First Emergency Hemodialysis Session at the Nephrology Department of the Teaching Hospital of Yopougon: About 146 Cases

Context: Due to the late referral of the pads to the nephrologist and the lack of medical follow-up, many patients are admitted with complications from kidney disease requiring the urgent start of hemodialysis sessions. Purpose: Study the profile of emergency hemodialysis patients in order to ease their management. Methods: This was a retrospective, descriptive and analytical study carried out at the Nephrology Department of the Teaching Hospital of Yopougon from January 1st to December 31st, 2016. This study included all patients who had received a first session of hemodialysis in an emergency context. Results: We collected 146 patients with an average age of 39.80 ± 14.55 years and a sex ratio of 0.6 for men. Before admission, patients were known as hypertensives (63.9%), followed by CKD (23.9%) and HIV-infected (8.2%). The main clinical signs were hypertension (64.3%), edema (44.5%) and coma (30.1%). Anemia was observed in 97.2% of cases and it was less than 8 g/dl in 57.5%. Kidney failure was chronic in 75.3% and acute in 24.6%. Chronic nephropathies were glomerular (54.1%), vascular (20.5%). The main indications for hemodialysis were encephalopathy (33.5%), severe uremia (28%), acute pulmonary edema (19.8%), persistent anuria (11.6%) and hyperkalemia (5.4%). The vascular approach was a catheter in 97.2% (femoral site in 53.4% and jugular in 43.8% and arteriovenous fistula in 2.7%). Death was observed in 17.8%. In univariate analysis, age > 65 years (p = 0.04), coma (p = 0.004) and acute kidney failure (p = 0.02) were associated with the risk of death, and in multivariate analysis, only coma (p = 0.024, OR = 5.88) seemed to be associated with mortality risk for our patients. Conclusion: Hemodialysis in an emergency situation is a common practice in the Teaching Hospital of Yopougon and mainly concerns patients with CKD.

Thoracic Aortic Aneurysm Revealed by Haemoptysis on a 10-Year-Old Girl at Paediatrics Department of Yalgado Ouedraogo University Hospital

Thoracic aortic aneurysm is a rather rare disorder in children and difficult to diagnose. It is generally linked to congenital heart defects or connective-tissue diseases. Our case is a 10-year-old girl admitted in the pediatric emergency care unit on January 19th, 2015 for massive haemoptysis and severe anaemia. Examination revealed severe anemia and a silent left lung. The Chest X-Ray revealed an abnormal mass on the upper left side of the mediastinum, and left lower lobe consolidation. The thoracic CT scan highlighted a 64 mm aneurysm of the subisthmic aorta with a thin 5 mm hole. It also showed pseudocoarctation of the aorta. Treatment in intensive care consisted of blood transfusion and iron supplement. She was due to travel abroad for cardio vascular surgery, but died on November 2016. Thoracic Aortic Aneurysm in our setting was discovered incidentally. In spite the fact that it is an extreme surgical emergency, in Burkina Faso, treatment can only be possible abroad upon medical evacuation.

Evolution of Proteinuria and Renal Function in Women with Pre-Eclampsia at the Gynecology Department of the Teaching Hospital of Cocody

Background: Pre-eclampsia has long been considered as a disease that disappears after the removal of the placenta. It has now been shown that its symptoms can persist for months after giving birth. Objectives: To study the evolution of proteinuria and renal function in women with pre-eclampsia. Patients and Methods: An analytical prospective study was carried out in the Hospitalization Unit of the Gynecology Department of the Teaching Hospital of Cocody (Abidjan) from May 3, 2021 to November 15, 2021. It focused on the follow-up of proteinuria and renal function in 50 women who had pre-eclampsia during their pregnancy, in the three months following their delivery. Results: The average age of the patients was 30.38 ± 6 years (range 18 and 40 years). Thirty-two percent were nulliparous and 62% had no risk factors for pre-eclampsia. The diagnosis of pre-eclampsia was made in 52% of cases before 37 weeks of amenorrhea. Sixty-two percent had Grade 3 arte-rial hypertension. The average proteinuria/creatininuria ratio was 3592.08 ± 7009.57 mg/g and 32% of women had glomerular grade proteinuria. The mean serum creatinine was 13.61 ± 12.62 mg/l. AKI (Acute Renal Failure) was present in 30% of women. All patients had received a central antihypertensive drug of which 88% were a calcium channel blocker. For the delivery mode, a Caesarean section was performed in 88% of cases. In the three months postpartum, 40% of women had persistent hypertension, 58% had persistent proteinuria and 6% had persistent impaired renal function. Prematurity (p = 0.0091), IUGR (intrauterine growth restriction) (p = 0.0012) and IUFD (intrauterine fetal death) (p = 0.0012) were associated with the persistence of proteinuria at M3 postpartum. Conclusion: Symptoms of pre-eclampsia do not automatically disappear after the delivery. Proteinuria and renal failure can persist beyond three months after the delivery and require treatment by a nephrologist.

