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| 1 | Increased circulating zonulin in children with biopsy-proven nonalcoholic fatty liver disease显示文摘AIM:To investigate the potential association of circulating zonulin with the stage of liver disease in obese children with biopsy-confirmed nonalcoholic fatty liver disease(NAFLD).METHODS:A case-control study was performed.Cases were 40 obese children with NAFLD.The diagnosis of NAFLD was based on magnetic resonance imaging(MRI)with high hepatic fat fraction(HFF≥5%),and confirmed by liver biopsy with≥5%of hepatocytes containing macrovesicular fat.Controls were selected from obese children with normal levels of aminotransferases,and without MRI evidence of fatty liver as well as of other causes of chronic liver diseases.Controls were matched(1-to 1)with the cases on age,gender,pubertal stage and as closely as possible on body mass index-standard deviation score.All participants underwent clinical examination,laboratory testsincluding zonulin,inflammatory and metabolic parameters,and MRI for measurement of HFF and visceral adipose tissue.RESULTS:Zonulin values were significantly greater in obese subjects with NAFLD than in those without NAFLD[median(interquartile range),4.23(3.18-5.89)vs 3.31(2.05-4.63),P<0.01].In patients with NAFLD,zonulin concentrations increased significantly with the severity of steatosis and the Spearman’s coefficient revealed a positive correlation between zonulin values and steatosis(r=0.372,P<0.05);however,we did not find a significant correlation between zonulin and lobular inflammation(P=0.23),ballooning(P=0.10),fibrosis score(P=0.18),or presence of nonalcoholic steatohepatitis(P=0.17).Within the entire study population,zonulin levels were positively associated with gamma-glutamyl transferase,2-h insulin,HFF,and negatively associated with whole-body insulin sensitivity index(WBISI),after adjustment for age,gender and pubertal status.When the associations were restricted to the group of NAFLD patients,2-h insulin,hepatic fat,and WBISI retained statistical significance.CONCLUSION:Circulating zonulin is increased in children and adolescents with NAFLD and correlates with the severity of steatosis. | Lucia Pacifico Enea Bonci Lidia Marandola Sara Romaggioli Stefano Bascetta Claudio Chiesa | 2014 | World Journal of Gastroenterology2014，20，45： | 4 |
| 2 | 病案教学法应用于儿科教学的体会显示文摘医学课是临床实践性与综合性较强的学科,应采用多方面、多渠道对医疗所需人才进行培养。本次研究基于中国医科大学附属盛京医院,将病案教学法应用于儿科教学中,通过使用不同的模拟病案教学法对不同教学阶段儿科护理教学,达到将护生引入临床实践中,起到事半功倍的教学效果,在扩展护生理论知识的同时,可培养其自学、查阅资料的能力、分析力、解决问题的能力、语言表达能力等,具有教学应用价值。 | 单丽沈 周倩兰 尚云晓 | 2017 | 中国继续医学教育2017，9，14： | 3 |
| 3 | Adipokines and C-reactive protein in relation to bone mineralization in pediatric nonalcoholic fatty liver disease显示文摘AIM: To investigate bone mineral density (BMD) in obese children with and without nonalcoholic fatty liver disease (NAFLD); and the association between BMD and serum adipokines, and high-sensitivity C-reactive protein (HSCRP). METHODS: A case-control study was performed. Cases were 44 obese children with NAFLD. The diagnosis of NAFLD was based on magnetic resonance imaging (MRI) with high hepatic fat fraction (≥ 5%). Other causes of chronic liver disease were ruled out. Controls were selected from obese children with normal levels of aminotransferases, and without MRI evidence of fatty liver as well as of other causes of chronic liver diseases. Controls were matched (1-to 1-basis) with thecases on age, gender, pubertal stage and as closely as possible on body mass index-SD score. All participants underwent clinical examination, laboratory tests, and whole body (WB) and lumbar spine (LS) BMD by dual energy X-ray absorptiometry. BMDZ-scores were calcu- lated using race and gender specific LMS curves. RESULTS: Obese children with NAFLD had a significantly lower LS BMDZ-score than those without NAFLD [mean, 0.55 (95%CI: 0.23-0.86) vs 1.29 (95%CI: 0.95-1.63); P < 0.01]. WB BMD Z-score was also decreased in obese children