristic curve, and Pearson correlation analyses were performed. Results:: Automatic whole liver segmentation liver volume and manual whole liver segmentation liver volume showed excellent agreement (ICC=0.97), high correlation (R2=0.96), and low bias (3.7%, 95% limits of agreement, -4.8%, 12.2%) in liver volume. There was the best agreement (ICC=0.99), highest correlation (R2=1.00), and minimum bias (0.84%, 95% limits of agreement, -0.20%, 1.89%) between automated whole liver segmentation MRI-PDFF and manual whole liver segmentation MRI-PDFF. There was no difference of each paired comparison of receiver operating characteristic curves for detecting steatosis (P=0.07–1.00). The minimum time burden for automatic whole liver segmentation was 0.32 s (0.32–0.33 s). Conclusion:: Automatic measurement has similar effects to manual measurement in quantifying liver volume, MRI-PDFF, and detecting steatosis. Time burden of automatic whole liver segmentation is minimal among all sampling strategies. Manual measurement can be replaced by automatic measurement to improve quantitative efficiency.

IntroductionFor childhood strabismus, early surgical intervention improves both motor and sensory outcomes. Botulinum toxin type A (BTX-A) injection is an alternative to incisional surgery that is fast, less invasive, and preserves a more normal biomechanical construct. This study was undertaken to assess the safety and effectiveness of BTX-A for horizontal concomitant strabismus in children in our institution.Patients and MethodsRecords of all children less than age 18 years with follow-up at least 12 months who were treated with BTX-A for horizontal concomitant strabismus at Beijing Children's Hospital between December 2014 and February 2021 were reviewed retrospectively. Bilateral injections of BTX-A (Henli, 1.25 IU to 5 IU/0.1 ml) were made into the medial or lateral rectus muscles according to the angle of deviation. Reinjection was permitted if the initial alignment was not satisfactory within 1 to 6 months post-injection. Motor success was defined as a final misalignment <= 10 PD. Sensory success was defined as the presence of any evidence of sensory fusion, distance stereopsis, or near stereopsis at the last visit.ResultsSeventy-one patients were included. Fifty-two had esotropia, and 19 had exotropia. There was a significant decrease in the angle of deviation in all treated patients. The overall motor success rate was 60.6%. The motor success rate was highest in children with esotropia <50 PD (81.5%). Motor success was better for children with partially accommodative esotropia and acquired non-accommodative esotropia (80%, 83.3%, respectively) than for children with infantile esotropia (47.4%). Compared with the esotropia group, the fusion was significantly higher in the exotropia group (p = .007), and the proportion of patients with stereoacuity of better than 100 sec arc was higher also in the exotropia group (71.4%, p = .007), evidence of sensory outcomes were significantly better in the exotropia group. Complications were few. Twenty patients (28.2%) developed transient ptosis after injections; transient vertical deviations were seen in 3 patients (4.2%); and subconjunctival hemorrhage was seen in 5 patients (7%).ConclusionsBTX-A appears to be an effective treatment for the management of horizontal strabismus with motor outcomes best in children with acquired smaller-angle esodeviations. Children with exodeviations had better sensory outcomes in this cohort. A randomized controlled study comparing incisional surgery to BTX-A will be important for guiding future treatment decisions.

fMRI是一项可用于定位和量化大脑功能区域的检测技术,已被大量应用于多个方面的视觉研究.共同性斜视发病原因至今尚不完全明确,目前认为其发病不仅与眼外肌有关,也与大脑处理视觉信息相关脑区的结构和功能紊乱有关.此外,斜视所引起的视觉损害、视功能障碍及眼球运动异常等在脑部也有相应的表现.本文系统性综述了共同性斜视患者大脑视觉相关脑区的改变在fMRI成像中的特征.

