Contrast-enhanced ultrasonography for the evaluation of liver fibrosis after biliary obstruction

AIM:To investigate perfusion change in contrastenhanced ultrasonography(CEUS) to evaluate liver fibrosis based on biliary obstruction using an animal model.METHODS:New Zealand white rabbits(3-4 kg) underwent bile duct ligation to form a biliary obstruction model.We performed liver CEUS and laboratory tests on the day before the operation(day 0) and every 7 postoperative days until the rabbits were sacrificed.After CEUS,signal intensity of liver parenchyma with a time-intensity curve was analyzed.Perfusion parameters were automatically calculated from regionof-interests,including peak signal intensity,mean transit time,area under the curve and time to peak.Histological grades of liver fibrosis were assessed according to the Metavir score system immediately after sacrifice.Generalized estimating equations were used to analyze the association between liver fibrosis grades and perfusion parameters for statistical analysis.The perfusion parameters were measured on the last day and the difference between day 0 and the last day were evaluated.RESULTS:From the nine rabbits,histological grades of liver fibrosis were grade 1 in one rabbit,grade 2 and 3 in three rabbits each,and grade 4 in two rabbits.Among the four CEUS parameters,only the peak signal intensity measured on the last day demonstrated a significant association with liver fibrosis grades(OR =1.392,95%CI:1.114-1.741,P =0.004).The difference in peak signal intensity between day 0 and the last dayalso demonstrated an association with liver fibrosis(OR =1.191,95%CI:0.999-1.419,P =0.051).The other parameters tested,including mean transit time,area under the curve,and time to peak,showed no significant correlation with liver fibrosis grades.CONCLUSION:This animal study demonstrates that CEUS can be used to evaluate liver fibrosis from biliary obstruction using peak signal intensity as a parameter.

A nomogram to preoperatively predict 1-year disease-specific survival in resected pancreatic cancer following neoadjuvant chemoradiation therapy

Objective: This study aimed to develop a nomogram to predict the 1-year survival of patients with pancreatic cancer who underwent pancreatectomy following neoadjuvant treatment with preoperatively detectable clinical parameters. Extended pancreatectomy is necessary to achieve complete tumor removal in borderline resectable and locally advanced pancreatic cancer. However, it increases postoperative morbidity and mortality rates, and should be balanced with potential benefit of long-term survival.Methods: The medical records of patients who underwent pancreatectomy following neoadjuvant treatment from January 2005 to December 2016 at Severance Hospital were retrospectively reviewed. Medical records were collected from five international institutions from Japan and Singapore for external validation.Results: A total of 113 patients were enrolled. The nomogram for predicting 1-year disease-specific survival was created based on 5 clinically detectable preoperative parameters as follows: age(year), symptom(no/yes), tumor size at initial diagnostic stage(cm), preoperative serum carbohydrate antigen(CA) 19-9 level after neoadjuvant treatment(<34/≥34 U/m L), and planned surgery [pancreaticoduodenectomy(PD)(pylorus-preserving PD)/distal pancreatectomy(DP)/total pancreatectomy]. Model performance was assessed for discrimination and calibration.The calibration plot showed good agreement between actual and predicted survival probabilities;the the Greenwood-Nam-D’Agostino(GND) goodness-of-fit test showed that the model was well calibrated(χ~2=8.24,P=0.5099). A total of 84 patients were used for external validation. When correlating actual disease-specific survival and calculated 1-year disease-specific survival, there were significance differences according to the calculated probability of 1-year survival among the three groups(P=0.044).Conclusions: The developed nomogram had quite acceptable accuracy and clinical feasibility in the decision-making process for the management of pancreatic cancer.

Low-dose amitriptyline combined with proton pump inhibitor for functional chest pain

AIM:To investigate the efficacy of amitriptyline with proton pump inhibitor(PPI)for the treatment of functional chest pain(FCP).METHODS:This was a randomized,open-label trial investigating the addition of low dose amitriptyline(10 mg at bedtime)to a conventional dose of rabeprazole(20 mg/d)(group A,n = 20)vs a double-dose of rabeprazole(20 mg twice daily)(group B,n = 20)for patients with FCP whose symptoms were refractory to PPI.The primary efficacy endpoints were assessed by global symptom score assessment and the total number of individuals with > 50% improvement in their symptom score.RESULTS:The between-group difference in global symptom scores was statistically significant during the last week of treatment(overall mean difference;3.75 ± 0.31 vs 4.35 ± 0.29,the between-group difference;P < 0.001).Furthermore,70.6% of patients in group A had their symptoms improve by > 50%,whereas only 26.3% of patients in group B had a similar treatment response(70.6% vs 26.3%,P = 0.008).Specifically,patients in group A had a significantly greater improvement in the domains of body pain and general health perception than did patients in group B(52.37 ± 17.00 vs 41.32 ± 12.34,P = 0.031 and 47.95 ± 18.58 vs 31.84 ± 16.84,P = 0.01,respectively).CONCLUSION:Adding amitriptyline to a PPI was more effective than a double-dose of PPI in patients with FCP refractory to a conventional dose of PPI.

Risk factors for computed tomography interpretation discrepancy in emergently transferred patients

Radiologic imaging is a diagnostic tool that greatly affects patient outcomes,[1]and with the recent development of imaging technology,advanced imaging tests such as computed tomography(CT)have gained widespread accessibility in hospitals.In particular,CT is essential in the evaluation of patients in low-level emergency departments(EDs)because of its ability to answer clinical questions accurately and quickly.[2]

Incidence, prevalence and risk of stroke in patients with Takayasu arteritis: a nationwide population-based study in South Korea

Background Takayasu arteritis(TAK)is a disease associated with increased risk of cardiovascular complications.We aimed to evaluate the incidence,prevalence and risk of stroke in patients with TAK.Methods Data from 1065 patients were obtained from a national database(2010–2018).The annual incidence and prevalence per 100000 persons were estimated using the registration population in the midst of every year,and the standardised incidence ratio(SIR)of stroke was compared with the general population based on the data from the 2006 national report for cardiovascular and cerebrovascular diseases.Age-adjusted incidence rate ratio(IRR)of stroke based on the time interval after diagnosis was also calculated.A time-dependent Cox regression was conducted to investigate predictive factors of stroke.Results The overall incidence rate of TAK ranged between 0.2 and 0.3/100000 person-years annually;the prevalence of TAK gradually increased,reaching 3.25/100000 person-years in 2018.Seventy-three(6.9%)patients experienced stroke during follow-up,and the risk of developing stroke was higher than the general population(overall SIR 7.39,95%CI 5.79 to 9.29;men:SIR 5.70,95%CI 2.84 to 10.20;women:SIR 7.06,95%CI 5.41 to 9.05).Most stroke events(90.9%)were cerebral infarction for men,whereas the proportion of cerebral infarction was lower(62.9%)in women.Over half of stroke events occurred within 6 months after diagnosis,and stroke was more common within 6 months of diagnosis compared with after 3 years in women(IRR 13.46,95%CI 6.86 to 26.40).In Cox regression analysis,age was the sole predictor of stroke(adjusted HR 1.02,95%CI 1.00 to 1.04,p=0.043).Conclusions The annual incidence of TAK was similar to the previous studies from Asia,and the risk of stroke increased in TAK.Different patterns of subtype and incidence of stroke were found according to sex,although age was the only predictor.