The Dual of the Two-Variable Exponent Amalgam Spaces (Lq(),lp())(Ω)

Wiener amalgam spaces are a class of function spaces where the function’s local and global behavior can be easily distinguished. These spaces are ex-tensively used in Harmonic analysis that originated in the work of Wiener. In this paper: we first introduce a two-variable exponent amalgam space (Lq(),lp())(Ω). Secondly, we investigate some basic properties of these spaces, and finally, we study their dual.

Advanced gastric cancer:Current treatment landscape and future perspectives

Gastric cancer currently ranks fourth in cancer-related mortality worldwide. In the western world, it is most often diagnosed at an advanced stage, after becoming metastatic at distant sites. Patients with advanced disease(locally advanced or metastatic) have a somber prognosis, with a median overall survival of 10-12 mo, and palliative chemotherapy is the mainstay of treatment. In recent years, novel approaches using inhibition of human epidermal growth factor receptor 2(HER2) have demonstrated significant improvements in progression-free and overall survival, compared with chemotherapy alone, in first-line treatment of patients with overexpression of HER2. In addition, both second-line chemotherapy and treatment with the vascular endothelial growth factor receptor-inhibitor ramucirumab demonstrated significant benefits in terms of overall survival, compared with best supportive care, in randomized studies. Moreover, ramucirumab in combination with chemotherapy demonstrated further significant benefits in terms of progression-free and overall survival, compared with chemotherapy alone, in second-line treatment for patients with metastatic gastric cancer. A recently published molecular classification of gastric cancer is expected to improve patient stratification and selection for clinical trials and provide a roadmap for future drug development. Nevertheless, despite these developments the prognosis of patients with advanced gastric cancer remains poor. In this review we discuss current standards of care and outline major topics of drug development in gastric cancer.

Epididymosomes are involved in the acquisition of new sperm proteins during epididymal transit

During epididymal transit, spermatozoa acquire new proteins. Some of these newly acquired proteins behave as integral membrane proteins, including glycosylphosphatidylinositol （GPI）-anchored proteins. This suggests that the secreted epididymal proteins are transferred to spermatozoa by an unusual mechanism. Within the epididymal lumen, spermatozoa interact with small membranous vesicles named epididymosomes. Many proteins are associated with epididymosomes and the protein composition of these vesicles varies along the excurrent duct and differs from soluble intraluminal proteins. Some epididymosome-associated proteins have been identified and their functions in sperm maturation hypothesized. These include P25b, a zona pellucida binding protein, macrophage migration inhibitory factor, enzymes of the polyol pathway, HE5/CD52, type 5 glutathione peroxidase, and SPAM 1 or PH-20. The electrophoretic patterns of proteins associated to epididymosomes are complex and some of these proteins are transferred to defined surface domains of epididymal spermatozoa. Epididymosomes collected from different epididymal segments interact differently with spermatozoa. This protein transfer from epididymosomes to spermatozoa is timedependent, temperature-dependent and pH-dependent, and is more efficient in the presence of zinc. Some proteins are segregated to lipid raft domains of epididymosomes and are selectively transferred to raft domains of the sperm plasma membrane. Some evidence is presented showing that epididymosomes are secreted in an apocrine manner by the epididymal epithelial cells. In conclusion, epididymosomes are small membranous vesicles secreted in an apocrine manner in the intraluminal compartment of the epididymis and play a major role in the acquisition of new proteins by the maturing spermatozoa. （Asian J Androl 2007 July; 9： 483-491）

