Diagnostic accuracy of the aspartate aminotransferase-to-platelet ratio index for the prediction of hepatitis B-related fibrosis: a leading meta-analysis

<p>Abstract</p> <p>Background</p> <p>The aspartate aminotransferase-to-platelet ratio index (APRI), a tool with limited expense and widespread availability, is a promising noninvasive alternative to liver biopsy for detecting hepatic fibrosis. The objective of this study was to systematically review the performance of the APRI in predicting significant fibrosis and cirrhosis in hepatitis B-related fibrosis.</p> <p>Methods</p> <p>Areas under summary receiver operating characteristic curves (AUROC), sensitivity and specificity were used to examine the accuracy of the APRI for the diagnosis of hepatitis B-related significant fibrosis and cirrhosis. Heterogeneity was explored using meta-regression.</p> <p>Results</p> <p>Nine studies were included in this meta-analysis (n = 1,798). Prevalence of significant fibrosis and cirrhosis were 53.1% and 13.5%, respectively. The summary AUCs of the APRI for significant fibrosis and cirrhosis were 0.79 and 0.75, respectively. For significant fibrosis, an APRI threshold of 0.5 was 84% sensitive and 41% specific. At the cutoff of 1.5, the summary sensitivity and specificity were 49% and 84%, respectively. For cirrhosis, an APRI threshold of 1.0-1.5 was 54% sensitive and 78% specific. At the cutoff of 2.0, the summary sensitivity and specificity were 28% and 87%, respectively. Meta-regression analysis indicated that the APRI accuracy for both significant fibrosis and cirrhosis was affected by histological classification systems, but not influenced by the interval between Biopsy & APRI or blind biopsy.</p> <p>Conclusion</p> <p>Our meta-analysis suggests that APRI show limited value in identifying hepatitis B-related significant fibrosis and cirrhosis.</p

Influencing factors for the length of hospital stay in patients with drug-induced liver injury

ObjectiveTo investigate the influencing factors for the length of hospital stay in patients with drug-induced liver injury (DILI), and to guide clinical practice, reduce the pressure of hospitalization, and reduce the patients′ economic burden. MethodsThe clinical data of the patients with DILI who were hospitalized in Qingdao Municipal Hospital from January 2012 to December 2014 were collected, including age, sex, primary disease, medication history, routine blood test, liver function parameters, DILI type, medication, and prognosis. The Spearman rank correlation, Wilcoxon rank sum test, and Kruskal-Wallis H rank sum test were used to analyze the influencing factors for the length of hospital stay. A multivariate linear regression analysis was performed for the factors with statistical significance determined by the univariate analysis. ResultsThe clinical data of 191 patients with DILI were collected. Among these patients, there were 114 male and 77 female patients aged 11-84 years (mean 50.83±2.72 years), and the mean hospital stay was 14 days (range 4-41 days). Patient′s age, the highest levels of alanine aminotransferase (ALT)/alkaline phosphatase (ALP)/total bilirubin (TBil), and the lowest level of prothrombin activity (PTA) were positively correlated with the length of hospital stay (rs=0.388, 0.247, 0.172, 0.487, and 0.120, all P＜0.05). The presence or absence of the histories of underlying liver disease, hypertension, malignant tumors, tuberculosis, and hyperthyroidism, use of different suspected drugs, therapies for DILI, and DILI types were the influencing factors for the length of hospital stay in patients with DILI (all P＜0.05). The multivariate linear regression analysis showed that age, the histories of underlying liver disease and malignant tumors, traditional Chinese medicine, antipyretic and analgesic drugs, the highest levels of ALT/ALP/TBil, the lowest level of PTA, therapies for DILI, and DILI types were independent risk factors for the length of hospital stay in patients with DILI (all P＜0.05). ConclusionAge, the histories of underlying liver disease and malignant tumors, traditional Chinese medicine, antipyretic and analgesic drugs, the highest levels of ALT/ALP/TBil, the lowest level of PTA, therapies for DILI, and DILI types are influencing factors for the length of hospital stay in patients with DILI. Regulation of the influencing factors for the length of hospital stay during clinical diagnosis and treatment can reduce hospital costs and plays an important role in reducing healthcare burden

The Long-term Outcome After Resection of Upper Cervical Spinal Cord Tumors: Report of 51 Consecutive Cases

Abstract The literature discussing the long-term outcome after resection of upper cervical spinal cord tumors is limited. The purpose of this study was to review the progression-free survival (PFS), overall survival (OS), and long-term outcomes in a consecutive series of 51 patients with upper cervical spinal cord tumors who underwent surgery at our institution between 2005 and 2010. Patient outcome were evaluated using the Japanese Orthopaedic Association score (JOA) and the McCormick functional schema. Follow-up data was collected completely and the median follow-up time was 6.1 years. Gross total resection (GTR) was performed in 27 patients (52.94%) and subtotal resection (STR) in 24 patients (47.06%). Progression-free survival and overall survival at 5 years was 88.23% and 92.16%, respectively. Good prognosis was defined as 74.51% based on JOA scoring. The univariate analysis showed that patients over 60y, tumors located higher than C2, tumor size greater than 4 cm as well as malignant tumors and subtotal resection were factors indicating a poor prognosis. However, the multivariate regression analyses showed only the level of tumor and tumor size were independent risk factors for a poor prognosis. The gold standard treatment for intraspinal tumors is gross total resection and follow-up should be focused on patients with a high risk of poor prognosis

Study on the Physical Properties and Joint Evolution Characteristics of Three-Dimensional Reconstructed Coal

There are various complex joints (fissures), laminae, and other soft structural surfaces in the roadway enclosure, and the existence of these soft structural surfaces seriously affects the stability of the roadway enclosure. In order to study the mechanical properties of the coal body and the development of joints during coal fracture, this paper establishes a three-dimensional model of the fracture structure of the coal body based on CT scanning and three-dimensional reconstruction technology. On this basis, a 3D numerical model of the equivalent nodal coal body is constructed, uniaxial compression simulation analysis is performed, and the joint evolution development law of the coal sample is studied by the built-in joint monitoring program of PFC3D. The results show that the larger the effective joint area and larger the joint size inside the coal sample, the smaller the compressive strength of the coal sample. The increase of joint size and joint surface area increased the ductility and stress-strain curve multipeak phenomenon of the coal sample to some extent. During the rupture of the coal sample, the changes of each phase of the statistical curve of joint number and the phases of the stress-strain curve of the coal sample are compatible