We have previously reported that Helicobacter pylori(H.pylori)-associated nodular gastritis could occur in both the antrum and the cardia.Cardiac nodularity-like appearance(hereafter,called as cardiac nodularity)had a...We have previously reported that Helicobacter pylori(H.pylori)-associated nodular gastritis could occur in both the antrum and the cardia.Cardiac nodularity-like appearance(hereafter,called as cardiac nodularity)had a high predictive accuracy for the diagnosis of H.pylori infection.In the previous study,we included only the patients who were evaluated for H.pylori infection for therst time,and excluded patients with a history of eradication.Therefore,the prevalence and clinical features of cardiac nodularity remains unknown.AIM To perform this cross-sectional study to explore the characteristics of cardiac nodularity.METHODS Consecutive patients who underwent esophagogastroduodenoscopy betweenMay,2017 and August,2019 in the Toyoshima Endoscopy Clinic were enrolled in this study.We included H.pylori-negative,H.pylori-positive,and H.pylorieradicated patients,and excluded patients with unclear H.pylori status and eradication failure.H.pylori infection was diagnosed according to serum anti-H.pylori antibody and the urea breath test or histology.Cardiac nodularity was defined as a miliary nodular appearance or the presence of scattered whitish circular small colorations within 2 cm of the esophagogastric junction.Nodularity was visualized as whitish in the narrow-band imaging mode.We collected data on the patients’baseline characteristics.RESULTS A total of 1078 patients were finally included.Among H.pylori-negative patients,cardiac nodularity and antral nodularity were recognized in 0.14%each.Among H.pylori-positive patients,cardiac nodularity and antral nodularity were recognized in 54.5%and 29.5%,respectively.Among H.pylori-eradicated patients,cardiac nodularity and antral nodularity were recognized in 4.5%and 0.6%,respectively.The frequency of cardiac nodularity was significantly higher than that of antral nodularity in H.pylori-positive and-eradicated patients.The frequencies of cardiac nodularity and antral nodularity in H.pylori-eradicated patients were significantly lower than those in H.pylori-positive patients(P<0.001).The patients with cardiac nodularity were significantly younger than those without cardiac nodularity(P=0.0013).Intestinal metaplasia score of the patients with cardiac nodularity were significantly lower than those without cardiac nodularity(P=0.0216).Among H.pylori-eradicated patients,the patients with cardiac nodularity underwent eradication significantly more recently compared with those without cardiac nodularity(P<0.0001).CONCLUSION This report outlines the prevalence and clinical features of cardiac nodularity,and confirm its close association with active H.pylori infection.展开更多
Ferritic spheroidal graphite irons with nodularity from 72%to 96%were prepared.The relationship between the nodularity and the mechanical properties of the ferritic spheroidal graphite iron was investigated.The effect...Ferritic spheroidal graphite irons with nodularity from 72%to 96%were prepared.The relationship between the nodularity and the mechanical properties of the ferritic spheroidal graphite iron was investigated.The effect of nodularity on the mechanical properties and tensile fracture of the cast iron were studied.Results showed that the tensile strength Rm,yield strength Rp0.2,elongation to failure A5,and impact energy KV2 of the cast iron had a good linear relationship with its nodularity.Nodularity and annealing treatment would obviously affect the fracture characteristics of ferritic spheroidal graphite iron.The annealed ferritic spheroidal graphite iron with 93%nodularity showed a completely ductile rupture.With the decrease of nodularity from 93%to 72%,the cleavage fracture area ratio increased gradually from 0%to 8.3%.Compared with as-cast ferritic spheroidal graphite iron,annealing treatment reduced the cleavage fracture area of the ferritic spheroidal graphite iron.展开更多
BACKGROUND Focal nodular hyperplasia(FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse.Although pathologically similar to hepatocellular carcinoma(HCC...BACKGROUND Focal nodular hyperplasia(FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse.Although pathologically similar to hepatocellular carcinoma(HCC)lesions,they are benign.As such,it is important to develop methods to distinguish between FNH-like lesions and HCC.AIM To evaluate diagnostically differential radiological findings between FNH-like lesions and HCC.METHODS We studied pathologically confirmed FNH-like lesions in 13 patients with alco-holic cirrhosis[10 men and 3 women;mean age:54.5±12.5(33-72)years]who were negative for hepatitis-B surface antigen and hepatitis-C virus antibody and underwent dynamic computed tomography(CT)and magnetic resonance imaging(MRI),including superparamagnetic iron oxide(SPIO)and/or gadoxetic acid-enhanced MRI.Seven patients also underwent angiography-assisted CT.RESULTS The evaluated lesion features included arterial enhancement pattern,washout appearance(low density compared with that of surrounding liver parenchyma),signal intensity on T1-weighted image(T1WI)and T2-weighted image(T2WI),central scar presence,chemical shift on in-and out-of-phase images,and uptake pattern on gadoxetic acid-enhanced MRI hepatobiliary phase and SPIO-enhanced MRI.Eleven patients had multiple small lesions(<1.5 cm).Radiological features of FNH-like lesions included hypervascularity despite small lesions,lack of“corona-like”enhancement in the late phase on CT during hepatic angiography(CTHA),high-intensity on T1WI,slightly high-or iso-intensity on T2WI,no signal decrease in out-of-phase images,and complete SPIO uptake or incomplete/partial uptake of gadoxetic acid.Pathologically,similar to HCC,FNH-like lesions showed many unpaired arteries and sinusoidal capillarization.CONCLUSION Overall,the present study showed that FNH-like lesions have unique radiological findings useful for differential diagnosis.Specifically,SPIO-and/or gadoxetic acid-enhanced MRI and CTHA features might facilitate differential diagnosis of FNH-like lesions and HCC.展开更多
BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrason...BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrasonography(EUS),but atypical EUS features have also been reported.Previous studies have found that atypical features of gastric IFPs observed under EUS have corresponding histological manifestations.At present,there is no study elaborating the EUS manifestations of gastric IFPs at different pathological stages.We hypothesize that gastric IFPs at different pathological stages may have different EUS features.AIM To describe EUS features of gastric IFPs and compare with their pathological characteristics.METHODS Clinical data of 53 inpatients with pathologically diagnosed gastric IFPs after endoscopic treatment were collected.All patients underwent preoperative EUS.We analyzed the EUS characteristics of the lesions and compared with the pathological characteristics and staging of the resected specimens.RESULTS Most gastric IFPs showed medium-low echo(67.9%),homogeneous echo(90.6%),and unclear boundaries(83%),and involved the second and third layers of the gastric wall(69.8%)under EUS.The echogenicity level and echo homogeneity were significantly correlated with the pathological stage of gastric IFP.Gastric IFPs in the nodular stage presented hypoechoic and homogeneous echo.Gastric IFPs in the fibrovascular stage mostly showed medium-low echo and homogeneous echo.Gastric IFPs in the sclerotic stage showed different echogenicity levels and echo homogeneity.The accuracy of EUS in diagnosing gastric IFPs was 66.0%(35/53),and the accuracy in determining the origin layer of gastric IFPs was 73.4%(39/53).CONCLUSION Gastric IFPs at different pathological stages have different EUS features.In order to improve the diagnostic rate,it is necessary to combine EUS with EUS-guided fine-needle aspiration or artificial intelligence.展开更多
This study systematically investigated the effects of graphite nodule parameters,including count,average diameter,and nodularity,on microstructure and mechanical properties of austempered ductile irons(ADIs).The ADI s...This study systematically investigated the effects of graphite nodule parameters,including count,average diameter,and nodularity,on microstructure and mechanical properties of austempered ductile irons(ADIs).The ADI specimens with graphite nodule counts of 212±11 mm^(-2),308±9 mm^(-2),415±10 mm^(-2),and 589±13 mm^(-2) were designated as G-200,G-300,G-400,and G-600,respectively.Results indicate a progressive refinement of graphite with an increase in nodule counts.Specifically,the average nodule diameter decreases from 33.3±1.3μm for G-200 to 17.0±0.7μm for G-600.The nodularity of all samples is above 90%.Furthermore,the nodularity exhibits a corresponding increasing trend with the rise of graphite nodule count in ADIs.Additionally,the volume fraction of the austenite phase in ADIs decreases with an increase in graphite nodule count.The graphite nodule count changes the tensile strength and elongation of ADIs.The specimen G-400 exhibits the ultimate tensile strength of 897±11 MPa and an elongation of 9.8%±0.6%,representing 5.3%and 44.1%improvements respectively compared to G-200.To explore the wear resistance of ADIs with different graphite nodule counts,dry sliding friction and wear test of different samples was carried out at room temperature.At a high load of 25 N,G-400 exhibits superior wear resistance,achieving a 42%reduction in worn volume compared to G-200.Worn micromorphology identifies three primary wear mechanisms:microcutting-dominated abrasive wear,adhesive wear,and fatigue wear.展开更多
BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension(NCPH)are poorly understood.AIM To investigate cardiopulmonary changes using transthoracic echocardiography(TTE)in NCPH and their correlation with ...BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension(NCPH)are poorly understood.AIM To investigate cardiopulmonary changes using transthoracic echocardiography(TTE)in NCPH and their correlation with clinical features.METHODS Prospective cohort including 10 preclinical NCPH[without portal hypertension(PH)]and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed.PH was defined by presence of either varices,ascites or portosystemic shunting.Intrapulmonary vascular dilatation(IPVD)is defined as appearance of microbubbles in the left atrium after three heartbeats.Right ventricular systolic pressure(RVSP)>38 mmHg was used to identify possible porto-pulmonary hypertension.Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.RESULTS Among 42 subjects,17(40%)had IPVD,4(9.5%)had RVSP>38 mmHg,and 6(14%)had cardiomyopathy.Aspartate aminotransferase to alanine aminotransferase(AST/ALT)(1.3 vs 1,P=0.04)and liver stiffness measurement(LSM)(12.4 kPa vs 7.1 kPa,P=0.03)were higher in those with IPVD.Presence of either LSM>10 or AST/ALT>1.2 aided in identifying subjects with IPVD-sensitivity,specificity,and accuracy of 76%.RVSP correlated with oxygen saturation(r=-0.33),and free right hepatic vein pressure(r=0.43).Those with PH had higher left atrial volume(LAV)(62 mL vs 48 mL,P<0.01),and LAV index(LAVI)(35 m^(2) vs 23 m^(2),P<0.01)compared to those without PH.Total bile acids,especially primary bile acids positively correlated with LAV(r=0.36),and LAVI(r=0.41).CONCLUSION Similar to cirrhotic patients,cardiopulmonary changes are prevalent in NCPH,especially among those with PH.In NCPH,cardiopulmonary changes occur despite preserved synthetic function,suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.展开更多
Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significa...Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.展开更多
It is important to improve the comprehensive performance of the ductile iron bars(DIBs)for the cylinder block of the extra high pressure hydraulic plunger pump and accelerate the industrial application.In this work,th...It is important to improve the comprehensive performance of the ductile iron bars(DIBs)for the cylinder block of the extra high pressure hydraulic plunger pump and accelerate the industrial application.In this work,the LZQT600-3 DIBs with the diameter of 145 mm were prepared by the horizontal continuous casting(HCC)process,that is,LZQT600-3 HCCDIBs.The microstructure and room temperature tensile properties of different sections[left-edge(surface layer),left-1/2R(left half of the radius),and the center of the HCCDIBs]were studied.The results show that the spheroidization of LZQT600-3 HCCDIBs matrix from the left-edge,left-1/2R to the center is at nodulizing grade II and above.As the cooling rate gradually decreases from surface to the center of the HCCIBs,the number of spheroidized graphite is gradually reduced,the size is gradually increased,the shape factor is decreased,and the pearlite content and lamellate spacing are increased.Along the horizontal direction of the section,the hardness of the material is distributed symmetrically around the center of the HCCDIBs.In the vertical direction,the hardness distribution in the center of the HCCDIBs is asymmetrical due to the gravity during the solidification process.Therefore,the microstructure in the lower part of the section solidifies relatively quickly.The left-edge has the best tensile mechanical properties,and the ultimate tensile strength,yield tensile strength and elongation are 597.3 MPa,418.5 MPa and 9.6%,respectively.The tensile fracture belongs to the ductile-brittle hybrid fracture.The comprehensive performances of LZQT600-3 HCCDIBs meet the actual application requirements of ultra-high pressure hydraulic plunger pump cylinder.展开更多
In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute ...In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.展开更多
