Recent advances in the diagnosis of drug-induced liver injury

Drug-induced liver injury(DILI)is a major problem in the United States,commonly leading to hospital admission.Diagnosing DILI is difficult as it is a diagnosis of exclusion requiring a temporal relationship between drug exposure and liver injury and a thorough work up for other causes.In addition,DILI has a very variable clinical and histologic presentation that can mimic many different etiologies of liver disease.Objective scoring systems can assess the probability that a drug caused the liver injury but liver biopsy findings are not part of the criteria used in these systems.This review will address some of the recent updates to the scoring systems and the role of liver biopsy in the diagnosis of DILI.

Visualizing traumatic brain injury:ocular clues for diagnosis and assessment

Traumatic brain injury (TBI) is defined as damage to the brain resulting from an external sudden physical force or shock to the head.It is considered a silent public health epidemic causing significant death and disability globally.There were 64,000 TBI related deaths reported in the USA in 2020,with about US$76 billion in direct and indirect medical costs annually.

Analysis of The Value of Multi-Slice Spiral CT and Magnetic Resonance Imaging in The Diagnosis of Carpal Joint Injury

Objective:To analyze the value of multi-slice spiral computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of carpal joint injury.Methods:A total of 130 patients with suspected wrist injuries admitted to the Department of Orthopedics of our hospital from January 2023 to January 2024 were selected and randomly divided into a single group(n=65)and a joint group(n=65).The single group was diagnosed using multi-slice spiral CT,and the joint group was diagnosed using multi-slice spiral CT and magnetic resonance imaging,with pathological diagnosis as the gold standard.The diagnostic results of both groups were compared to the gold standard,and the diagnostic energy efficiency of both groups was compared.Results:The diagnostic results of the single group compared with the gold standard were significant(P<0.05).The diagnostic results of the joint group compared with the gold standard were not significant(P>0.05).The sensitivity and accuracy of diagnosis in the joint group were significantly higher than that in the single group(P<0.05).The specificity of diagnosis in the joint group was higher as compared to that in the single group(P>0.05).Conclusion:The combination of multi-slice spiral CT and MRI was highly accurate in diagnosing wrist injuries,and the misdiagnosis rate and leakage rate were relatively low.Hence,this diagnostic program is recommended to be popularized.

Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament

Injury to the anterior talofibular ligament(ATFL)is a common acute injury of the lateral foot ligament.Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients.The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL.The clinical manifestations of acute injury to the ATFL include pain,swelling,and dysfunction.At present,non-surgical treatment is the first choice for acute injury of the ATFL.The standard treatment strategy involves the“peace and love”principle.After initial treatment in the acute phase,personalized rehabilitation training programs can be followed.These may involve proprioception training,muscle training,and functional exercise to restore limb coordination and muscle strength.Static stretching and other techniques to loosen joints,acupuncture,moxibustion massage,and other traditional medical treatments can relieve pain,restore range of motion,and prevent joint stiffness.If the non-surgical treatment is not ideal or fails,surgical treatment is feasible.Currently,arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice.Although open Broström surgery provides good results,the modified arthroscopic Broström surgery has many advantages,such as less trauma,rapid pain relief,rapid postoperative recovery,and fewer complications,and is more popular with patients.In general,when treating acute injury to the ATFL,treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.

A molecular probe carrying anti-tropomyosin 4 for early diagnosis of cerebral ischemia/reperfusion injury

In vivo imaging of cerebral ischemia/reperfusion injury remains an important challenge.We injected porous Ag/Au@SiO_(2) bimetallic hollow nanoshells carrying anti-tropomyosin 4 as a molecular probe into mice with cerebral ischemia/reperfusion injury and observed microvascular changes in the brain using photoacoustic imaging with ultrasonography.At each measured time point,the total photoacoustic signal was significantly higher on the affected side than on the healthy side.Twelve hours after reperfusion,cerebral perfusion on the affected side increased,cerebrovascular injury worsened,and anti-tropomyosin 4 expression increased.Twenty-four hours after reperfusion and later,perfusion on the affected side declined slowly and stabilized after 1 week;brain injury was also alleviated.Histopathological and immunohistochemical examinations confirmed the brain injury tissue changes.The nanoshell molecular probe carrying anti-tropomyosin 4 has potential for use in early diagnosis of cerebral ischemia/reperfusion injury and evaluating its progression.

