Biliary fistula after treatment for hydatid disease of the liver:When to intervene

AIM:To determine the outcome of patients with biliary fistula(BF)after treatment for hydatid disease of the liver. METHODS:Between January 2000 and December 2010,out of 301 patients with a diagnosis of hydatid cyst of the liver,282 patients who underwent treatment [either surgery or puncture,aspiration,injection and reaspiration(PAIR)procedure]were analysed.Patients were grouped according to the presence or absence of postoperative biliary fistula(PBF)(PBF vs no-PBF groups,respectively).Preoperative clinical,radiological and laboratory characteristics,operative characteristics including type of surgery,peroperative detection of BF,postoperative drain output,morbidity,mortality and length of hospital stays of patients were compared amongst groups.Multivariate analysis was performed to detect factors predictive of PBF.Receiver operative characteristics(ROC)curve analysis were used to determine ideal cutoff values for those variables found to be significant.A comparison was also made between patients whose fistula closed spontaneously(CS)and those with intervention in order to find predictive fac-tors associated with spontaneous closure. RESULTS:Among 282 patients[median(range)age, 23(16-78)years;77.0%male];210(74.5%)were treated with conservative surgery,33(11.7%)radical surgery and 39(13.8%)underwent percutaneous drainage with PAIR procedure A PBF developed in 46(16.3%) patients,all within 5 d after operation.The maximum cyst diameter and preoperative alkaline phosphatase levels(U/L)were significantly higher in the PBF group than in the no-PBF group[10.5±3.7 U/L vs 8.4±3.5 U/L(P<0.001)and 40.0±235.1 U/Lvs 190.0±167.3 U/L(P=0.02),respectively].Hospitalization time was also significantly longer in the PBF group than in the no-PBF group[37.4±18.0 d vs 22.4±17.9 d(P< 0.001)].A preoperative high alanine aminotransferase level(>40 U/L)and a peroperative attempt for fistula closure were significant predictors of PBF development (P=0.02,95%CI:-0.03-0.5 and P=0.001,95%CI:0.1-0.4),respectively.Comparison of patients whose PBF CS or with biliary intervention(BI)revealed that the mean diameter of the cyst was not significantly different between CS and BI groups however maximum drain output was significantly higher in the BI group(81.6± 118.1 cm vs 423.9±298.4 cm,P<0.001).Time for fistula closure was significantly higher in the BI group(10.1 ±3.7 d vs 30.7±15.1 d,P<0.001).The ROC curve analysis revealed cut-off values of a maximum bilious drainage<102 mL and a waiting period of 5.5 postoperative days for spontaneous closure with the sensitivity and specificity values of(83.3%-91.1%,AUC:0.90)and (97%-91%,AUC:0.95),respectively.The multivariate analysis demonstrated a PBF drainage volume<102 mL to be the only statistically significant predictor of spontaneous closure(P<0.001,95%CI:0.5-1.0). CONCLUSION:Patients with PBF after hydatid surgery often have complicated postoperative course with serious morbidity.Patients who develop PBF with an output <102 mL might be managed expectantly.

Improved experimental model of hepatic cystic hydatid disease resembling natural infection route with stable growing dynamics and immune reaction

AIM To investigate a safer way to set up the disease model of cystic echinococcosis without contamination risk and develop a novel experimental murine model of hepatic cystic echinococcosis. METHODS C57 B/6 mice were injected with human protoscolices of three different concentrations via the portal vein. The mice were followed for 10 mo by ultrasound,gross anatomy,and pathological and immunological examinations. The protoscolex migration in the portal vein,hydatid cyst growth,host immune reaction,and hepatic histopathology were examined periodically.RESULTS The infection rates in the mice in the high,medium,and low concentration groups were 90%,100%,and 63.6%,respectively. The protoscolices migrated in the portal vein with blood flow,settled in the liver,and developed into orthotopic hepatic hydatid cysts,resembling the natural infection route and course.CONCLUSION We have established an improved experimental model of hepatic cystic echinococcosis with low biohazard risk but stable growing dynamics and immune reaction. It is especially useful for new anti-parasite medication trials against hydatid disease.