Amyloidosis is a rare spectrum of disease which involves deposition of misfolded extracellular proteins (amyloids) in various body organs leading to progressive organ dysfunction. Clinical presentation can be variable...Amyloidosis is a rare spectrum of disease which involves deposition of misfolded extracellular proteins (amyloids) in various body organs leading to progressive organ dysfunction. Clinical presentation can be variable depending on the organ involved and type of protein. Amyloidosis can be classified based on quantity, type, and location of these proteins. Amyloid light-chain amyloidosis develops in the bone marrow, producing abnormal forms of light-chain proteins, which cannot be broken down. These proteins transform into amyloid fibrils and form amyloid deposits in different organs. Pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis;however, it may present as localised pulmonary disease. Localized pulmonary Amyloidosis can present as nodular, cystic, or tracheobronchial amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. This is a case of a 47-year-old female with background history of interstitial lung disease presenting with progressive shortness of breath. Computed tomography scan revealed bilateral pulmonary nodules. The patient was referred to our thoracic surgery team with the suspicion of bronchogenic malignancy with metastasis. Diagnostic video assisted wedge resection was performed for this patient, and histology confirmed pulmonary amyloidosis of nodular type. Amyloid deposition simulates both inflammatory and neoplastic conditions. Definitive diagnosis requires biopsy confirmation therefore early detection and commencing the patient on appropriate treatment pathway may help in symptomatic relief and better outcome.展开更多
Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infecti...Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infection and evaluate gastric cancer risk.In 2013,the Japan Gastroenterological Endoscopy Society advocated the Kyoto classification,a new grading system for endoscopic gastritis.The Kyoto classification organized endoscopic findings related to H.pylori infection.The Kyoto classification score is the sum of scores for five endoscopic findings(atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness with or without regular arrangement of collecting venules)and ranges from 0 to 8.Atrophy,intestinal metaplasia,enlarged folds,and nodularity contribute to gastric cancer risk.Diffuse redness and regular arrangement of collecting venules are related to H.pylori infection status.In subjects without a history of H.pylori eradication,the infection rates in those with Kyoto scores of 0,1,and≥2 were 1.5%,45%,and 82%,respectively.A Kyoto classification score of 0 indicates no H.pylori infection.A Kyoto classification score of 2 or more indicates H.pylori infection.Kyoto classification scores of patients with and without gastric cancer were 4.8 and 3.8,respectively.A Kyoto classification score of 4 or more might indicate gastric cancer risk.展开更多
Collagenous gastritis is a rare disease characterized by the subepithelial deposition of collagen bands thicker than 10 μm and the infiltration of inflammatory mononuclear cells in the lamina propria. Collagenous col...Collagenous gastritis is a rare disease characterized by the subepithelial deposition of collagen bands thicker than 10 μm and the infiltration of inflammatory mononuclear cells in the lamina propria. Collagenous colitis and collagenous sprue have similar histological characteristics to collagenous gastritis and are thought to be part of the same disease entity. However, while collagenous colitis has become more common in the field of gastroenterology, presenting with clinical symptoms of chronic diarrhea in older patients,collagenous gastritis is rare. Since the disease was first reported in 1989, only 60 cases have been documented in the English literature. No safe and effective treatments have been identified from randomized, controlled trials. Therefore, better understanding of the disease and the reporting of more cases will help to establish diagnostic criteria and to develop therapeutic strategies. Therefore, here we review the clinical characteristics, endoscopic and histological findings, treatment, and clinical outcomes from case reports and case series published to date, and provide a summary of the latest information on the disease. This information will contribute to improved knowledge of collagenous gastritis so physicians can recognize and correctly diagnose the disease, and will help to develop a standard therapeutic strategy for future clinical trials.展开更多
Ductile iron （DI） is a preferred material for use in various structural, automotive, and engineering fields because of its excellent combination of strength, toughness, and ductility. In the current investigation, w...Ductile iron （DI） is a preferred material for use in various structural, automotive, and engineering fields because of its excellent combination of strength, toughness, and ductility. In the current investigation, we elucidate the relationship between the morphological and mechanical properties of DI intended for use in safety applications in the nuclear industry. DI specimens with various alloying elements were subjected to annealing and austempering heat treatment processes. A faster cooling rate appeared to increase the nodule count in austempered specimens, compensating for their nodularity value and subsequently decreasing their ductility and impact strength. The ductility and impact energy values of annealed specimens increased with increasing ferrite area fraction and nodularity, whereas an increase in the amounts of Ni and Cr resulted in an increase of hardness via solid solution strengthening. Austempered specimens were observed to be stronger than an- nealed specimens and failed in a somewhat brittle manner characterized by a river pattern, whereas the ductile failure mode was character- ized by the presence of dimples.展开更多
The demands for improved engine performance,fuel economy,durability,and lower emissions provide a continual challenge for engine designers.The use of Compacted Graphite Iron(CGI)has been established for successful hig...The demands for improved engine performance,fuel economy,durability,and lower emissions provide a continual challenge for engine designers.The use of Compacted Graphite Iron(CGI)has been established for successful high volume series production in the passenger vehicle,commercial vehicle and industrial power sectors over the last decade.The increased demand for CGI engine components provides new opportunities for the cast iron foundry industry to establish efficient and robust CGI volume production processes,in China and globally.The production window range for stable CGI is narrow and constantly moving.Therefore,any one step single addition of magnesium alloy and the inoculant cannot ensure a reliable and consistent production process for complicated CGI engine castings.The present paper introduces the SinterCast thermal analysis process control system that provides for the consistent production of CGI with low nodularity and reduced porosity,without risking the formation of flake graphite.The technology is currently being used in high volume Chinese foundry production.The Chinese foundry industry can develop complicated high demand CGI engine castings with the proper process control technology.展开更多