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China Department of Ophthalmology, Beijing Children’s Hospital, Capital Medical University, Beijing 100054, China Correspondence to: Gang-Wei Cheng. Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China. gangweic@163.com Received: 2021-01-25 Accepted: 2021-12-08

Introduction Upper abdominal magnetic resonance (MR) imaging is appropriate for body composition analysis.[1] Especially for individuals with obesity, it is of great value to quantify the hepatic proton density fat fraction (PDFF) and the amount of abdominal adipose tissue during clinical evaluation and for research on obesity-related risks. Analytical results may be used to determine the optimal choice of surgical procedure and evaluate treatment outcomes. Multiple artificial intelligence (AI) algorithms and systems have been developed for the automated measurement of body composition. The basis of AI development and application is to have uniform standards for clinical data acquisition and management. The uneven quality of MR images is one of the major obstacles to AI system development and analytical results. A standardized process of MR scanning and clinical data management is urgently needed. Purpose and Target Audience This guideline aims to standardize data acquisition, utilization, and storage for AI systems that target the automatic quantification of body composition. This guide is recommended for surgeons, clinical researchers, and radiologists who focus on body composition analysis and obesity-related topics, for example, type 2 diabetes, metabolic syndrome, and bariatric surgery. Data Acquisition and Evaluation The standardized data acquisition process guarantees high-quality MR images for AI analysis. An image used for AI labeling and clinical diagnosis must follow the basic process mentioned in the following sections. Subject preparation Patients should have an empty stomach before MR scanning. Metal articles should be removed. For overweight subjects with a large waist circumference, wide-bore MR equipment is preferred. According to clinical practice experience, if the patient is >125 kg, doctors or technicians should carefully evaluate the feasibility of upper abdominal MR examination. One challenge is that the bore may not be sufficiently large to accommodate the subject's abdomen. Furthermore, it may be difficult for the patient to hold their breath during MR examination, leading to significant motion artifacts. MR parameter setting A 3.0-T or 1.5-T MR device is preferred for data acquisition. The standard parameters for MR examination for AI analysis are listed in Supplementary Table 1, https://links.lww.com/CM9/A951. PDFF is a reliable measure that can be used to accurately evaluate hepatic steatosis.[2] The Dixon image is 3-dimensional with high resolution. The fat image at the axial level of lumbar 1 to lumbar 2 (L1–L2) intervertebral disc on the Dixon image is considered the best choice for quantifying adipose tissue.[1] If a 1.5-T MR device cannot perform 3-dimensional Dixon imaging, dual-echo scanning is also available. Availability of the MR image for AI quantification All acquired images should be saved in the Digital Imaging and Communications in Medicine (DICOM) format, as the slice thickness and other important information can be stored. The image quality required by the AI analysis is similar to that required for clinical diagnosis. Overall, images with significant artifacts are judged not acceptable. The other requirements for different applications are listed in the following sections. The image quality required for PDFF quantification is usually high.[1] For AI analysis of hepatic PDFF, the first step is to recognize the margin of the liver parenchyma. For patients with hepatic steatosis over grade 2 (PDFF >17.4%),[2] the signal intensity of the liver parenchyma is significantly higher than that of the vessels and adjacent organs. As a result, the margin of the liver is relatively easy for the AI system to recognize. However, for patients with hepatic steatosis grade 1 (6.4% < PDFF ≤ 17.4%),[2] the margin of the liver parenchyma is difficult to recognize. Therefore, AI annotation may not be precise. For subjects without hepatic steatosis (PDFF ≤6.4%),[2] AI annotation may fail if only based on PDFF images. The principles and examples of different degrees of hepatic steatosis are listed in Supplementary Table 2, https://links.lww.com/CM9/A951. According to the recently developed appropriateness criteria, a Dixon sequence image of fat at the axial level of the L1–L2 intervertebral disc can be used for abdominal adipose tissue quantification.[1] It is essential to cover the skin of the abdomen; otherwise, subcutaneous adipose tissue (SAT) cannot be measured. Owing to an insufficient field of view, parallel acquisition, or an uneven magnetic field, the quality of the image may vary. The principles and examples of different image quality degrees are shown in Supplementary Table 3, https://links.lww.com/CM9/A951. Comprehensive evaluation of MR image quality Quality evaluation of both the PDFF and fat images should be considered. These principles are listed in Supplementary Table 4, https://links.lww.com/CM9/A951. Annotation standards Image for PDFF quantification The whole liver parenchyma should be included. Large vessels, local lesions, regions beyond the margin of the liver, and imaging artifacts should be avoided [Figure 1A].Figure 1: Examples of annotation. (A and B) Annotated areas on a PDFF image. The whole parenchyma of the liver is Included. Large vessels, local lesions, regions beyond the margin of the liver, and imaging artifacts are avoided. Different segments of the liver are also annotated. (C and D) Annotated areas on a fat image of the Dixon sequence at the axial level of the L1–L2 intervertebral disc. The red color represents SAT (19,287 mm2), while the green color represents VAT (9718 mm2). L1–L2: Lumbar 1 to lumbar 2; PDFF: Proton density fat fraction; SAT: Subcutaneous adipose tissue; VAT: Visceral adipose tissue.The average PDFF value can be calculated by averaging the values of all voxels included in the region of interest. Since the PDFF value and its change after bariatric surgery vary in different parts of the liver,[3] AI systems are being developed to record the values of different liver segments [Figure 1B]. Image for abdominal adipose tissue quantification Visceral adipose tissue (VAT) and SAT can be recognized and labeled. Different regions of interest, for example, muscle, can also be defined for analysis [Figure 1C and 1D]. The images can be labeled automatically using AI[4] or manually using ITK-SNAP 3.8.0 software (http://www.itksnap.org/). Since a single slice of an MR image is volumetric, the value acquired after labeling is influenced by slice thickness. The volume is calculated as the Supplementary formulas, https://links.lww.com/CM9/A951. Database management For clinical follow-up and research, it is recommended to set up a database to manage clinical data and MR images. Data registry The clinical and radiological data should be registered in a standardized database. For example, there is a prospective national registry database named the “Greater China Metabolic and Bariatric Surgery Database” (GC-MBD®) (Clinicaltrial.gov: NCT03800160) where data of >10,000 cases have been recorded. Data quality control The database needs a committee to hold regular meetings to discuss issues concerning quality control. It is highly recommended that a multidisciplinary team achieve a consensus on the variables in the database. For example, according to the consensus of surgeons, radiologists, clinical researchers, and statisticians, variables that should be documented in the GC-MBD include, but are not limited to, structured demographic information, laboratory tests, PDFF values, VAT and SAT values, biological sample information, and adverse event records. Upper abdominal MR images in the DICOM format should also be uploaded. Before data entry, it is essential for the team's main participants to undergo training. The manager of the database should check and verify the authenticity, accuracy, and integrity of all information according to the source data. Data modification traces should be recorded in the system. After verification, the data should be locked. Discussion There are three key points in AI analysis of body composition using upper abdominal MR images: uniform data acquisition standards, imaging annotation, and database management. This guideline will promote the development and application of AI systems for the automatic quantification of PDFF and abdominal adipose tissue. The PDFF value can significantly influence the availability of PDFF images. For patients without hepatic steatosis, the grayscale contrast between the hepatic parenchyma and vessels is insufficient to train the neural network of the AI system. New strategies may solve this problem. For example, the liver may need to be registered with other higher contrast sequences (eg, axial T1-weighted imaging[5] or portal venous phase of contrast-enhanced imaging[6]) to achieve margin recognition for the AI system. As such, additional MR sequences and related parameter standards are required. Whole-body MR imaging can precisely quantify the volume of adipose tissue. For timesaving, scanning and analyzing a single-slice abdominal MR is preferred. Since imaging annotation for AI analysis requires only a single slice image of fat, we can acquire a single slice at the axial level of the L1–L2 intervertebral disc during the Dixon sequence acquisition to achieve further reduction of scanning time. Clinical practice guideline registration and ethical approval This guideline was registered on the International Practice Guideline Registry (IPGRP-2021CN177). This work was approved by the Ethics Committees of Beijing Friendship Hospital, Capital Medical University (No. 2018-P2-022-01). Funding This work was supported by the National Natural Science Foundation of China (No. 62171297), the Capital's Funds for Health Improvement and Research (No. 2020-1-2021), and the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (No. ZYLX202101). Conflicts of interest None.

