Introduction: CT alone cannot provide sufficient information referring to response after neoadjuvant therapy in a timely manner. To evaluate the role of 18F-FDG-PET after neoadjuvant chemoradiation as a valid, non-inv...Introduction: CT alone cannot provide sufficient information referring to response after neoadjuvant therapy in a timely manner. To evaluate the role of 18F-FDG-PET after neoadjuvant chemoradiation as a valid, non-invasive predictor for early therapy response and its effect on survival as compared to histopathologic tumor response, data of 32 of 210 randomized patients with NSCLC stage IIIA/IIIB, who were treated in a?prospective randomized controlled multicenter trial (LUCAS- MD), were re-evaluated. Material and Methods: For 32 patients with NSCLC stage IIIA (44%) IIIB (56%) neoadjuvant treatment consisted of two to three cycles of chemotherapy (225 mg/m2 paclitaxel and carboplatin AUC 6 d1q22) and concomitant chemoradiation (50 mg/m2 paclitaxel and carboplatin AUC 2 d1, d8, d15;1.5 Gy b.i.d. up to 45 Gy). Documentation of involved lymph node stations as detected by 18F-FDG-PET/CT and lymph node sampling during surgery according to the IASLC lymph node mapping (2009). Evaluation of histological regression grade (RG) according to Junker et al. (2001) and correlation with?18F-FDG-PET/CT for primary tumor and each lymph node station. Calculation of disease free survival using Kaplan-Meier estimates and log rank tests. Results: Actuarial tumor specific survival for the 32 patients with concomitant chemoradiation plus?chemotherapy: complete vs. incomplete metabolic remission prior to surgery after 60 months:?40% vs. 24% (p?= 0.018). RG III/IIb (no/less than 10% of vital tumor cells) vs. RG IIa/I (more than 10% vital tumor cells) after 60 months: 46% vs. 15% (p?= 0.006). 18/32 (56%) patients had RG III/IIb, 8/32 (25%) patients had regression grade III. 1/8 pts. with RG III were in the 18F-FDG- PET/CT false positive, 10 pts. with RG IIb (i.e. all pts. with RG IIb) were in the 18F-FDG-PET/CT false negative. One patient with RG IIa was in the 18F-FDG-PET/CT false negative. Hence, the cut-off level in detecting vital tumor cells by 18F-FDG-PET/CT after neoadjuvant chemoradiation for NSCLC is about 10%. Conclusion: Histological regression grading correlates well with metabolic remission as detected by 18F-FDG-PET. Thus, 18F-FDG-PET precedes CT in measuring the tumor response and may predict long-term therapeutic outcome in patients with stage III NSCLC. Invasive staging procedures may be avoided and patients who will not profit from resection due to insufficient downstaging after neoadjuvant treatment will be easily detected by using 18F-FDG-PET as standard imaging in workup and evaluation of treatment response.展开更多
BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from mode...BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies(serum,urine)represent a promising innovation in the monitoring of kidney transplant recipients.AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment.METHODS A systematic review was conducted in accordance with PRISMA guidelines,based on research results from the PubMed and Scopus databases.The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related com-plications.Eligibility criteria included protein biomarkers and urine and blood samples,while exclusion criteria were language other than English and the use of low resolution and sensitivity methods.The selected research articles,were categorized based on the biological sample,condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted.Functional and network analysis of the selected proteins was performed.RESULTS In 17 included studies,58 proteins were studied,with the cytokine CXCL10 being the most investigated.Biological pathways related to immune response and fibrosis have shown to be enriched.Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported.Overall,all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods,as far as renal graft assessment is concerned.CONCLUSION Our review suggests that protein biomarkers,evaluated in specific biological fluids,can make a significant contribution to the timely,valid and non-invasive assessment of kidney graft.展开更多
Gastric cancer(GC),a multifaceted and highly aggressive malignancy,represents challenging healthcare burdens globally,with a high incidence and mortality rate.Although endoscopy,combined with histological examination,...Gastric cancer(GC),a multifaceted and highly aggressive malignancy,represents challenging healthcare burdens globally,with a high incidence and mortality rate.Although endoscopy,combined with histological examination,is the gold stan-dard for GC diagnosis,its high cost,invasiveness,and specialized requirements hinder widespread use for screening.With the emergence of innovative techno-logies such as advanced imaging,liquid biopsy,and breath tests,the landscape of GC diagnosis is poised for radical transformation,becoming more accessible,less invasive,and more efficient.As the non-invasive diagnostic techniques continue to advance and undergo rigorous clinical validation,they hold the promise of sig-nificantly impacting patient outcomes,ultimately leading to better treatment results and improved quality of life for patients with GC.展开更多
Chronic kidney disease(CKD)is a degenerative disorder that affects millions of people throughout the world,causing considerable morbidity and healthcare burden.Frequent blood sampling is the current gold standard for ...Chronic kidney disease(CKD)is a degenerative disorder that affects millions of people throughout the world,causing considerable morbidity and healthcare burden.Frequent blood sampling is the current gold standard for monitoring CKD to evaluate biochemical and mineral indicators.However,there are draw-backs to frequent blood draws,such as pain for patients,the possibility of infe-ction,and higher medical expenses.Saliva-based diagnostics offer advantages such as ease of collection,reduced invasiveness,and improved patient compli-ance.A comprehensive literature review was conducted to analyze studies eva-luating the diagnostic utility of salivary creatinine,urea,calcium,and parathyroid hormone(PTH)in patients with CKD.Various saliva collection methods,inc-luding stimulated and unstimulated approaches,were investigated for efficiency and reliability,and a correlation was shown between serum and salivary crea-tinine,urea,PTH,and calcium levels,indicating their potential as CKD biomar-kers.Despite these promising findings,challenges such as standardization of collection methods,variability in salivary flow rates,and predictive value in association with blood parameters are addressed to ensure clinical applicability.This review explores the potential and challenges of saliva as a non-invasive alternative for CKD diagnostics.展开更多
Flip-flow screens offer unique advantages in grading fine-grained materials.To address inaccuracies caused by sensor vibra-tions in traditional contact measurement methods,we constructed a non-invasive measurement sys...Flip-flow screens offer unique advantages in grading fine-grained materials.To address inaccuracies caused by sensor vibra-tions in traditional contact measurement methods,we constructed a non-invasive measurement system based on electrical and optical sig-nals.A trajectory tracking algorithm for the screen-body was developed to visually measure the kinematics.Employing the principle oflaser reflection for distance measurement,optical techniques were performed to capture the kinematic information of the screen-plate.Ad-ditionally,by using Wi-Fi and Bluetooth transmission of electrical signals,tracer particle tracking technology was implemented to elec-trically measure the kinematic information of mineral particles.Consequently,intelligent fusion and perception of the kinematic informa-tion for the screen-body,screen-plate,and particles in the screening system have been achieved.展开更多