with NAFLD compared to obese children with no NAFLD, though borderline significance was observed [1.55 (95%CI: 1.23-1.87) vs 1.95 (95%CI: 1.67-2.10); P = 0.06]. Children with NAFLD had significantly higher HSCRP, lower adiponectin, but similar leptin levels. Thirty five of the 44 children with MRI-diagnosed NAFLD underwent liver biopsy. Among the children with biopsy-proven NAFLD, 20 (57%) had nonalcoholic steatohepatitis (NASH), while 15 (43%) no NASH. Compared to children without NASH, those with NASH had a significantly lower LS BMD Z-score [mean, 0.27 (95%CI: -0.17-0.71) vs 0.75 (95%CI: 0.13-1.39); P < 0.05] as well as a significantly lower WB BMD Z-score [1.38 (95%CI: 0.89-1.17) vs 1.93 (95%CI: 1.32-2.36); P < 0.05]. In multiple regression analysis, NASH (standardized β coefficient, -0.272; P < 0.01) and HSCRP (standardized β coefficient, -0.192; P < 0.05) were significantly and independently associated with LS BMD Z-score. Similar results were obtained when NAFLD (instead of NASH) was included in the model. WB BMD Z-scores were significantly and independently associated with NASH (standardized β coefficient, -0.248;P < 0.05) and fat mass (standardized β coefficient, -0.224;P < 0.05). CONCLUSION: This study reveals that NAFLD is associated with low BMD in obese children, and that systemic, low-grade inflammation may accelerate loss of bone mass in patients with NAFLD. | Lucia Pacifico Mario Bezzi Concetta Valentina Lombardo Sara Romaggioli Flavia Ferraro Stefano Bascetta Claudio Chiesa | 2013 | World Journal of Gastroenterology2013，19，25： | 3 |
| 4 | 基于低场磁共振的脉冲序列设计和成像研究显示文摘目的利用低场磁共振序列设计平台探讨脉冲序列的设计方法,并分析评价成像质量。方法在低场磁共振平台上,基于序列编码语言及脉冲和编码梯度的最佳施加时间来设计成像序列,并对含油和硫酸铜的样品管进行成像,然后根据T_1、T_2、质子密度、回波时间、重复时间等基本成像参数对样品管图像进行比较和验证。结果探索出磁共振成像序列设计的基本方法和流程,并且获得了清晰的磁共振图像。结论低场磁共振可作为基础研究平台用以设计成像序列并进行成像。在进一步的研究中,可针对不同组织部位设计具有特异性效果的脉冲序列,以将磁共振技术更好地应用于临床。 | 高宏建 易周 吴水才 杨春兰 薛艳青 | 2013 | 北京生物医学工程2013，32，3： | 3 |
| 5 | 三酰甘油/高密度脂蛋白胆固醇比值对青少年肥胖人群非酒精性脂肪性肝病的预测价值显示文摘目的:探讨三酰甘油/高密度脂蛋白胆固醇比值(TG/HDL-C)对肥胖青少年非酒精性脂肪性肝病(NAFLD)的预测价值。方法:选取2012年8月至2017年8月无锡市第二人民医院内分泌科门诊或住院的肥胖青少年患者共114例,收集腰围(WC)、体质指数(BMI)、血压(BP)、氢质子磁共振波普数据(1H-MRS)、血清谷丙转氨酶(ALT)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)及胰岛素(INS)等临床指标,计算TG/HDL-C及稳态模型胰岛素抵抗指数(HOMA-IR)。结果:两组患者的年龄、性别、BMI、TC、腰围、舒张压、ALT和空腹血糖及胰岛素差异无统计学意义。高TG/HDL-C组患者收缩压和肝脏三酰甘油含量均显著高于低TG/HDL-C组(P<0.05)。多因素Logistic回归分析提示:TG/HDL-C是青少年肥胖人群患NAFLD的独立危险因素(OR=5.78,95%CI 2.23~14.97)。TG/HDL-C预测青少年肥胖人群患NAFLD的ROC曲线下面积为0.73,以2.64为诊断界点时,灵敏度为72.5%,特异度为71.6%。结论:TG/HDL-C有助于预测肥胖青少年人群NAFLD的患病风险。 | 王卓平 黄雌友 王雯 姚伟峰 | 2019 | 中国临床医学2019，26，6： | 3 |
| 6 | Pediatric fatty liver disease:Role of ethnicity and genetics显示文摘Non-alcoholic fatty liver disease(NAFLD)comprehends a wide range of conditions,encompassing from fatty liver or steatohepatitis with or without fibrosis,to cirrhosis and its complications.NAFLD has become the most common form of liver disease in childhood as its prevalence has more than doubled over the past 20years,paralleling the increased prevalence of childhood obesity.It currently affects between 3%and11%of the pediatric population reaching the rate of46%among overweight and obese children and adolescents.The prevalence of hepatic steatosis varies among different ethnic groups.The ethnic group with the highest prevalence is the Hispanic one followed by the Caucasian and the African-American.This evidence suggests that there is a strong genetic background in the predisposition to fatty liver.In fact,since 2008several common gene variants have been implicated in the pathogenesis of fatty liver disease.The most important is probably the patatin like phospholipase containing domain 3 gene(PNPLA3)discovered by the Hobbs’group in 2008.This article reviews the current knowledge regarding the role of ethnicity and genetics in pathogenesis of pediatric fatty liver. | Pierluigi Marzuillo Emanuele Miraglia del Giudice Nicola Santoro | 2014 | World Journal of Gastroenterology2014，20，23： | 3 |