Green remediation of tetracyclines in soil-water systems

The presence of tetracyclines in soil and surface water is an emerging concern. The present study was undertaken to investigate remediation of tetracylines (tetracycline (TC), oxytetracycline (OTC) and chlortetracycline (CTC)) from aqueous solution using vetiver grass, water lettuce, and sunflower and root exudates of water lettuce, sunflower and from soil by tomato, Indian mustard and carrot plant. The data of this study denote that vetiver grass, water lettuce, sunflower remedy tetracyclines from water. The remediation % after 63 days of treatment was 87-61 for TC;88-68 for OTC and 87-68 for CTC. The remediation of tetracyclines at lower concentration of antibiotics in presence of root exudates of water lettuce and sunflower was more than 99% and remediation was faster than water lettuce or sunflower. The remediation of tetracyclines from aqueous solution may be due to oxidation of-OH group(s) of tetracycline through a process that is thought to involve reactive oxygen intermediates and/or role of peroxidase enzyme. The plant crops viz., tomato, Indian mustard and carrot can remedy 41%-72% of amended tetracyclines. The maximum bioaccumulation of TC and CTC was in Indian mustard and OTC was maximally bioaccumulated in tomato.

GOAL: ZERO ENERGY BUILDING Exemplary Experience Based on the Solar Estate Solarsiedlung Freiburg am Schlierberg, Germany

Zero energy consumption.The goal sounds simple and is presented excessively in variations all over the world.Energy and environmental politics demand zero consumption as a long-term goal,marketing has discovered the concept and fi rst buildings and settlements aiming at balanced energy or emission budgets have been constructed.As an example,the German Federal Government specifi es in its fi fth energy research programme(2005):For new buildings,the goal is to reduce the primary energy demand,i.e.the energy demand for heating,domestic hot water,ventilation,air-conditioning,lighting and auxiliary energy,again by half compared to the current state of the art.The long-term goal is zero-emission buildings.England and the USA aim for zero carbon developments and net-zero energy buildings(DOE,2009)in political programmes.The Vatican accepted the offer of climatic“indulgence”—and thus became the fi rst country in the world to completely compensate its carbon emission(Spiegel online,2007).Megaprojects in the growth regions of the Arabian Gulf and China advertise with a CO2-neutral balance.A Zero Carbon Community is to be created in Masdar,Abu Dhabi(Foster,2007),and the fi rst Chinese carbon-neutral ecocity was planned for Dongtan,Shanghai(Pearce,2009).Not only to aid international communication,but also to further the processes required to solve energy-related problems,it is essential that key words,central concepts,their usage and their relationships be clarifi ed.This article intends to contribute to this clarifi cation based on the monitored example of a solar estate.Net zero energy building,equilibrium building,carbon neutral city—the accounting method varies,depending on motivation and point of view.If the focus is on fi nite and scarce resources,energy is the currency;CO2-equivalent emissions are considered if global warming and public health is the issue;the cost of energy is what concerns a tenant paying for heating and electricity.A balance in one set of units can be converted to another,but the conversion factors often also shift the balance point.Energy will be used as the reference quantity in the following article,which prevents confusion with non-energy measures(e.g.carbon credits for forestry)and avoids the nuclear power debate,in which nuclear power is partly calculated as being CO2 neutral.The diversity of concepts is an indicator that a scientifi cally based methodology is still lacking,though initial publications focus hereon(Pless et al.2009).Since October 2008,a group of experts in the International Energy Agency has been addressing this issue under the heading,Towards Net Zero Energy Solar Buildings(Riley et al.2008).The goal is to document and analyse outstanding examples that are close to being net zero-energy buildings,and while doing so,to develop the methodology and tools for working with such buildings.The Chair of Technical Building Services,University of Wuppertal,is co-ordinating the methodological work.The zero-energy approach—still under construction—will here be presented using a solar estate as an illustration.

The mini-GWAC optical follow-up of gravitational wave alerts – results from the O2 campaign and prospects for the upcoming O3 run

