Transient elastography (TE) is routinely used for noninvasive staging of hepatic fibrosis. The objective of the present study was to investigate the role of TE (FibroScan) in determining changes in liver congestion in patients with Budd–Chiari syndrome (BCS) treated by endovascular interventions and determine the effects of pretreatment Meta-analysis of Histological Data in Viral Hepatitis (METAVIR) fibrosis score on posttreatment liver stiffness (LS).
Materials and Methods
Twenty-five patients undergoing endovascular procedures for treatment of BCS underwent TE immediately before and within 24 hours after the procedure. Fifteen patients available for 3-month follow-up were again subjected to TE. Mean LS values before and after intervention were compared in 12 of these patients for whom METAVIR scores were available. Pressure gradient changes across the stenosed hepatic veins/inferior vena cava were measured during the procedure. Statistical analysis of these data was performed by Wilcoxon signed-rank test, Mann–Whitney U test, and Pearson product–moment correlation coefficient.
Results
Significant differences were found between mean LS measurements before and within 24 hours after intervention (Z-score = 4.372) and between the mean values obtained before and 3 months after treatment (Z-score = 3.408). Mean changes in LS values after intervention in patients with METAVIR fibrosis scores ≤ 2 and > 2 were not significant. There was no correlation between changes in pressure gradients and the degree of LS.
Conclusions
TE is a useful tool to assess the reduction in hepatic congestion in patients with BCS undergoing endovascular interventions. 相似文献
Backgrounds: Defect in kidney is one major reason of hypertension. The study aimed ao uncovering the regulatory mechanisms of miRNAs and the targets in hypertensive kidney.
Methods: Gene expression profile of GSE28345 and miRNA expression profile of GSE28283 were downloaded from GEO database. After data preprocessing, differently expressed genes (DEGs) and miRNAs (DE-miRs) were identified using limma package. Then targets of miRNAs were predicted according to information in relevant databases. Function and pathway enrichment analyses were performed for DEGs using DAVID software. Furthermore, protein–protein interaction (PPI) networks were constructed for up- and down-regulated genes, respectively, using the Cytoscape. Additionally, for down-regulated DEGs, the integrated regulatory network was established combining PPI network with the miRNA–mRNA interactions.
Results: As a result, 285 DEGs were identified, including 177 up-regulated and 108 down-regulated genes. Combined with the predicted targets of miRNAs, 22 up-regulated DE-miRs were identified. In the integrated network for down-regulated DEGs, three crucial nodes were identified as ASPN, COL12A1, and SCN2A. ASPN was predicted as target of miR-21 and miR-374b, and COL12A1 was the target of miR-30e, miR-21, and miR-195, while SCN2A was the target of miR-30e, miR-374b, and miR-195. Notably, COL12A1 and ASPN were linked with each other in the network.
Conclusion: Three crucial genes were identified in hypertensive kidney, such as COL12A1, ASPN, and SCN2A. ASPN might co-function with COL12A1, and they both might be the targets of miR-21. SCN2A might be a novel target of miR-30e and miR-374b. However, more experiments are needed to validate these results. 相似文献
To determine conditional recurrence-free survival (RFS) and progression-free survival (PFS) and improve decision-making toward surveillance protocols and scheduling. Furthermore, evaluating the evolution of predictors for disease recurrence over time, because TaG1 non–muscle-invasive bladder cancer harbors a risk of disease recurrence and progression.
Material and methods
The retrospective multicenter design study includes 1,245 TaG1 bladder cancer patients with median follow-up of 62.7 (interquartile range: 34.3–91.1) months. Conditional RFS and PFS estimates were calculated using the Kaplan-Meier method. Multivariable Cox regression model was calculated proportional for the prediction of recurrence and progression (covariables: age, tumor size, multiple tumors, prior recurrence, and immediate postoperative instillation of chemotherapy).
Results
After 3 months without event, the conditional RFS and PFS (to ≥pT2) rates for 5 additional years without event were 57.5% and 93.4%, respectively. Given a 1-, 2-, 3-, and 5-year survival, the conditional RFS rates for 5 additional years without event improved by +9.8 (67.3%), +5.2 (72.5%), +6.5 (79.0%), +2.0 (81.0%), and +1.0% (82.0%), respectively. In contrast, the 5-year conditional PFS rates were more or less stable with 94.3% after 1 year to 94.1% after 5 years. Multivariable analyses showed decreasing impact of risk parameters on RFS estimates over time. Based on these findings, we suggest a risk stratification to individualize follow-up for intermediate risk TaG1. Main limitation was the retrospective design.