Hyaline Membrane Disease(HMD)in newborns,also known as neonatal respiratory distress syndrome,is a common critical illness in premature infants,with an incidence inversely correlated with gestational age,posing a seri...Hyaline Membrane Disease(HMD)in newborns,also known as neonatal respiratory distress syndrome,is a common critical illness in premature infants,with an incidence inversely correlated with gestational age,posing a serious threat to the life and health of newborns.This paper systematically reviews the core pathogenesis of HMD,focusing on the abnormal metabolism of pulmonary surfactant(PS),genetic factors,immature lung development,and the synergistic effects of inflammatory oxidative stress.It highlights the advances in non-invasive ventilation(NIV)therapy for HMD,including the mechanisms of action,clinical application effects,and optimization strategies of mainstream modalities such as nasal continuous positive airway pressure ventilation(NCPAP),nasal intermittent positive pressure ventilation(NIPPV),and heated humidified high-flow nasal cannula ventilation(HHHFNC).The aim is to provide references for standardized clinical treatment.展开更多
Metabolic dysfunction-associated steatotic liver disease(MASLD)requires accurate liver fibrosis assessment for management.While liver biopsy remains the gold standard,its invasiveness drives demand for non-invasive bi...Metabolic dysfunction-associated steatotic liver disease(MASLD)requires accurate liver fibrosis assessment for management.While liver biopsy remains the gold standard,its invasiveness drives demand for non-invasive biomarkers.This review evaluates blood biomarkers for MASLD fibrosis staging.Established scores(fibrosis-4,non-alcoholic fatty liver disease fibrosis score)offer accessible screening but exhibit variable performance influenced by age,obesity,and comorbidities.Patented panels(e.g.,enhanced liver fibrosis test,FibroMeter)improve accuracy by integrating extracellular matrix or metabolic markers,though context-specific thresholds are essential.Emerging biomarkers like propeptide of type 3 collagen,Mac-2 binding protein glycosylation isomer,epigenetic markers(proliferator-activated receptor-γmethylation),and angiopoietin-like proteins a family of eight glycoproteins show promise but require large-scale validation.Genetic risk scores and multi-omics approaches face generalizability challenges.Integration strategies,such as combining serum biomarkers with liver stiffness measurement via Agile scores,enhance diagnostic precision and reduce indeterminate classifications.Current tools aid risk stratification,but no single biomarker replicates biopsy-level precision.Future efforts must prioritize MASLD-specific diagnostic frameworks,standardized protocols,and multi-modal integration to enhance clinical utility and address MASLD’s growing burden.展开更多
BACKGROUND Internet gaming disorder(IGD)is a growing concern among adolescents and adults,necessitating effective treatment strategies beyond pharmacological interventions.AIM To evaluated the effectiveness of non-inv...BACKGROUND Internet gaming disorder(IGD)is a growing concern among adolescents and adults,necessitating effective treatment strategies beyond pharmacological interventions.AIM To evaluated the effectiveness of non-invasive interventions for treating IGD among adolescents and adults.METHODS A total of 11 randomized controlled trials published between 2020 and 2025 were included in this meta-analysis,encompassing 1208 participants from diverse geographic and cultural contexts.The interventions examined included cognitive behavioral therapy(CBT),internet-based CBT,neurofeedback,virtual reality therapy,abstinence-based programs,and school-based prevention.The primary outcomes assessed were reductions in gaming time and IGD severity.Secondary outcomes included improvements in mood,anxiety,and psychosocial functioning(e.g.,stronger peer relationships,better academic or work performance,and healthier daily-life role fulfillment).RESULTS The pooled standardized mean difference for IGD symptom reduction significantly favored non-invasive interventions(Hedges’g=0.56,95%CI:0.38-0.74,P<0.001),with moderate heterogeneity observed(I2=47%).Subgroup analyses indicated that CBT-based programs,both in-person and online,yielded the strongest effects,particularly when caregiver involvement or self-monitoring was incorporated.Funnel plot asymmetry was minimal,suggesting a low risk of publication bias.CONCLUSION These findings support the efficacy of scalable,low-risk non-invasive interventions as first-line treatment options for IGD,particularly in youth populations.Future studies should prioritize investigating long-term outcomes,comparing the effectiveness of different non-invasive modalities,and developing culturally adaptive delivery methods.展开更多
In this article,we comment on the article by Peta et al.This study evaluates the diagnostic performance of FibroTest-Actitest,transient elastography,and the fibrosis-4 index against a histological reference.Using the ...In this article,we comment on the article by Peta et al.This study evaluates the diagnostic performance of FibroTest-Actitest,transient elastography,and the fibrosis-4 index against a histological reference.Using the Obuchowski measure,the authors demonstrate that FibroTest and vibration-controlled transient elastography outperform the fibrosis-4 index in detecting fibrosis.Additionally,Actitest offers superior estimation of inflammatory activity compared to conventional biomarkers.Assessing liver fibrosis is crucial for managing autoimmune hepatitis(AIH),yet reliance on invasive liver biopsy remains higher than in other liver diseases.This is partly due to more complex diagnostic criteria for AIH,the lack of standardized scoring for non-invasive testing,and the presence of inflammation,which can lead to falsely elevated results with non-invasive tests.A Bayesian latent class model further supports the reliability of these non-invasive tests,highlighting their potential to complement biopsy,particularly for longterm disease monitoring.These findings underscore the importance of noninvasive diagnostics in optimizing AIH management.展开更多
Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive...Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.展开更多
BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifyi...BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.展开更多
The evaluation and follow up of liver fibrosis and cirrhosis have been traditionally performed by liver biopsy. However, during the last 20 years, it has become evident that this "gold-standard" is imperfect...The evaluation and follow up of liver fibrosis and cirrhosis have been traditionally performed by liver biopsy. However, during the last 20 years, it has become evident that this "gold-standard" is imperfect; even according to its proponents, it is only "the best" among available methods. Attempts at uncovering non-invasive diagnostic tools have yielded multiple scores, formulae, and imaging modalities. All are better tolerated, safer, more acceptable to the patient, and can be repeated essentially as often as required. Most are much less expensive than liver biopsy. Consequently, their use is growing, and in some countries the number of biopsies performed, at least for routine evaluation of hepatitis B and C, has declined sharply. However, the accuracy and diagnostic value of most, if not all, of these methods remains controversial. In this review for the practicing physician, we analyze established and novel biomarkers and physical techniques. We may be witnessing in recent years the beginning of the end of the first phase for the development of non-invasive markers. Early evidence suggests that they might be at least as good as liver biopsy. Novel experimental markers and imaging techniques could produce a dramatic change in diagnosis in the near future.展开更多
Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction p...Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction patients with left ventricular failure. Methods: A number of 96 acute myocardial infarction patients accompanied with heart failure after PCI hospitalized in the People's Hospital of Sanya during February 2012 to October 2015 were selected. They were randomly divided into the therapy group(n = 50) and control group(n = 46). On the basis of routine treatment, patients in the therapy group were treated with intravenous rh BNP(1.5 μg/kg was intravenous injection with uniform speed of 3 min, followed by continuous infusion 0.007 5 μg/kg·min for 72 h), while the control group received conventional treatment. Bio Z-2011 non-invasive hemodynamic real-time monitoring system was used to monitor the hemodynamic parameters changes and the leves of plasma pro-BNP, serum creatinine, serum potassium, serum sodium and urine volume of each group before and after treating for 30 min, 1 h, 3 h, 6 h, 12 h, 24 h, 48 h, 72 h. Results: Patients in the therapy group showed no effect on heart rate, while after 30 min of intravenous injection of rh BNP, CO, CI, SV, and SI increased significantly and LVET and TFC reduced at the same time, which had certain effect on blood pressure(SBP/DBP). Compared with the control group, the therapy group showed a faster and more effective improvement on haemodynamics. Conclusions: Acute myocardial infarction patients complicated with left heart failure after primary PCI can significantly improve hemodynamics by treating with rh BNP.展开更多
Liver fibrosis is an important pathological precondition for hepatocellular carcinoma.The degree of hepatic fibrosis is positively correlated with liver cancer.Liver fibrosis is a series of pathological and physiologi...Liver fibrosis is an important pathological precondition for hepatocellular carcinoma.The degree of hepatic fibrosis is positively correlated with liver cancer.Liver fibrosis is a series of pathological and physiological process related to liver cell necrosis and degeneration after chronic liver injury,which finally leads to extracellular matrix and collagen deposition.The early detection and precise staging of fibrosis and cirrhosis are very important for early diagnosis and timely initiation of appropriate therapeutic regimens.The risk of severe liver fibrosis finally progressing to liver carcinoma is＆gt;50%.It is known that biopsy is the gold standard for the diagnosis and staging of liver fibrosis.However,this method has some limitations,such as the potential for pain,sampling variability,and low patient acceptance.Furthermore,the necessity of obtaining a tissue diagnosis of liver fibrosis still remains controversial.An increasing number of reliable non-invasive approaches are now available that are widely applied in clinical practice,mostly in cases of viral hepatitis,resulting in a significantly decreased need for liver biopsy.In fact,the noninvasive detection and evaluation of liver cirrhosis now has good accuracy due to current serum markers,ultrasound imaging,and magnetic resonance imaging quantification techniques.A prominent advantage of the non-invasive detection and assessment of liver fibrosis is that liver fibrosis can be monitored repeatedly and easily in the same patient.Serum biomarkers have the advantages of high applicability（〉95%）and good reproducibility.However,their results can be influenced by different patient conditions because none of these markers are liver-specific.The most promising techniques appear to be transient elastography and magnetic resonance elastography because they provide reliable results for the detection of fibrosis in the advanced stages,and future developments promise to increase the reliability and accuracy of the staging of hepatic fibrosis.This article aims to describe the recent progress in the development of non-invasive assessment methods for the staging of liver fibrosis,with a special emphasize on computer-aided quantitative and deep learning methods.展开更多
Tinnitus is defined as a perception of sound without any external sound source.Chronic tinnitus is a frequent condition that can affect the quality of life.So far,no causal cure for tinnitus has been documented,and mo...Tinnitus is defined as a perception of sound without any external sound source.Chronic tinnitus is a frequent condition that can affect the quality of life.So far,no causal cure for tinnitus has been documented,and most pharmacologic and psychosomatic treatment modalities aim to diminish tinnitus’impact on the quality of life.Neuromodulation,a novel therapeutic modality,which aims at alternating nerve activity through a targeted delivery of a stimulus,has emerged as a potential option in tinnitus treatment.This review provides a brief overview of the current neuromodulation techniques as tinnitus treatment options.The main intention is to provide updated knowledge especially for medical professionals counselling tinnitus patients in this emerging field of medicine.Non-invasive methods such as repetitive transcranial magnetic stimulation,transcranial electrical stimulation,neurofeedback,and transcutaneous vagus nerve stimulation were included,as well as invasive methods such as implanted vagus nerve stimulation and invasive brain stimulation.Some of these neuromodulation techniques revealed promising results;nevertheless,further research is needed,especially regarding the pathophysiological principle as to how these neuromodulation techniques work and what neuronal change they induce.Various studies suggest that individually different brain states and networks are involved in the generation and perception of tinnitus.Therefore,in the future,individually tailored neuromodulation strategies could be a promising approach in tinnitus treatment for achieving a more substantial and longer lasting improvement of complaints.展开更多
AIM： To assess the performance of several noninvasive markers and of our recently proposed stepwise combination algorithms to diagnose significant fibrosis （F ≥ 2 by METAVIR） and cirrhosis （F4 by METAVIR） in chr...AIM： To assess the performance of several noninvasive markers and of our recently proposed stepwise combination algorithms to diagnose significant fibrosis （F ≥ 2 by METAVIR） and cirrhosis （F4 by METAVIR） in chronic hepatitis B （CHB）.METHODS： One hundred and ten consecutive patients （80 males, 30 females, mean age： 42.6 ± 11.3） with CHB undergoing diagnostic liver biopsy were included. AST-to-Platelet ratio （APRI）, Forns＇ index, AST-to-ALT Ratio, Goteborg University Cirrhosis Index （GUCD, Hui＇s model and Fibrotest were measured on the day of liver biopsy. The performance of these methods and of sequential algorithms combining Fibrotest, APRI and biopsy was defined by positive （PPV） and negative （NPV） predictive values, accuracy and area under the curve （AUC）. RESULTS： PPV for significant fibrosis was excellent （100%） with Forns and high （〉 92%） with APR1, GUCI, Fibrotest and Hui. However, significant fibrosis could not be excluded by any marker （NPV 〈 65%）. Fibretest had the best PPV and NPV for cirrhosis （87% and 90%, respectively）. Fibrotest showed the best AUC for both significant fibrosis and cirrhosis （0.85 and 0.76, respectively）. Stepwise combination algorithms of APR1, Fibrotest and biopsy showed excellent performance （0.96 AUC, 100% NPV） for significant fibrosis and 0.95 AUC, 98% NPV for cirrhosis, with 50%-80% reduced need for liver biopsy. CONCLUSION： In CHB sequential combination of APRI, Fibrotest and liver biopsy greatly improves the diagnostic performance of the single non-invasive markers. Need for liver biopsy is reduced by 50%-80% but cannot be completely avoided. Non-invasive markers and biopsy should be considered as agonists and not antagonists towards the common goal of estimating liver fibrosis.展开更多
