Background and objectives:Catecholamine-dependent acute obstructive suppurative cholangitis (CD-AOSC) is a severe form of cholangitis characterized by refractory hypotension. This study aimed to investigate its underlying pathogenic mechanisms. Methods:We conducted a retrospective case-control study involving 345 patients with biliary infections treated at Tongji Hospital, Tongji University, between 2012 and 2022. Patients were divided into three groups: chronic cholecystitis (CC; negative control), acute obstructive suppurative cholangitis (AOSC; positive control), and CD-AOSC (case group). Clinical and laboratory data were analyzed. Endotoxin levels in subcutaneous adipose tissue were measured, and transcriptomic analysis was performed to explore potential mechanisms. A rat model of cholangitis was used to validate findings related to hypotension in CD-AOSC. Results:Patients with CD-AOSC exhibited slower endotoxin clearance from adipose tissue (1st week vs. 2nd week: 72.7 ± 4.0 EU/g vs. 23.3 ± 3.2 EU/g) and milder inflammation (Immune cell count: 665.4 ± 179.1, Immunodeconv analysis: 0.3 ± 0.1) compared to AOSC patients (1st week vs. 2nd week: 9.7 ± 2.6 EU/g vs. 2.6 ± 0.7 EU/g, Immune cell count: 1344.0 ± 599.3, Immunodeconv analysis: 0.6 ± 0.1). This slower clearance of endotoxin allowed adipose tissue to function as an endotoxin reservoir. Persistent endotoxin release resulted in prolonged activation of the interleukin-18 (IL-18)/IL-18 receptor accesary protein (IL-18RAP) pathway, thereby sustaining inflammation and contributing to extended hypotension. The rat model confirmed the role of the interleukin-1β (IL-1β) inhibitor in decelerating endotoxin release and maintaining activation of the IL-18/IL-18RAP/interferon-γ (IFN-γ) pathway. Conclusions:Persistent hypotension in CD-AOSC appears to result from sustained activation of the IL-18/IL-18RAP pathway, driven by prolonged endotoxin release from adipose tissue. These findings highlight the potential of "Hours Exchanged Against (severity) Loss (HEAL)" strategy, in which early modulation of endotoxin release from adipose tissue by IL-1β inhibition during the initial phase of sepsis in cholangitis may improve patient survival.

This study aimed to explore the role of connexin 32 (Cx32) in the directional differentiation of induced pluripotent stem cells (iPSCs) into hepatocytes. Urine-derived epithelial cells were collected from the fresh urine of a healthy donor and transducted with reprogramming plasmid mixture to generate iPSCs. The iPSCs were then directionally differentiated into hepatocytes. During the differentiation, the upregulated and downregulated groups were treated with vitamin K2 (VK2) and 2-aminoethoxyboronate diphenylester (2-APB) to increase and inhibit Cx32 expression, respectively. The control group was not treated with the regulatory factor. Expression of Cx32 and hepatocyte-specific markers, including AFP, hepatocyte nuclear factor 4α (HNF-4α), albumin (ALB) and cytokeratin 18 (CK18) were detected. It indicated that Cx32 expression was not observed in iPSCs, but gradually increased during the process of hepatic differentiation from iPSCs. Upregulation of Cx32 expression by VK2 treatment promoted hepatocyte maturation and enhanced the expression of the aforementioned hepatic specific markers, whereas downregulation of Cx32 expression by 2-APB treatment had the opposite effects. In conclusion, urine-derived iPSCs could be directionally differentiated into hepatocytes. Up-regulation of Cx32 improves the efficiency and maturity of differentiation of iPSCs into hepatocytes, and Cx32 may be a promoting factor during the process of hepatic differentiation from iPSCs.

