The Gut Microbiota,Tumorigenesis, and Liver Diseases

In recent decades, diseases concerning the gut microbiota have presented some of the most serious public health problems worldwide. The human host’s physiological status is influenced by the intestinal microbiome, thus integrating external factors, such as diet, with genetic and immune signals. The notion that chronic inflammation drives carcinogenesis has been widely established for various tissues. It is surprising that the role of the microbiota in tumorigenesis has only recently been recognized, given that the presence of bacteria at tumor sites was first described more than a century ago. Extensive epidemiological studies have revealed that there is a strong link between the gut microbiota and some common cancers. However, the exact molecular mechanisms linking the gut microbiota and cancer are not yet fully understood. Changes to the gut microbiota are instrumental in determining the occurrence and progression of hepatocarcinoma, chronic liver diseases related to alcohol, nonalcoholic fatty liver disease (NAFLD), and cirrhosis. To be specific, the gut milieu may play an important role in systemic inflammation, endotoxemia, and vasodilation, which leads to complications such as spontaneous bacterial peritonitis and hepatic encephalopathy. Relevant animal studies involving gut microbiota manipulations, combined with observational studies on patients with NAFLD, have provided ample evidence pointing to the contribution of dysbiosis to the pathogenesis of NAFLD. Given the poor prognosis of these clinical events, their prevention and early management are essential. Studies of the composition and function of the gut microbiota could shed some light on understanding the prognosis because the microbiota serves as an essential component of the gut milieu that can impact the aforementioned clinical events. As far as disease management is concerned, probiotics may provide a novel direction for therapeutics for hepatocellular carcinoma (HCC) and NAFLD, given that probiotics function as a type of medicine that can improve human health by regulating the immune system. Here, we provide an overview of the relationships among the gut microbiota, tumors, and liver diseases. In addition, considering the significance of bacterial homeostasis, we discuss probiotics in this article in order to guide treatments for related diseases.     

Targeting Gut Microbiota Dysbiosis: Potential Intervention Strategies for Neurological Disorders

It is well known that the gut microbiota plays an extremely important role in modulating host physiological functions such as immunity and metabolic homeostasis. In recent years, accumulated evidence has revealed that the gut microbiota can regulate the functions of the central nervous system (CNS) through the gut–brain axis, which provides a novel insight into the interactions between the gut and brain. This review focuses on the molecular mechanism of the crosstalk between the gut microbiota and the brain via the gut–brain axis, and on the onset and development of neurological disorders triggered by gut microbiota dysbiosis. These topics are followed by a critical analysis of potential intervention strategies targeting gut microbiota dysbiosis, including the use of probiotics, prebiotics, synbiotics, and diets. While research on the microbiota–gut–brain axis is still in its relative infancy, clarifying the molecular mechanism that underlies how the gut microbiota regulates neurological functions not only holds the promise of revealing potentially novel pathogeneses of neurological disorders, but also may lead to the development of potential diagnosis biomarkers and intervention strategies targeting microbiota dysbiosis for neurological disorders.     

64排多层螺旋CT冠状动脉成像在临床中的应用价值

目的:探讨64排多层螺旋CT冠状动脉成像的临床应用价值.方法:对230例临床拟诊为冠心病患者行64排多层螺旋CT血管成像,对所有原始数据进行冠状动脉三维重建等图像后处理,显示冠状动脉主干及主要分支,并对图像质量进行判定.结果:对比选择性冠状动脉造影检查显示64排多层螺旋CT冠状动脉成像对中度及以上狭窄的敏感性和特导性分别为92.5％和96.3％.结论:64排螺旋CT对中度及以上的冠脉狭窄具有良好的诊断价值,基本满足冠心病的诊断需求,可作为冠心病高危人群的一种初筛手段,具有重要的临床应用价值.     

