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| 1 | Transient elastography compared to liver biopsy and morphometry for predicting fibrosis in pediatric chronic liver disease: Does etiology matter?显示文摘AIM: To evaluate transient elastography(TE) as a noninvasive tool in staging liver fibrosis compared with liver biopsy and morphometry in children with different chronic liver diseases.METHODS: A total of 90 children [50 with chronic hepatitis C virus(HCV), 20 with autoimmune hepatitis(AIH) and 20 with Wilson disease] were included in the study and underwent liver stiffness measurement(LSM) using TE. Liver biopsies were evaluated for fibrosis, qualitatively, by Ishak score and quantitatively by fibrosis area fraction(FAF) using digital image analysis(morphometry). LSM was correlated with fibrosis and other studied variables using spearman correlation. A stepwise multiple regression analysis was alsoperformed to examine independent factors associated with LSM. Different cut-off values of LSM were calculated for predicting individual fibrosis stages using receiveroperating characteristic curve. Cut-off values with optimal clinical performance(optimal sensitivity and specificity simultaneously) were selected.RESULTS: The majority of HCV group had minimal activity(80%) and no/mild fibrosis(72%). On the other hand, the majority of AIH group had mild to moderate activity(70%) and moderate to severe fibrosis(95%) and all Wilson disease group had mild to moderate activity(100%) and moderate to severe fibrosis(100%). LSM correlated significantly with both FAF and Ishak scores and the correlation appeared better with the latter(r = 0.839 vs 0.879, P < 0.0001 for both). LSM discriminated individual stages of fibrosis with high performance. Sensitivity ranged from 81.4% to 100% and specificity ranged from 75.0% to 97.2%. When we compared LSM values for the same stage of fibrosis, they varied according to the different etiologies. Higher values were in AIH(16.15 ± 7.23 k Pa) compared to Wilson disease(8.30 ± 0.84 k Pa) and HCV groups(7.43 ± 1.73 k Pa). Multiple regression analysis revealed that Ishak fibrosis stage was the only independent variable associated with higher LSM(P < 0.0001).CONCLUSION: TE appears reliable in distinguishing different stages of liver fibrosis in children. However, its values vary according to the disease type. For that, a disease-specific estimation of cut-off values for fibrosis staging is worthy. | Behairy El-Sayed Behairy Mostafa Mohamed Sira Khaled Refat Zalata El-Sayed Ebrahem Salama Mohamed Ahmed Abd-Allah | 2016 | World Journal of Gastroenterology2016，22，16： | 6 |
| 2 | 同时性肝肾联合移植适应症探讨显示文摘器官移植技术形成于20世纪中叶,成熟于20世纪后半叶,因其显著改善了人类生存状态,成为20世纪最重要的医学成就之一。随着手术技术、医疗设备、麻醉、免疫等学科的进步和相关器官移植法律、伦理学的完善,器官移植技术已成为治疗人类终末期器官疾病成熟而有效的方法。近50年的肝脏移植发展显示:影响肝移植疗效的主要危险因素从早期的手术相关并发症、急慢性排斥和乙肝复发转变为丙肝复发、糖尿病、恶性肿瘤和肾功能不全, | 赵红川 耿小平 | 2015 | 肝胆外科杂志2015，23，4： | 1 |
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