BACKGROUND:Pancreatic cancer continues to be one of the world's most lethal cancers. Chemotherapy resistance in patients with advanced pancreatic cancer often accompany with dismal prognosis, highlighting the need to investigate mechanisms of drug resistance and develop therapies to overcome chemoresistance.METHODS:This research was filed with the Chinese Clinical Trial Registry (ChiCTR2200061320). In order to isolate primary normal fibroblasts (NFs) and cancer-associated fibroblasts (CAFs) samples of pancreatic ductal adenocarcinoma (PDAC) and paracancerous pancreatic tissue from individuals diagnosed with PDAC were obtained. The exosomes were obtained using ultracentrifugation, and their characteristics were determined by Western blotting, nanoparticle tracking analysis, and transmission electron microscopy. CAF-derived miRNAs were analyzed by RT-qPCR and high-throughput sequencing. Gemcitabine (GEM) was employed to promote ferroptosis, and ferroptosis levels were determined by monitoring lipid reactive oxygen species (ROS), cell survival, and intracellular Fe2+ concentrations. To assess in vivo tumor response to GEM therapy, a xenograft tumor mouse model was utilized.RESULTS:Exosomes derived from CAFs in PDAC did not exhibit innate GEM resistance. CAFs promoted chemoresistance in PDAC cells following GEM treatment by secreting exosomes, and maintaining signaling communication with cancer cells. Mechanistically, miR-3173-5p derived from CAF exosomes sponged ACSL4 and inhibited ferroptosis after uptake by cancer cells.CONCLUSION:This work demonstrates a novel mode of acquired chemoresistance in PDAC and identifies the miR-3173-5p/ACSL4 pathway as a promising treatment target for GEM-resistant pancreatic cancer.

目的 探讨超声造影技术在慢性肾脏病肾脏纤维化中的评估价值.方法 采用超声造影技术检测25例患者穿刺侧肾脏,肾组织Masson染色评估纤维化程度,进行相关性分析.结果 25例肾穿刺患者以肾脏病理进行纤维化分级,估算肾小球滤过率与肾脏纤维化面积呈负相关(r=-0.65,P<0.05);定量分析超声参数上升时间和平均渡越时间与肾脏纤维化面积有相关性,相关系数分别为0.45和0.49(均P<0.05).最大峰值强度和上升时间在T3组和T0组差异有统计学意义(P均<0.05).结论 超声造影参数上升时间和平均渡越时间与肾组织纤维化面积有相关性,超声造影技术在肾脏纤维化无创评估中具有诊断价值.

目的 研究超声弹性成像评估宫颈成熟度对临产时间的预测.方法 选取符合要求的孕晚期孕妇共176例,根据距离临产时间(TOL)将研究对象分为两组.TOL≤1周组96例、TOL>1周组80例.通过腹部超声和弹性成像功能记录两组患者的一般资料、宫颈长度、宫颈宽度、胎先露高度、羊膜腔嵌入宫颈内口级别、B/A值.利用单因素分析找出影响临产时间的指标,再利用多因素logistic回归分析找出预测临产的独立影响因子,并利用ROC曲线分析其对临产时间的预测价值.结果 宫颈长度、胎先露高度、B/A值是预测临产的独立影响因子(P<0.05).宫颈长度、胎先露高度、B/A值以及3个指标联合在ROC曲线下面积分别为0.740、0.743、0.817、0.903.经比较,3个指标联合的AUC最高,其次为B/A值,宫颈长度与胎先露高度相对较低.B/A值预测临产的最佳诊断点为1.325,灵敏度为50％,特异度为95.8％;三者联合诊断的灵敏度为98.8％,特异度为62.5％.结论 B/A值可作为预测临产的指标之一,与宫颈长度和胎先露高度联合可提高预测临产时间的准确性,为临床预测临产时间提供指导.