目的 探讨病态肥胖患者脂肪肝不同分级之间的临床指标差异及其与临床非酒精性脂肪性肝炎(C-NASH)评分的相关性.方法 66例符合条件的病态肥胖患者被纳入,所有患者均行上腹部MRI检查.根据脂肪分数值,按照标准分为无脂肪肝和轻、中、重度脂肪肝.分析性别、年龄、身高、体质量、体质量指数(BMI)、收缩压、舒张压、空腹血糖、空腹胰岛素、胰岛素抵抗的稳态模型评估(HOMA-IR)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)与脂肪肝程度的关系.采用单因素分析和Bonferroni法进行事后两两比较.肝脏脂肪分数(LFF)与C-NASH评分的相关性分析采用Spearman秩相关.结果 在不同的脂肪肝程度之间,ALT、AST、空腹胰岛素、HOMA-IR、TC及LDL组间差异有统计学意义(P<0.05).行两两比较后,无脂肪肝和轻度脂肪肝组之间,ALT、AST、LDL和TC值差异有统计学意义(P=0.016、0.040、0.016、0.015);无脂肪肝和中度脂肪肝组之间,ALT和AST值差异有统计学意义(P=0.005、0.018),无脂肪肝和重度脂肪肝组之间,ALT、AST、空腹胰岛素、HOMA-IR值差异有统计学意义(P=0.002、0.003、0.027、0.021).肝脏脂肪含量与C-NASH之间呈低度正相关(r=0.267,P=0.030).结论 病态肥胖患者脂肪肝不同分级之间的部分临床指标(ALT、AST、空腹胰岛素、HOMA-IR、TC及LDL)存在差异,肝脏脂肪含量与C-NASH有关.