应用无创性影像学方法探讨冠状动脉和颅脑动脉粥样硬化相关性及临床价值

目的：探讨冠状动脉和颅脑动脉粥样硬化相关性及其临床应用价值。方法：选取疑似冠心病患者90例,分别进行CT血管造影、颈动脉超声、经颅多普勒超声检查,统计对比相关指标。结果：经CCTA评估轻度狭窄31例、中度狭窄32例、重度狭窄27例;冠状动脉狭窄程度不同患者颈动脉超声检查IMT、斑块数目差异、TCD颅内血管PI、RI指标差异具有统计学意义（P＜0.05）。结论：冠状动脉与颅脑动脉粥样硬化具有一致性,因此冠心病患者应积极诊断、治疗脑血管疾病。     

老年冠状动脉粥样硬化性心脏病(冠心病)患者心律失常和心肌缺血诊断中动态心电图的临床价值

目的:探究动态心电图在老年冠状动脉粥样硬化性心脏病(冠心病)患者心律失常和心肌缺血诊断中的临床应用价值.方法:选择2018年6月至2020年6月在我院接受诊疗的70例冠状动脉粥样硬化性心脏病患者作为研究对象,随机将患者分成两组,35例对照组患者接受常规心电图检查,另外35例观察组患者接受动态心电图检查.对比两组患者心律...     

基于光流法的冠状动脉造影图像序列中血管运动的估计

利用冠状动脉造影图像序列进行二维血管运动的分析，对于准确估计与解释心脏的运动，从而正确诊断心血管和心脏疾病十分关键。同时也是由血管造影图进行冠状动脉树三维重建的重要步骤。笔者采用光流法对单面冠状动脉造影图像序列进行血管运动估计，以动脉分叉点作为运动跟踪的标志，并提出在很短的时间间隔内冠状动脉上很小部分的运动可以认为是简单平移的假设，从而计算出血管以及相关心外膜的运动参数。     

弹性配准在冠状动脉三维运动分析中的应用

针对冠状动脉的运动分析问题,本文提出基于弹性配准的血管骨架三维运动估计方法.在对X射线冠脉造影图像序列进行三维血管骨架序列重建的基础上,寻找两个时刻同一血管分支上点之间的对应关系,得到各点的运动向量.通过使适当的目标函数最小化,运用动态规划算法,得到最优匹配.通过采用运动场已知的模拟数据对算法精度进行定量估计,并采用临床图像序列进行实验,结果表明,算法具有较高的精度和较快的运算速度.     

基于冠脉造影序列信息的基础矩阵计算方法

在冠脉造影的三维重建过程中,由于在成像过程中不同方向上的对应图像形状差别很大,通过常规的特征点匹配方法得不到匹配点,因此只能手动选取血管中轴的分叉点作为特征点,这样得到的特征点的数目有限,一般为十个左右,这样对于基础矩阵的精确计算是一个难点.为了解决这一难题,本文利用冠状动脉造影序列信息提取大样本匹配点对,将景物重建中的常用的随机采样一致性(RANSAC)方法应用到冠状动脉造影三维重建中来.试验表明本方法对冠脉造影的对极几何估计具有很强的适应性和鲁棒性.     

Coronary artery calcification in Korean patients with incident dialysis

Introduction: Patients with chronic kidney disease have an extremely high risk of developing cardiovascular disease (CVD). In patients with end‐stage renal disease (ESRD), coronary artery calcification (CAC) is associated with increased mortality from CVD. Methods: The present study aimed to investigate the risk factors for CAC in Korean patients with incident dialysis. Data on 423 patients with ESRD who started dialysis therapy between December 2012 and March 2014 were obtained from 10 university‐affiliated hospitals. CAC was identified by using noncontrast‐enhanced cardiac multidetector computed tomography. The CAC score was calculated according to the Agatston score, with CAC‐positive subjects defined by an Agatston score >0. Findings: Patients' mean age was 55.6 ± 14.6 years, and 64.1% were men. The CAC‐positive rate was 63.8% (270 of 423). Results of univariate analyses showed significant differences in age, sex, etiology of ESRD and comorbid conditions according to the CAC score. However, results of multiple regression analysis showed that only a higher age was significantly associated with the CAC score. Receiver operating characteristic curves showed that the sensitivity and specificity of L‐spine radiography for diagnosing CAC were 56% and 91%, respectively, for diagnosing CAC (area under the curve, 0.735). Discussion: CAC was frequent in patients with incident dialysis, and multiple regression analysis showed that only age was significantly associated with the CAC score. In addition, L‐spine radiography could be a helpful modality for diagnosing CAC in patients with incident dialysis.     