EN-GJS-450-10 ductile cast iron was produced with and without vibration to evaluate microstructural features. To investigate the effect of vibration, a reference, and two different castings having amplitudes of 0.9 mm...EN-GJS-450-10 ductile cast iron was produced with and without vibration to evaluate microstructural features. To investigate the effect of vibration, a reference, and two different castings having amplitudes of 0.9 mm and 1.8 mm were cast with a fixed vibration frequency of 50 Hz. The nodule count (density), form (type), size distribution, nodularity, and the fraction of graphite, percentages of both ferrite and pearlite phases, length of ferrite shell, and pore, were evaluated via optical microscopy using an image analysis software. It is observed that the microstructure of the cast iron is more uniform by vibrational casting than that by non-vibrational casting. Additionally, mechanical vibration enhances nodule count and nodularity, also, more ferritic matrix could be obtained after the application of vibration. Nodule count and nodularity of vibrational casting with 1.8 mm amplitude increased from 226 nodule per mm2 and 80% to 311 nodule per mm2 and 86.5% of non-vibrational casting. Percentages of ferrite and graphite area dramatically improved from 24% and 16.5% for non-vibrational casting to 57% and 22.3% for vibrational casting with 1.8 mm amplitude, whereas the percentages of pearlite and pores decreased significantly from 56.1% and 5% to 20% and 1%, respectively.展开更多
The“six-and-twelve”(6&12)score is a new hepatocellular carcinoma(HCC)prognostic index designed for recommended transarterial chemoembolization(TACE)candidates.Quick and easy to use by the sum of tumor size(cm)an...The“six-and-twelve”(6&12)score is a new hepatocellular carcinoma(HCC)prognostic index designed for recommended transarterial chemoembolization(TACE)candidates.Quick and easy to use by the sum of tumor size(cm)and number,this model identifies three groups with different survival time(the sum is≤6;or>6 but≤12;or>12);a survival benefit with TACE can be expected for HCC patients with a score not exceeding twelve.Recently,Wang ZW et al showed that the“6&12”model was the best system correlated with radiological response after the first TACE.Thus,we wanted to assess its survival prediction ability as well as its prognostic value and compared it to other systems(Barcelona Clinic Liver Cancer,Hong Kong Liver Cancer(HKLC)staging,Albumin-Bilirubin grade,tumor nodularity,infiltrative nature of the tumor,alpha-fetoprotein,Child-Pugh class,and Performance Status score,Cancer of the Liver Italian Program,Model to Estimate Survival for HCC scores,up-to-seven criteria)different from Wang ZW et al study in a multicenter French cohort of HCC including only recommended TACE candidates retrospectively enrolled.As previously demonstrated,we show that the"6&12”score can classify survival within this French cohort,with a prognostic value comparable to that of other systems,except HKLC staging.More importantly,the“6&12”score simplicity and ability in patients’stratification outperform other systems for a routine clinical practice.展开更多
AIM:To investigate the diagnostic performance of acoustic radiation force impulse(ARFI) elastography for characterizing focal liver mass by quantifying their stiffness.METHODS:This prospective study included 62 patien...AIM:To investigate the diagnostic performance of acoustic radiation force impulse(ARFI) elastography for characterizing focal liver mass by quantifying their stiffness.METHODS:This prospective study included 62 patients with a focal liver mass that was well visualized on conventional ultrasonography performed in our institution from February 2011 to November 2011.Among them,12 patients were excluded for ARFI measurement failure due to a lesion that was smaller than the region of the interest and at an inaccessible location(deeper than 8 cm)(n = 7) or poor compliance to hold their breath as required(n = 5).Finally,50 patients with valid ARFI measurements were enrolled.If a patient had multiple liver masses,only one mass of interest was chosen.The masses were diagnosed by histological examination or clinical diagnostic criteria.During ultrasonographic evaluation,stiffness,expressed as velocity,was checked 10 times per focal liver mass and the surrounding liver parenchyma.RESULTS:After further excluding three masses that were non-diagnostic on biopsy,a total of 47 focal mass lesions were tested,including 39(83.0%) malignant masses [24 hepatocellular carcinomas(HCC),seven cholangiocellular carcinomas(CCC),and eight liver metastases] and eight(17.0%) benign masses(five hemangiomas and three focal nodular hyperplasias,FNH).Thirty-seven(74.0%) masses were confirmed by histological examination.The mean velocity was 2.48 m/s in HCCs,1.65 m/s in CCCs,2.35 m/s in metastases,1.83 m/s in hemangiomas,and 0.97 m/s in FNHs.Although considerable overlap was still noted between malignant and benign masses,significant differences in ARFI values were observed between malignant and benign masses(mean 2.31 m/s vs 1.51 m/s,P = 0.047),as well as between HCCs and benign masses(mean 2.48 m/s vs 1.51 m/s,P = 0.006).The areas under the receiver operating characteristics curves(AUROC) for discriminating the malignant masses from benign masses was 0.724(95%CI,0.566-0.883,P = 0.048),and the AUROC for discriminating HCCs from benign masses was 0.813(95%CI,0.649-0.976,P = 0.008).To maximize the sum of sensitivity and specificity,an ARFI value of 1.82 m/s was selected as the cutoff value to differentiate malignant from benign liver masses.Furthermore,the cutoff value for distinguishing HCCs from benign masses was also determined to be 1.82 m/s.The diagnostic performance of the sum of the ARFI values for focal liver masses and the surrounding liver parenchyma to differentiate liver masses improved(AUROC = 0.853;95%CI,0.745-0.960;P = 0.002 in malignant liver masses vs benign ones and AUROC = 0.948;95%CI,0.896-0.992,P < 0.001 in HCCs vs benign masses).CONCLUSION:ARFI elastography provides additional information for the differential diagnosis of liver masses.However,our results should be interpreted in clinical context,because considerable overlap in ARFI values existed among liver masses.展开更多
