Objective To observe the cervical elasticity of healthy adult nulliparous women at different age groups and different stages of menstrual cycle with E-Cervix imaging technology.Methods A total of 218 healthy adult nul...Objective To observe the cervical elasticity of healthy adult nulliparous women at different age groups and different stages of menstrual cycle with E-Cervix imaging technology.Methods A total of 218 healthy adult nulliparous women who underwent transvaginal ultrasound examination for routine physical examination were retrospectively enrolled,including 103 in follicular phase,78 in ovulation phase and 37 in luteal phase.Cervical canal length(CL)and E-Cervix elasticity parameters were compared among different age groups and different stages of menstrual cycle,including elasticity contrast index(ECI),hardness ratio(HR),cervical internal and external orifice strain values(IOS and EOS)and IOS/EOS ratio.Results No significant difference of CL nor cervical elasticity parameters was detected among healthy adult nulliparous women at different age groups(all P>0.05).There were significant differences of ECI,HR and IOS among different menstrual cycle stages(all P<0.05),among which women in follicular phase had higher ECI and IOS but lower HR than those in luteal phase(all P<0.05).Conclusion No significant difference of cervical elasticity existed among healthy adult nulliparous women at different age groups.Meanwhile,cervical elasticity of healthy adult nulliparous women changed during menstrual cycle,in follicular phase had higher ECI and IOS but lower HR than in luteal phase.展开更多
AIM:To investigate the diagnostic accuracy of acoustic radiation force impulse (ARFI) imaging as a noninvasive method for the assessment of liver fibrosis in chronic hepatitis C (CHC) patients.METHODS:We performed a p...AIM:To investigate the diagnostic accuracy of acoustic radiation force impulse (ARFI) imaging as a noninvasive method for the assessment of liver fibrosis in chronic hepatitis C (CHC) patients.METHODS:We performed a prospective blind com-parison of ARFI elastography,APRI index and FibroMax in a consecutive series of patients who underwent liver biopsy for CHC in University Hospital Bucharest. His-topathological staging of liver fibrosis according to the METAVIR scoring system served as the reference. A to-tal of 74 patients underwent ARFI elastography,APRI index,FibroMax and successful liver biopsy. RESULTS:The noninvasive tests had a good correlation with the liver biopsy results. The most powerful test in predicting fibrosis was ARFI elastography. The diagnostic accuracy of ARFI elastography,expressedas area under receiver operating characteristic curve (AUROC) had a validity of 90.2% (95% CI AUROC = 0.831-0.972,P < 0.001) for the diagnosis of significant f ibrosis (F ≥ 2). ARFI sonoelastography predicted even better F3 or F4 fibrosis (AUROC = 0.993,95% CI = 0.979-1).CONCLUSION:ARFI elastography had very good accuracy for the assessment of liver fibrosis and was superior to other noninvasive methods (APRI Index,FibroMax) for staging liver fibrosis.展开更多
Assessment of liver fibrosis in chronic hepatitis C virus(HCV)infection is considered a relevant part of patient care and key for decision making.Although liver biopsy has been considered the gold standard for staging...Assessment of liver fibrosis in chronic hepatitis C virus(HCV)infection is considered a relevant part of patient care and key for decision making.Although liver biopsy has been considered the gold standard for staging liver fibrosis,it is an invasive technique and subject to sampling errors and significant intra-and inter-observer variability.Over the last decade,several noninvasive markers were proposed for liver fibrosis diagnosis in chronic HCV infection,with variable performance.Besides the clear advantage of being noninvasive,a more objective interpretation of test results may overcome the mentioned intra-and inter-observer variability of liver biopsy.In addition,these tests can theoretically offer a more accurate view of fibrogenic events occurring in the entire liver with the advantage of providing frequent fibrosis evaluation without additional risk.However,in general,these tests show low accuracy in discriminating between intermediate stages of fibrosis and may be influenced by several hepatic and extrahepatic conditions.These methods are either serum markers(usually combined in a mathematical model)or imaging modalities that can be used separately or combined in algorithms to improve accuracy.In this review we will discuss the different noninvasive methods that are currently available for the evaluation of liver fibrosis in chronic hepatitis C,their advantages,limitations and application in clinical practice.展开更多
