A study of T1 relaxation time as a measure of liver fibrosis and the influence of confounding histological factors

Liver biopsy is the standard test for the assessment of fibrosis in liver tissue of patients with chronic liver disease. Recent studies have used a non‐invasive measure of T₁ relaxation time to estimate the degree of fibrosis in a single slice of the liver. Here, we extend this work to measure T₁ of the whole liver and investigate the effects of additional histological factors such as steatosis, inflammation and iron accumulation on the relationship between liver T₁ and fibrosis. We prospectively enrolled patients who had previously undergone liver biopsy to have MR scans. A non‐breath‐holding, fast scanning protocol was used to acquire MR relaxation time data (T₁ and T₂*), and blood serum was used to determine the enhanced liver fibrosis (ELF) score. Areas under the receiver operator curves (AUROCs) for T₁ to detect advanced fibrosis and cirrhosis were derived in a training cohort and then validated in a second cohort. Combining the cohorts, the influence of various histology factors on liver T₁ relaxation time was investigated. The AUROCs (95% confidence interval (CI)) for detecting advanced fibrosis (F ≥ 3) and cirrhosis (F = 4) for the training cohort were 0.81 (0.65–0.96) and 0.92 (0.81–1.0) respectively (p < 0.01). Inflammation and iron accumulation were shown to significantly alter T₁ in opposing directions in the absence of advanced fibrosis; inflammation increasing T₁ and iron decreasing T₁. A decision tree model was developed to allow the assessment of early liver disease based on relaxation times and ELF, and to screen for the need for biopsy. T₁ relaxation time increases with advanced fibrosis in liver patients, but is also influenced by iron accumulation and inflammation. Together with ELF, relaxation time measures provide a marker to stratify patients with suspected liver disease for biopsy. Copyright © 2015 John Wiley & Sons, Ltd.     

Nurse-Led Follow-Up at Home vs. Conventional Medical Outpatient Clinic Follow-Up in Patients With Incurable Upper Gastrointestinal Cancer: A Randomized Study

ContextUpper gastrointestinal cancer is associated with a poor prognosis. The multidimensional problems of incurable patients require close monitoring and frequent support, which cannot sufficiently be provided during conventional one to two month follow-up visits to the outpatient clinic.ObjectivesTo compare nurse-led follow-up at home with conventional medical follow-up in the outpatient clinic for patients with incurable primary or recurrent esophageal, pancreatic, or hepatobiliary cancer.MethodsPatients were randomized to nurse-led follow-up at home or conventional medical follow-up in the outpatient clinic. Outcome parameters were quality of life (QoL), patient satisfaction, and health care consumption, measured by different questionnaires at one and a half and four months after randomization. As well, cost analyses were done for both follow-up strategies in the first four months.ResultsIn total, 138 patients were randomized, of which 66 (48%) were evaluable. At baseline, both groups were similar with respect to clinical and sociodemographic characteristics and health-related QoL. Patients in the nurse-led follow-up group were significantly more satisfied with the visits, whereas QoL and health care consumption within the first four months were comparable between the two groups. Nurse-led follow-up was less expensive than conventional medical follow-up. However, the total costs for the first four months of follow-up in this study were higher in the nurse-led follow-up group because of a higher frequency of visits.ConclusionThe results suggest that conventional medical follow-up is interchangeable with nurse-led follow-up. A cost utility study is necessary to determine the preferred frequency and duration of the home visits.     