患儿男性,3岁6个月,以48小时为周期,眼位向内偏斜1个月.2017年3月就诊于北京儿童医院眼科.患儿无全身及眼部手术史,系第1胎第1产,足月顺产,否认家族性遗传疾病及斜视家族史,生长发育与同龄儿无异.眼科检查示:右眼裸眼视力0.6,左眼裸眼视力0.6,双眼可交替注视,斜视日的内斜视角度,看近斜视度从+25△到+60△出现波动,看远斜视度从+20△到+40△出现波动,同视机检查没有同时视,Titmus立体图检测没有立体视,AC/A比值为3;正位日检查斜视度从0到+15△出现微量波动,看近和看远基本一致,同视机检查双眼视及融合范围正常,Titmus立体图检测基本位于40秒角到100秒角之间.阿托品散瞳后右眼屈光度为+1.25DS,左眼屈光度为+1.0DS.眼球各方向运动大致正常.眼前节,眼底未见异常,脑部影像学检查未发现占位性病变.结合患儿病史及临床表现,诊断:周期性内斜视.

The magnetic resonance imaging (MRI)-based proton density fat fraction (PDFF) has become popular for quantifying liver fat content. However, the variability of the region-of-interest (ROI) sampling strategy may result in a lack of standardisation of this technology. In an effort to establish an accurate and effective PDFF measurement scheme, this study assessed the pathological correlation, the reader agreement, and time-burden of different sampling strategies with variable ROI size, location, and number. Six-echo spoiled gradient-recalled-echo magnitude-based fat quantification was performed for 50 patients with obesity, using a 3.0-T MRI scanner. Two readers used different ROI sampling strategies to measure liver PDFF, three times. Intra-reader and inter-reader agreement was evaluated using intra-class correlation coefficients and Bland‒Altman analysis. Pearson correlations were used to assess the correlation between PDFFs and liver biopsy. Time-burden was recorded. For pathological correlations, the correlations for the strategy of using three large ROIs in Couinaud segment 3 (S3 3L-ROI) were significantly greater than those for all sampling strategies at the whole-liver level (P < 0.05). For inter-reader agreement, the sampling strategies at the segmental level for S3 3L-ROI and using three large ROIs in Couinaud segment 6 (S6 3L-ROI) and the sampling strategies at the whole-liver level for three small ROIs per Couinaud segment (27S-ROI), one large ROI per Couinaud segment (9L-ROI), and three large ROIs per Couinaud segment (27S-ROI) had limits of agreement (LOA) < 1.5%. For intra-reader agreement, the sampling strategies at the whole-liver level for 27S-ROI, 9L-ROI, and 27L-ROI had both intraclass coefficients > 0.995 and LOAs < 1.5%. The change in the time-burden was the largest (100.80 s) when 9L-ROI was changed to 27L-ROI. For hepatic PDFF measurement without liver puncture biopsy as the gold standard, and for general hepatic PDFF assessment, 9L-ROI sampling strategy at the whole-liver level should be used preferentially. For hepatic PDFF with liver puncture biopsy as the gold standard, 3L-ROI sampling strategy at the puncture site segment is recommended.