BACKGROUND Timely differentiation of biliary atresia(BA)from other infantile cholestatic diseases can impact patient outcomes.Additionally,non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not be...BACKGROUND Timely differentiation of biliary atresia(BA)from other infantile cholestatic diseases can impact patient outcomes.Additionally,non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized.Shear wave elastography is an ultrasound modality that detects changes in tissue stiffness.The authors propose that the utility of elastography in BA can be elucidated through meta-analysis of existing studies.AIM To assess the utility of elastography in:(1)BA diagnosis,and(2)post-Kasai fibrosis surveillance.METHODS A literature search identified articles that evaluated elastography for BA diagnosis and for post-Kasai follow-up.Twenty studies met criteria for meta-analysis:Eleven for diagnosis and nine for follow-up post-Kasai.Estimated diagnostic odds ratio(DOR),sensitivity,and specificity of elastography were calculated through a random-effects model using Meta-DiSc software.RESULTS Mean liver stiffness in BA infants at diagnosis was significantly higher than in non-BA,with overall DOR 24.61,sensitivity 83%,and specificity 79%.Post-Kasai,mean liver stiffness was significantly higher in BA patients with varices than in patients without,with DOR 16.36,sensitivity 85%,and specificity 76%.Elastography differentiated stage F4 fibrosis from F0-F3 with DOR of 70.03,sensitivity 96%,and specificity 89%.Elastography also differentiated F3-F4 fibrosis from F0-F2 with DOR of 24.68,sensitivity 85%,and specificity 81%.CONCLUSION Elastography has potential as a non-invasive modality for BA diagnosis and surveillance post-Kasai.This paper’s limitations include inter-study method heterogeneity and small sample sizes.Future,standardized,multi-center studies are recommended.展开更多
BACKGROUND Hepatic sinusoidal obstruction syndrome(SOS)is caused by damage to hepatic sinusoidal endothelial cells that results in fibrous obliteration of intrahepatic venules and necrosis of hepatocytes.Currently the...BACKGROUND Hepatic sinusoidal obstruction syndrome(SOS)is caused by damage to hepatic sinusoidal endothelial cells that results in fibrous obliteration of intrahepatic venules and necrosis of hepatocytes.Currently the diagnosis is primarily based on nonspecific clinical features and invasive liver biopsy.Therefore,noninvasive imaging methods are required for the early diagnosis and severity assessment of hepatic SOS.AIM To determine the effectiveness of supersonic shear wave imaging(SSI)and dual energy computed tomography(DECT)for diagnosing hepatic SOS using a rabbit model.METHODS Among nine New Zealand white rabbits(3-4 kg,male),three in control group ingested normal saline for 20 d and six in the SOS group ingested 6-thioguanine(5 mg/kg/d)for 20 d.Liver stiffness was measured using SSI on days 0,3,10,and 20.On the same days,liver perfusion was evaluated from virtual monochromatic images of 55 keV and iodine map using DECT.Morphologic changes in the liver were assessed using CT.Final pathology scores were compared between the two groups.Liver stiffness and perfusion parameters were compared according to the groups,days,and pathology scores.RESULTS Final pathology scores were significantly higher in the SOS than the control group(median 22 vs 2,P=0.024).No gross morphologic changes were seen in livers.Liver stiffness,Hounsfield Unit values,and iodine concentrations were higher in the SOS compared to the control group on days 10 and 20(all,P≤0.007).Compared to day 0,liver stiffness and perfusion parameters were higher on day 20 in the SOS group(all,P≤0.001).Correlation coefficients for liver stiffness(r=0.635),Hounsfield Unit values(r=0.587),and iodine concentration(r=0.611)with final pathology scores were positive without significance(all,P>0.05).CONCLUSION Liver stiffness and perfusion parameters were significantly increased in the livers of a rabbit SOS model.SSI and DECT might aid in early diagnosis of hepatic SOS.展开更多