Primary pancreatic hydatid disease associated with acute pancreatitis

The Editor welcomes submissions for possible publication in the Letters to the Editor section. Letters commenting on an article published in the Journal or other interesting pieces will be considered if they are received within 6 weeks of the time the article was published. Authors of the article being commented on will be given an opportunity to offer a timely response to the letter. Authors of letters will be notified that the letter has been received. Unpublished letters cannot be returned.

The occurrence of Helicobacter pylori in hydatid liver disease

Objective:To detect the prevalence of Helicobacter pylori(H.pylori) in hydatid liver disease. Methods:A lolal of 58 patients with hydatid liver disease attending AL-Sadder Teaching Hospital in Al-Najaf and Al-Basrah governorate from February to August,2008 were included in the study and served as group A.One hundred and twenty 1st degree relative patients(group B) and 20 normal persons including 10 male and 10 female(group C) as control were detected for the presence of H.pylori infection in general population.Chest X-ray was done for the above groups to exclude lung hydrated cyst.The patients were screened by ultrasound to obtain intra abdominal hydrated cyst and enzymc-linkcd immuno sorbcnt assay(ELISA) test was utilized to detect the H.pylori infection.Results:Fifty eight patients from group A with hydatid liver disease,30 male(51.7%) and 28 female(48.3%) were screened for the presence of H.pylori infection by using ELISA test.We found that 28 patients from group A had positive ELISA test including 19 male(32.8%) and 9 female(15.5%)(P<0.0l).However,there were no positive results of H.pylori infection in group B and C by chest X-ray,ultrasound and ELISA test.Conclusions:It can be concluded that there is a strong relationship between hydatid liver disease and presence of H.pylori.

Management of Pulmonary Hydatid Disease: Review of 66 Cases from Iraq

Background: Hydatid disease is a serious health hazard and a major problem to the community in Iraq. The disease is still endemic as witnessed in everyday surgical practice. The aim of this prospective study was to review the management of pulmonary hydatid disease (PHD) in two major thoracic surgical centers (Ibn-Alnafis and Medical City Teaching Hospitals), Baghdad, Iraq over one year period. Materials and Methods: Sixty six patients (38 females and 28 males) with PHD admitted and treated surgically in the Departments of Thoracic Surgery in the aforementioned hospitals were studied. Demographic and clinical features were obtained by direct patients’ interviews and thorough physical examination. The diagnosis in the vast majority of patients was based on plain chest radiography while few had bronchoscopy. All patients had posterolateral thoracotomy for removal of pulmonary hydatid cysts (PHC). The clinical and radiographic findings as well as operative procedures and postoperative complications were reviewed. Results: The age ranged from two and a half years to 60 years with a mean of 22.3. Sixty percent of patients were in second and third decades. Most patients (n = 51, 77%) lived in rural areas. Housewives and students predominated. A positive family history was obtained in 5. Cough, chest pain, dyspnoea and haemoptysis were the main symptoms whereas 15 were acutely ill. Three patients presented with pathognomonic expectoration of laminated membrane and 2 had intra-pleural cyst rupture. The total number of cysts was 99 (61 intact, 50 solitary, and 55 unilateral). The right lung was more frequently involved (n = 64) and right lower lobe was on the top. Cyst size ranged from 3 to 25 cm with a mean of 8.5. The main radiographic appearance was the “full moon against dark sky” visible in 61.6%. Abdominal ultrasound was carried out in 40 patients who revealed 12 hepatic and one splenic HCs. Lung preserving surgery was done in 76 cysts (91.5%) while lobectomy was necessary in 7. Capitonnage was used in 16 cases only (19.2%). Two patients had lung decortication and four had trans-diaphragmatic removal of liver HCs. Few complications developed mostly managed conservatively. Reoperation was necessary in 4 patients (prolonged air leak, n = 2 and bleeding, n = 2). Two patients died (3%). Conclusion: PHC is endemic in Iraq, mainly diagnosed by plain chest radiography, and can be safely managed by lung preserving surgery with minimal morbidity and mortality.