AIM: To validate a non-invasive method to detect gastric mucosal atrophy in a Chilean population with high prevalence of gastric cancer and a poor survival rate. METHODS: We first determined the optimal cut-off level ...AIM: To validate a non-invasive method to detect gastric mucosal atrophy in a Chilean population with high prevalence of gastric cancer and a poor survival rate. METHODS: We first determined the optimal cut-off level of serum pepsinogen (PG)-1, PG-1/PG-2 ratio and 17-gastrin in 31 voluntary symptomatic patients (mean age: 66.1 years), of them 61% had histologically confirmed gastric atrophy. Then, in a population-based sample of 536 healthy individuals (209 residents in counties with higher relative risk and 327 residents in counties with lower relative risk for gastric cancer), we measured serum anti-H pylori antibodies, PG and 17-gastrin and estimated their risk of gastric cancer. RESULTS: We found that serum PG-1 < 61.5 μg/L, PG-1/PG-2 ratio < 2.2 and 17-gastrin > 13.3 pmol/L had a high specificity (91%-100%) and a fair sensitivity (56%-78%) to detect corpus-predominant atrophy. Based on low serum PG-1 and PG-1/PG-2 ratio together as diagnostic criteria, 12.5% of the asymptomatic subjects had corpus-predominant atrophy (0% of those under 25 years and 20.2% over 65 years old). The frequency of gastric atrophy was similar (12% vs 13%) but H pylori infection rate was slightly higher (77% vs 71%) in the high-risk compared to the low-risk counties. Based on their estimated gastric cancer risk, individuals were classified as: low-risk group (no H pylori infection and no atrophy; n = 115; 21.4%); moderate-risk group(H pylori infection but no atrophy; n = 354, 66.0%); and high-risk group (gastric atrophy, with or without H pylori infection; n = 67, 12.5%). The high-risk group was significantly older (mean age: 61.9 ± 13.3 years), more frequently men and less educated as compared with the low-risk group. CONCLUSION: We propose to concentrate on an upper gastrointestinal endoscopy for detection of early gastric cancer in the high-risk group. This intervention model could improve the poor prognosis of gastric cancer in Chile.展开更多
Background Hypoxemia sometimes occurs in the emergency room in the patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）, even in those with administration of conventional ...Background Hypoxemia sometimes occurs in the emergency room in the patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）, even in those with administration of conventional high-flow oxygen inhalation. The objective of the present study was to evaluate the effectiveness of non-invasive ventilation （NIV） in improving blood oxygen content and hemorheology in patients with AMI and hypoxemia. Methods This prospective study enrolled 50 consecutive eligible patients with AMI （aged 72.3 ± 9.5 years）, who had undergone PCI and been administered high-flow oxygen but still had hypoxemia. Blood was taken before NIV and at 0.5, 1, and 2 h after NIV. Blood gases, hemorheological variables including erythrocyte deformability, erythrocyte aggregation, erythrocyte osmotic fragility, membrane fluidity, and oxidative stress level were measured. Results Blood PaO2 increased to normal by 1 h after NIV. Assessed hemorheological variables had all improved and plasma malondialdehyde concentration decreased significantly after 2 h of NIV. Conclusions Our data suggest that NIV can help to improve blood oxygen content, hemorheological status, and minimize plasma lipid peroxidation injury in hypoxemic patients with AMI who have undergone PCI.展开更多
Chronic liver disease is a major cause of morbidity and mortality worldwide and usually develops over many years, as a result of chronic inflammation and scarring, resulting in end-stage liver disease and its complica...Chronic liver disease is a major cause of morbidity and mortality worldwide and usually develops over many years, as a result of chronic inflammation and scarring, resulting in end-stage liver disease and its complications. The progression of disease is characterised by ongoing inflammation and consequent fibrosis, although hepatic steatosis is increasingly being recognised as an important pathological feature of disease, rather than being simply an innocent bystander. However, the current gold standard method of quantifying and staging liver disease, histological analysis by liver biopsy, has several limitations and can have associated morbidity and even mortality. Therefore, there is a clear need for safe and noninvasive assessment modalities to determine hepatic steatosis, inflammation and fibrosis. This review covers key mechanisms and the importance of fibrosis and steatosis in the progression of liver disease. We address non-invasive imaging and blood biomarker assessments that can be used as an alternative to information gained on liver biopsy.展开更多
Alcoholic liver disease(ALD)is the most common liver disease in the Western world.For many reasons,it isunderestimated and underdiagnosed.An early diagnosis is absolutely essential since it(1)helps to identify patient...Alcoholic liver disease(ALD)is the most common liver disease in the Western world.For many reasons,it isunderestimated and underdiagnosed.An early diagnosis is absolutely essential since it(1)helps to identify patients at genetic risk for ALD;(2)can trigger efficient abstinence namely in non-addicted patients;and(3)initiate screening programs to prevent life-threateningcomplications such as bleeding from varices,spontaneous bacterial peritonitis or hepatocellular cancer.The two major end points of ALD are alcoholic liver cirrhosis and the rare and clinically-defined alcoholic hepatitis(AH).The prediction and early diagnosis of both entities is still insufficiently solved and usually relies on acombination of laboratory,clinical and imaging findings.It is not widely conceived that conventional screeningtools for ALD such as ultrasound imaging or routine laboratory testing can easily overlook ca.40%of manifest alcoholic liver cirrhosis.Non-invasive methods such as transient elastography(Fibroscan),acoustic radiation force impulse imaging or shear wave elastography have significantly improved the early diagnosis of alcoholiccirrhosis.Present algorithms allow either the exclusion or the exact definition of advanced fibrosis stages in ca.95%of patients.The correct interpretation of liver stiffness requires a timely abdominal ultrasound and actual transaminase levels.Other non-invasive methods such as controlled attenuation parameter,serum levels of M30 or M65,susceptometry or breath tests are under current evaluation to assess the degree of steatosis,apoptosis and iron overload in these patients.Liver biopsy still remains an important option to rule out comorbidities and to confirm the prognosis namely for patients with AH.展开更多