A seed-like hydrogel with metabolic cascade microbiota for oral treatment of liver failure

Liver failure is a fatal disease with a mortality rate of 80%. The only access to treat liver failure is invasive operation, which is restricted by limited donor sources or high costs. Thus, non-invasive medication for liver failure is urgently needed. Herein, we tried the first attempt to design a seed-inspired hydrogel with a micro-ecosystem, which imitates characteristics of seed with high intestinal adaptability, for the elimination of harmful metabolites in liver failure using a cascade reaction triggered by encapsulated microbes. Focusing on abnormal ammonia assimilation and intestinal oxygen metabolism, a two-component artificial microbiota was constructed to enable efficient intestinal oxygen consumption and subsequent hypoxia-induced ammonia elimination. More importantly, we imitated plant seeds with high adaptability to the intestinal environment to improve the performance of bacteria. A hydrogel particle with the seed shape, lignin coating, and porous structure, for achieving intentional retention, bacterial protection, and diffusion promotion, respectively was prepared. In murine and porcine models of liver failure, the artificial reactor lowered the blood ammonia to prevent nerve damage, and consumed oxygen to inhibit pathogenic facultative anaerobes for alleviating liver failure. This work underscores the great potential of medication with a bioinspired micro-ecosystem for liver failure.     

变形模型技术在冠状动脉造影图像序列后处理中的应用

以冠状动脉血管轴线的三维运动跟踪和心脏的形状建模为例,论述了变形模型在X射线心血管造影图像序列后处理中的应用.首先采用3D snake模型,表示血管轴线的曲线在三维空间中的变形,完成对血管骨架的序列重建.然后以各时刻的血管骨架点作为采样点,采用基于扩展超二次曲面的变形模型,建立心脏形状模型,通过分析不同时刻模型参数的变化,获得心脏变形参数的估计.     

Metaheuristics with Deep Learning Empowered Biomedical Atherosclerosis Disease Diagnosis and Classification

Atherosclerosis diagnosis is an inarticulate and complicated cognitive process. Researches on medical diagnosis necessitate maximum accuracy and performance to make optimal clinical decisions. Since the medical diagnostic outcomes need to be prompt and accurate, the recently developed artificial intelligence (AI) and deep learning (DL) models have received considerable attention among research communities. This study develops a novel Metaheuristics with Deep Learning Empowered Biomedical Atherosclerosis Disease Diagnosis and Classification (MDL-BADDC) model. The proposed MDL-BADDC technique encompasses several stages of operations such as pre-processing, feature selection, classification, and parameter tuning. Besides, the proposed MDL-BADDC technique designs a novel Quasi-Oppositional Barnacles Mating Optimizer (QOBMO) based feature selection technique. Moreover, the deep stacked autoencoder (DSAE) based classification model is designed for the detection and classification of atherosclerosis disease. Furthermore, the krill herd algorithm (KHA) based parameter tuning technique is applied to properly adjust the parameter values. In order to showcase the enhanced classification performance of the MDL-BADDC technique, a wide range of simulations take place on three benchmarks biomedical datasets. The comparative result analysis reported the better performance of the MDL-BADDC technique over the compared methods.     