| 7 | 脑转移瘤周围脑水肿通透性的磁共振成像定量研究显示文摘目的 探讨容量转移常数(Ktrans)对脑转移瘤周水肿的血管通透性的定量评价价值。方法选择54名经临床证实脑转移瘤的患者纳入研究,选择脑转移性灶共72个。所有患者均进行磁共振平扫和动态对比增强磁共振(DCE-MRI)检查,其中包括双角度(2°和15°)增强的T1W-VIBE(容积插值屏气检查)序列,以计算T1参数图。使用增强的T1-3D序列来测量肿瘤体积,通过Tofts双室模型计算Ktrans。对Ktrans、瘤周水肿指数(EI)、肿瘤体积之间的相关性进行了统计学分析。结果 Ktrans和瘤周水肿指数(EI)高度相关(r=0.67,P<0.001),Ktrans与肿瘤体积无统计学相关性(r=0.10,P=0.334),而EI与肿瘤体积有统计学相关性(r=0.23,P=0.031)。结论 Ktrans和瘤周水肿指数(EI)显著相关,可以作为评估脑转移瘤周围水肿的定量指标。 | 高强 王传堂 孙丽英 | 2022 | 实用医学影像杂志2022，23，4： | 0 |
| 8 | Changes of liver fat content and transaminases in obese children after 12-mo nutritional intervention显示文摘AIM:To assess a relationship between longitudinal changes in liver fat content and biochemical parameters in obese children after 1-year nutritional intervention.METHODS:Forty-six obese children, 21 males and 25females, aged 6-14 years, underwent metabolic measurements, liver ultrasonography(US) and chemicalshift magnetic resonance imaging(MRI) examinations at baseline and after 1-year nutritional intervention. A child was defined obese if her/his body mass index(BMI)was above the age- and sex-adjusted BMI Cole's curve passing through the cut-off of 30 kg/m2 at 18 years.BMI Z scores were calculated and adjusted for age and gender by using the Cole's LMS-method and Italian reference data. Biochemistry included serum alanine aminotransferase(ALT) and aspartate aminotransferase(AST). Abdominal US and chemical-shift MRI were performed according to a randomized sequence.The same radiologist performed US by a GE Logiq 9(General Electric Healthcare Medical Systems, Milwaukee, WI, United States) using a 3.5-MHz convex array transducer. Liver echogenicity was evaluated independently on videotape by 3 radiologists unaware of the child and MRI outcomes, and a consensus was established. Another experienced radiologist, unaware of the child and US data, performed the abdominal chemicalshift MRI with a 1-t system NT-Intera(Philips Medical Systems, Best, The Netherlands) and a phased-array coil. Liver fat fraction(FF) on MRI was judged elevated when greater than 9%. A FF>18% was considered expressing more severe cases of fatty liver according to Fishbein. A nutritional-behavioral intervention was recommended to promote a normocaloric balanced diet and active lifestyle based on the Italian guidelines for treatment of childhood obesity.RESULTS:Compared to baseline, at the end of intervention children showed lower intakes of energy(mean± SD:2549±1238 Kcal vs 1770±622 Kcal, P<0.0001), total fat(90±47 g vs 52± 23g, P<0.0001),carbohydrates(356±174g vs 241±111 g, P=0.001),and protein(99±48g vs 75±23g, P=0.006) intakes. Prevalence of FF≥9% declined from 34.8%to 8.7%(P<0.01), with a mean reduction of 7.8%(95%CI:5.0-10.6). At baseline, FF was associated with liver biochemical parameters(maximum P<0.001). At the end of the intervention association was found with AST(P=0.017). Change of FF was associated with change in AST(P =0.027) and ALT(P=0.024). Rate of increased liver echogenicity declined from 45.6% to21.7%(P<0.0001). Liver echogenicity was associated with ALT at baseline only(P<0.001). An age-and sexadjusted multiple regression analysis showed that FF change was independently associated with change in serum AST(adjusted regression coefficient 0.348, P=0.048).CONCLUSION:The results suggest that in obese children longitudinal changes in liver fat content based on MRI may be associated with change in serum transaminases suggesting novelty in monitoring nonalcoholic fatty liver disease. | Elvira Verduci Carlo Pozzato Giuseppe Banderali Giovanni Radaelli Chiara Arrizza Antonio Rovere Enrica Riva Marcello Giovannini | 2013 | World Journal of Hepatology2013，5，9： | 0 |
| 9 | 磁共振及超声瞬时弹性成像对代谢相关脂肪性肝病定量评估的研究进展显示文摘代谢相关脂肪性肝病(MAFLD)会导致脂肪性肝炎、肝硬化及肝细胞性癌。肝穿刺是诊断MAFLD的金标准。然而,有创检查不能广泛应用于临床实践中,无创诊断MAFLD是未来发展趋势。目前主要的检查方法有超声瞬时弹性成像、磁共振质子密度脂肪分数、磁共振波谱成像、磁共振弹性成像等。因此,本文就MRI及超声瞬时弹性成像技术在MAFLD定量评估中的研究进展进行综述,旨在为临床精准诊疗提供影像标记物。 | 王妙艳 朱立红 华晨辰 钱超越 章乐 蒋昊翔 | 2024 | 中国CT和MRI杂志2024，22，1： | 0 |
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