文摘Introduction: CT alone cannot provide sufficient information referring to response after neoadjuvant therapy in a timely manner. To evaluate the role of 18F-FDG-PET after neoadjuvant chemoradiation as a valid, non-invasive predictor for early therapy response and its effect on survival as compared to histopathologic tumor response, data of 32 of 210 randomized patients with NSCLC stage IIIA/IIIB, who were treated in a?prospective randomized controlled multicenter trial (LUCAS- MD), were re-evaluated. Material and Methods: For 32 patients with NSCLC stage IIIA (44%) IIIB (56%) neoadjuvant treatment consisted of two to three cycles of chemotherapy (225 mg/m2 paclitaxel and carboplatin AUC 6 d1q22) and concomitant chemoradiation (50 mg/m2 paclitaxel and carboplatin AUC 2 d1, d8, d15;1.5 Gy b.i.d. up to 45 Gy). Documentation of involved lymph node stations as detected by 18F-FDG-PET/CT and lymph node sampling during surgery according to the IASLC lymph node mapping (2009). Evaluation of histological regression grade (RG) according to Junker et al. (2001) and correlation with?18F-FDG-PET/CT for primary tumor and each lymph node station. Calculation of disease free survival using Kaplan-Meier estimates and log rank tests. Results: Actuarial tumor specific survival for the 32 patients with concomitant chemoradiation plus?chemotherapy: complete vs. incomplete metabolic remission prior to surgery after 60 months:?40% vs. 24% (p?= 0.018). RG III/IIb (no/less than 10% of vital tumor cells) vs. RG IIa/I (more than 10% vital tumor cells) after 60 months: 46% vs. 15% (p?= 0.006). 18/32 (56%) patients had RG III/IIb, 8/32 (25%) patients had regression grade III. 1/8 pts. with RG III were in the 18F-FDG- PET/CT false positive, 10 pts. with RG IIb (i.e. all pts. with RG IIb) were in the 18F-FDG-PET/CT false negative. One patient with RG IIa was in the 18F-FDG-PET/CT false negative. Hence, the cut-off level in detecting vital tumor cells by 18F-FDG-PET/CT after neoadjuvant chemoradiation for NSCLC is about 10%. Conclusion: Histological regression grading correlates well with metabolic remission as detected by 18F-FDG-PET. Thus, 18F-FDG-PET precedes CT in measuring the tumor response and may predict long-term therapeutic outcome in patients with stage III NSCLC. Invasive staging procedures may be avoided and patients who will not profit from resection due to insufficient downstaging after neoadjuvant treatment will be easily detected by using 18F-FDG-PET as standard imaging in workup and evaluation of treatment response.
文摘BACKGROUND Despite the developments in the field of kidney transplantation,the already existing diagnostic techniques for patient monitoring are considered insufficient.Protein biomarkers that can be derived from modern approaches of proteomic analysis of liquid biopsies(serum,urine)represent a promising innovation in the monitoring of kidney transplant recipients.AIM To investigate the diagnostic utility of protein biomarkers derived from proteomics approaches in renal allograft assessment.METHODS A systematic review was conducted in accordance with PRISMA guidelines,based on research results from the PubMed and Scopus databases.The primary focus was on evaluating the role of biomarkers in the non-invasive diagnosis of transplant-related com-plications.Eligibility criteria included protein biomarkers and urine and blood samples,while exclusion criteria were language other than English and the use of low resolution and sensitivity methods.The selected research articles,were categorized based on the biological sample,condition and methodology and the significantly and reproducibly differentiated proteins were manually selected and extracted.Functional and network analysis of the selected proteins was performed.RESULTS In 17 included studies,58 proteins were studied,with the cytokine CXCL10 being the most investigated.Biological pathways related to immune response and fibrosis have shown to be enriched.Applications of biomarkers for the assessment of renal damage as well as the prediction of short-term and long-term function of the graft were reported.Overall,all studies have shown satisfactory diagnostic accuracy of proteins alone or in combination with conventional methods,as far as renal graft assessment is concerned.CONCLUSION Our review suggests that protein biomarkers,evaluated in specific biological fluids,can make a significant contribution to the timely,valid and non-invasive assessment of kidney graft.
基金Supported by National Natural Science Foundation of China,No.82300451Research Foundation of Wuhan Union Hospital,No.2022xhyn050.
文摘Gastric cancer(GC),a multifaceted and highly aggressive malignancy,represents challenging healthcare burdens globally,with a high incidence and mortality rate.Although endoscopy,combined with histological examination,is the gold stan-dard for GC diagnosis,its high cost,invasiveness,and specialized requirements hinder widespread use for screening.With the emergence of innovative techno-logies such as advanced imaging,liquid biopsy,and breath tests,the landscape of GC diagnosis is poised for radical transformation,becoming more accessible,less invasive,and more efficient.As the non-invasive diagnostic techniques continue to advance and undergo rigorous clinical validation,they hold the promise of sig-nificantly impacting patient outcomes,ultimately leading to better treatment results and improved quality of life for patients with GC.
文摘Chronic kidney disease(CKD)is a degenerative disorder that affects millions of people throughout the world,causing considerable morbidity and healthcare burden.Frequent blood sampling is the current gold standard for monitoring CKD to evaluate biochemical and mineral indicators.However,there are draw-backs to frequent blood draws,such as pain for patients,the possibility of infe-ction,and higher medical expenses.Saliva-based diagnostics offer advantages such as ease of collection,reduced invasiveness,and improved patient compli-ance.A comprehensive literature review was conducted to analyze studies eva-luating the diagnostic utility of salivary creatinine,urea,calcium,and parathyroid hormone(PTH)in patients with CKD.Various saliva collection methods,inc-luding stimulated and unstimulated approaches,were investigated for efficiency and reliability,and a correlation was shown between serum and salivary crea-tinine,urea,PTH,and calcium levels,indicating their potential as CKD biomar-kers.Despite these promising findings,challenges such as standardization of collection methods,variability in salivary flow rates,and predictive value in association with blood parameters are addressed to ensure clinical applicability.This review explores the potential and challenges of saliva as a non-invasive alternative for CKD diagnostics.
基金financially supported by ChinaNational Funds for Distinguished Young Scientists(No.52125403)National Natural Science Foundation of China(Nos.52261135540 and 52404303)Science and Tech-nology Plan Special Fund Project of Jiangsu Province,China(No.BZ2024046)。
文摘Flip-flow screens offer unique advantages in grading fine-grained materials.To address inaccuracies caused by sensor vibra-tions in traditional contact measurement methods,we constructed a non-invasive measurement system based on electrical and optical sig-nals.A trajectory tracking algorithm for the screen-body was developed to visually measure the kinematics.Employing the principle oflaser reflection for distance measurement,optical techniques were performed to capture the kinematic information of the screen-plate.Ad-ditionally,by using Wi-Fi and Bluetooth transmission of electrical signals,tracer particle tracking technology was implemented to elec-trically measure the kinematic information of mineral particles.Consequently,intelligent fusion and perception of the kinematic informa-tion for the screen-body,screen-plate,and particles in the screening system have been achieved.