BackgroundThis study aimed to explore the regulatory mechanism of hsa-miR-143-3p and lncRNA RP11-363N22.3–functioning upstream of KRAS–in exosomes derived from human mesenchymal stem cells (hMSCs) in pancreatic cancer.MethodsWestern blotting and quantitative PCR were used to determine gene expression. In vitro, cell proliferation, apoptosis, and cell cycle and invasion were evaluated using CCK-8 assay, flow cytometry, and transwell assays, respectively. In vivo, the effect of hsa-miR143-3p was investigated using a tumorigenesis test in nude mice. The association between hsa-miR-143-3p and lncRNA RP11-363N22.3 was investigated using the dual-luciferase assay.Resultshsa-miR-143-3p expression significantly increased in hMSC exosomes than in those in human pancreatic cancer cell line (CFPAC-1) exosomes. In vitro, compared to the MOCK (CFPAC-1 only) group, cell proliferation and invasion were inhibited and apoptosis was induced in the inhibitor NC (CFPAC-1 + MSC-hsa-miR-3p inhibitor NC) group, while these changes were reversed in the inhibitor (CFPAC-1 + MSC-hsa-miR-3p inhibitor) group. The expression of lncRNA RP11-363N22.3 and genes related to miR-143 significantly decreased in the inhibitor NC group compared to the MOCK group, and increased in the inhibitor group compared to inhibitor NC group. A targeted combinatorial effect was observed between lncRNA RP11-363N22.3 and hsa-miR-143-3p. In vivo, the tumor volume of the mimics (CFPAC-1 + MSC-hsa-miR-143-3p mimics) group was smaller than that of the mimics NC (CFPAC-1 + MSC-hsa-miR-143-3p mimics NC) and MOCK groups. H&E staining showed that there were no obvious pathological changes in MOCK and mimic NC groups, while cell necrosis was seen in some regions in mimic groups.Conclusionhsa-miR-143-3p may promote apoptosis and suppress cell growth and invasion in pancreatic cancer.

Background 46XY partial gonadal dysgenesis (PGD) is a rare subtype of disorder of sex development (DSD). 46YY PGD is a congenital disease with atypical chromosomal, gonadal, or anatomical sex development. The patient in this case report had male and female genitalia simultaneously. We created a flowchart of the differential diagnosis for clinicians. Case presentation A 41-year-old male was admitted to the hospital complaining of lower quadrant abdominal pain for 1 day. Physical examination revealed that his penis size was normal, but a urethral orifice was located in the perineum area between the scrotum and anus. One small testicle was in the left scrotum, but no testicle was present on the right. The patient’s abdomen was bulging, and he had lower abdominal pain. According to the emergency CT scan, a lesion (74*65 mm) was found in the right pelvis between the bladder and rectum. The lesion showed an unclear boundary and hematocele appearance. The lesion was removed by emergency surgery, and the pathology report indicated a mixed germ cell tumor with a seminoma and yolk sac tumors. Conclusion This article is a case report of germ cell tumors in 46XY PGD patients. The literature review summarizes the clinical diagnosis, and a flowchart is provided for physicians in future practice. The importance of this report is that it will help acquaint physicians with this rare disease and make the right initial clinical decision quickly through the use of this flowchart. However, the variants of special subtypes of 46XY DSD are myriad, and all the diagnoses could not be covered in one flowchart.

Objective This study aims to explore the roles of miR-124 in pancreatic tumor and potential vehicles. Methods The expression of miR-124 and EZH2 was determined in both pancreatic cancer tissues and cell lines. miR-124 or EZH2 was overexpressed in AsPC-1 and PANC1 cells. Then, the effects on cell viability. apoptosis, invasion, migration and epithelial mesenchymal transition were evaluated. Afterwards, the roles of miR-124 on the expression and function of EZH2 in pancreatic tumors were determined by dual luciferase reporter assay. Subsequently, miR-124 was transfected to bone marrow mesenchymal stromal cells (BM-MSCs), and the BM-MSCs derived exosomes were isolated and co-cultured with AsPC-1 and PANC1 cells, or injected into pancreatic cancer tumor-bearing mice. Results The miR-124 expression levels decreased in pancreatic adenocarcinoma tissues and cancer cell lines AsPC-1, PANC1, BxPC-3 and SW1990. Furthermore, the elevated expression of miR-124 in AsPC-1 and PANC1 via miR-124 mimic transfection-induced apoptosis, metastasis and epithelial mesenchymal transition was suppressed, and the EZH2 overexpression partly reversed the protective effects of miR-124 against pancreatic tumors. In addition, the expression of miR-124 was detected in exosomes extracted from miR-124-transfected BM-MSCs, and these exosomes delivered miR-124 into pancreatic cancer cells, and presented the anti-tumor effects in vitro and in vivo . Conclusion MiR-124-carried BM-MSC-derived exosomes have potential applications for the treatment of pancreatic tumors.