AIM To investigate changes in hepatic and splenic stiffness in patients without chronic liver disease during liver resection for hepatic tumors.METHODS Patients scheduled for liver resection for hepatic tumors were co...AIM To investigate changes in hepatic and splenic stiffness in patients without chronic liver disease during liver resection for hepatic tumors.METHODS Patients scheduled for liver resection for hepatic tumors were considered for enrollment. Tissue stiffness measurements on liver and spleen were conducted before and two days after liver resection using point shear-wave elastography. Histological analysis of the resected liver specimen was conducted in all patients and patients with marked liver fibrosis were excluded from further study analysis. Patients were divided into groups depending on size of resection and whether they had received preoperative chemotherapy or not. The relation between tissue stiffness and postoperative biochemistry was investigated. RESULTS Results are presented as median(interquartile range). 35 patients were included. The liver stiffness increased in patients undergoing a major resection from 1.41(1.24-1.63) m/s to 2.20(1.72-2.44) m/s(P = 0.001). No change in liver stiffness in patients undergoing a minor resection was found [1.31(1.15-1.52) m/s vs 1.37(1.12-1.77) m/s, P = 0.438]. A major resection resulted in a 16%(7%-33%) increase in spleen stiffness, more(P = 0.047) than after a minor resection [2(-1-13) %]. Patients who underwent preoperative chemotherapy(n = 20) did not differ from others in preoperative right liver lobe [1.31(1.16-1.50) vs 1.38(1.12-1.56) m/s, P = 0.569] or spleen [2.79(2.33-3.11) vs 2.71(2.37-2.86) m/s, P = 0.515] stiffness. Remnant liver stiffness on the second postoperative day did not show strong correlations with maximum postoperative increase in bilirubin(R^2 = 0.154, Pearson's r = 0.392, P = 0.032) and international normalized ratio(R^2 = 0.285, Pearson's r = 0.534, P = 0.003). CONCLUSION Liver and spleen stiffness increase after a major liver resection for hepatic tumors in patients without chronic liver disease.展开更多
Schistosomiasis mansoni is a neglected disease and key public health problem,mainly due to its high prevalence,the scarcity of public policies,and the severity of some clinical forms.Periportal fibrosis(PPF)is the com...Schistosomiasis mansoni is a neglected disease and key public health problem,mainly due to its high prevalence,the scarcity of public policies,and the severity of some clinical forms.Periportal fibrosis(PPF)is the commonest complication of chronic schistosomiasis mansoni and its diagnosis requires different techniques.Even though wedge biopsy of the liver is considered the gold standard,it is not justified in non-surgical patients,and percutaneous liver biopsy may be informative but does not have sufficient sensitivity.Noninvasive PPF tests mostly include biological(serum biomarkers or combined scores)or physical assessments(imaging assessment of fibrosis pattern or tissue stiffness).Moreover,imaging techniques,such as ultrasound,computed tomography,magnetic resonance imaging,and elastography are applied not only to support the diagnosis of schistosomiasis,but also to assess and detect signs of portal hypertension and organ damage due to chronic schistosomiasis.A combination between a comprehensive history and physical examination with biomarkers for liver fibrosis and imaging methods seems to offer the best approach for evaluating these patients.In addition,understanding their strengths and limitations will allow a more accurate interpretation in the clinical context and can lead to greater accuracy in estimating the degree of fibrosis in patients with Schistosomiasis mansoni(S.mansoni)infection.This review will discuss the different noninvasive methods that are currently available for the evaluation of PPF in S.mansoni infection,and their application,advantages,and limitations in clinical practice.展开更多
Background:This study aimed to assess the performance of transient elastography(TE),two-dimensional shear wave elastography(2D-SWE),and magnetic resonance elastography(MRE)for staging significant fibrosis and cirrhosi...Background:This study aimed to assess the performance of transient elastography(TE),two-dimensional shear wave elastography(2D-SWE),and magnetic resonance elastography(MRE)for staging significant fibrosis and cirrhosis in untreated chronic hepatitis B(CHB)patients.Methods:Pubmed,Embase,Web of Science,and Cochrane Library were searched for terms involving CHB,TE,2D-SWE,and MRE.Other etiologies of chronic liver disease,previous treatment in patients,or articles not published in SCI journals were excluded.Hierarchical non-linear models were used to evaluate the diagnostic accuracy of TE,2D-SWE,and MRE.Heterogeneity was explored via analysis of threshold effect and meta-regression.Results:Twenty-eight articles with a total of 4,540 untreated CHB patients were included.The summary areas under the receiver-operating characteristic curves(AUROCs)using TE,2D-SWE,and MRE for predicting significant fibrosis(SF)were 0.84,0.89,and 0.99,respectively.The AUROC values of TE,2D-SWE,and MRE for staging cirrhosis were 0.9,0.94,and 0.99,respectively.Based on the meta-analysis of studies with head-to-head comparison,2D-SWE is superior to TE(0.92 vs 0.85,P<0.01)in staging significant fibrosis.Conclusion:TE,2D-SWE,and MRE express acceptable diagnostic accuracies in staging significant fibrosis and cirrhosis in untreated CHB patients.2D-SWE outperforms TE in detecting significant fibrosis in treatment-naive people with hepatitis B virus.展开更多