Intracystic bleeding of a solitary hydatid cyst: A rare complication of a rare disease in central Africa. A case report

Splenic cysts are rare lesions and most of them are hydatid in origin. Hydatid disease is very rare in central Africa although it is cosmopolitan in North Africa. We are presenting a case of intracystic bleeding complicated with shock in a rural based Cameroonian and owner of hunting dogs treated in our university teaching hospital.

A New Multi-Agent Feature Wrapper Machine Learning Approach for Heart Disease Diagnosis

Heart disease(HD)is a serious widespread life-threatening disease.The heart of patients with HD fails to pump sufcient amounts of blood to the entire body.Diagnosing the occurrence of HD early and efciently may prevent the manifestation of the debilitating effects of this disease and aid in its effective treatment.Classical methods for diagnosing HD are sometimes unreliable and insufcient in analyzing the related symptoms.As an alternative,noninvasive medical procedures based on machine learning(ML)methods provide reliable HD diagnosis and efcient prediction of HD conditions.However,the existing models of automated ML-based HD diagnostic methods cannot satisfy clinical evaluation criteria because of their inability to recognize anomalies in extracted symptoms represented as classication features from patients with HD.In this study,we propose an automated heart disease diagnosis(AHDD)system that integrates a binary convolutional neural network(CNN)with a new multi-agent feature wrapper(MAFW)model.The MAFW model consists of four software agents that operate a genetic algorithm(GA),a support vector machine(SVM),and Naïve Bayes(NB).The agents instruct the GA to perform a global search on HD features and adjust the weights of SVM and BN during initial classication.A nal tuning to CNN is then performed to ensure that the best set of features are included in HD identication.The CNN consists of ve layers that categorize patients as healthy or with HD according to the analysis of optimized HD features.We evaluate the classication performance of the proposed AHDD system via 12 common ML techniques and conventional CNN models by using across-validation technique and by assessing six evaluation criteria.The AHDD system achieves the highest accuracy of 90.1%,whereas the other ML and conventional CNN models attain only 72.3%–83.8%accuracy on average.Therefore,the AHDD system proposed herein has the highest capability to identify patients with HD.This system can be used by medical practitioners to diagnose HD efciently。

Factors contributing to clinical picture and progression of Huntington's disease

Huntington’s disease（HD）is an autosomal dominant,monogenic,progressive,neurodegenerative and rare disease with a frequency of10 per 100,000 in the Caucasian population and occurring more rarely in other races（Squitieri et al.,1994）.HD is,nevertheless,one of the most frequently and extensively studied diseases of those caused by a dynamic mutation.The HD mutation is located on the short arm of the 4th chromosome within the HTT gene.

Molecular Analysis of the Huntington's Disease with Expanded CAG Trinucleotide Repeat in Chinese

The polymorphic CAG repeats in the IT15 gene in Chinese normal and Huntington’s dis-ease(HD)chromosomes were determined by using nested PCR and denaturing polyacry-lamide gel electrophoretic autoradiography as well as direct sequencing analysis.A total of40 normal individuals and 122 members of 13 unrelated HD families originating from Shang-hai,Jiangsu,Zhejiang,Anhui,Shandong,Guangdong and Henan,respectively,were in-volved in this study.The results showed that the(CAG)n repeat numbers in 270 normal al-leles ranged from 13 to 26 but most in 16;while in 54 HD alleles,the CAG repeats from 40to 94,with an unstable inheritance of expanded repeats in some families.There was no over-lap between the normal and affected alleles.Additionally,the presymptomatic diagnosis in103 family members at risk for HD disclosed that 35 individuals had HD alleles,which were-in accordance with the pedigree analysis and clinical investigation.All these results indicatedthat the dynamic mutation in IT15 gene was responsible for the genetic defect in the ChineseHD patients and that a correlation existed between the numbers of(CAG)n repeat and theonset age of the disease.All-of these provide valuable data for HD molecular diagnosis,ge-netic counselling and genetic health.