文摘Hyaline Membrane Disease(HMD)in newborns,also known as neonatal respiratory distress syndrome,is a common critical illness in premature infants,with an incidence inversely correlated with gestational age,posing a serious threat to the life and health of newborns.This paper systematically reviews the core pathogenesis of HMD,focusing on the abnormal metabolism of pulmonary surfactant(PS),genetic factors,immature lung development,and the synergistic effects of inflammatory oxidative stress.It highlights the advances in non-invasive ventilation(NIV)therapy for HMD,including the mechanisms of action,clinical application effects,and optimization strategies of mainstream modalities such as nasal continuous positive airway pressure ventilation(NCPAP),nasal intermittent positive pressure ventilation(NIPPV),and heated humidified high-flow nasal cannula ventilation(HHHFNC).The aim is to provide references for standardized clinical treatment.
基金Supported by the National Natural Science Foundation of China,No.82402719Sichuan Science and Technology Program,No.2025ZNSFSC1553.
文摘Metabolic dysfunction-associated steatotic liver disease(MASLD)requires accurate liver fibrosis assessment for management.While liver biopsy remains the gold standard,its invasiveness drives demand for non-invasive biomarkers.This review evaluates blood biomarkers for MASLD fibrosis staging.Established scores(fibrosis-4,non-alcoholic fatty liver disease fibrosis score)offer accessible screening but exhibit variable performance influenced by age,obesity,and comorbidities.Patented panels(e.g.,enhanced liver fibrosis test,FibroMeter)improve accuracy by integrating extracellular matrix or metabolic markers,though context-specific thresholds are essential.Emerging biomarkers like propeptide of type 3 collagen,Mac-2 binding protein glycosylation isomer,epigenetic markers(proliferator-activated receptor-γmethylation),and angiopoietin-like proteins a family of eight glycoproteins show promise but require large-scale validation.Genetic risk scores and multi-omics approaches face generalizability challenges.Integration strategies,such as combining serum biomarkers with liver stiffness measurement via Agile scores,enhance diagnostic precision and reduce indeterminate classifications.Current tools aid risk stratification,but no single biomarker replicates biopsy-level precision.Future efforts must prioritize MASLD-specific diagnostic frameworks,standardized protocols,and multi-modal integration to enhance clinical utility and address MASLD’s growing burden.
基金Supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)Funded by the Ministry of Education,No.NRF-RS-2023-00237287.
文摘BACKGROUND Internet gaming disorder(IGD)is a growing concern among adolescents and adults,necessitating effective treatment strategies beyond pharmacological interventions.AIM To evaluated the effectiveness of non-invasive interventions for treating IGD among adolescents and adults.METHODS A total of 11 randomized controlled trials published between 2020 and 2025 were included in this meta-analysis,encompassing 1208 participants from diverse geographic and cultural contexts.The interventions examined included cognitive behavioral therapy(CBT),internet-based CBT,neurofeedback,virtual reality therapy,abstinence-based programs,and school-based prevention.The primary outcomes assessed were reductions in gaming time and IGD severity.Secondary outcomes included improvements in mood,anxiety,and psychosocial functioning(e.g.,stronger peer relationships,better academic or work performance,and healthier daily-life role fulfillment).RESULTS The pooled standardized mean difference for IGD symptom reduction significantly favored non-invasive interventions(Hedges’g=0.56,95%CI:0.38-0.74,P<0.001),with moderate heterogeneity observed(I2=47%).Subgroup analyses indicated that CBT-based programs,both in-person and online,yielded the strongest effects,particularly when caregiver involvement or self-monitoring was incorporated.Funnel plot asymmetry was minimal,suggesting a low risk of publication bias.CONCLUSION These findings support the efficacy of scalable,low-risk non-invasive interventions as first-line treatment options for IGD,particularly in youth populations.Future studies should prioritize investigating long-term outcomes,comparing the effectiveness of different non-invasive modalities,and developing culturally adaptive delivery methods.
文摘In this article,we comment on the article by Peta et al.This study evaluates the diagnostic performance of FibroTest-Actitest,transient elastography,and the fibrosis-4 index against a histological reference.Using the Obuchowski measure,the authors demonstrate that FibroTest and vibration-controlled transient elastography outperform the fibrosis-4 index in detecting fibrosis.Additionally,Actitest offers superior estimation of inflammatory activity compared to conventional biomarkers.Assessing liver fibrosis is crucial for managing autoimmune hepatitis(AIH),yet reliance on invasive liver biopsy remains higher than in other liver diseases.This is partly due to more complex diagnostic criteria for AIH,the lack of standardized scoring for non-invasive testing,and the presence of inflammation,which can lead to falsely elevated results with non-invasive tests.A Bayesian latent class model further supports the reliability of these non-invasive tests,highlighting their potential to complement biopsy,particularly for longterm disease monitoring.These findings underscore the importance of noninvasive diagnostics in optimizing AIH management.
基金2022 Inner Mongolia Autonomous Region Health and Wellness Science and Technology Program Project(Project No.:202201533)。
文摘Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.
文摘BACKGROUND An echocardiogram is an essential tool in the evaluation of potential kidney transplant recipients(KTRs).Despite cardiac clearance,potential KTRs still have structural and functional abnormalities.Identifying the prevalence of these abnormalities and understanding their predictors is vital for optimizing pretransplant risk stratification and improving post-transplant outcomes.AIM To determine the prevalence of left ventricular hypertrophy(LVH),left ventricular systolic dysfunction(LVSD),diastolic dysfunction(DD),pulmonary hypertension(PH),and their predictors,and to assess their impact on graft function in pre-transplant candidates.METHODS The study included all successful transplant candidates older than 14 who had a baseline echocardiogram.Binary logistic regression models were constructed to identify factors associated with LVH,LVSD,DD,and PH.RESULTS Out of 259 patients,LVH was present in 64%(166),12%(31)had LVSD,27.5%(71)had DD,and 66(25.5%)had PH.Independent predictors of LVH included male gender[odds ratio(OR):2.51;95%CI:1.17-5.41 P=0.02],PH(OR=2.07;95%CI:1.11-3.86;P=0.02),DD(OR:2.47;95%CI:1.29-4.73;P=0.006),and dyslipidemia(OR=1.94;95%CI:1.07-3.53;P=0.03).Predictors for LVSD included patients with DD(OR=3.3,95%CI:1.41-7.81;P=0.006)and a family history of coronary artery disease(OR=4.50,95%CI:1.33-15.20;P=0.015).Peritoneal dialysis was an independent predictor for DD(OR=10.03;95%CI:1.71-58.94,P=0.011).The presence of LVH(OR=3.32,95%CI:1.05-10.55,P=0.04)and mild to moderate or moderate to severe mitral regurgitation(OR=4.63,95%CI:1.45-14.78,P=0.01)were significant factors associated with PH.These abnormalities had no significant impact on estimated glomerular filtration at discharge,6 months,1 year,or 2 years post-transplant.CONCLUSION Significant echocardiographic abnormalities persist in a potential transplant candidate despite cardiac clearance,although they don’t affect future graft function.Understanding the risk factors associated with these abnormalities may help clinicians address these factors pre-and post-transplant to achieve better outcomes.