The second(O2)observational campaign of gravitational waves(GWs)organized by the LIGO/Virgo Collaborations has led to several breakthroughs such as the detection of GW signals from merger systems involving black holes or neutrons stars.During O2,14 GW alerts were sent to the astronomical community with sky regions mostly covering over hundreds of square degrees.Among them,six were finally confirmed as real astrophysical events.Since 2013,a new set of ground-based robotic telescopes called Ground-based Wide Angle Camera system(GWAC)project and its pathfinder mini-GWAC has been developed to contribute to the various challenges of multi-messenger and time domain astronomy.The GWAC system is built up in the framework of the ground-segment system of the SVOM mission that will be devoted to the study of the multi-wavelength transient sky in the next decade.During O2,only the mini-GWAC telescope network was fully operational.Due to the wide field of view and fast automatic follow-up capabilities of the mini-GWAC telescopes,they were adept to efficiently cover the sky localization areas of GW event candidates.In this paper,we present the mini-GWAC pipeline we have set up to respond to GW alerts and we report our optical follow-up observations of eight GW alerts detected during the O2 run.Our observations provided the largest coverage of the GW localization areas with a short latency made by any optical facility.We found tens of optical transient candidates in our images,but none of those could be securely associated with any confirmed black hole-black hole merger event.Based on this first experience and the near future technical improvements of our network system,we will be more competitive in detecting the optical counterparts from some GW events that will be identified during the upcoming O3 run,especially those emerging from binary neutron star mergers.

Cognitive Workload Assessment of Aircraft Pilots

In this research, we study the cognitive workload of aircraft pilots during a simulated takeoff procedure. We propose a proof-of-concept setup environment to gather heart rate, pupil dilation, and brain cognitive workload data during an A320 takeoff within a simulator. Experiments were performed during which we collected 136 takeoffs across 13 pilots for more than 9 hours of time-series data. Moreover, this paper investigates the correlations between heart rate, pupil dilation, and cognitive workload during such exercise and found that a spike in cognitive load during a critical moment, such as an engine failure, augments a pilot’s heart rate and pupil dilation. Results show that a critical moment within a takeoff procedure increases a pilot’s cognitive load. Next, we used a stacked-LSTM model to predict cognitive workload 5 seconds into the future. The model was able to produce accurate predictions.

Structural and electrical characterization of Cu_(2)ZnSnS_(4) ingot material grown by melting method

In this work,a Cu_(2)ZnSnS_(4)(CZTS)ingot is grown via a melting method,then cooled;the resulting molten stoichiomet-ric mixture is sealed off in a quartz ampoule under vacuum.The CZTS powder chemical composition analyses are determined us-ing energy dispersive spectroscopy,and revealing the slightly Cu-rich and Zn-poor character of the ingot.Powder X-ray diffrac-tion analysis reveals a crystalline structure with a kesterite phase formation,and a preferred orientation of(112)plane.The lat-tice constants of the a-and c-axes,calculated based on the XRD analyses,are a=5.40Åand c=10.84Å.Based on Hall measure-ments at room temperature,we find that the crystal exhibits p-type conductivity,with a high concentration of 1018 cm^(-3),a res-istivity of 1.7Ωcm,and a mobility of 10.69 cm^(2)V-1s-1.Activation energies are estimated based on an Arrhenius plot of conductiv-ity versus 1/T,for a temperature range of 80-350 K,measuring 35 and 160 meV in low-and high-temperature regimes,respect-ively,which is attributed to complex defects(2CuZn+SnZn)and antisite defects(CuZn),respectively.The observed scattering mech-anisms are attributed to ionized impurities and acoustic phonons at low and high temperatures,respectively.The extracted band-gap is 1.37 eV.

Lifshitz Transition Including Many-Body Effects in Bi-Layer Graphene and Change in Stacking Order

We consider the AB-(Bernal) stacking for the bi-layer graphene (BLG) system and assume that a perpendicular electric field is created by the external gates deposited on the BLG surface. In the basis (A1, B2, A2, B1) for the valleyKand the basis (B2, A1, B1, A2) for the valley K′, we show the occurrence of trigonal warping [1], that is, splitting of the energy bands or the density of states on the kx - ky plane into four pockets comprising of the central part and three legs due to a (skew) interlayer hopping between A1 and B2. The hopping between A1 - B2 leads to a concurrent velocity v3 in addition to the Fermi velocity vF. Our noteworthy outcome is that the above-mentioned topological change, referred to as the Lifshitz transition [2, 3], is entirely bias-tunable. Furthermore, the many-body effects, which is known to yield logarithmic renormalizations [4] in the band dispersions of monolayer graphene, is found to have significant effect on the bias-tunability of this transition. We also consider a variant of the system where the A atoms of the two layers are over each other and the B atoms of the layers are displaced with respect to each other. The Fermi energy density of statesfor zero bias corresponds to the inverted sombrero-like structure. The structure is found to get deformed due to the increase in the bias.

