New Definition Criteria of Myocardial Dysfunction in Patients with Liver Cirrhosis: A Speckle Tracking and Tissue Doppler Imaging Study

There are no clear recommendations regarding cirrhotic cardiomyopathy (CC) evaluation in patients with pre-transplant liver cirrhosis. The roles of new methods, tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) in the diagnosis and prognosis of cirrhotic cardiomyopathy remain controversial. We investigated the utility of TDI/STE parameters in cirrhotic cardiomyopathy diagnosis and also in predicting mortality in patients with liver cirrhosis. Left/right ventricular function was studied using conventional TDI (velocities) and STE (strain/strain rate). We assessed left ventricular diastolic dysfunction, graded into four new classes (I/Ia/II/III). Serum NTproBNP (N-terminal prohormone of brain natriuretic peptide), troponin I, β-crosslaps, QTc interval, arterial compliance and endothelial function were measured. Liver-specific scores (Child–Pugh, MELD, MELDNa) were computed. There was a 1-y follow-up visit to determine mortality. We observed resting biventricular diastolic myocardial dysfunction, not presently included in the definition of cirrhotic cardiomyopathy. We provided an improved characterization of cardiac dysfunction in patients with liver cirrhosis. This might change the current definition. However, the utility of STE/TDI parameters in predicting long-term mortality in patients with liver cirrhosis remains controversial.     

不同疗效评价标准对结肠癌肝转移瘤疗效评价的一致性研究

目的探讨不同疗效评价标准对结肠癌肝脏转移瘤的疗效评价是否具有一致性。方法收集2010年12月-2012年12月我院临床资料完整且手术病理证实的结肠癌肝脏转移瘤患者68例，治疗前2周内及治疗6周后分别行多层螺旋CT（multi—slicespiralcomputedtomography，MSCT）增强扫描，通过西门子软件半自动处理技术对病灶进行测量后用实体瘤疗效评价的WHO标准、RECISTl．0标准和RECISTl．1标准进行评估。结果通过Spearman相关性分析，WHO标准与RECIST1．0标准、WHO标准与RECISTl．1标准，RECISTl．0标准与REClSTl．1标准相关系数分别为0．834、0．827、0．843，P均〈0．05。结论WHO标准、RECISTl．0标准和RECISTl．1标准具有较好的一致性，RECIST1．1标准更适合对结肠癌肝脏转移瘤患者进行疗效评价。     

Natural history of descending thoracic and thoracoabdominal aortic aneurysms

ObjectivesElucidating critical aortic diameters at which natural complications (rupture, dissection, and death) occur is of paramount importance to guide timely surgical intervention. Natural history knowledge for descending thoracic and thoracoabdominal aortic aneurysms is sparse. Our small early studies recommended repairing descending thoracic and thoracoabdominal aortic aneurysms before a critical diameter of 7.0 cm. We focus exclusively on a large number of descending thoracic and thoracoabdominal aortic aneurysms followed over time, enabling a more detailed analysis with greater granularity across aortic sizes.MethodsAortic diameters and long-term complications of 907 patients with descending thoracic and thoracoabdominal aortic aneurysms were reviewed. Growth rates (instrumental variables approach), yearly complication rates, 5-year event-free survival (Kaplan–Meier), and risk of complications as a function of aortic height index (aortic diameter [centimeters]/height [meters]) (competing-risks regression) were calculated.ResultsEstimated mean growth rate of descending thoracic and thoracoabdominal aortic aneurysms was 0.19 cm/year, increasing with increasing aortic size. Median size at acute type B dissection was 4.1 cm. Some 80% of dissections occurred below 5 cm, whereas 93% of ruptures occurred above 5 cm. Descending thoracic and thoracoabdominal aortic aneurysm diameter 6 cm or greater was associated with a 19% yearly rate of rupture, dissection, or death. Five-year complication-free survival progressively decreased with increasing aortic height index. Hazard of complications showed a 6-fold increase at an aortic height index of 4.2 or greater compared with an aortic height index of 3.0 to 3.5 (P < .05). The probability of fatal complications (aortic rupture or death) increased sharply at 2 hinge points: 6.0 and 6.5 cm.ConclusionsAcute type B dissections occur frequently at small aortic sizes; thus, prophylactic size-based surgery may not afford a means for dissection protection. However, fatal complications increase dramatically at 6.0 cm, suggesting that preemptive intervention before that criterion can save lives.     

Impact of ultra-low dose CT acquisition on semi-automated RECIST tool in the evaluation of malignant focal liver lesions

PurposeTo compare the evaluation of malignant focal liver lesions (FLLs) using a semi-automated RECIST tool with a standard and an ultra-low dose (ULD) computed tomography (CT) protocol.Materials and methodsThirty-four patients with malignant FLLs underwent two abdominal-pelvic CT examinations one using a standard protocol and one using an ULD protocol. There were 23 men and 11 women with a mean age 64.3 ± 14.4 (SD) years (range: 22–91 years). Dosimetric indicators were recorded, and effective dose was calculated for both examinations. Mean malignant FLL attenuation, image noise and contrast-to-noise-ratio (CNR) were compared. The largest malignant FLL per patient was evaluated using the semi-automated RECIST tool to determine longest axis length, longest orthogonal axis length, volume and World Health Organisation area.ResultsDosimetric values were significantly reduced by −56% with ULD compared to standard protocol. No differences in mean malignant FLL attenuation values were found between the two protocols. Image noise was significantly increased for all locations (P < 0.05) with ULD compared to standard protocol, and CNR was significantly reduced (P < 0.05). On the 34 malignant FLLs analyzed, six semi-automated shapes non-concordant with radiologist's visual impression were highlighted with the software, including one FLL (1/34; 3%) with standard CT acquisition only, three FLLs (3/34; 9%) with ULD CT acquisition only and two FLLs (2/34; 6%) with both CT acquisitions. After manual editing, the concordance of the values of the studied criteria between both acquisitions was good and no significant difference was reported.ConclusionSemi-automated RECIST tool demonstrates good performances using ULD CT protocol. It could be used in routine clinical practice with a ULD protocol for follow-up studies in patients with known malignant FLL.     

Criterios específicos de respuesta tumoral

Recent advances in biology and genetics have accelerated our knowledge about the development, growth, and dissemination of cancer, generating great expectations that these new discoveries will be translated into effective treatments for patients. Imaging techniques play a central role in the care of oncologic patients, since they have become tools capable of evaluating important characteristics of tumors and the response of tumors to different treatments. The objective of this article is to evaluate the different imaging-based criteria for assessing tumor response, discussing their advantages and limitations and illustrating the possible contribution of new imaging techniques as biomarkers of tumor response.     

建立年幼儿童哮喘诊断标准及预测工具的探索

与其他年龄段儿童相比,年幼儿童是发生哮喘的高危年龄段.由于临床表现非特异、喘息表型多样、辅助检查难以实施等原因,年幼儿童哮喘的诊断对临床医师而言存在一定困难.近二十年来,国内外对年幼儿童诊断标准及预测工具的探索从未停止,而我国也亟需建立起年幼儿童哮喘的诊断标准.该文综述国内外建立年幼儿童哮喘诊断标准及预测工具的过程,为建立我国新的年幼儿童哮喘诊断标准及预测工具提供参考.     

The changing diagnosis of gestational diabetes mellitus: Does anyone miss out?

Our aim was to identify women diagnosed with gestational diabetes mellitus (GDM) using 1999 WHO diagnostic criteria but who would be now classified as normal glucose tolerance (NGT) using updated criteria. We demonstrate that this category change affected 3.3% women and they have a limited increased risk of adverse outcomes.