文摘The evaluation and follow up of liver fibrosis and cirrhosis have been traditionally performed by liver biopsy. However, during the last 20 years, it has become evident that this "gold-standard" is imperfect; even according to its proponents, it is only "the best" among available methods. Attempts at uncovering non-invasive diagnostic tools have yielded multiple scores, formulae, and imaging modalities. All are better tolerated, safer, more acceptable to the patient, and can be repeated essentially as often as required. Most are much less expensive than liver biopsy. Consequently, their use is growing, and in some countries the number of biopsies performed, at least for routine evaluation of hepatitis B and C, has declined sharply. However, the accuracy and diagnostic value of most, if not all, of these methods remains controversial. In this review for the practicing physician, we analyze established and novel biomarkers and physical techniques. We may be witnessing in recent years the beginning of the end of the first phase for the development of non-invasive markers. Early evidence suggests that they might be at least as good as liver biopsy. Novel experimental markers and imaging techniques could produce a dramatic change in diagnosis in the near future.
基金supported by Science and Education Project of Hainan Province Health and Family Planning administrationand Sanya Health and Technology Innovation Project(NO.2015YW19)
文摘Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction patients with left ventricular failure. Methods: A number of 96 acute myocardial infarction patients accompanied with heart failure after PCI hospitalized in the People's Hospital of Sanya during February 2012 to October 2015 were selected. They were randomly divided into the therapy group(n = 50) and control group(n = 46). On the basis of routine treatment, patients in the therapy group were treated with intravenous rh BNP(1.5 μg/kg was intravenous injection with uniform speed of 3 min, followed by continuous infusion 0.007 5 μg/kg·min for 72 h), while the control group received conventional treatment. Bio Z-2011 non-invasive hemodynamic real-time monitoring system was used to monitor the hemodynamic parameters changes and the leves of plasma pro-BNP, serum creatinine, serum potassium, serum sodium and urine volume of each group before and after treating for 30 min, 1 h, 3 h, 6 h, 12 h, 24 h, 48 h, 72 h. Results: Patients in the therapy group showed no effect on heart rate, while after 30 min of intravenous injection of rh BNP, CO, CI, SV, and SI increased significantly and LVET and TFC reduced at the same time, which had certain effect on blood pressure(SBP/DBP). Compared with the control group, the therapy group showed a faster and more effective improvement on haemodynamics. Conclusions: Acute myocardial infarction patients complicated with left heart failure after primary PCI can significantly improve hemodynamics by treating with rh BNP.
文摘Liver fibrosis is an important pathological precondition for hepatocellular carcinoma.The degree of hepatic fibrosis is positively correlated with liver cancer.Liver fibrosis is a series of pathological and physiological process related to liver cell necrosis and degeneration after chronic liver injury,which finally leads to extracellular matrix and collagen deposition.The early detection and precise staging of fibrosis and cirrhosis are very important for early diagnosis and timely initiation of appropriate therapeutic regimens.The risk of severe liver fibrosis finally progressing to liver carcinoma is＆gt;50%.It is known that biopsy is the gold standard for the diagnosis and staging of liver fibrosis.However,this method has some limitations,such as the potential for pain,sampling variability,and low patient acceptance.Furthermore,the necessity of obtaining a tissue diagnosis of liver fibrosis still remains controversial.An increasing number of reliable non-invasive approaches are now available that are widely applied in clinical practice,mostly in cases of viral hepatitis,resulting in a significantly decreased need for liver biopsy.In fact,the noninvasive detection and evaluation of liver cirrhosis now has good accuracy due to current serum markers,ultrasound imaging,and magnetic resonance imaging quantification techniques.A prominent advantage of the non-invasive detection and assessment of liver fibrosis is that liver fibrosis can be monitored repeatedly and easily in the same patient.Serum biomarkers have the advantages of high applicability（〉95%）and good reproducibility.However,their results can be influenced by different patient conditions because none of these markers are liver-specific.The most promising techniques appear to be transient elastography and magnetic resonance elastography because they provide reliable results for the detection of fibrosis in the advanced stages,and future developments promise to increase the reliability and accuracy of the staging of hepatic fibrosis.This article aims to describe the recent progress in the development of non-invasive assessment methods for the staging of liver fibrosis,with a special emphasize on computer-aided quantitative and deep learning methods.
文摘Tinnitus is defined as a perception of sound without any external sound source.Chronic tinnitus is a frequent condition that can affect the quality of life.So far,no causal cure for tinnitus has been documented,and most pharmacologic and psychosomatic treatment modalities aim to diminish tinnitus’impact on the quality of life.Neuromodulation,a novel therapeutic modality,which aims at alternating nerve activity through a targeted delivery of a stimulus,has emerged as a potential option in tinnitus treatment.This review provides a brief overview of the current neuromodulation techniques as tinnitus treatment options.The main intention is to provide updated knowledge especially for medical professionals counselling tinnitus patients in this emerging field of medicine.Non-invasive methods such as repetitive transcranial magnetic stimulation,transcranial electrical stimulation,neurofeedback,and transcutaneous vagus nerve stimulation were included,as well as invasive methods such as implanted vagus nerve stimulation and invasive brain stimulation.Some of these neuromodulation techniques revealed promising results;nevertheless,further research is needed,especially regarding the pathophysiological principle as to how these neuromodulation techniques work and what neuronal change they induce.Various studies suggest that individually different brain states and networks are involved in the generation and perception of tinnitus.Therefore,in the future,individually tailored neuromodulation strategies could be a promising approach in tinnitus treatment for achieving a more substantial and longer lasting improvement of complaints.