目的 探讨运用高频超声灰度技术诊断腕管综合征的可行性,并比较其与测量正中神经截面积法诊断腕管综合征的应用价值.方法 对经电生理及临床症状确诊的35例腕管综合征患者的59侧患手和30例(60侧)无腕管综合征健康志愿者行腕管处高频超声检测,测量该处正中神经截面积(area of media nerve,MNA)和灰度(grayscale),结果行组间对比分析,由受试者工作特性曲线(receiver operating characteristic curve,ROC)评价灰度指标和截面积指标诊断腕管综合征的准确性.结果 腕管综合征患者的豌豆骨水平正中神经灰度和截面积在对照组和观察组中均有显著性差异,灰度诊断腕管综合征的敏感性和特异性高于截面积.结论 高频超声测量腕管处正中神经灰度是诊断腕管综合征的可靠方法.

Background: Identifying patients with atherosclerotic renal artery stenosis (ARAS) who will be improved in renal function after percutaneous transluminal renal artery stenting (PTRAS) is crucial since most patients show no worthwhile benefit of PTRAS. Although the assessment of renal parenchymal perfusion is useful for the identification, few studies predict the renal functional improvement by evaluating the characteristics of renal perfusion. Objective: The aim of this study was to assess the renal parenchymal perfusion in ARAS patients with contrast-enhanced ultrasonography (CEUS) and predict the benefits of renal function after PTRAS utilizing time-intensity curve (TIC) parameters. Methods: Thirty-eight kidneys in 30 ARAS patients received PTRAS in this study. They were divided into moderate stenosis group (n=25) and severe stenosis group (n=13) and mild dysfunction group (n=14) and moderate dysfunction group (n=24) according to the degree of renal stenosis and radioisotope glomerular filtration rate (rGFR). The baseline assessment of renal function and renal parenchymal perfusion were performed for all patients. rGFR was repeated to evaluate the renal outcome at 4 months after PTRAS. The outcome of PTRAS was classified as improved, stable, or deteriorated compared to the baseline. Time-intensity curve (TIC) parameters obtained from CEUS were analyzed to evaluate the predictive accuracy. Results: TIC parameters (AUC and PI) were positively correlated with renal function (1=0.617, 0.663; P<0.05) but weakly and negatively correlated with the stenosis (r=-0.360, -0.435; P<0.05). Baseline rGFR was not accurate in predicting improved renal function after PTRAS (0.670). The accuracy of the combined prediction model of baseline AUC and PI (0.889) was higher than the individual indicators (baseline AUC: 0.855 and PI: 0.782). Conclusion: CEUS could accurately assess renal parenchymal perfusion and identify ARAS patients with potential benefit after PTRAS. The combination of TIC parameters (AUC and PI) is valuable in the prediction of improved renal function after PTRAS.

BACKGROUND The incidence of acute kidney injury (AKI) in patients with sepsis is high, and the prognosis of patients with septic AKI is poor. The early diagnosis and treatment of septic AKI is of great significance in improving the prognosis of patients with sepsis. AIM To explore the value of contrast-enhanced ultrasound (CEUS), serum creatinine (Scr), and other indicators in the early diagnosis of septic AKI. METHODS Ninety patients with sepsis during hospitalization at Tongji Hospital of Tongji University were recruited as subjects. Each patient was recorded with relevant basic data, clinical indicators, and CEUS results. The patients were divided into AKI group and non-AKI group according to the results of renal function diagnosis after 48 h. On the 7th day, the renal function of the non-AKI group was re-evaluated and the patients were further divided into AKI subgroup and non-AKI subgroup. The differences of the indicators in different groups were compared, and the diagnostic value of each indicator and their combination for septic AKI was analyzed. RESULTS Systemic inflammatory response score (2.58 ± 0.75), blood lactic acid (3.01 ± 1.33 mmol/L), Scr (141.82 ± 27.19 μmol/L), blood urea nitrogen (4.41 ± 0.81mmol/L), and rise time (10.23 ± 2.63 s) in the AKI group were higher than those in the non-AKI group. Peak intensity (PI) (10.78 ± 3.98 dB) and wash in slope (WIS) (1.07 ± 0.53 dB/s) were lower than those in the non-AKI group. The differences were statistically significant (P < 0.05). The PI (12.83 ± 3.77 dB) and WIS (1.22 ± 0.68 dB/s) in the AKI subgroup were lower than those in the non-AKI subgroup, and the differences were statistically significant (P < 0.05). The area under curve (AUC) of Scr for the diagnosis of septic AKI was 0.825 with a sensitivity of 56.76% and a specificity of 100%. The AUCs of WIS and PI (0.928 and 0.912) were higher than those of Scr. Their sensitivities were 100%, but the specificities were 71.70% and 75.47%. The AUC of the combination of three indicators for the diagnosis of septic AKI was 0.943, which was significantly higher than the AUC diagnosed by each single indicator. The sensitivity was 94.59%, and the specificity was 81.13%. CONCLUSION The combination of Scr, PI, and WIS can improve the diagnostic accuracy of septic AKI. PI and WIS are expected to predict the occurrence of early septic AKI.