Enzymatic determination of serum 3α-sulfated bile acids concentration with bile acid 3α-sulfate sulfohydrolase

A newly developed enzymatic method for determining urinary 3-sulfated bile acids was used to measure serum 3-sulfated bile acid levels in 114 patients with hepatobiliary diseases and 56 healthy subjects. The lowest measurable amount of the 3-sulfated bile acids was 0.5 µmol/liter. The standard curves for glycolithocholic acid 3-sulfate, glycoursodeoxycholic acid 3-sulfate, and lithocholic acid 3-sulfate were linear from 0.5 to 250 µmol/liter. Specificity of the assay was satisfactory and intra- and interassay variations ranged from 0.8 to 4.4% and from 1.2 to 7.9%, respectively. Analytical recovery was more than 91%. The values obtained by this assay were well correlated with those by gas-liquid chromatography measurement (r=0.91,P<0.01). The fasting serum 3-sulfated bile acids level in healthy subjects ranged from undetectable to 1.9 µmol/liter (mean±se; 0.9±0.1 µmol/liter). The percentage of 3-sulfated bile acids in total bile acids (sum of 3-sulfated and 3-hydroxy bile acids) in serum was 16.8±1.5%. In subjects with hepatobiliary diseases, serum 3-sulfated bile acids levels were elevated; however, the percentage of 3-sulfated bile acids in total bile acids was decreased and correlated with the severity of hepatocellular insufficiency. This enzymatic assay is simple, rapid, and accurate for the determination of serum 3-sulfated bile acids.     

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??Abstract??The most common etiology of abdominal pain in children caused by liver and biliary disease is chronic hepatitis?? sphincter of Oddi dysfunction?? cholangitis?? cholecystitis?? choledochal cyst and biliary movement disorder?? presented with right upper abdominal dull pain?? but clinical manifestation of biliary tract roundworm disease is colic?? always complicated with hepatomegaly. Children co-infected with microorganism often have fever??jaundice??increased white blood cells??etc. History?? physical sign and imaging examinations are useful to the diagnosis.     

加速康复肝胆外科患者围术期睡眠状况的监测研究

目的 了解加速康复肝胆外科患者围术期的睡眠状况,为进一步制定睡眠管理策略提供理论依据。方法 选取肝胆外科实施加速康复手术治疗的患者200例为研究对象,采用睡眠监测手环对围术期患者的睡眠状况进行动态监测。结果 加速康复肝胆外科患者围术期睡眠不足发生率达73%。胰腺手术患者围术期睡眠状况最差。开腹手术围术期睡眠时长低于腔镜手术患者(P＜0.05)。四级手术患者围术期睡眠时长低于三级手术者(P＜0.05)。结论 加速康复肝胆外科患者围术期睡眠问题不容乐观。不同手术类型、不同手术方式、不同手术分级的患者围术期睡眠状况存在差异。医护人员应高度重视围术期患者的睡眠状况,进一步探讨睡眠问题的影响因素,并采取积极有效的护理干预措施。     

Helicobacter pylori in Thai patients with cholangiocarcinoma and its association with biliary inflammation and proliferation

Objectives

To investigate whether Helicobacter spp. infection and the cagA of H. pylori are associated with hepatobiliary pathology, specifically biliary inflammation, cell proliferation and cholangiocarcinoma (CCA).

Methods

Helicobacter species including H. pylori, H. bilis and H. hepaticus were detected in the specimens using the polymerase chain reaction (PCR). Biliary inflammation of the liver and gallbladders was semi-quantitatively graded on hematoxylin and eosin (H&E)-stained slides. Biliary proliferation was evaluated by immunohistochemistry using the Ki-67-labelling index.

Results

Helicobacter pylori was found in 66.7%, 41.5% and 25.0% of the patients in the CCA, cholelithiasis and control groups (P < 0.05), respectively. By comparison, H. bilis was found in 14.9% and 9.4% of the patients with CCA and cholelithiasis, respectively (P > 0.05), and was absent in the control group. The cagA gene of H. pylori was detected in 36.2% and 9.1% of the patients with CCA and cholelithiasis, respectively (P < 0.05). Among patients with CCA, cell inflammation and proliferation in the liver and gallbladder were significantly higher among those DNA H. pylori positive than negative.

Conclusions

The present findings suggest that H. pylori, especially the cagA-positive strains, may be involved in the pathogenesis of hepatobiliary diseases, especially CCA through enhanced biliary cell inflammation and proliferation.