The tissue stiffness is always an interesting issue to clinicians.Traditionally,it is assessed by the manual palpation,and this now can be measured by the ultrasound-based elastography.The basic physics is based on Yo...The tissue stiffness is always an interesting issue to clinicians.Traditionally,it is assessed by the manual palpation,and this now can be measured by the ultrasound-based elastography.The basic physics is based on Young's modulus through the Hooke's law:E=S/e,where the Young's modulus(E)equals to the stress applied to the object(S)divided by the generated strain(e).With the rapid advancement of technology,the elastography has evolved from quasi-static elastography(ie,strain elastography)to dynamic elastography(i,e,shear wave elastography).The key differentiation of these two categories roots in the stimuli applied,namely mechanical or acoustic radiation force,and the response of the soft tissue.The strain elastography requires the operator to compress and decompress the tissue manually and the motion of the tissue during the stimuli is tracked to calculate the strain to reflect the tissue stiffness.While strain elastography is operator-dependent,shear wave elastography is not.Using shear wave elastography,the tissue is stimulated by the acoustic radiation force which can generate shear wave traveling through the tissue transversely.The shear wave propagation speed(Vs)is related to the shear modulus(μ)of the medium:μ=pVs^(2),where p is the density of the tissue and assumed to be a constant as 1000 kg/m^(3).In the incompressible biological tissue,the Young's modulus is approximately three times the shear modulus(E≈3μ).So the quantitative measurements of the tissue stiffness can be attained by shear wave elastography.The clinical application of elastography and its diagnostic capability has been extended.The knowledge of the basic physics of the various type of elastography facilitates the effective use of elastography.This review presented the clinical application and the risks of different types of elastography.展开更多
The room temperature brittleness has been a long standing problem in bulk metallic glasses realm.This has seriously limited the application potential of metallic glasses and their composites.The elastic deformation be...The room temperature brittleness has been a long standing problem in bulk metallic glasses realm.This has seriously limited the application potential of metallic glasses and their composites.The elastic deformation behaviors of metallic glass matrix composites are closely related to their plastic deformation states.The elastic deformation behaviors of Cu48-xZr48Al4Nbx（x=0,3at.%）metallic glass matrix composites（MGMCs）with different crystallization degrees were investigated using an in-situ digital image correlation（DIC）technique during tensile process.With decreasing crystallization degree,MGMC exhibits obvious elastic deformation ability and an increased tensile fracture strength.The notable tensile elasticity is attributed to the larger shear strain heterogeneity emerging on the surface of the sample.This finding has implications for the development of MGMCs with excellent tensile properties.展开更多
文摘Objective To observe the cervical elasticity of healthy adult nulliparous women at different age groups and different stages of menstrual cycle with E-Cervix imaging technology.Methods A total of 218 healthy adult nulliparous women who underwent transvaginal ultrasound examination for routine physical examination were retrospectively enrolled,including 103 in follicular phase,78 in ovulation phase and 37 in luteal phase.Cervical canal length(CL)and E-Cervix elasticity parameters were compared among different age groups and different stages of menstrual cycle,including elasticity contrast index(ECI),hardness ratio(HR),cervical internal and external orifice strain values(IOS and EOS)and IOS/EOS ratio.Results No significant difference of CL nor cervical elasticity parameters was detected among healthy adult nulliparous women at different age groups(all P>0.05).There were significant differences of ECI,HR and IOS among different menstrual cycle stages(all P<0.05),among which women in follicular phase had higher ECI and IOS but lower HR than those in luteal phase(all P<0.05).Conclusion No significant difference of cervical elasticity existed among healthy adult nulliparous women at different age groups.Meanwhile,cervical elasticity of healthy adult nulliparous women changed during menstrual cycle,in follicular phase had higher ECI and IOS but lower HR than in luteal phase.