Diagnosis and Treatment of 42 Cases of Multiple Injuries with Pancreatic Injury

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures （52.3%）, shock （50%）, multiple fractures （47.6%）, and severe brain injury （26.1%）. In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases （97.6%） were cured （including 40 cases receiving surgical operation and one case receiving the conservative treatment）. Postoperative complications occurred in 16 cases （21 cases/times）： pancreatic fistula （5 cases/times） and incisional wound infection （5 cases/times）, intra-abdominal infection （3 cases/times）, stress ulcer （3 cases/times）, pleural effusion （3 cases/times）, pulmonary infection （one case） and wound dehiscence （1 case）. The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.

Practical guidelines for diagnosis and early management of drug-induced liver injury

The spectrum of drug-induced liver injury （DILI） is both diverse and complex. The first step in diagnosis is a suspicion of DILl based on careful consideration of recent comprehensive reports on the disease. There are some situations in which the suspicion of DILI is particularly strong. Exclusion of other possible etiologies according to the pattern of liver injury is essential for the diagnosis. In patients with suspected DILl, diagnostic scales, such as the Councils for International Organizations of Medical Sciences/ Roussel Uclaf Causality Assessment Method （CIOMS/RUCAM） scale, may be helpful for the final diagnosis. Early management of DILl involves prompt withdrawal of the drug suspected of being responsible, according to serum levels of alanine aminotransferase （ALT）, alkaline phosphatase （ALP）, and total bilirubin （T-Bil）. However, as DILI patients may show resolution of liver injury without discontinuation of the drug, it should be carefully evaluated whether the suspected drug should be discontinued immediately with adequate consideration of the importance of the medication.

Expert consensus on the evaluation and diagnosis of combat injuries of the Chinese People's Liberation Army

The accurate assessment and diagnosis of combat injuries are the basis for triage and treatment of combat casualties. A consensus on the assessment and diagnosis of combat injuries was made and discussed at the second annual meeting of the Professional Committee on Disaster Medicine of the Chinese People's Liberation Army(PLA). In this consensus agreement, the massive hemorrhage, airway, respiration, circulation and hypothermia(MARCH) algorithm, which is a simple triage and rapid treatment and field triage score, was recommended to assess combat casualties during the first-aid stage, whereas the abbreviated scoring method for combat casualty and the MARCH algorithm were recommended to assess combat casualties in level Ⅱ facilities. In level Ⅲ facilities, combined measures, including a history inquiry, thorough physical examination, laboratory examination, X-ray, and ultrasound examination, were recommended for the diagnosis of combat casualties. In addition, corresponding methods were recommended for the recognition of casualties needing massive transfusions, assessment of firearm wounds, evaluation of mangled extremities, and assessment of injury severity in this consensus.

Non-image diagnosis of bile duct injury during laparoscopic cholecystectomy

Objective: To evaluate the role of simple non-imagetechnique in intraoperative diagnosis of bile duct in-jury (BDI).Methods: BDI was highly suspected at the original la-paroscopic cholecystectomy (LC) when the following 3abnormal findings were noted: the 'cystic duct' stump(the common bile duct stump actually) markedly re-tracted down to the duodenum; bile leakage from theporta hepatis; abnormal mucosal patch attached to the'cystic duct' stump of the removed gallbladder. Allcases of suspected BDI were converted to have laparo-tomy. Image techniques such as intraoperative cholan-giography or ultrasonography were not utilized forrecognition of BDI in all 9 patients.Results: BDI in 4 of the 9 patients was suspected ac-cording to 1-3 abnormal intraoperative findings de-scribed above. The four patients were subjected imme-diately to converted laparotomy. Abnormal findingswere not observed or misinterpreted in the other 5misdiagnosed patients.Conclusions: Timely recognizing whether BDI occursshould be considered as a routine procedure ofLC. Negligence of operators to the abnormalities of theoriginal LC, is the main cause of misdiagnosis forBDL. Simple non-image approaches such as close ob-servation of these abnormalities can make timely diag-nosis for most BDIs during the original LC.

Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injury

Research scientists and clinicians should be aware that missed diagnoses of mild-moderate traumatic brain injuries in post-acute patients having spinal cord injuries may approach 60-74% with certain risk factors, potentially causing clinical consequences for patients, and confounding the results of clinical research studies. Factors leading to a missed diagnosis may include acute trauma-related life-threatening issues, sedation/intubation, subtle neuropathology on neuroimaging, failure to collect Glasgow Coma Scale scores or duration of posttraumatic amnesia, or lack of validity of this information, and overlap in neuro-cognitive symptoms with emotional responses to spinal cord injuries. Strategies for avoiding a missed diagnosis of mild-moderate traumatic brain injuries in patients having a spinal cord injuries are highlighted in this perspective.

Application value of biofluid-based biomarkers for the diagnosis and treatment of spinal cord injury

Recent studies in patients with spinal cord injuries(SCIs)have confirmed the diagnostic potential of biofluid-based biomarkers,as a topic of increasing interest in relation to SCI diagnosis and treatment.This paper reviews the research progress and application prospects of recently identified SCI-related biomarkers.Many structural proteins,such as glial fibrillary acidic protein,S100-β,ubiquitin carboxy-terminal hydrolase-L1,neurofilament light,and tau protein were correlated with the diagnosis,American Spinal Injury Association Impairment Scale,and prognosis of SCI to different degrees.Inflammatory factors,including interleukin-6,interleukin-8,and tumor necrosis factorα,are also good biomarkers for the diagnosis of acute and chronic SCI,while non-coding RNAs(micro RNAs and long non-coding RNAs)also show diagnostic potential for SCI.Trace elements(Mg,Se,Cu,Zn)have been shown to be related to motor recovery and can predict motor function after SCI,while humoral markers can reflect the pathophysiological changes after SCI.These factors have the advantages of low cost,convenient sampling,and ease of dynamic tracking,but are also associated with disadvantages,including diverse influencing factors and complex level changes.Although various proteins have been verified as potential biomarkers for SCI,more convincing evidence from large clinical and prospective studies is thus required to identify the most valuable diagnostic and prognostic biomarkers for SCI.

Diagnosis of erythropoietic protoporphyria with severe liver injury: A case report

BACKGROUND Porphyria is a rare disease with complex classification. Erythropoietic protoporphyria(EPP) is an autosomal recessively inherited disease, and most are caused by mutations in the FECH gene. EPP combined with liver injury is even rarer.CASE SUMMARY This paper reports a case of EPP which was admitted to the hospital with abnormal liver function and diagnosed by repeated questioning of medical history, screening of common causes of severe liver injury, and second generation sequencing of the whole exon genome. We also summarize the clinical characteristics of EPP with liver injury, and put forward some suggestions on EPP to provide a reference for the diagnosis of such rare disease.CONCLUSION A new mutation locus(c.32_35 dupCCCT) which may be related to the disease was found by detecting the FECH gene in the pedigree of this case.

Clinical study on improving the diagnostic accuracy of adult elbow joint cartilage injury by multisequence magnetic resonance imaging

BACKGROUND Due to frequent and high-risk sports activities,the elbow joint is susceptible to injury,especially to cartilage tissue,which can cause pain,limited movement and even loss of joint function.AIM To evaluate magnetic resonance imaging(MRI)multisequence imaging for improving the diagnostic accuracy of adult elbow cartilage injury.METHODS A total of 60 patients diagnosed with elbow cartilage injury in our hospital from January 2020 to December 2021 were enrolled in this retrospective study.We analyzed the accuracy of conventional MRI sequences(T1-weighted imaging,T2-weighted imaging,proton density weighted imaging,and T2 star weighted image)and Three-Dimensional Coronary Imaging by Spiral Scanning(3D-CISS)in the diagnosis of elbow cartilage injury.Arthroscopy was used as the gold standard to evaluate the diagnostic effect of single and combination sequences in different injury degrees and the consistency with arthroscopy.RESULTS The diagnostic accuracy of 3D-CISS sequence was 89.34%±4.98%,the sensitivity was 90%,and the specificity was 88.33%,which showed the best performance among all sequences(P<0.05).The combined application of the whole sequence had the highest accuracy in all sequence combinations,the accuracy of mild injury was 91.30%,the accuracy of moderate injury was 96.15%,and the accuracy of severe injury was 93.33%(P<0.05).Compared with arthroscopy,the combination of all MRI sequences had the highest consistency of 91.67%,and the kappa value reached 0.890(P<0.001).CONCLUSION Combination of 3D-CISS and each sequence had significant advantages in improving MRI diagnostic accuracy of elbow cartilage injuries in adults.Multisequence MRI is recommended to ensure the best diagnosis and treatment.