AIM To analyze the incidence of hepatocellular carcinoma (HCC) in a population that underwent health checkups and had high serum miR-106b levels. METHODS A total of 335 subjects who underwent checkups in the Digestive and Liver Disease Department of our hospital were randomly selected. RT-PCR was used to detect the level of miR-106b in serum samples. Laboratory and imaging examinations were carried out to confirm the HCC diagnosis in patients who had a > 2-fold change in miR-106b levels. Ultrasound-guided biopsy was also used for HCC diagnosis when necessary. On this basis, the clinical data of these subjects, including history of hepatitis virus infection, obesity, long-term history of alcohol use and stage of HCC, were collected. Then, the impact of these factors on the level of miR-106b in serum was analyzed. Furthermore, receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic efficacy of miR-106b for HCC. RESULTS A total of 35 subjects had abnormal serum miR-106b levels, of which 20 subjects were diagnosed with HCC. t-test revealed that the difference in serum miR-106b level in terms of sex, age, history of hepatitis virus infection, obesity and long-term history of alcohol use was not statistically significant. However, serum miR-106b levels in patients with advanced HCC (stage III/IV) was higher than in patients with early HCC (stage I/II), and the difference was statistically significant (P = 0.000). Moreover, the ROC curve revealed that the area under the curve value for miR-106b was 0.885, which shows that serum miR-106b level has a certain clinical value for HCC diagnosis. CONCLUSION The random sampling survey shows that serum miR-106b level is a valuable diagnostic marker for HCC. However, the diagnostic threshold value needs to be further researched.

Hepatic fibrosis is a common middle stage of the pathological processes of chronic liver diseases. Clinical intervention during the early stages of hepatic fibrosis can slow the development of liver cirrhosis and reduce the risk of developing liver cancer. Performing a liver biopsy, the gold standard for viral liver disease management, has drawbacks such as invasiveness and a relatively high sampling error rate. Real-time tissue elastography (RTE), one of the most recently developed technologies, might be promising imaging technology because it is both noninvasive and provides accurate assessments of hepatic fibrosis. However, determining the stage of liver fibrosis from RTE images in a clinic is a challenging task. In this study, in contrast to the previous liver fibrosis index (LFI) method, which predicts the stage of diagnosis using RTE images and multiple regression analysis, we employed four classical classifiers (i.e., Support Vector Machine, Naïve Bayes, Random Forest and K-Nearest Neighbor) to build a decision-support system to improve the hepatitis B stage diagnosis performance. Eleven RTE image features were obtained from 513 subjects who underwent liver biopsies in this multicenter collaborative research. The experimental results showed that the adopted classifiers significantly outperformed the LFI method and that the Random Forest(RF) classifier provided the highest average accuracy among the four machine algorithms. This result suggests that sophisticated machine-learning methods can be powerful tools for evaluating the stage of hepatic fibrosis and show promise for clinical applications.