基金Supported by Grant 41066/2007, financed by the Ministry of Education and Research
文摘AIM:To investigate the diagnostic accuracy of acoustic radiation force impulse (ARFI) imaging as a noninvasive method for the assessment of liver fibrosis in chronic hepatitis C (CHC) patients.METHODS:We performed a prospective blind com-parison of ARFI elastography,APRI index and FibroMax in a consecutive series of patients who underwent liver biopsy for CHC in University Hospital Bucharest. His-topathological staging of liver fibrosis according to the METAVIR scoring system served as the reference. A to-tal of 74 patients underwent ARFI elastography,APRI index,FibroMax and successful liver biopsy. RESULTS:The noninvasive tests had a good correlation with the liver biopsy results. The most powerful test in predicting fibrosis was ARFI elastography. The diagnostic accuracy of ARFI elastography,expressedas area under receiver operating characteristic curve (AUROC) had a validity of 90.2% (95% CI AUROC = 0.831-0.972,P < 0.001) for the diagnosis of significant f ibrosis (F ≥ 2). ARFI sonoelastography predicted even better F3 or F4 fibrosis (AUROC = 0.993,95% CI = 0.979-1).CONCLUSION:ARFI elastography had very good accuracy for the assessment of liver fibrosis and was superior to other noninvasive methods (APRI Index,FibroMax) for staging liver fibrosis.
文摘Assessment of liver fibrosis in chronic hepatitis C virus(HCV)infection is considered a relevant part of patient care and key for decision making.Although liver biopsy has been considered the gold standard for staging liver fibrosis,it is an invasive technique and subject to sampling errors and significant intra-and inter-observer variability.Over the last decade,several noninvasive markers were proposed for liver fibrosis diagnosis in chronic HCV infection,with variable performance.Besides the clear advantage of being noninvasive,a more objective interpretation of test results may overcome the mentioned intra-and inter-observer variability of liver biopsy.In addition,these tests can theoretically offer a more accurate view of fibrogenic events occurring in the entire liver with the advantage of providing frequent fibrosis evaluation without additional risk.However,in general,these tests show low accuracy in discriminating between intermediate stages of fibrosis and may be influenced by several hepatic and extrahepatic conditions.These methods are either serum markers(usually combined in a mathematical model)or imaging modalities that can be used separately or combined in algorithms to improve accuracy.In this review we will discuss the different noninvasive methods that are currently available for the evaluation of liver fibrosis in chronic hepatitis C,their advantages,limitations and application in clinical practice.
文摘BACKGROUND Timely differentiation of biliary atresia(BA)from other infantile cholestatic diseases can impact patient outcomes.Additionally,non-invasive staging of fibrosis after Kasai hepatoportoenterostomy has not been widely standardized.Shear wave elastography is an ultrasound modality that detects changes in tissue stiffness.The authors propose that the utility of elastography in BA can be elucidated through meta-analysis of existing studies.AIM To assess the utility of elastography in:(1)BA diagnosis,and(2)post-Kasai fibrosis surveillance.METHODS A literature search identified articles that evaluated elastography for BA diagnosis and for post-Kasai follow-up.Twenty studies met criteria for meta-analysis:Eleven for diagnosis and nine for follow-up post-Kasai.Estimated diagnostic odds ratio(DOR),sensitivity,and specificity of elastography were calculated through a random-effects model using Meta-DiSc software.RESULTS Mean liver stiffness in BA infants at diagnosis was significantly higher than in non-BA,with overall DOR 24.61,sensitivity 83%,and specificity 79%.Post-Kasai,mean liver stiffness was significantly higher in BA patients with varices than in patients without,with DOR 16.36,sensitivity 85%,and specificity 76%.Elastography differentiated stage F4 fibrosis from F0-F3 with DOR of 70.03,sensitivity 96%,and specificity 89%.Elastography also differentiated F3-F4 fibrosis from F0-F2 with DOR of 24.68,sensitivity 85%,and specificity 81%.CONCLUSION Elastography has potential as a non-invasive modality for BA diagnosis and surveillance post-Kasai.This paper’s limitations include inter-study method heterogeneity and small sample sizes.Future,standardized,multi-center studies are recommended.