Analysis of CT and MRI in the Diagnosis of Shoulder Joint Injury

Objective: To observe the effect of multi-slice spiral CT and magnetic resonance imaging (MRI) in the diagnosis of shoulder injury. Methods: 120 patients with shoulder injury who were treated in our hospital (January 2020 to December 2021) and underwent surgical treatment were diagnosed as shoulder injury. They were divided into CT group, MRI group and joint diagnosis group. The detection rates of the two methods were compared. Results: In the diagnosis of shoulder injury, MRI group was higher than CT group, and the joint diagnosis group was higher than the other two groups. Conclusion: In the diagnosis of shoulder injury, the joint examination of multi-slice spiral CT and magnetic resonance imaging (MRI) can obtain a higher diagnostic rate and ideal effect.

Early Diagnosis and Treatment of Traumatic Diaphragmatic Injuries

Introduction: Early diagnosis and treatment of injuries of the diaphragm are important both because of high incidence of concomitant injuries and since they may lead to life-threatening intestinal and gastric strangulation in the late term. Herein, cases with diaphragmatic injury that have been diagnosed and operated in the early period after injury or during surgery were presented. Methods: Data of 14 cases, which have been diagnosed with diaphragmatic injury after trauma or during surgical procedure that was performed because of concomitant abdominal or intra-thoracic injury between January 2008 and April 2013, were retrospectively reviewed. Results: Of the traumatic diaphragmatic injuries, 10 (71.4%) have occurred due to penetrating trauma, whereas 4 (28.5%) have occurred due to blunt trauma. Diagnosis was made using I.V. contrast-enhanced whole abdominal and thoracic tomography in all 3 pediatric cases (21.4%) and during surgery in the others (78.5%). Conclusion: All of the diaphragmatic injuries have been accompanied by intra-abdominal or intra-thoracic organ injury that requires surgery. In these cases, the diagnosis was made on suspicion of diaphragmatic injury in the course of surgical procedure performed for concomitant organ injury. Computed tomography was diagnostic for diaphragmatic injuries in the pediatric cases.

Hepatorenal syndrome: Update on diagnosis and treatment

Acute kidney injury(AKI) is a common complication in patients with end-stage liver disease and advanced cirrhosis regardless of the underlying cause. Hepatorenal syndrome(HRS), a functional form of kidney failure, is one of the many possible causes of AKI. HRS is potentially reversible but involves highly complex pathogenetic mechanisms and equally complex clinical and therapeutic management. Once HRS has developed, it has a very poor prognosis. This review focuses on the diagnostic approach to HRS and discusses the therapeutic protocols currently adopted in clinical practice.

Traumatic abdominal wall hernia:a rare and often missed diagnosis in blunt trauma

Dear editor,Traumatic abdominal wall hernia(TAWH)is defined as disruption of the abdominal wall musculature and fascia with herniation of intra-abdominal contents,in the absence of surgery to that area of the abdominal wall.[1]It is rare,with an incidence of 0.17%-0.90%in patients with blunt abdominal trauma.[2,3]Deceleration forces caused by falls from height or seat belt injuries are the most common causes of TAWH.[4]Low-energy blunt injuries from bicycle or motorcycles handlebars or charging animals are less frequent causes.Due to the rare incidence and complex presentation of this condition with other distracting injuries,this diagnosis is often not considered,resulting in missed or delayed diagnosis.We present a case of a 46-year-old male who suffered major abdominal trauma,and was found to have TAWH as well as intra-abdominal organ injury.