Objective To investigate the value of elasticity contrast index (ECI) of ultrasound to the diagnosis of renal fibrosis in unilateral ureteral ligation rat models.Methods Twenty-four SD rats were divided into sham operation group (n=6) and model group (n=18).Model group was redivided into postoperative 3-,7-and 14-day groups,with 6 rats in each group.Model group was performed right ureteral ligation and sham operation group was performed ureteral separation without ligation.Sham operation group and model group were measured the ECI value on the 3rd,7th and 14th days after operation under intraperitoneal anesthesia with 5％ chloral hydrate.The right kidney underwent Masson staining and the renal tubular interstitial lesion score was evaluated.Results The ECI value was significantly higher on the 14th day after operation in model group (1.20±0.18) than that in sham operation group (0.59±0.09) (P＜0.05),and there were no significant differences in the ECI values on the 3rd and 7th days after operation between model group (0.62±0.10,0.68±0.12) and sham operation group (P＞0.05).The renal tubular interstitial lesion scores on the 3rd,7th and 14th days after operation in model group (2.56±0.73,4.35±0.84,6.93±0.72) were significantly higher than those in sham operation group (0,0,0) (P＜0.05),and significant differences were found in multiple comparison on the 3rd,7th and 14th days after operation in model group (P＜0.05).Conclusion ECI could be used to assess the degree of renal fibrosis,and could be a semi-quantitative evaluation index for renal fibrosis.

Objective To evaluate the application value of contrast-enhanced ultrasound ( CEUS) in the diagnosis of renal occupied lesions systematically.Methods The related literatures which used CEUS in the diagnosis of renal occu-pied lesions were searched from Pubmed, Embase, Cochrane Library, CBM and CNKI database.The heterogeneity test was conducted on these literatures by using Stata 12.0 and Meta-disc software.The weighted sensitivity, specificity, diagnosis odds ratio, positive likelihood ratio and negative likelihood ratio were calculated as well as the summary receiver operating characteristic ( SROC) curve.Results Fourteen literatures were included, the weighted sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio and negative likelihood ratio were 0.957, 0.748, 66.277, 3.797 and 0.057, respec-tively;and the SROC curve was 0.96.Conclusion Using CEUS has a low missed diagnosis rate, an relative high misdi-agnosis rate and small range of summary sensitivity in the differential diagnosis of renal occupied lesions.

The aim of the present study was to assess the value of real-time elastography (RTE) quantitative parameters, namely the liver fibrosis (LF) index and the ratio of blue area (% AREA), in evaluating the stage of liver fibrosis. RTE quantitative analysis software was used to examine 120 patients with chronic hepatitis in order to obtain the values for 12 quantitative parameters from the elastic images. The diagnostic performance of two such parameters, the LF index and % AREA, were assessed with a receiver operating characteristic (ROC) curve to determine the optimal diagnostic cut-off values for liver cirrhosis and fibrosis. A good correlation was observed between the LF index and % AREA with the fibrosis stage. The areas under the ROC curve for the LF index were 0.985 for the diagnosis of liver cirrhosis and 0.790 for liver fibrosis. With regard to % AREA, the areas under the ROC curve for the diagnosis of liver cirrhosis and fibrosis were 0.963 and 0.770, respectively. An LF index of >3.25 and a % AREA of >28.83 for the diagnosis of cirrhosis stage resulted in sensitivity values of 100 and 100%, specificity values of 88.9 and 85.9% and accuracy values of 90.8 and 88.3%, respectively. The LF index and % AREA parameters exhibited higher reliability in the diagnosis of liver cirrhosis compared with the diagnosis of the liver fibrosis stage. However, the two parameters possessed a similar efficacy in the diagnosis of liver cirrhosis and the stage of liver fibrosis. Therefore, the quantitative RTE parameters of the LF index and % AREA may be clinically applicable as reliable indices for the early diagnosis of liver cirrhosis, without the requirement of an invasive procedure.

Pancreatic ductal adenocarcinoma (PDAC) is the most common epithelial, exocrine pancreatic malignancy, accounting for more than 80 % of the malignant neoplasms of the pancreas. Although the molecular basis of pancreatic cancer is now better understood than ever before, there remains a long distance from being completely understood. In this study, we identified the differentially expressed genes (DEGs) in PDAC tissue compared with normal tissue and constructed a co-expression network by computing the pairwise correlation coefficient between the DEGs. We applied a statistical approach of MCODE to cluster genes in the coexpression network. Ten functional modules were identified in this network. Our results strongly suggest that dysregulations of immune response, homeostasis and cell adhesion may significantly contribute to the development and progression of PDAC. Results from this study will provide the groundwork for the understanding of PDAC. Future studies are needed to confirm some of the possible interactions suggested by this study.