Nodular regenerative hyperplasia(NRH)is a rare liver condition characterized by a widespread benign transformation of the hepatic parenchyma into small regenerative nodules.NRH may lead to the development of non-cirrh...Nodular regenerative hyperplasia(NRH)is a rare liver condition characterized by a widespread benign transformation of the hepatic parenchyma into small regenerative nodules.NRH may lead to the development of non-cirrhotic portal hypertension.There are no published systematic population studies on NRH and our current knowledge is limited to case reports and case series.NRH may develop via autoimmune,hematological,infectious,neoplastic,or drug-related causes.The disease is usually asymptomatic,slowly or nonprogressive unless complications of portal hypertension develop.Accurate diagnosis is made by histopathology,which demonstrates diffuse micronodular transformation without fibrous septa.Lack of perinuclear collagen tissue distinguishes NRH from typical regenerative nodules in the cirrhotic liver.While the initial treatment is to address the underlying disease,ultimately the therapy is directed to the management of portal hypertension.The prognosis of NRH depends on both the severity of the underlying illness and the prevention of secondary complications of portal hypertension.In this review we detail the epidemiology,pathogenesis,diagnosis,management,and prognosis of NRH.展开更多
文摘We have previously reported that Helicobacter pylori(H.pylori)-associated nodular gastritis could occur in both the antrum and the cardia.Cardiac nodularity-like appearance(hereafter,called as cardiac nodularity)had a high predictive accuracy for the diagnosis of H.pylori infection.In the previous study,we included only the patients who were evaluated for H.pylori infection for therst time,and excluded patients with a history of eradication.Therefore,the prevalence and clinical features of cardiac nodularity remains unknown.AIM To perform this cross-sectional study to explore the characteristics of cardiac nodularity.METHODS Consecutive patients who underwent esophagogastroduodenoscopy betweenMay,2017 and August,2019 in the Toyoshima Endoscopy Clinic were enrolled in this study.We included H.pylori-negative,H.pylori-positive,and H.pylorieradicated patients,and excluded patients with unclear H.pylori status and eradication failure.H.pylori infection was diagnosed according to serum anti-H.pylori antibody and the urea breath test or histology.Cardiac nodularity was defined as a miliary nodular appearance or the presence of scattered whitish circular small colorations within 2 cm of the esophagogastric junction.Nodularity was visualized as whitish in the narrow-band imaging mode.We collected data on the patients’baseline characteristics.RESULTS A total of 1078 patients were finally included.Among H.pylori-negative patients,cardiac nodularity and antral nodularity were recognized in 0.14%each.Among H.pylori-positive patients,cardiac nodularity and antral nodularity were recognized in 54.5%and 29.5%,respectively.Among H.pylori-eradicated patients,cardiac nodularity and antral nodularity were recognized in 4.5%and 0.6%,respectively.The frequency of cardiac nodularity was significantly higher than that of antral nodularity in H.pylori-positive and-eradicated patients.The frequencies of cardiac nodularity and antral nodularity in H.pylori-eradicated patients were significantly lower than those in H.pylori-positive patients(P<0.001).The patients with cardiac nodularity were significantly younger than those without cardiac nodularity(P=0.0013).Intestinal metaplasia score of the patients with cardiac nodularity were significantly lower than those without cardiac nodularity(P=0.0216).Among H.pylori-eradicated patients,the patients with cardiac nodularity underwent eradication significantly more recently compared with those without cardiac nodularity(P<0.0001).CONCLUSION This report outlines the prevalence and clinical features of cardiac nodularity,and confirm its close association with active H.pylori infection.
基金Fundamental Research Funds for the Central Universities,China(Grant No.2013B18020459).
文摘Ferritic spheroidal graphite irons with nodularity from 72%to 96%were prepared.The relationship between the nodularity and the mechanical properties of the ferritic spheroidal graphite iron was investigated.The effect of nodularity on the mechanical properties and tensile fracture of the cast iron were studied.Results showed that the tensile strength Rm,yield strength Rp0.2,elongation to failure A5,and impact energy KV2 of the cast iron had a good linear relationship with its nodularity.Nodularity and annealing treatment would obviously affect the fracture characteristics of ferritic spheroidal graphite iron.The annealed ferritic spheroidal graphite iron with 93%nodularity showed a completely ductile rupture.With the decrease of nodularity from 93%to 72%,the cleavage fracture area ratio increased gradually from 0%to 8.3%.Compared with as-cast ferritic spheroidal graphite iron,annealing treatment reduced the cleavage fracture area of the ferritic spheroidal graphite iron.
文摘BACKGROUND Focal nodular hyperplasia(FNH)-like lesions are hyperplastic formations in patients with micronodular cirrhosis and a history of alcohol abuse.Although pathologically similar to hepatocellular carcinoma(HCC)lesions,they are benign.As such,it is important to develop methods to distinguish between FNH-like lesions and HCC.AIM To evaluate diagnostically differential radiological findings between FNH-like lesions and HCC.METHODS We studied pathologically confirmed FNH-like lesions in 13 patients with alco-holic cirrhosis[10 men and 3 women;mean age:54.5±12.5(33-72)years]who were negative for hepatitis-B surface antigen and hepatitis-C virus antibody and underwent dynamic computed tomography(CT)and magnetic resonance imaging(MRI),including superparamagnetic iron oxide(SPIO)and/or gadoxetic acid-enhanced MRI.Seven patients also underwent angiography-assisted CT.RESULTS The evaluated lesion features included arterial enhancement pattern,washout appearance(low density compared with that of surrounding liver parenchyma),signal intensity on T1-weighted image(T1WI)and T2-weighted image(T2WI),central scar presence,chemical shift on in-and out-of-phase images,and uptake pattern on gadoxetic acid-enhanced MRI hepatobiliary phase and SPIO-enhanced MRI.Eleven patients had multiple small lesions(<1.5 cm).Radiological features of FNH-like lesions included hypervascularity despite small lesions,lack of“corona-like”enhancement in the late phase on CT during hepatic angiography(CTHA),high-intensity on T1WI,slightly high-or iso-intensity on T2WI,no signal decrease in out-of-phase images,and complete SPIO uptake or incomplete/partial uptake of gadoxetic acid.Pathologically,similar to HCC,FNH-like lesions showed many unpaired arteries and sinusoidal capillarization.CONCLUSION Overall,the present study showed that FNH-like lesions have unique radiological findings useful for differential diagnosis.Specifically,SPIO-and/or gadoxetic acid-enhanced MRI and CTHA features might facilitate differential diagnosis of FNH-like lesions and HCC.