Can leukocyte telomere shortening be a possible biomarker to track Huntington’s disease progression?

Huntington's disease (HD): HD is an autosomal dominant neurodegenerative disease, caused by a CAG trinucleotide repeat expansion in the first exon of the HTT gene encoding the huntingtin protein. The mutant protein contains an expanded polyglutamine sequence that confers a toxic gain-of-function and causes neurodegeneration. Moreover, several studies indicate that loss of the normal protein beneficial functions, contribute to the pathology (Schulte and Littleton 2011). Triplet expansion over 40 repeats are fully penetrant and invariably lead to manifest HD in the fourth or fifth decade of life.

Literature Review of the Outcome after One-Stage Transanal Endorectal Pull-Through Procedure for Hirschsprung’s Disease in Children

Background: Transanal endorectal one-stage pull-through (TERPT) procedure in children with Hirschsprung’s disease (HD) is frequently used worldwide. In order to give the families realistic expectations and to plan the medical care for the years after TERPT, the long term outcome is of great importance. Aim: To collect information on the long term outcome reported after one stage TERPT procedure for HD in children 0 - 15 years. Method: A literature review on the outcome of planned TERPT from 2005 through 2012 was carried out. Information was collected on the number of daily stools a few months postoperatively, incontinence and constipation and the measures taken to deal with these. Results: The reports are few and prospective studies were missing. The results show an initial high frequency of daily stools, 12% had later abnormal stool patterns, 21% had fecal incontinence and 10% had problems with constipation. Conclusion: In order to compare the long term outcome, it would be desirable to have uniform regular reports on the daily frequency of passed stools, incontinence and constipation during the first years after TERPT. Such knowledge would be of importance for the information given to the guardians of children with HD preoperatively to TERPT and in the planning of the future care. The findings can, furthermore, provide a benchmark for the outcome from a single centre.

National Institutes of Health Funding for disease categories related to Neural Regeneration Research

The National Institutes of Health （NIH）, a part of the U.S. Department of Health and Human Services, is the nation＇s medical research agency-making important discoveries that improve health and save lives.Thanks in large part to NIH-funded medical research, Americans today are living longer and healthier. Life expectancy in the United States has jumped from 47 years in 1900 to 78 years as reported in 2009, and disability in people over age 65 has dropped dramatically in the past 3 decades. In recent years, nationwide rates of new diagnoses and deaths from all cancers combined have fallen significantly.

Glyco-sphingo biology: a novel perspective for potential new treatments in Huntington's disease

Huntington＇s disease （HD） is the most common dominantly inherited neurodegenerative disorder, mainly characterized by the progressive striatal and cortical neurodegeneration and as- sociated motor, cognitive and behavioural disturbances （Zuccato et al., 2010）. The disease-causing mutation is an expansion of a GAG trinucleotide repeat （〉 36 repeats） encoding a polygluta- mine stretch in the N-terminal region ofhuntingtin （Htt） （Zuc- cato et al., 2010）, a ubiquitous protein whose function is still unclear （Zuccato et al., 2010）. Expansion of the polyQ stretch endows mutant Htt （mHtt） with toxic properties, and results in the development of a broad array of undesirable effects in both neuronal and non-neuronal cells （Zuccato et al., 2010）. Among all cellular dysfunctions and biochemical imbalances classically associated with HD, perturbed metabolism of （glyco） sphingolipids appears to play a crucial role in the pathogenesis of the disease. Over the last years, we and other have extensively contributed to these findings （Desplats et al., 2007;

Histone methylation in Huntington's disease:are bivalent promoters the critical targets?