RXPERIMENTAL AND CLINICAL STUDY OF CREATINE KINASE BB ACTIVITY FOR THE DIAGNOSIS ON BRAIN DAMAGE

Objective To study the differential diagnosis on cerebral concussion and mild cerebral contusion value of the brain type creatine kinase isoenzyme(CK BB),and evaluate the seriousness of brain damage and prognosis of the patients with acute head injury.Methods Chromatographic separating and fluorometric quantifying technique was used to detect the CK BB activity in the cerebrospinal fluid(CSF) of 117 patients with acute head injury and 12 patients with increased intracranial pressure and 20 normal people.Results The CSF CK BB activity of the patients with acute head injury was remarkably higher than that of the normal people and the CSF CK BB activity increased with the seriousness of brain damage.There was a close relationship between CSF CK BB activity and prognosis,and higher activity of CSF CK BB indicated poor prognosis.Conclusion CSF CK BB activity could be used as a new index to diagnose brain damage and evaluate the seriousness of brain damage and prognosis.

内分泌指标及超声检查在小儿胰腺损伤早期诊断中的应用

腹部外伤的发生率在小儿创伤中占比逐年增加,创伤性胰腺损伤应引起临床医生的足够重视。胰腺位于腹膜后,尤其是Ⅰ、Ⅱ级损伤的患儿,其早期诊断较为困难。本文通过文献复习,分析内分泌指标及腹部超声检查在小儿胰腺损伤早期诊断中的价值,以提高早诊率,避免相关并发症的发生。内分泌指标中血清胰岛素、C肽等指标的变化,对于诊断和评估小儿胰腺损伤有一定的优势,可作为小儿胰腺损伤病情的预警指标。超声弹性成像技术为胰腺损伤的诊断和鉴别提供了新的方法;而对比增强超声在识别患儿胰腺损伤中具有较高的特异度及敏感度,由于其无放射性损害,有望成为CT检查的替代方案。

血清NLRX1水平在创伤性脑损伤患者早期诊断及预后评估中的临床价值

目的 分析血清中核苷酸结合寡聚化结构域样受体家族X1(NLRX1)水平对创伤性脑损伤患者早期诊断及预后评估的价值。方法 选取2021年1月—2022年4月在我院接受治疗的160例创伤性脑损伤患者作为观察组,同期160例健康体检志愿者作为对照组。根据格拉斯哥昏迷评分(GCS)将患者分为重度组30例、中度组45例、轻度组85例。采用酶联免疫吸附(ELISA)法对血清中NLRX1的水平进行检测;对患者血清NLRX1水平与GCS评分的相关性进行Spearman分析。采用Logistic回归分析影响创伤性脑损伤及患者预后的因素;采用受试者工作特征(ROC)曲线分析血清中NLRX1水平对创伤性脑损伤诊断及预后的预测价值。结果 与对照组相比,轻度、中度、重度组患者血清NLRX1水平均明显降低(F=172.695,P<0.05);与轻度组相比,随着病情的加重,中度、重度组患者血清NLRX1水平均依次显著降低(P<0.05);创伤性脑损伤患者血清NLRX1水平与GCS评分呈正相关(r=0.602,P<0.05);Logistic回归分析发现,NLRX1是影响创伤性脑损伤的保护因素(OR=0.545,95%CI 0.362~0.821,P<0.05);血清NLRX1水平诊断创伤性脑损伤的ROC曲线下面积(AUC)为0.937,截断值为8.61μg/L。与预后良好组相比,预后不良组创伤性脑损伤患者血清NLRX1水平明显降低(P<0.05);Logistic回归分析发现,NLRX1是影响创伤性脑损伤患者预后的保护因素(OR=0.645,95%CI 0.488~0.852,P<0.05);血清NLRX1水平预测创伤性脑损伤患者预后的AUC为0.947,截断值为4.35μg/L。结论 创伤性脑损伤患者血清NLRX1水平降低,与患者病情严重程度有关,在创伤性脑损伤早期诊断及预后预测中具有较高的价值。