BACKGROUND:The prognosis and management of hepatic fibrosis are closely related to the stage of the disease. The limitations of liver biopsy, which is the gold standard for treatment, include its invasiveness and sampling error. Ultrasound elasticity might be the most promising imaging technology for the noninvasive and accurate assessment of hepatic fibrosis. Real-time tissue elastography (RTE) measures the relative stiffness of the tissue in the region of interest caused by the heartbeat. Many studies have verified that RTE is useful for the diagnosis of hepatic fibrosis in patients with chronic hepatitis C (CHC).PURPOSE:To determine the formula of the liver fibrosis index for chronic hepatitis B (BLFI) and to validate the diagnostic accuracy of the BLFI for hepatic fibrosis compared with the liver fibrosis index (LFI).MATERIALS AND METHODS:RTE was performed in 747 prospectively enrolled patients with chronic hepatitis B (CHB) or cirrhosis from 8 centers in China; 375 patients were analyzed as the training set, and 372 patients were evaluated as the validation set. The fibrosis stage was diagnosed from pathological specimens obtained by ultrasound-guided liver biopsy. Nine image features were measured from strain images, and the new formula for the BLFI was obtained by combining the nine imaging features of the RTE images using multiple regression analysis of the training set. The BLFI and LFI were compared with the pathological fibrosis stage at diagnosis, and the diagnostic performances of the indexes were compared.RESULTS:The Spearman correlation coefficient between the BLFI and hepatic fibrosis stages was significantly positive (r = 0.711, p < 0.001), and significant differences were present between all disease stages. The areas under the receiver-operating characteristic (AUROC) curves of the BLFI and LFI for predicting significant fibrosis (S0-S1 vs. S2-S4) were 0.858 and 0.858, respectively. For cirrhosis (S0-S3 vs. S4), the AUROC curves of the BLFI and LFI were 0.868 and 0.862, respectively.CONCLUSION:The results of this large, multicenter study confirmed that RTE is valuable for the diagnosis of hepatic fibrosis in patients with CHB. However, the diagnostic efficiencies of the new BLFI and the original LFI, which were based on CHC, for the assessment of CHB hepatic fibrosis were similar; thus, the LFI has the potential to be used to directly evaluate the extent of hepatic fibrosis in patients with CHB.

肝纤维化(LF)是肝硬化的早期改变,如果在此时消除病因,积极治疗,纤维化可以逐步缓解.我们应用无创的超声弹性成像技术评估LF程度,并探讨LF指数诊断早期肝硬化期及LF期的最佳临界值.一、材料与方法1.研究对象:选取2010年6月至2013年3月在我院就诊的慢性肝炎患者123例,其中男89例,女34例,平均年龄(43.7±9.2)岁,其中乙肝114例,丙肝9例.病理获取途径为肝穿刺活检.排除可能导致肝实质病变的慢性疾病及可能影响肝脏弹性的其他病变.肝穿刺活检组织的LF分级标准按Metavir分级:S0,无LF;S1,汇管区有纤维化但无分隔;S2,汇管区有纤维化伴少量分隔;S3,有大量分隔但无肝硬化;S4,早期肝硬化。

Objective To discuss the proper surgical management for pancreatic benign and lowgrade malignancies.Methods The clinical data of 28 cases who accepted organ preserving pancreatectomy from May 2005 to June 2011 was analyzed retrospectively.Results Seven cases underwent duodenumpreserving resection of the head of the pancreas,9 cases underwent middle segmental pancreatectomy,5 cases underwent spleen-preserving distal pancreatectomy,7 cases underwent partial pancreatectomy.Pancreatic fistula occurred in one of 7 cases who accepted duodenum-preserving resection of the head of the pancreas,pancreatic fistula developed in one of 9 cases who accepted middle segmental pancreatectomy.Fat liquefaction occurred in 2 of 7 cases after partial pancreatectomy.These complications were cured by conservative treatment.All cases were followed-up from 6 months to six years.There was no tumor recurrence nor new-onset diabetes mellitus,steatorrhea and pancreatic pseudocyst formation.Conclusions Organ preserving pancreatectomy is effective treatment for pancreatic benign and low-grade malignant tumors.