Huntington’s disease（HD）is a currently incurable,late onset,progressive,ultimately fatal neurological disorder（Bates et al.,2015）.We have recently published the results of comprehensive genetic interaction tests aimed at identification of histone methyltransferases and demethylases involved in HD pathogenesis in a Drosophila model of the disease（Song et al.,2018）.

Staged Surgery for Bronchobiliary Fistula and Incidental Finding of Mitral Valve Disease

Bronchobiliary fistula (BBF) is defined as abnormal passage between bronchial system and the bile tree which often manifests as presence of bile in the sputum (biloptysis). BBF is a serious complication which requires early diagnosis and well-planned management strategy to avoid the high morbidity and mortality rate. The hydatid cystic disease is still the leading cause of the BBF. In this paper we present a case of 32-year-old man with BBF who was incidentally found to have a mitral valve disease for which he underwent mitral valve replacement during his management course.

Biliary fistula and late recurrence of liver hydatid cyst:Role of cystobiliary communication:A prospective multicenter study

BACKGROUND Hydatid cyst disease(HCD)is common in certain locations.Surgery is associated with postoperative biliary fistula(POBF)and recurrence.The primary aim of this study was to identify whether occult cysto-biliary communication(CBC)can predict recurrent HCD.The secondary aim was to assess the role of cystic fluid bilirubin and alkaline phosphatase(ALP)levels in predicting POBF and recurrent HCD.AIM To identify whether occult CBC can predict recurrent HCD.The secondary aim was to assess the role of cystic fluid bilirubin and ALP levels in predicting POBF and recurrent HCD.METHODS From September 2010 to September 2016,a prospective multicenter study was undertaken involving 244 patients with solitary primary superficial stage cystic echinococcosis 2 and cystic echinococcosis 3b HCD who underwent laparoscopic partial cystectomy with omentoplasty.Univariable logistic regression analysis assessed independent factors determining biliary complications and recurrence.RESULTS There was a highly statistically significant association(P≤0.001)between cystic fluid biochemical indices and the development of biliary complications(of 16 patients with POBF,15 patients had high cyst fluid bilirubin and ALP levels),where patients with high bilirubin-ALP levels were 3405 times more likely to have biliary complications.There was a highly statistically significant association(P≤0.001)between biliary complications,biochemical indices,and the occurrence of recurrent HCD(of 30 patients with recurrent HCD,15 patients had high cyst fluid bilirubin and ALP;all 16 patients who had POBF later developed recurrent HCD),where patients who developed biliary complications and high bilirubin-ALP were 244.6 and 214 times more likely to have recurrent hydatid cysts,respectively.CONCLUSION Occult CBC can predict recurrent HCD.Elevated cyst fluid bilirubin and ALP levels predicted POBF and recurrent HCD.

西藏地区肝脏与盆腔共发包虫病超声分型的相关性

目的探讨西藏地区肝脏与盆腔共发包虫病患者病灶超声分型的相关性。方法收集西藏自治区人民医院均经手术病理、超声或CT检查证实的肝脏与盆腔共发包虫病患者23例,应用超声观察肝脏及盆腔病灶的位置、数目、大小、形态及回声情况并进行WHO分型,分析肝脏与盆腔病灶超声分型的相关性。结果23例肝脏与盆腔共发包虫病患者中,肝脏病灶位于左肝3例,右肝19例,左右叶多发1例,除2例病灶位于肝右后叶外,其余21例病灶均贴近肝包膜;超声分型为多子囊型2例,内囊破裂型3例,实变型3例,钙化型15例。盆腔病灶位于腹盆腔3例,盆腔20例,其中左侧盆腔3例,右侧盆腔9例,累及整个盆腔8例;超声分型为单囊型1例,多子囊型10例,内囊破裂型4例,实变型4例,钙化型4例;超声准确诊断14例(60.9%),未定性8例(34.8%),定性错误1例(4.3%)。同一患者盆腔病灶超声分型均低于或等于肝脏病灶,其肝脏与盆腔病灶超声分型呈正相关(r=0.442,P<0.05)。结论西藏地区肝脏与盆腔共发包虫病患者的盆腔包虫病多由肝包虫病种植转移,二者的超声分型存在相关性。