OBJECTIVE:Patients undergoing liver transplantation for hepatocellular carcinoma (HCC) within the Milan criteria have an excellent outcome. We developed a program to analyze and prove that the Milan criteria can be expanded safely and effectively.METHODS:We retrospectively reviewed 117 HCC patients treated with liver transplantation between January 2013 and December 2017. Patients were grouped according to the Milan criteria, the University of California, San Francisco (UCSF) criteria, Up-to-seven criteria and Hangzhou criteria. Tumor-free and overall survival rates were investigated with a Kaplan-Meier analysis. Multivariable regression Cox models produced survival estimates for the patients that exceeded the Milan criteria.RESULTS:The 1-year, 3-year and 5-year overall survival rates of patients fulfilling the Milan criteria (n=44) were 100%, 87.5% and 78.9%, respectively. Compared with the Milan criteria, the UCSF criteria (n=50), Up-to-seven criteria (n=51) and Hangzhou criteria (n=86) provided an expansion of 13.6%, 15.9% and 95.9%, respectively. The 1-year, 3-year and 5-year overall survival rates of patients fulfilling UCSF criteria, Up-to-seven criteria and Hangzhou criteria were 96.0%, 84.9%, 76.9%; 96.1%, 85.2%, 77.6% and 97.7%, 83.9%, 66.7%, respectively (P>0.05). Multifactor Cox regression showed that tumor diameter and microvascular invasion were independent risk factors for survival in patients that exceeded the Milan criteria.CONCLUSION:Compared with the Milan criteria, the Hangzhou criteria can safely expand the scope of liver transplantation for HCC to a certain extent. By contrast, the UCSF criteria and Up-to-seven criteria result in a limited number of patients which need further expansion. Tumor diameter and microvascular invasion were the independent risk factors for survival in patients that exceeded the Milan criteria.

本文回顾性分析2013年1月至2019年12月在首都医科大学附属北京朝阳医院肝胆外科因胰头癌行胰十二指肠切除术的154例患者的临床及随访资料。根据患者术前CA19-9/GGT与1年生存情况绘制ROC曲线，确定CA19-9/GGT的最佳cut-off值，并以此将患者分为低比值组和高比值组。单因素及多因素分析筛选出CA19-9/GGT（ RR=1.842，95% CI：1.081~3.193）和淋巴结转移（ RR=1.780，95% CI：1.118~2.835）是影响胰头癌术后远期生存的独立预后因素。本研究显示CA19-9/GGT相对于单纯CA19-9而言，在判断胰头癌远期生存方面更具有价值。

门静脉积气是指由于各种原因导致气体在门静脉及肝内门静脉分支的异常聚集，临床较少见，目前CT为明确诊断的重要辅助检查，治疗主要分为手术治疗和保守治疗。本文报道了首都医科大学附属北京朝阳医院自2016年1月至2021年11月共6例门静脉积气患者的诊疗经过，并进行相关文献回顾。结果表明，门静脉积气病情较轻患者可采用保守治疗并严密观察病情变化，如病情不能控制或怀疑合并有肠坏死、肠穿孔或严重感染，应积极急诊手术治疗。

目的 探讨肝移植术后耐万古霉素肠球菌感染的病原学和耐药性特点.方法 回顾性分析我科2015年1月～2019年12月524例同种异体肝移植病人的临床资料,分析其术后发生耐万古霉素肠球菌感染的发病率、病原学特点、分布情况和耐药性特点.结果 524例肝移植病人中共109例病人术后发生腹腔感染,发病率为20.80％(109/524),其中肠球菌感染46例,全为屎肠球菌;肠球菌感染发病率为8.78％(46/524),肠球菌感染占腹腔感染病人的42.2％(46/109),占革兰阳性球菌感染的64.79％(46/71);46例病人中15例为耐万古霉素肠球菌感染,万古霉素耐药率为32.61％(15/46);药敏结果显示,耐万古霉素肠球菌对青霉素、氨苄西林、环丙沙星、左旋氧氟沙星及红霉素类抗生素完全耐药;对四环素类、高浓度链霉素、高浓度庆大霉素等抗生素也广泛耐药,耐药率分别为71.43％(15/21)、85.71％(18/21)和71.43％(15/21);对替考拉宁耐药率为38.10％(8/21);对利奈唑胺亦出现耐药株,耐药率为9.52％(2/21);替加环素最为敏感,尚未检出耐药菌.结论 耐万古霉素肠球菌是肝移植病人术后常见的病原菌之一.常规预防性抗生素对耐万古霉素肠球菌治疗无效,临床上可根据药敏结果选择抗生素,替加环素和利奈唑胺可作为治疗的首选.

