Magnetic resonance spectroscopy to study hepatic metabolism in diffuse liver diseases, diabetes and cancer

This review provides an overview of the current state of the art of magnetic resonance spectroscopy (MRS) in in vivo investigations of diffuse liver disease. So far, MRS of the human liver in vivo has mainly been used as a research tool rather than a clinical tool. The liver is particularly suitable for static and dynamic metabolic studies due to its high metabolic activity. Furthermore, its relatively superfi cial position allows excellent MRS localization, while its large volume allows detection of signals with relatively low intensity. This review describes the application of MRS to study the metabolic consequences of different conditions including diffuse and chronic liver diseases, congenital diseases, diabetes, and the presence of a distant malignancy on hepatic metabolism. In addition, future prospects of MRS are discussed. It is anticipated that future technical developments such as clinical MRS magnets with higher fi eld strength (3 T) and improved delineation of multicomponent signals such as phosphomonoester and phosphodiester using proton decoupling, especially if combined with price reductions for stable isotope tracers, will lead to intensifi ed research into metabolic syndrome, cardiovascular disease, hepato-biliary diseases, as well as non-metastatic liver metabolism in patients with a distant malignant tumor.

Off-pump Coronary Endarterectomy and Bypass Grafting in Patients With Diffuse Coronary Artery Disease

Objectives preliminary experience on endarterectomy and To summarize our off-pump coronary bypass grafting in patients with diffuse coronary artery disease. Methods Over a 3year period, 53 patients （41 male） with diffuse coronary artery disease underwent off-pump coronary endarterectomy and bypass grafting at our institution. Patients＇ age ranged from 55 to 79 years. Prior to surgery, 70% of patients were in CCS angina class 2 （n=5） or 3 （n=32）, and nearly half of them （26/53） had history of myocardial infarction. Most patients （n= 50） had triple vessel lesions, with left main stem involvement in 9. Their left ventricular ejection fraction ranged from 26% to 65% （mean 52%）. At the end of operation, a flow-meter was routinely applied to measure the perfusion flow of each postendarterectomy graft. Results In total, 70 endarterectomies were performed in 53 patients, including 38 in left anterior descending artery （LAD）, 8 in circumflex artery and 24 in right coronary artery. Four operations were emergency or urgent in nature. Five patients received on-lay venous patch after endarterectomy in LAD, followed by left internal mammary artery （LIMA） grafting on the patch. The graft conduits included 53 LIMAs and 2 radial arteries, and saphenous veins in others. Mean number of grafts per patient was 3.75. The overall index of complet-eness of revascularization reached 1.03±0.07. There was no death in this group of patients during their post-operative hospital stay （mean duration = 9 days）. Intra-operatively, 63 （90%） out of the 70 grafts after coronary endarterectomy showed satisfactory flow. Two patients had perioperative neither experienced signifi myocardial infarctions but cant hemodynamic deteriations. Conclusions Off-pump coronary endarterectomy with bypass grafting is technically feasible and can be coronary improve zation. performed safely in patients with diffuse artery disease. This strategy may help to the completeness of myocardial revasculariation.

Location problem of emergency supplies reserve storages under disease diffusion environment

Under the threat of bio-terrorism,this paper aims at improving the emergency rescue system's ability of dealing with a public health emergency.Focusing on the demand network,this research establishes the emergency rescue supply storage network under a danger diffusion environment.Combined with the infectious disease diffusion model,the traditional set covering model is rebuilt taking the decision optimization of reserve quantity into consideration.Under the premise of a certain emergency service level,the collaborative location optimizing model of an emergency rescue supply storage network is established in order to minimize the sum of the building costs and the preserving costs.The model is proved to be effective through numerical simulation.The collaborative location optimization of the nodes of the emergency rescue supply storage network and the reserve quantity of each storage node is realized.

An abnormal resting-state functional brain network indicates progression towards Alzheimer's disease

Brain structure and cognitive function change in the temporal lobe, hippocampus, and prefrontal cortex of patients with mild cognitive impairment and Alzheimer＇s disease, and brain network-connection strength, network efficiency, and nodal attributes are abnormal. However, existing research has only analyzed the differences between these patients and normal controls. In this study, we constructed brain networks using resting-state functional MRI data that was extracted from four populations （nor- mal controls, patients with early mild cognitive impairment, patients with late mild cognitive impairment, and patients with Alzheimer＇s disease） using the Alzheimer＇s Disease Neuroimaging Initiative data set. The aim was to analyze the characteristics of resting-state functional neural networks, and to observe mild cognitive impairment at different stages before the transformation to Alzheimer＇s disease. Results showed that as cognitive deficits increased across the four groups, the shortest path in the rest- ing-state functional network gradually increased, while clustering coefficients gradually decreased. This evidence indicates that dementia is associated with a decline of brain network efficiency. In addi- tion, the changes in functional networks revealed the progressive deterioration of network function across brain regions from healthy elderly adults to those with mild cognitive impairment and AIz- heimer＇s disease. The alterations of node attributes in brain regions may reflect the cognitive functions in brain regions, and we speculate that early impairments in memory, hearing, and language function can eventually lead to diffuse brain injury and other cognitive impairments.

