BACKGROUND Congestive hepatopathy,also known as nutmeg liver,is liver damage secondary to chronic heart failure(HF).Its morphological characteristics in terms of medical imaging are not defined and remain unclear.AIM ...BACKGROUND Congestive hepatopathy,also known as nutmeg liver,is liver damage secondary to chronic heart failure(HF).Its morphological characteristics in terms of medical imaging are not defined and remain unclear.AIM To leverage machine learning to capture imaging features of congestive hepatopathy using incidentally acquired computed tomography(CT)scans.METHODS We retrospectively analyzed 179 chronic HF patients who underwent echocardiography and CT within one year.Right HF severity was classified into three grades.Liver CT images at the paraumbilical vein level were used to develop a ResNet-based machine learning model to predict tricuspid regurgitation(TR)severity.Model accuracy was compared with that of six gastroenterology and four radiology experts.RESULTS In the included patients,120 were male(mean age:73.1±14.4 years).The accuracy of the results predicting TR severity from a single CT image for the machine learning model was significantly higher than the average accuracy of the experts.The model was found to be exceptionally reliable for predicting severe TR.CONCLUSION Deep learning models,particularly those using ResNet architectures,can help identify morphological changes associated with TR severity,aiding in early liver dysfunction detection in patients with HF,thereby improving outcomes.展开更多
Rupture of gastric varices(GVs)can be fatal.Balloon-occluded retrograde transvenous obliteration(BRTO),as known as retrograde sclerotherapy,has been widely adopted for treatment of GVs because of its effectiveness,abi...Rupture of gastric varices(GVs)can be fatal.Balloon-occluded retrograde transvenous obliteration(BRTO),as known as retrograde sclerotherapy,has been widely adopted for treatment of GVs because of its effectiveness,ability to cure,and utility in emergency and prophylactic treatment.Simplifying the route of blood flow from GVs to the gastrorenal shunt is important for the successful BRTO.This review outlines BRTO indications and contraindications,describes basic BRTO procedures and modifications,compares BRTO with other GVs treatments,and discusses various combination therapies.Combined BRTO and partial splenic embolization may prevent exacerbation of esophageal varices and shows promise as a treatment option.展开更多
In this review,we focused on two molecules,connexin and sodium-glucose cotransporter,which can link to diabetic hyperfiltration.In diabetic kidney,the activation of renin-angiotensin system occurs simultaneously with ...In this review,we focused on two molecules,connexin and sodium-glucose cotransporter,which can link to diabetic hyperfiltration.In diabetic kidney,the activation of renin-angiotensin system occurs simultaneously with glomerular hyperfiltration.The latter largely dependson pathophysiological afferent arteriolar dilation in the presence of high angiotensin Ⅱ.As a mechanistic basis for the above,tubular hypothesis has been proposed for type 1 diabetic patients as well as experimental models.Although tubular hypothesis has not been well evaluated in type 2 diabetes,clinical observations support that tubular hypothesis is true also in type 2 diabetes.Recent results on tubular hypothesis along with connexin abnormality in type 2 diabetes were revisited.In addition,the importance of sodium-glucose cotransporter in diabetic hyperfiltration is discussed.The link between salt paradox and the activation of reninangiotensin system will be also reviewed.展开更多
基金Supported by Grant-in-Aid for Research on Hepatitis from the Japan Agency for Medical Research and Development,No.24fk0210128h0002Grant-in-Aid for Scientific Research,No.KAKENHI-23K07372.
文摘BACKGROUND Congestive hepatopathy,also known as nutmeg liver,is liver damage secondary to chronic heart failure(HF).Its morphological characteristics in terms of medical imaging are not defined and remain unclear.AIM To leverage machine learning to capture imaging features of congestive hepatopathy using incidentally acquired computed tomography(CT)scans.METHODS We retrospectively analyzed 179 chronic HF patients who underwent echocardiography and CT within one year.Right HF severity was classified into three grades.Liver CT images at the paraumbilical vein level were used to develop a ResNet-based machine learning model to predict tricuspid regurgitation(TR)severity.Model accuracy was compared with that of six gastroenterology and four radiology experts.RESULTS In the included patients,120 were male(mean age:73.1±14.4 years).The accuracy of the results predicting TR severity from a single CT image for the machine learning model was significantly higher than the average accuracy of the experts.The model was found to be exceptionally reliable for predicting severe TR.CONCLUSION Deep learning models,particularly those using ResNet architectures,can help identify morphological changes associated with TR severity,aiding in early liver dysfunction detection in patients with HF,thereby improving outcomes.
文摘Rupture of gastric varices(GVs)can be fatal.Balloon-occluded retrograde transvenous obliteration(BRTO),as known as retrograde sclerotherapy,has been widely adopted for treatment of GVs because of its effectiveness,ability to cure,and utility in emergency and prophylactic treatment.Simplifying the route of blood flow from GVs to the gastrorenal shunt is important for the successful BRTO.This review outlines BRTO indications and contraindications,describes basic BRTO procedures and modifications,compares BRTO with other GVs treatments,and discusses various combination therapies.Combined BRTO and partial splenic embolization may prevent exacerbation of esophageal varices and shows promise as a treatment option.
文摘In this review,we focused on two molecules,connexin and sodium-glucose cotransporter,which can link to diabetic hyperfiltration.In diabetic kidney,the activation of renin-angiotensin system occurs simultaneously with glomerular hyperfiltration.The latter largely dependson pathophysiological afferent arteriolar dilation in the presence of high angiotensin Ⅱ.As a mechanistic basis for the above,tubular hypothesis has been proposed for type 1 diabetic patients as well as experimental models.Although tubular hypothesis has not been well evaluated in type 2 diabetes,clinical observations support that tubular hypothesis is true also in type 2 diabetes.Recent results on tubular hypothesis along with connexin abnormality in type 2 diabetes were revisited.In addition,the importance of sodium-glucose cotransporter in diabetic hyperfiltration is discussed.The link between salt paradox and the activation of reninangiotensin system will be also reviewed.