北京朝阳医院2015年1月至2020年6月共收治8例远端胆管腺鳞癌患者，结合临床表现、病理特征、治疗及预后进行分析。本组远端胆管腺鳞癌临床表现无特异性，明确诊断主要靠术后病理或活检病理。患者存活时间为1~60个月，中位生存时间为44个月。本研究结果表明，胆管腺鳞癌极其少见，预后较差，其生物学行为及对生存期的影响尚不十分明确，早期根治性手术切除可能对患者生存期有利。

PURPOSE:Pancreaticoduodenectomy combined with portal vein resection for distal cholangiocarcinoma is rarely reported because it is a rare disease. We developed a program to evaluate the vascular invasion type, operation procedure, and long-term survival of distal cholangiocarcinoma patients with portal vein invasion.METHODS:We retrospectively reviewed data for 123 distal cholangiocarcinoma patients after pancreaticoduodenectomy between January 2013 and December 2019. Portal vein system invasion was confirmed pathologically in 17 patients.RESULTS:Multivariable Cox regression identified tumor differentiation degree, portal vein system invasion, and lymph node metastasis as independent risk factors affecting long-term survival. The 1- and 2-year overall survival rates for patients without and with portal vein system invasion were 79.7% and 58.9%, and 48.6% and 10.8%, respectively. Median overall survival in patients without and with portal vein system invasion was 33 months and 12 months, respectively.CONCLUSION:Portal vein system invasion is an important independent risk factor affecting long-term survival in patients with distal cholangiocarcinoma. Pancreaticoduodenectomy combined with portal vein system resection and reconstruction did not increase the incidence of perioperative complications or mortality.

目的:评价不同血管重建方式对伴有门静脉系统侵犯胰腺癌围手术期及远期预后的影响。方法:依据纳入标准回顾性分析49例伴有门静脉系统侵犯的胰腺癌患者的临床资料，依据患者门静脉系统重建方式分为端端吻合组16例，血管置换组33例。比较分析两组患者之间围手术期和远期预后的差异。结果:围手术期死亡1例(2.0%)，发生并发症12例(24.5%)。血管置换组的静脉侵犯长度大于端端吻合组[(3.2±0.9)cm vs (2.3±0.7)cm， P＝0.002]，两组患者之间手术时间、并发症发生率和术后住院时间差异均无统计学意义( P>0.05)。血管置换组和端端吻合组的术后半年、1、2年的生存率分别为72.7%、49.8%、29.5%和75.0%、43.8%、30.0%，差异无统计学意义( P＝0.930)。 结论:采用异体血管进行门静脉系统切除后重建是安全可行的，不同血管重建方式并不影响患者的远期预后。

目的 检测Myc相互作用的锌指蛋白1(MIZ1)在重症和非重症社区获得性肺炎(CAP)患者外周血单个核细胞(PBMC)中的表达水平,探究其与炎症因子的关系.方法 纳入2018年4月至2019年6月在北京朝阳医院感染和临床微生物科和呼吸科住院治疗的CAP患者36例,收集患者的PBMC,提取PBMC中的总RNA并用逆转录-定量聚合酶链式反应测量PBMC中MIZ1 mRNA的水平.部分患者用酶联免疫吸附试验检测血清白细胞介素(IL)-6、IL-8、IL-10和α干扰素等炎症因子的水平.对比重症与非重症CAP患者MIZ1 mRNA和炎症因子的水平的差异.结果 相比非重症CAP患者,重症CAP患者PBMC中MIZ1 mRNA的表达水平更低(P＜0.05).根据CAP为重症或非重症计算PBMC中MIZ1 mRNA的表达水平的受试者工作特征曲线,曲线下面积为0.731,P=0.018.重症CAP患者中MIZ1 mRNA与IL-10水平呈负相关(n=11,Spearman相关系数为-0.620,P＜0.05).结论 MIZ1与CAP病情的严重程度相关,可作为重症CAP的潜在标志物;MIZ1可能通过影响IL-10来发挥炎症调控的作用.