基金Supported by a Faculty Research Grant of Yonsei University College of Medicine for 2017,No.6-2017-0090
文摘BACKGROUND Hepatic sinusoidal obstruction syndrome(SOS)is caused by damage to hepatic sinusoidal endothelial cells that results in fibrous obliteration of intrahepatic venules and necrosis of hepatocytes.Currently the diagnosis is primarily based on nonspecific clinical features and invasive liver biopsy.Therefore,noninvasive imaging methods are required for the early diagnosis and severity assessment of hepatic SOS.AIM To determine the effectiveness of supersonic shear wave imaging(SSI)and dual energy computed tomography(DECT)for diagnosing hepatic SOS using a rabbit model.METHODS Among nine New Zealand white rabbits(3-4 kg,male),three in control group ingested normal saline for 20 d and six in the SOS group ingested 6-thioguanine(5 mg/kg/d)for 20 d.Liver stiffness was measured using SSI on days 0,3,10,and 20.On the same days,liver perfusion was evaluated from virtual monochromatic images of 55 keV and iodine map using DECT.Morphologic changes in the liver were assessed using CT.Final pathology scores were compared between the two groups.Liver stiffness and perfusion parameters were compared according to the groups,days,and pathology scores.RESULTS Final pathology scores were significantly higher in the SOS than the control group(median 22 vs 2,P=0.024).No gross morphologic changes were seen in livers.Liver stiffness,Hounsfield Unit values,and iodine concentrations were higher in the SOS compared to the control group on days 10 and 20(all,P≤0.007).Compared to day 0,liver stiffness and perfusion parameters were higher on day 20 in the SOS group(all,P≤0.001).Correlation coefficients for liver stiffness(r=0.635),Hounsfield Unit values(r=0.587),and iodine concentration(r=0.611)with final pathology scores were positive without significance(all,P>0.05).CONCLUSION Liver stiffness and perfusion parameters were significantly increased in the livers of a rabbit SOS model.SSI and DECT might aid in early diagnosis of hepatic SOS.
文摘AIM To investigate changes in hepatic and splenic stiffness in patients without chronic liver disease during liver resection for hepatic tumors.METHODS Patients scheduled for liver resection for hepatic tumors were considered for enrollment. Tissue stiffness measurements on liver and spleen were conducted before and two days after liver resection using point shear-wave elastography. Histological analysis of the resected liver specimen was conducted in all patients and patients with marked liver fibrosis were excluded from further study analysis. Patients were divided into groups depending on size of resection and whether they had received preoperative chemotherapy or not. The relation between tissue stiffness and postoperative biochemistry was investigated. RESULTS Results are presented as median(interquartile range). 35 patients were included. The liver stiffness increased in patients undergoing a major resection from 1.41(1.24-1.63) m/s to 2.20(1.72-2.44) m/s(P = 0.001). No change in liver stiffness in patients undergoing a minor resection was found [1.31(1.15-1.52) m/s vs 1.37(1.12-1.77) m/s, P = 0.438]. A major resection resulted in a 16%(7%-33%) increase in spleen stiffness, more(P = 0.047) than after a minor resection [2(-1-13) %]. Patients who underwent preoperative chemotherapy(n = 20) did not differ from others in preoperative right liver lobe [1.31(1.16-1.50) vs 1.38(1.12-1.56) m/s, P = 0.569] or spleen [2.79(2.33-3.11) vs 2.71(2.37-2.86) m/s, P = 0.515] stiffness. Remnant liver stiffness on the second postoperative day did not show strong correlations with maximum postoperative increase in bilirubin(R^2 = 0.154, Pearson's r = 0.392, P = 0.032) and international normalized ratio(R^2 = 0.285, Pearson's r = 0.534, P = 0.003). CONCLUSION Liver and spleen stiffness increase after a major liver resection for hepatic tumors in patients without chronic liver disease.
文摘Schistosomiasis mansoni is a neglected disease and key public health problem,mainly due to its high prevalence,the scarcity of public policies,and the severity of some clinical forms.Periportal fibrosis(PPF)is the commonest complication of chronic schistosomiasis mansoni and its diagnosis requires different techniques.Even though wedge biopsy of the liver is considered the gold standard,it is not justified in non-surgical patients,and percutaneous liver biopsy may be informative but does not have sufficient sensitivity.Noninvasive PPF tests mostly include biological(serum biomarkers or combined scores)or physical assessments(imaging assessment of fibrosis pattern or tissue stiffness).Moreover,imaging techniques,such as ultrasound,computed tomography,magnetic resonance imaging,and elastography are applied not only to support the diagnosis of schistosomiasis,but also to assess and detect signs of portal hypertension and organ damage due to chronic schistosomiasis.A combination between a comprehensive history and physical examination with biomarkers for liver fibrosis and imaging methods seems to offer the best approach for evaluating these patients.In addition,understanding their strengths and limitations will allow a more accurate interpretation in the clinical context and can lead to greater accuracy in estimating the degree of fibrosis in patients with Schistosomiasis mansoni(S.mansoni)infection.This review will discuss the different noninvasive methods that are currently available for the evaluation of PPF in S.mansoni infection,and their application,advantages,and limitations in clinical practice.