Conclusions
Conditional-survival analyses demonstrates that the patient risk profile changes over time. RFS rates rise with increasing survival whereas PFS rates were stable. The impact of prognostic features decreases over time. Our findings can be used for patient counseling and planning of personalized follow-up. 相似文献
The traditional approach to acid–base physiology is based on the Henderson–Hasselbalch equation which is derived from the buffer system. However, it is becoming increasingly recognized that this is an incomplete analysis as it focuses on only one of the six reactions involving H+ and can lead to the incorrect assumption that CO2 and are independently adjusted factors that ultimately determine pH. In 1983, Stewart, a Canadian physiologist, proposed that a fuller understanding of acid–base physiology required consideration of biological fluids as a complex dynamic system, taking into account the interactions of all the chemical species involved. He showed that the true independent variables controlling the pH of any given fluid compartment are: the difference in the concentration of ‘strong ions’; the total concentration of ‘weak acid’; and the PCO2. Importantly, H+ and are dependent variables and it is incorrect to think of them as being specifically regulated to manipulate pH. This review will discuss the importance of pH homeostasis and highlight the implications of the Stewart approach in our understanding of acid–base control mechanisms and disorders. In particular, the true mechanisms by which the kidney regulates plasma pH will be discussed, emphasizing key misconceptions that have been propagated as a result of the traditional approach. 相似文献
Aim of this study was to evaluate the collateral blood flow between more distal branches of the middle cerebral artery (MCA) in the case of peripheral MCA branch occlusion on dynamic 4D angiograms. We sought to individually predict the finally resulting infarction volume with regard to the extent of collateral blood flow.
Methods
Overall, 35 acute ischemic stroke patients with peripheral MCA branch occlusion were included. Volumes of the ischemic infarctions and perfusion deficits were measured on diffusion-weighted images DWI and time-to-peak TTP (>?4?s). Collateral flow on 4D MR angiograms were classified as previously specified.
Results
On DWI, the ischemic lesions had a mean volume of 3.4?±?15.1?mL while the mean volume on TTP (>?4?s) was significantly larger 22.0?±?18.1?mL (P?<?0.001). On dynamic 4D angiograms we observed grade 1 in 8 (22.9%), grade 2 in 4 (11.4%), grade 3 in 10 (28.6%), and grade 4 in 13 (37.1%) patients. In comparison to patients with better collateralization (grade 3–4) patients with less sufficient collateralization (grade 0–2) demonstrated larger infarction volumes on initial (11.1?mL (IQR 2.9–35.5) vs. 2.1?mL (IQR 0.5–4.5), P?=?0.03) and follow-up DWI (15.5?mL (IQR 12.6–23.3) vs. 1.9?mL (IQR 0.5–4.5), P?=?0.03) with prominent infarction growth (7.4?mL (IQR 2.6–10.1) vs. 0.9?mL (IQR 0.2–2.6), P?=?0.08).
Conclusions
In the majority of cases with distal MCA branch occlusion a good collateral blood flow has been observed. Nevertheless, in approximately one quarter of patients an insufficient collateral blood flow has been detected that was associated with substantial infarction growth. 相似文献
Although there have been several case reports and simulation models of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission associated with air travel, there are limited data to guide testing strategy to minimize the risk of SARS-CoV-2 exposure and transmission onboard commercial aircraft. Among 9853 passengers with a negative SARS-CoV-2 polymerase chain reaction test performed within 72 hours of departure from December 2020 through May 2021, five (0.05%) passengers with active SARS-CoV-2 infection were identified with rapid antigen tests and confirmed with rapid molecular test performed before and after an international flight from the United States to Italy. This translates to a case detection rate of 1 per 1970 travelers during a time of high prevalence of active infection in the United States. A negative molecular test for SARS-CoV-2 within 72 hours of international airline departure results in a low probability of active infection identified on antigen testing during commercial airline flight. 相似文献