Objective:To explore the influence of fatty liver donor on the prognosis of benign liver disease liver transplantation.Methods:The clinical data of 229 recipients and donors who underwent liver transplantation at Beijing Chaoyang Hospital affiliated to Capital Medical University from January 2015 to December 2019 due to benign liver diseases were retrospectively analyzed. According to the degree of fatty degeneration of the donor liver, the patients were divided into non-fatty liver group( n=168), mild-medium fatty liver group( n=43), and severe fatty liver group( n=18). First, the overall prognosis after liver transplantation was analyzed, the general data of the donor and recipient were compared, and the perioperative complications of the three groups were compared. Finally, survival analysis was performed to compare the long-term prognosis of the three groups. Measurement data with the normal distribution were represented as ( Mean± SD), comparisons among groups were analyzed using t test. Comparisons of counting data between groups were analyzed using chi-square test. The theoretical frequency was less than 1. Fisher exact probability method was used, and variance analysis was used for the comparison among the multiple groups. Results:The overall 1-year, 3-year, and 5-year survival rates of the patients were 86.9%, 70.7%, 70.7%, respectively, and the average survival time was 53.1 months. The general data of donors and recipients were not significantly different among the three groups. The probability of perioperative transplanted liver failure, delayed liver function recovery, and acute kidney injury in recipients with severe fatty liver was significantly higher than that of mild to moderate fatty liver group and non-fatty liver group ( P<0.05). The results of survival analysis showed that the 1-year, 3-year, and 5-year survival rates of the non-fatty liver group were 90.5%, 71.7%, 71.7%, the mild-moderate group were 88.4%, 76.7%, 64.0% and the severe fatty liver group were 61.1%, 49.4%, 49.4%, the survival rate of patients with severe fatty liver was significantly lower than that of the other two groups ( P<0.05). Conclusion:Donor weight-grade steatosis leads to a higher incidence of transplanted liver failure, delayed liver function recovery, acute kidney injury, and worse long-term prognosis.

Objective:This research aimed to study the relationship between preoperative CA19-9/GGT ratio and postoperative long-term survival in patients with distal cholangiocarcinoma.Methods:The clinical data of 121 patients with distal cholangiocarcinoma who underwent radical pancreaticoduodenectomy (PD) at the Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University from January 2013 to December 2019 were retrospectively analyzed. The ROC curve was drawn based on the preoperative CA19-9/GGT ratio and postoperative 1-year survival. Using the best cut-off value of CA19-9/GGT ratio, the 121 patients were divided into two groups: the low ratio group (CA19-9/GGT≤0.12, n=53) and the high ratio group (CA19-9/GGT>0.12, n=68). The clinical data of the two groups were compared, and the risk factors of long-term survival were analyzed. Results:There were 72 male and 49 female patients, aged (64.9±9.2) years. When compared with the high ratio group, the low ratio group had significantly less requirement for preoperative jaundice reduction, lower CA19-9, higher GGT, better tumor differentiation, and more patients without lymph node metastasis (all P<0.05). The median follow-up time was 26 months. The 1-, 3- and 5-year survival rates of the low vs. high ratio groups were 89.4% vs. 64.7%, 64.4% vs. 14.1%, 48.7% vs. 14.1%, respectively (all P<0.001). Multivariate analysis showed that CA19-9/GGT ratio>0.12 ( RR=2.802, 95% CI: 1.494-5.256), poor differentiation ( RR=1.855, 95% CI: 1.106-3.111) and lymph node metastasis ( RR=1.891, 95% CI: 1.129-3.169) were independent risk factors for long-term survival ( P<0.05). Conclusion:The ratio of CA19-9/GGT could be used as an index to predict long-term survival of patients with distal cholangiocarcinoma after PD. The smaller the ratio, the better was the long-term prognosis.