Use of Sediment and Algae for Biomonitoring the Coast of Honaïne (Far West Algerian)

Concentrations of Fe, Cu, Pb, Zn, Cd and Ni were determined in the red alga Corallina officinalis (Linnaeus, 1758), the green alga Ulva lactuca (Linnaeus, 1753) and sediment sampled in four stations of the coastline of Hona?ne (extreme Western Algeria). The abundance of metal concentrations in algae and sediment samples, is in the following order: Fe > Zn > Pb > Ni > Cu > Cd. The schematic representation by PCA reflects a strong correlation of the corallina with Cd and Pb, the ulva with Zn and Ni and sediment with Cu and Fe, in addition, to homogeneity of rehearsals in each matrix. The results of this study validate the use of these species as reliable tools for biomonitoring of metal pollution of coastal ecosystems, even if the levels of heavy metals in sediment and algae from the coastline of Hona?ne are in general, very low compared with those from other geographic areas and by guidelines.

Identification of Sustainability Indicators and Evaluation of Transportation Corridors during Construction Using Fuzzy VIKOR Method

Sustainability is popularly defined as meeting the needs of the present generation without compromising the ability of future generations to meet their own needs. Social, economic and environmental parameters are most commonly accepted as the three pillars of sustainability. In this paper, various sustainability indicators have been identified during the construction stage for elevated transportation corridors and thereafter classified under various categories. Using fuzzy VIKOR technique, sustainability evaluation of transportation corridors is made on two selected project sites of two different government organizations using various identified sustainability indicators, i.e., a 3.2-km long elevated road project under construction from Vikaspuri to Meerabagh in West Delhi by PWD （Public Works Department） and the metro rail elevated corridor （part） from Punjabi Bagh to Mayapuri as a part of Phase 3, Line 7 by DMRC （Delhi Metro Rail Corporation）. The study is made at both sites in the midst of the construction period and it is identified that during the construction stage, the sustainability of these transportation corridors is just not limited to three pillars, but in actuality, it is much beyond that. From the study, it is inferred that the metro rail elevated corridor is a more sustainable corridor, in the context of the identified sustainability indicators.

Invasive Thymoma with Endobronchial Polypoid Growth

Thymomas are the most common neoplasms of the mediastinum. It is common that thymoma invades neighboring structures in the thorax, but direct polypoid tumor growth into the airway is extremely rare. We report a rare case of invasive thymoma with polypoid endobronchial growth in a 66-year-old woman. Computed tomography demonstrated an anterior mediastinal tumor which extended into the right upper lobe. Endoscopic examination revealed a polypoid tumor which occluded the right upper bronchus. A biopsy specimen obtained from the intraluminal mass was very suggestive of thymoma. The patient had no parathymic syndrome. The tumor was resected with the right upper lobe. The final post-operative tissue findings confirmed a type B2 thymoma of the World Health Organisation classification.

COVID-19 mental health care toolkit:an international collaborative effort by Early Career Psychiatrists section

The collaborative effort of an international research team from the Early Career Psychiatrists section of the World Psychiatry Association has brought about an easy-to-use,quick and stepwise mental health care toolkit for the identification and appropriate referral of those in need of mental health care during the pandemic.This simple guide can be applied in the general outpatient setting and is catered for all healthcare professionals,regardless of their expertise within the mental health field with minimal training.It is our hope that by incorporating this toolkit into our daily clinical care during the pandemic for high-risk patients and patients with non-specific complaints,we will be able to bridge the mental health gap present in our society.

QBC ParaLens^(TM) LED fluorescent microscope attachment with QBC F.A.S.T.^(TM) AFB staining system

This study was designed to evaluate the QBC ParaLensTM LED fluorescent microscope attachment and the QBC F.A.S.T.TM AFB staining system for the detection of Acid Fast Bacilli in pathological samples in Abidjan, Cote d’Ivoire. A total of 50 patients were tested using direct smear specimens with both Ziehl-Neelsen (ZN) light microscopy and LED fluorescence microscopy with QBC F.A.S.T. AFB stain. The samples were also cultured and tested using an immunochromatograpic test for detection of antigen MPT 64 and the results were compared to direct examination. ZN light microscopy detected 20 positive cases and LED fluorescent microscopy with QBC F.A.S.T. AFB stain detected 21. The sensitivity and specificity of ZN light microscopy was determined to be 84.2% and 87.1% respectively. The sensitivity and specificity of LED fluorescent microscopy with QBC F.A.S.T. AFB stain was determined to be 94.7% and 90.3% respectively. Compared to ZN light microscopy, LED fluorescent microscopy with QBC F.A.S.T. AFB stain increased the sensitivity of direct examination without concentration by 10.5%.