文摘BACKGROUND The diagnosis of gastric inflammatory fibroid polyps(IFPs)mainly depends on pathological confirmation after endoscopic or surgical treatment.Gastric IFP have typical manifestations under endoscopic ultrasonography(EUS),but atypical EUS features have also been reported.Previous studies have found that atypical features of gastric IFPs observed under EUS have corresponding histological manifestations.At present,there is no study elaborating the EUS manifestations of gastric IFPs at different pathological stages.We hypothesize that gastric IFPs at different pathological stages may have different EUS features.AIM To describe EUS features of gastric IFPs and compare with their pathological characteristics.METHODS Clinical data of 53 inpatients with pathologically diagnosed gastric IFPs after endoscopic treatment were collected.All patients underwent preoperative EUS.We analyzed the EUS characteristics of the lesions and compared with the pathological characteristics and staging of the resected specimens.RESULTS Most gastric IFPs showed medium-low echo(67.9%),homogeneous echo(90.6%),and unclear boundaries(83%),and involved the second and third layers of the gastric wall(69.8%)under EUS.The echogenicity level and echo homogeneity were significantly correlated with the pathological stage of gastric IFP.Gastric IFPs in the nodular stage presented hypoechoic and homogeneous echo.Gastric IFPs in the fibrovascular stage mostly showed medium-low echo and homogeneous echo.Gastric IFPs in the sclerotic stage showed different echogenicity levels and echo homogeneity.The accuracy of EUS in diagnosing gastric IFPs was 66.0%(35/53),and the accuracy in determining the origin layer of gastric IFPs was 73.4%(39/53).CONCLUSION Gastric IFPs at different pathological stages have different EUS features.In order to improve the diagnostic rate,it is necessary to combine EUS with EUS-guided fine-needle aspiration or artificial intelligence.
基金supported by the Science and Technology Project of Hebei Education Department(Grant No.BJK2023075)the Science and Technology Project of Tianjin Education Department(Grant No.2022K1087)the Chunhui Project Foundation of the Education Department of China(Grant No.HZKY20220264).
文摘This study systematically investigated the effects of graphite nodule parameters,including count,average diameter,and nodularity,on microstructure and mechanical properties of austempered ductile irons(ADIs).The ADI specimens with graphite nodule counts of 212±11 mm^(-2),308±9 mm^(-2),415±10 mm^(-2),and 589±13 mm^(-2) were designated as G-200,G-300,G-400,and G-600,respectively.Results indicate a progressive refinement of graphite with an increase in nodule counts.Specifically,the average nodule diameter decreases from 33.3±1.3μm for G-200 to 17.0±0.7μm for G-600.The nodularity of all samples is above 90%.Furthermore,the nodularity exhibits a corresponding increasing trend with the rise of graphite nodule count in ADIs.Additionally,the volume fraction of the austenite phase in ADIs decreases with an increase in graphite nodule count.The graphite nodule count changes the tensile strength and elongation of ADIs.The specimen G-400 exhibits the ultimate tensile strength of 897±11 MPa and an elongation of 9.8%±0.6%,representing 5.3%and 44.1%improvements respectively compared to G-200.To explore the wear resistance of ADIs with different graphite nodule counts,dry sliding friction and wear test of different samples was carried out at room temperature.At a high load of 25 N,G-400 exhibits superior wear resistance,achieving a 42%reduction in worn volume compared to G-200.Worn micromorphology identifies three primary wear mechanisms:microcutting-dominated abrasive wear,adhesive wear,and fatigue wear.
基金Supported by Division of Intramural Research Program at National Institute of Diabetes and Digestive and Kidney Diseases,No.1ZIADK075008。
文摘BACKGROUND Cardiopulmonary changes in noncirrhotic portal hypertension(NCPH)are poorly understood.AIM To investigate cardiopulmonary changes using transthoracic echocardiography(TTE)in NCPH and their correlation with clinical features.METHODS Prospective cohort including 10 preclinical NCPH[without portal hypertension(PH)]and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed.PH was defined by presence of either varices,ascites or portosystemic shunting.Intrapulmonary vascular dilatation(IPVD)is defined as appearance of microbubbles in the left atrium after three heartbeats.Right ventricular systolic pressure(RVSP)>38 mmHg was used to identify possible porto-pulmonary hypertension.Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.RESULTS Among 42 subjects,17(40%)had IPVD,4(9.5%)had RVSP>38 mmHg,and 6(14%)had cardiomyopathy.Aspartate aminotransferase to alanine aminotransferase(AST/ALT)(1.3 vs 1,P=0.04)and liver stiffness measurement(LSM)(12.4 kPa vs 7.1 kPa,P=0.03)were higher in those with IPVD.Presence of either LSM>10 or AST/ALT>1.2 aided in identifying subjects with IPVD-sensitivity,specificity,and accuracy of 76%.RVSP correlated with oxygen saturation(r=-0.33),and free right hepatic vein pressure(r=0.43).Those with PH had higher left atrial volume(LAV)(62 mL vs 48 mL,P<0.01),and LAV index(LAVI)(35 m^(2) vs 23 m^(2),P<0.01)compared to those without PH.Total bile acids,especially primary bile acids positively correlated with LAV(r=0.36),and LAVI(r=0.41).CONCLUSION Similar to cirrhotic patients,cardiopulmonary changes are prevalent in NCPH,especially among those with PH.In NCPH,cardiopulmonary changes occur despite preserved synthetic function,suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.
基金supported by grants from the National Natural Science Foundation of China (82150 0 04)the National Municipal Key Clinical Specialtythe Clinical Research Project for Major Diseases in Municipal Hospitals (SHDC2020CR1022B)。
文摘Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.
基金the support from the International Science and Technology Cooperation Program of Shaanxi Province(No.2023-GHZD-50)the Projects of Major Innovation Platforms for Scientific and Technological and Local Transformation of Scientific and Technological Achievements of Xi’an(No.20GXSF0003)+1 种基金the Projects of Major Scientific and Technological Achievements Local Transformation of Xi’an(No.2022JH-ZDZH-0039)the Higher Education Institution Discipline Innovation and Intelligence Base of Shaanxi Provincial(No.S2021-ZC-GXYZ-0011)。
文摘It is important to improve the comprehensive performance of the ductile iron bars(DIBs)for the cylinder block of the extra high pressure hydraulic plunger pump and accelerate the industrial application.In this work,the LZQT600-3 DIBs with the diameter of 145 mm were prepared by the horizontal continuous casting(HCC)process,that is,LZQT600-3 HCCDIBs.The microstructure and room temperature tensile properties of different sections[left-edge(surface layer),left-1/2R(left half of the radius),and the center of the HCCDIBs]were studied.The results show that the spheroidization of LZQT600-3 HCCDIBs matrix from the left-edge,left-1/2R to the center is at nodulizing grade II and above.As the cooling rate gradually decreases from surface to the center of the HCCIBs,the number of spheroidized graphite is gradually reduced,the size is gradually increased,the shape factor is decreased,and the pearlite content and lamellate spacing are increased.Along the horizontal direction of the section,the hardness of the material is distributed symmetrically around the center of the HCCDIBs.In the vertical direction,the hardness distribution in the center of the HCCDIBs is asymmetrical due to the gravity during the solidification process.Therefore,the microstructure in the lower part of the section solidifies relatively quickly.The left-edge has the best tensile mechanical properties,and the ultimate tensile strength,yield tensile strength and elongation are 597.3 MPa,418.5 MPa and 9.6%,respectively.The tensile fracture belongs to the ductile-brittle hybrid fracture.The comprehensive performances of LZQT600-3 HCCDIBs meet the actual application requirements of ultra-high pressure hydraulic plunger pump cylinder.