文摘AIM： To assess the performance of several noninvasive markers and of our recently proposed stepwise combination algorithms to diagnose significant fibrosis （F ≥ 2 by METAVIR） and cirrhosis （F4 by METAVIR） in chronic hepatitis B （CHB）.METHODS： One hundred and ten consecutive patients （80 males, 30 females, mean age： 42.6 ± 11.3） with CHB undergoing diagnostic liver biopsy were included. AST-to-Platelet ratio （APRI）, Forns＇ index, AST-to-ALT Ratio, Goteborg University Cirrhosis Index （GUCD, Hui＇s model and Fibrotest were measured on the day of liver biopsy. The performance of these methods and of sequential algorithms combining Fibrotest, APRI and biopsy was defined by positive （PPV） and negative （NPV） predictive values, accuracy and area under the curve （AUC）. RESULTS： PPV for significant fibrosis was excellent （100%） with Forns and high （〉 92%） with APR1, GUCI, Fibrotest and Hui. However, significant fibrosis could not be excluded by any marker （NPV 〈 65%）. Fibretest had the best PPV and NPV for cirrhosis （87% and 90%, respectively）. Fibrotest showed the best AUC for both significant fibrosis and cirrhosis （0.85 and 0.76, respectively）. Stepwise combination algorithms of APR1, Fibrotest and biopsy showed excellent performance （0.96 AUC, 100% NPV） for significant fibrosis and 0.95 AUC, 98% NPV for cirrhosis, with 50%-80% reduced need for liver biopsy. CONCLUSION： In CHB sequential combination of APRI, Fibrotest and liver biopsy greatly improves the diagnostic performance of the single non-invasive markers. Need for liver biopsy is reduced by 50%-80% but cannot be completely avoided. Non-invasive markers and biopsy should be considered as agonists and not antagonists towards the common goal of estimating liver fibrosis.
文摘AIM: To validate a non-invasive method to detect gastric mucosal atrophy in a Chilean population with high prevalence of gastric cancer and a poor survival rate. METHODS: We first determined the optimal cut-off level of serum pepsinogen (PG)-1, PG-1/PG-2 ratio and 17-gastrin in 31 voluntary symptomatic patients (mean age: 66.1 years), of them 61% had histologically confirmed gastric atrophy. Then, in a population-based sample of 536 healthy individuals (209 residents in counties with higher relative risk and 327 residents in counties with lower relative risk for gastric cancer), we measured serum anti-H pylori antibodies, PG and 17-gastrin and estimated their risk of gastric cancer. RESULTS: We found that serum PG-1 < 61.5 μg/L, PG-1/PG-2 ratio < 2.2 and 17-gastrin > 13.3 pmol/L had a high specificity (91%-100%) and a fair sensitivity (56%-78%) to detect corpus-predominant atrophy. Based on low serum PG-1 and PG-1/PG-2 ratio together as diagnostic criteria, 12.5% of the asymptomatic subjects had corpus-predominant atrophy (0% of those under 25 years and 20.2% over 65 years old). The frequency of gastric atrophy was similar (12% vs 13%) but H pylori infection rate was slightly higher (77% vs 71%) in the high-risk compared to the low-risk counties. Based on their estimated gastric cancer risk, individuals were classified as: low-risk group (no H pylori infection and no atrophy; n = 115; 21.4%); moderate-risk group(H pylori infection but no atrophy; n = 354, 66.0%); and high-risk group (gastric atrophy, with or without H pylori infection; n = 67, 12.5%). The high-risk group was significantly older (mean age: 61.9 ± 13.3 years), more frequently men and less educated as compared with the low-risk group. CONCLUSION: We propose to concentrate on an upper gastrointestinal endoscopy for detection of early gastric cancer in the high-risk group. This intervention model could improve the poor prognosis of gastric cancer in Chile.
文摘Background Hypoxemia sometimes occurs in the emergency room in the patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）, even in those with administration of conventional high-flow oxygen inhalation. The objective of the present study was to evaluate the effectiveness of non-invasive ventilation （NIV） in improving blood oxygen content and hemorheology in patients with AMI and hypoxemia. Methods This prospective study enrolled 50 consecutive eligible patients with AMI （aged 72.3 ± 9.5 years）, who had undergone PCI and been administered high-flow oxygen but still had hypoxemia. Blood was taken before NIV and at 0.5, 1, and 2 h after NIV. Blood gases, hemorheological variables including erythrocyte deformability, erythrocyte aggregation, erythrocyte osmotic fragility, membrane fluidity, and oxidative stress level were measured. Results Blood PaO2 increased to normal by 1 h after NIV. Assessed hemorheological variables had all improved and plasma malondialdehyde concentration decreased significantly after 2 h of NIV. Conclusions Our data suggest that NIV can help to improve blood oxygen content, hemorheological status, and minimize plasma lipid peroxidation injury in hypoxemic patients with AMI who have undergone PCI.
基金MMEC is supported by a Fellowship from the Sir Halley Stewart Trust (Cambridge, United Kingdom)SDT-R, MMEC, HKSF and RN have been participant workers in the PROLIFICA project in West Africafunded by the European Union Framework 7
文摘Chronic liver disease is a major cause of morbidity and mortality worldwide and usually develops over many years, as a result of chronic inflammation and scarring, resulting in end-stage liver disease and its complications. The progression of disease is characterised by ongoing inflammation and consequent fibrosis, although hepatic steatosis is increasingly being recognised as an important pathological feature of disease, rather than being simply an innocent bystander. However, the current gold standard method of quantifying and staging liver disease, histological analysis by liver biopsy, has several limitations and can have associated morbidity and even mortality. Therefore, there is a clear need for safe and noninvasive assessment modalities to determine hepatic steatosis, inflammation and fibrosis. This review covers key mechanisms and the importance of fibrosis and steatosis in the progression of liver disease. We address non-invasive imaging and blood biomarker assessments that can be used as an alternative to information gained on liver biopsy.
文摘Alcoholic liver disease(ALD)is the most common liver disease in the Western world.For many reasons,it isunderestimated and underdiagnosed.An early diagnosis is absolutely essential since it(1)helps to identify patients at genetic risk for ALD;(2)can trigger efficient abstinence namely in non-addicted patients;and(3)initiate screening programs to prevent life-threateningcomplications such as bleeding from varices,spontaneous bacterial peritonitis or hepatocellular cancer.The two major end points of ALD are alcoholic liver cirrhosis and the rare and clinically-defined alcoholic hepatitis(AH).The prediction and early diagnosis of both entities is still insufficiently solved and usually relies on acombination of laboratory,clinical and imaging findings.It is not widely conceived that conventional screeningtools for ALD such as ultrasound imaging or routine laboratory testing can easily overlook ca.40%of manifest alcoholic liver cirrhosis.Non-invasive methods such as transient elastography(Fibroscan),acoustic radiation force impulse imaging or shear wave elastography have significantly improved the early diagnosis of alcoholiccirrhosis.Present algorithms allow either the exclusion or the exact definition of advanced fibrosis stages in ca.95%of patients.The correct interpretation of liver stiffness requires a timely abdominal ultrasound and actual transaminase levels.Other non-invasive methods such as controlled attenuation parameter,serum levels of M30 or M65,susceptometry or breath tests are under current evaluation to assess the degree of steatosis,apoptosis and iron overload in these patients.Liver biopsy still remains an important option to rule out comorbidities and to confirm the prognosis namely for patients with AH.