基金funding by the National Natural Science Foundation of China[82070574]the Natural Science Foundation Team Project of Guangdong Province[2018B030312009].
文摘Background:This study aimed to assess the performance of transient elastography(TE),two-dimensional shear wave elastography(2D-SWE),and magnetic resonance elastography(MRE)for staging significant fibrosis and cirrhosis in untreated chronic hepatitis B(CHB)patients.Methods:Pubmed,Embase,Web of Science,and Cochrane Library were searched for terms involving CHB,TE,2D-SWE,and MRE.Other etiologies of chronic liver disease,previous treatment in patients,or articles not published in SCI journals were excluded.Hierarchical non-linear models were used to evaluate the diagnostic accuracy of TE,2D-SWE,and MRE.Heterogeneity was explored via analysis of threshold effect and meta-regression.Results:Twenty-eight articles with a total of 4,540 untreated CHB patients were included.The summary areas under the receiver-operating characteristic curves(AUROCs)using TE,2D-SWE,and MRE for predicting significant fibrosis(SF)were 0.84,0.89,and 0.99,respectively.The AUROC values of TE,2D-SWE,and MRE for staging cirrhosis were 0.9,0.94,and 0.99,respectively.Based on the meta-analysis of studies with head-to-head comparison,2D-SWE is superior to TE(0.92 vs 0.85,P<0.01)in staging significant fibrosis.Conclusion:TE,2D-SWE,and MRE express acceptable diagnostic accuracies in staging significant fibrosis and cirrhosis in untreated CHB patients.2D-SWE outperforms TE in detecting significant fibrosis in treatment-naive people with hepatitis B virus.
文摘The tissue stiffness is always an interesting issue to clinicians.Traditionally,it is assessed by the manual palpation,and this now can be measured by the ultrasound-based elastography.The basic physics is based on Young's modulus through the Hooke's law:E=S/e,where the Young's modulus(E)equals to the stress applied to the object(S)divided by the generated strain(e).With the rapid advancement of technology,the elastography has evolved from quasi-static elastography(ie,strain elastography)to dynamic elastography(i,e,shear wave elastography).The key differentiation of these two categories roots in the stimuli applied,namely mechanical or acoustic radiation force,and the response of the soft tissue.The strain elastography requires the operator to compress and decompress the tissue manually and the motion of the tissue during the stimuli is tracked to calculate the strain to reflect the tissue stiffness.While strain elastography is operator-dependent,shear wave elastography is not.Using shear wave elastography,the tissue is stimulated by the acoustic radiation force which can generate shear wave traveling through the tissue transversely.The shear wave propagation speed(Vs)is related to the shear modulus(μ)of the medium:μ=pVs^(2),where p is the density of the tissue and assumed to be a constant as 1000 kg/m^(3).In the incompressible biological tissue,the Young's modulus is approximately three times the shear modulus(E≈3μ).So the quantitative measurements of the tissue stiffness can be attained by shear wave elastography.The clinical application of elastography and its diagnostic capability has been extended.The knowledge of the basic physics of the various type of elastography facilitates the effective use of elastography.This review presented the clinical application and the risks of different types of elastography.
基金the financial support by the National Natural Science Foundation of China(51371078,51671067)
文摘The room temperature brittleness has been a long standing problem in bulk metallic glasses realm.This has seriously limited the application potential of metallic glasses and their composites.The elastic deformation behaviors of metallic glass matrix composites are closely related to their plastic deformation states.The elastic deformation behaviors of Cu48-xZr48Al4Nbx（x=0,3at.%）metallic glass matrix composites（MGMCs）with different crystallization degrees were investigated using an in-situ digital image correlation（DIC）technique during tensile process.With decreasing crystallization degree,MGMC exhibits obvious elastic deformation ability and an increased tensile fracture strength.The notable tensile elasticity is attributed to the larger shear strain heterogeneity emerging on the surface of the sample.This finding has implications for the development of MGMCs with excellent tensile properties.