文摘In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.
文摘Amyloidosis is a rare spectrum of disease which involves deposition of misfolded extracellular proteins (amyloids) in various body organs leading to progressive organ dysfunction. Clinical presentation can be variable depending on the organ involved and type of protein. Amyloidosis can be classified based on quantity, type, and location of these proteins. Amyloid light-chain amyloidosis develops in the bone marrow, producing abnormal forms of light-chain proteins, which cannot be broken down. These proteins transform into amyloid fibrils and form amyloid deposits in different organs. Pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis;however, it may present as localised pulmonary disease. Localized pulmonary Amyloidosis can present as nodular, cystic, or tracheobronchial amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. This is a case of a 47-year-old female with background history of interstitial lung disease presenting with progressive shortness of breath. Computed tomography scan revealed bilateral pulmonary nodules. The patient was referred to our thoracic surgery team with the suspicion of bronchogenic malignancy with metastasis. Diagnostic video assisted wedge resection was performed for this patient, and histology confirmed pulmonary amyloidosis of nodular type. Amyloid deposition simulates both inflammatory and neoplastic conditions. Definitive diagnosis requires biopsy confirmation therefore early detection and commencing the patient on appropriate treatment pathway may help in symptomatic relief and better outcome.
文摘Recent advances in endoscopic technology allow detailed observation of the gastric mucosa.Today,endoscopy is used in the diagnosis of gastritis to determine the presence/absence of Helicobacter pylori(H.pylori)infection and evaluate gastric cancer risk.In 2013,the Japan Gastroenterological Endoscopy Society advocated the Kyoto classification,a new grading system for endoscopic gastritis.The Kyoto classification organized endoscopic findings related to H.pylori infection.The Kyoto classification score is the sum of scores for five endoscopic findings(atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness with or without regular arrangement of collecting venules)and ranges from 0 to 8.Atrophy,intestinal metaplasia,enlarged folds,and nodularity contribute to gastric cancer risk.Diffuse redness and regular arrangement of collecting venules are related to H.pylori infection status.In subjects without a history of H.pylori eradication,the infection rates in those with Kyoto scores of 0,1,and≥2 were 1.5%,45%,and 82%,respectively.A Kyoto classification score of 0 indicates no H.pylori infection.A Kyoto classification score of 2 or more indicates H.pylori infection.Kyoto classification scores of patients with and without gastric cancer were 4.8 and 3.8,respectively.A Kyoto classification score of 4 or more might indicate gastric cancer risk.
文摘Collagenous gastritis is a rare disease characterized by the subepithelial deposition of collagen bands thicker than 10 μm and the infiltration of inflammatory mononuclear cells in the lamina propria. Collagenous colitis and collagenous sprue have similar histological characteristics to collagenous gastritis and are thought to be part of the same disease entity. However, while collagenous colitis has become more common in the field of gastroenterology, presenting with clinical symptoms of chronic diarrhea in older patients,collagenous gastritis is rare. Since the disease was first reported in 1989, only 60 cases have been documented in the English literature. No safe and effective treatments have been identified from randomized, controlled trials. Therefore, better understanding of the disease and the reporting of more cases will help to establish diagnostic criteria and to develop therapeutic strategies. Therefore, here we review the clinical characteristics, endoscopic and histological findings, treatment, and clinical outcomes from case reports and case series published to date, and provide a summary of the latest information on the disease. This information will contribute to improved knowledge of collagenous gastritis so physicians can recognize and correctly diagnose the disease, and will help to develop a standard therapeutic strategy for future clinical trials.
基金the Board of Research in Nuclear Science (Project Grant No. 2011/36/18-BRNS), India for carrying out this investigation
文摘Ductile iron （DI） is a preferred material for use in various structural, automotive, and engineering fields because of its excellent combination of strength, toughness, and ductility. In the current investigation, we elucidate the relationship between the morphological and mechanical properties of DI intended for use in safety applications in the nuclear industry. DI specimens with various alloying elements were subjected to annealing and austempering heat treatment processes. A faster cooling rate appeared to increase the nodule count in austempered specimens, compensating for their nodularity value and subsequently decreasing their ductility and impact strength. The ductility and impact energy values of annealed specimens increased with increasing ferrite area fraction and nodularity, whereas an increase in the amounts of Ni and Cr resulted in an increase of hardness via solid solution strengthening. Austempered specimens were observed to be stronger than an- nealed specimens and failed in a somewhat brittle manner characterized by a river pattern, whereas the ductile failure mode was character- ized by the presence of dimples.
文摘The demands for improved engine performance,fuel economy,durability,and lower emissions provide a continual challenge for engine designers.The use of Compacted Graphite Iron(CGI)has been established for successful high volume series production in the passenger vehicle,commercial vehicle and industrial power sectors over the last decade.The increased demand for CGI engine components provides new opportunities for the cast iron foundry industry to establish efficient and robust CGI volume production processes,in China and globally.The production window range for stable CGI is narrow and constantly moving.Therefore,any one step single addition of magnesium alloy and the inoculant cannot ensure a reliable and consistent production process for complicated CGI engine castings.The present paper introduces the SinterCast thermal analysis process control system that provides for the consistent production of CGI with low nodularity and reduced porosity,without risking the formation of flake graphite.The technology is currently being used in high volume Chinese foundry production.The Chinese foundry industry can develop complicated high demand CGI engine castings with the proper process control technology.