MRI影像组学机器学习模型对肝泡型包虫病边缘带微血管侵犯的预测价值

目的探讨MRI影像组学机器学习模型对肝泡型包虫病(HAE)边缘带微血管侵犯的预测价值。方法采用回顾性分析法选取110例经术后病理确诊的HAE患者,收集患者的MR影像资料及病理切片资料,提取病灶MR影像组学特征。将患者按照8∶2比例分为训练集(88例),测试集(22例),建立极限梯度增强树(XGBoost)、随机森林(RF)、Logistic回归(LR)、支持向量机(SVM)和经典决策树(cDT)预测HAE边缘带微血管侵犯的机器学习模型,进行模型验证,并绘制ROC曲线分析不同模型对HAE边缘带微血管侵犯的预测效能。结果病理结果显示110例患者中有25例存在边缘带微血管侵犯,无边缘带微血管侵犯85例。有边缘带微血管侵犯与无边缘带微血管侵犯HAE患者的性别、年龄、病灶部位及病灶大小对比,差异均无统计学意义(P>0.05)。训练集中有20例存在边缘带微血管侵犯,测试集中有5例存在边缘带微血管侵犯。影像组学特征共提取出759个,经方差阈值法、单变量选择法最终筛选出最优影像组学特征6个。训练集中,XGBoost、RF对边缘微血管侵犯诊断的AUC值最高(0.95和0.96);测试集中,XGBoost、RF对边缘微血管侵犯诊断的AUC值(0.88和0.84)也高于其他3组模型。XGBoost模型与RF模型在训练集及测试集中的AUC值比较,差异均无统计学意义(P>0.05)。结论MRI影像组学的XGBoost模型和RF模型对HAE边缘带微血管侵犯的预测均有较高的效能。

HD肝病治疗仪对肝纤维化和肝硬化患者治疗探讨

为探讨对慢性肝炎所致纤维化和肝硬化的有效治疗方法,采用随机对照方法,观察HD肝病治疗仪和中药穴位透入治疗93例慢性乙型病毒性肝炎肝纤维化和肝硬化患者的疗效。结果表明,治疗组患者症状改善,肝功能复常,肿大的肝脾回缩,HD肝病治疗仪和中药穴位透人治疗有较好的抗肝纤维化作用。

HD组方对血透患者内皮素与降钙素基因相关肽影响的临床研究

目的 :观察中药HD组方在血液透析中对血透患者内皮素 (ET)、降钙素基因相关肽 (CGRP)的影响 ,探讨如何进一步提高尿毒症终末期维持性血透患者的透析效率和生活质量。方法 :选择终末期肾衰竭 (ESRD)患者6 6例 ,已作维持性血液透析 (HD)治疗 1年以上 ,随机分为常规治疗组 32例 ,中药治疗组 34例 ;另设正常对照组 2 0例。常规治疗组 :继续进行常规血液透析 ;中药治疗组 :在常规治疗组透析的基础上 ,将常规透析液中加入中药HD组方。并定期观察各组患者的收缩压 (SBP)、舒张压 (DBP)、内皮素 (ET)、降钙素基因相关肽 (CGRP) ,疗程均为 6个月。结果 :治疗 6个月后 ,中药治疗组与治疗前及常规治疗组相比SBP、DBP、ET水平显著降低 (P <0 .0 1) ,而CGRP水分显著增高 (P <0 .0 5 )。结论 :HD组方的应用可通过改善血循环状态 ,调节患者ET、CGRP代谢失衡状况 ,从而调节血管舒、缩功能 。