Use of Antipsychotics: A Study from the French National Insurance Healthcare System Database

A marked increase in antipsychotic prescriptions has been observed in most countries since the introduction of second-generation antipsychotics. Misuse could partly explain this rise. We described the use of antipsychotic medication in France. This retrospective analysis was conducted on the sample “Echantillon généraliste de beneficiaries” from the French National Insurance Healthcare System. All reimbursements for antipsychotic medications in 2010 were identified. Antipsychotics use was described in terms of patient’s profiles and condition of use. In 2010, we identified 11,729 single patients with at least one reimbursement for antipsychotic medication (2.23% of French health insurance beneficiaries). The mean age in the population was 54 (sd 20) years. Forty-one percent had declared psychiatric disorder and 15% had a psychiatric follow-up for unknown diseases. Schizophrenia, others psychosis and personality disorders were the three main diagnoses of psychiatric disease. Patients without declared psychiatric disorders and without psychiatric follow-up accounted for 23% (aged between 15 and 65) and 20% (aged 65 years and over) of the population using antipsychotics. Forty-five percent of patients aged between 15 and 65 had more than 3 months of treatment refunded. Patients aged 65 years and over were 69% without dementia and 47% had more than three months of treatment of antipsychotics refunded during the year. These results suggested that antipsychotic treatments were used in France at long term in particular for patients without declared psychiatric disorder or psychiatric follow-up.

Cell Proliferation Ability of Mouse Fibroblast-Like Cells and Osteoblast-Like Cells on a Ti-6Al-4V Alloy Film Produced by Selective Laser Melting

Successful regeneration of tissues and organs relies on the application of suitable substrates or scaffolds in scaffold-based regenerative medicine. In this study, Ti-6Al-4V alloy films (Ti alloy film) were produced using a three-dimensional printing technique called Selective Laser Melting (SLM), which is one of the metal additive manufacturing techniques. The thickness of produced Ti alloy film was approximately 250 μm. The laser-irradiated surface of Ti alloy film had a relatively smooth yet porous surface. The non-irradiated surface was also porous but also retained a lot of partially melted Ti-6Al-4V powder. Cell proliferation ability of mouse fibroblast-like cells (L929 cells) and mouse osteoblast-like cells (MC3T3-E1 cells) on both the surfaces of Ti alloy film was examined using WST assay. Both L929 and MC3T3-E1 cells underwent cell proliferation during the culture period. These results indicate that selective laser melting is suitable for producing a cell-compatible Ti-6Al-4V alloy film for biomaterials applications.

Can gadoxetic acid–enhanced magnetic resonance imaging be used to avoid liver biopsy in patients with nonalcoholic fatty liver disease?

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a major cause of liver disease worldwide.The diagnosis of nonalcoholic steatohepatitis(NASH),the most severe form of NAFLD,is crucial and has prognostic and therapeutic implications.However,currently this diagnosis is based on liver biopsy and has several limitations.AIM To evaluate the performance of gadoxetic acid–enhanced magnetic resonance imaging(GA-MRI)in differentiating isolated steatosis from NASH in patients with NAFLD.METHODS In this prospective study,56 patients with NAFLD(18 with isolated steatosis and 38 with NASH)underwent GA-MRI.The contrast enhancement index(CEI)was calculated as the rate of increase of the liver-to-muscle signal intensity ratio from before and 20 min after intravenous GA administration.Between-group differences in mean CEI were examined using Student's t test.The area under the receiver operator characteristic curve and the diagnostic performance of gadoxetic acid–enhanced magnetic resonance imaging were evaluated.RESULTS The mean CEI for all subjects was 1.82±0.19.The mean CEI was significantly lower in patients with NASH than in those with isolated steatosis(P=0.008).Two CEI cut-off points were used:<1.66(94%specificity)to characterize NASH and>2.00(89%sensitivity)to characterize isolated steatosis.CEI values between 1.66 and 2.00 indicated liver biopsy,and the procedure could be avoided in 40%of patients with NAFLD.CONCLUSION GA-MRI is an effective noninvasive method that may be useful for the differentiation of NASH from isolated steatosis,and could help to avoid liver biopsy in patients with NAFLD.