文摘EN-GJS-450-10 ductile cast iron was produced with and without vibration to evaluate microstructural features. To investigate the effect of vibration, a reference, and two different castings having amplitudes of 0.9 mm and 1.8 mm were cast with a fixed vibration frequency of 50 Hz. The nodule count (density), form (type), size distribution, nodularity, and the fraction of graphite, percentages of both ferrite and pearlite phases, length of ferrite shell, and pore, were evaluated via optical microscopy using an image analysis software. It is observed that the microstructure of the cast iron is more uniform by vibrational casting than that by non-vibrational casting. Additionally, mechanical vibration enhances nodule count and nodularity, also, more ferritic matrix could be obtained after the application of vibration. Nodule count and nodularity of vibrational casting with 1.8 mm amplitude increased from 226 nodule per mm2 and 80% to 311 nodule per mm2 and 86.5% of non-vibrational casting. Percentages of ferrite and graphite area dramatically improved from 24% and 16.5% for non-vibrational casting to 57% and 22.3% for vibrational casting with 1.8 mm amplitude, whereas the percentages of pearlite and pores decreased significantly from 56.1% and 5% to 20% and 1%, respectively.
文摘The“six-and-twelve”(6&12)score is a new hepatocellular carcinoma(HCC)prognostic index designed for recommended transarterial chemoembolization(TACE)candidates.Quick and easy to use by the sum of tumor size(cm)and number,this model identifies three groups with different survival time(the sum is≤6;or>6 but≤12;or>12);a survival benefit with TACE can be expected for HCC patients with a score not exceeding twelve.Recently,Wang ZW et al showed that the“6&12”model was the best system correlated with radiological response after the first TACE.Thus,we wanted to assess its survival prediction ability as well as its prognostic value and compared it to other systems(Barcelona Clinic Liver Cancer,Hong Kong Liver Cancer(HKLC)staging,Albumin-Bilirubin grade,tumor nodularity,infiltrative nature of the tumor,alpha-fetoprotein,Child-Pugh class,and Performance Status score,Cancer of the Liver Italian Program,Model to Estimate Survival for HCC scores,up-to-seven criteria)different from Wang ZW et al study in a multicenter French cohort of HCC including only recommended TACE candidates retrospectively enrolled.As previously demonstrated,we show that the"6&12”score can classify survival within this French cohort,with a prognostic value comparable to that of other systems,except HKLC staging.More importantly,the“6&12”score simplicity and ability in patients’stratification outperform other systems for a routine clinical practice.
基金Supported by A Grant of the Korea Healthcare Technology R and D Project,Ministry of Health and Welfare,South Korea, A102065
文摘AIM:To investigate the diagnostic performance of acoustic radiation force impulse(ARFI) elastography for characterizing focal liver mass by quantifying their stiffness.METHODS:This prospective study included 62 patients with a focal liver mass that was well visualized on conventional ultrasonography performed in our institution from February 2011 to November 2011.Among them,12 patients were excluded for ARFI measurement failure due to a lesion that was smaller than the region of the interest and at an inaccessible location(deeper than 8 cm)(n = 7) or poor compliance to hold their breath as required(n = 5).Finally,50 patients with valid ARFI measurements were enrolled.If a patient had multiple liver masses,only one mass of interest was chosen.The masses were diagnosed by histological examination or clinical diagnostic criteria.During ultrasonographic evaluation,stiffness,expressed as velocity,was checked 10 times per focal liver mass and the surrounding liver parenchyma.RESULTS:After further excluding three masses that were non-diagnostic on biopsy,a total of 47 focal mass lesions were tested,including 39(83.0%) malignant masses [24 hepatocellular carcinomas(HCC),seven cholangiocellular carcinomas(CCC),and eight liver metastases] and eight(17.0%) benign masses(five hemangiomas and three focal nodular hyperplasias,FNH).Thirty-seven(74.0%) masses were confirmed by histological examination.The mean velocity was 2.48 m/s in HCCs,1.65 m/s in CCCs,2.35 m/s in metastases,1.83 m/s in hemangiomas,and 0.97 m/s in FNHs.Although considerable overlap was still noted between malignant and benign masses,significant differences in ARFI values were observed between malignant and benign masses(mean 2.31 m/s vs 1.51 m/s,P = 0.047),as well as between HCCs and benign masses(mean 2.48 m/s vs 1.51 m/s,P = 0.006).The areas under the receiver operating characteristics curves(AUROC) for discriminating the malignant masses from benign masses was 0.724(95%CI,0.566-0.883,P = 0.048),and the AUROC for discriminating HCCs from benign masses was 0.813(95%CI,0.649-0.976,P = 0.008).To maximize the sum of sensitivity and specificity,an ARFI value of 1.82 m/s was selected as the cutoff value to differentiate malignant from benign liver masses.Furthermore,the cutoff value for distinguishing HCCs from benign masses was also determined to be 1.82 m/s.The diagnostic performance of the sum of the ARFI values for focal liver masses and the surrounding liver parenchyma to differentiate liver masses improved(AUROC = 0.853;95%CI,0.745-0.960;P = 0.002 in malignant liver masses vs benign ones and AUROC = 0.948;95%CI,0.896-0.992,P < 0.001 in HCCs vs benign masses).CONCLUSION:ARFI elastography provides additional information for the differential diagnosis of liver masses.However,our results should be interpreted in clinical context,because considerable overlap in ARFI values existed among liver masses.
文摘Nodular regenerative hyperplasia(NRH)is a rare liver condition characterized by a widespread benign transformation of the hepatic parenchyma into small regenerative nodules.NRH may lead to the development of non-cirrhotic portal hypertension.There are no published systematic population studies on NRH and our current knowledge is limited to case reports and case series.NRH may develop via autoimmune,hematological,infectious,neoplastic,or drug-related causes.The disease is usually asymptomatic,slowly or nonprogressive unless complications of portal hypertension develop.Accurate diagnosis is made by histopathology,which demonstrates diffuse micronodular transformation without fibrous septa.Lack of perinuclear collagen tissue distinguishes NRH from typical regenerative nodules in the cirrhotic liver.While the initial treatment is to address the underlying disease,ultimately the therapy is directed to the management of portal hypertension.The prognosis of NRH depends on both the severity of the underlying illness and the prevention of secondary complications of portal hypertension.In this review we detail the epidemiology,pathogenesis,diagnosis,management,and prognosis of NRH.