Diffusion weighted magnetic resonance imaging of liver: Principles, clinical applications and recent updates

Diffusion-weighted imaging(DWI), a functional imaging technique exploiting the Brownian motion of water molecules, is increasingly shown to have value in various oncological and non-oncological applications. Factors such as the ease of acquisition and ability to obtain functional information in the absence of intravenous contrast, especially in patients with abnormal renal function, have contributed to the growing interest in exploring clinical applications of DWI. In the liver, DWI demonstrates a gamut of clinical applications ranging from detecting focal liver lesions to monitoring response in patients undergoing serial follow-up after loco-regional and systemic therapies. DWI is also being applied in the evaluation of diffuse liver diseases such as non-alcoholic fatty liver disease, hepatic fibrosis and cirrhosis. In this review, we intend to review the basic principles, technique, current clinical applications and future trends of DW-MRI in the liver.

Artificial intelligence in liver ultrasound

Artificial intelligence(AI)is playing an increasingly important role in medicine,especially in the field of medical imaging.It can be used to diagnose diseases and predict certain statuses and possible events that may happen.Recently,more and more studies have confirmed the value of AI based on ultrasound in the evaluation of diffuse liver diseases and focal liver lesions.It can assess the severity of liver fibrosis and nonalcoholic fatty liver,differentially diagnose benign and malignant liver lesions,distinguish primary from secondary liver cancers,predict the curative effect of liver cancer treatment and recurrence after treatment,and predict microvascular invasion in hepatocellular carcinoma.The findings from these studies have great clinical application potential in the near future.The purpose of this review is to comprehensively introduce the current status and future perspectives of AI in liver ultrasound.

Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

Background： It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease （CAD）. Coronary endarterectomy （CE） offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft （CABG） was discussed in the treatment for the diffused CAD. Methods： From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE ＋ CABG were pertbrmed, which was about 17.2% （38/221） of the cohort. All these patients were divided into two groups： CE ＋ CABG group （Group A） and CABG alone group and postoperative complications and in-hospital mortality were Chi-square test and Student＇s t-test respectively. （Group B）. All clinical data were compared between the two groups, analyzed. The categorical and continuous variables were analyzed by Results： Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was perfbrmed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A （3/38）, which was more often than that in Group B （3/183）. At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent （50/50）. There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions： Coronary endarterectomy ＋ CABG can oilier satisfactory result for patients with diffused CAD in a short-term after the operation.

TRAVELLING FRONT SOLUTIONS IN A DIFFUSIVE VECTOR DISEASE MODEL WITH SPATIO-TEMPORAL DELAY

This paper is concerned with travelling front solutions to a vector disease model with a spatio-temporal delay incorporated as an integral convolution over all the past time up to now and the whole one-dimensional spatial domain R.When the delay kernel is assumed to be the strong generic kernel,using the linear chain techniques and the geometric singular perturbation theory,the existence of travelling front solutions is shown for small delay.

Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery

Currently coronary artery bypass grafting （CABG） is the most commonly used procedure for revascularization of coronary heart disease. However it may not be suitable for the patients with diffuse coronary artery diseases. Under this circumstance, retrograde perfusion via cardiac venous system, namely retrograde coronary venous bypass graft （CVBG）,

Utility of transbronchial biopsy in the diagnosis of lymphangioleiomyomatosis

Pulmonary lymphangioleiomyomatosis(LAM)is a rare cystic lung disease that targets women during their reproductive years.A confident diagnosis can often be based on clinical grounds,but diagnostic certainty requires pathological analysis.Although surgical lung biopsy is considered the gold standard for obtaining tissue in patients with diffuse lung disease,it is also associated with higher morbidity and mortality than alternative,less invasive techniques.The objective of our study was to examine the utility of transbronchial biopsy in the diagnosis of LAM.We conducted two online surveys of over 1000 LAM patients registered with the LAM Foundation who were accessible by email.Transbronchial biopsy specimens were subsequently collected and reviewed by an expert pathologist to validate the diagnosis.We found that transbronchial biopsy has a yield of approximately 60% in patients with LAM.We conclude that transbronchial biopsy may be a safe and effective method for establishing the diagnosis of LAM,obviating the need for surgical lung biopsy in more than half of LAM patients.

NEWS AND NOTES

Lung biopsies examined with light microscope and electron microscope were performed in 34 cases of diffuse pulmonary disease.Open lung biopsy was done in 2 cases,