Ascidian-Inspired Temperature-Switchable Hydrogels with Antioxidant Fullerenols for Protecting Radiation-Induced Oral Mucositis and Maintaining the Homeostasis of Oral Microbiota

A key characteristic of radiation-induced oral mucositis (RIOM) is oxidative stress mediated by the “reactive oxygen species (ROS) storm” generated from water radiolysis, resulting in severe pathological lesions, accompanied by a disturbance of oral microbiota. Therefore, a sprayable in situ hydrogel loaded with “free radical sponge” fullerenols (FOH) is developed as antioxidant agent for RIOM radioprotection. Inspired by marine organisms, 3,4,5-trihydroxyphenylalanine (TOPA) which is enriched in ascidians is grafted to clinically approved temperature-switchable Pluronic F127 to produce gallic acid (containing the TOPA fragment)-modified Pluronic F127 (MGA) hydrogels to resist the fast loss of FOH via biomimetic adhesion during oral movement and saliva erosion. Based on this, progressive RIOM found in mice is alleviated by treatment of FOH-loaded MGA hydrogels whether pre-irradiation prophylactic administration or post-irradiation therapeutic administration, which contributes to maintaining the homeostasis of oral microbiota. Mechanistically, FOH inhibits cell apoptosis by scavenging radiation-induced excess ROS and up-regulates the inherent enzymatic antioxidants, thereby protecting the proliferation and migration of mucosal epithelial cells. In conclusion, this work not only provides proof-of-principle evidence for the oral radioprotection of FOH by blocking the “ROS storm”, but also provides an effective and easy-to-use hydrogel system for mucosal in situ administration.     

面向老年人的社区慢性病管理服务设计研究

目的 探索如何为社区慢性病老人提供更好的健康管理服务,构建出本土化的社区慢性病管理服务模式.方法 首先通过文献分析了解国内外社区慢性病管理的研究现状,其次以一位老年慢性肾脏病患者为目标用户进行个案研究.运用半参与式观察、深度访谈等用户研究方法,理解与分析慢性病老人在社区慢性病管理活动中的外显行为与内隐需求,最后依据目标用户的主要需求与痛点,综合各方服务人员进行概念设计.结论 提出了5种面向老年人社区慢性病管理的功能服务模块:健康档案共享模块、协同诊疗服务模块、药物分装管理模块、药物配送服务模块和健康学习分享模块,构建了面向老年慢性肾脏病患者的综合护理服务系统,为应对我国老龄化和老年慢性病管理问题提供了新的思考与路径.     

针对老年慢性病的参与式社区医疗服务设计方法探究

目的探究老年人参与式的慢性病社区医疗服务设计方法及流程。方法以老年慢性病的社区医疗为背景,结合用户参与模式从服务设计的层面对社区医疗的设计方法及设计流程进行探讨。结果得出在用户参与模式指导下的服务设计方法及流程,并以老年慢性病的社区医疗为背景进行方法探究。结论通过用户参与模式的社区医疗服务设计理论框架的建立,提高了服务设计过程中的用户参与度,通过引导老年人参与到慢性病社区医疗的服务设计过程中,提高社区医疗服务的合理性和设计结果的适用性,为相关领域的服务设计活动提供了可借鉴的理论依据和参考。     

Impact of coronary artery calcification in hemodialysis patients: Risk factors and associations with prognosis

The risk factors of coronary artery calcification (CAC) and the impact of CAC on cardiovascular events, cardiovascular deaths, and all‐cause deaths in hemodialysis (HD) patients have not been fully elucidated. We examined the CAC score (CACS) in 74 HD patients using electron‐beam computed tomography. Fifty‐six patients underwent a second electron‐beam computed tomography after a 15‐month interval to evaluate CAC progression. We evaluated (1) the risk factors for CAC and its progression and (2) the impact of CAC on the prognosis. In the cross‐sectional study, HD vintage and high‐sensitive C‐reactive protein (hsCRP) were the independent risk factors for CAC. In the prospective cohort study, delta CACS (progression of CAC) was significantly correlated with hsCRP, fibrinogen, and serum calcium level in the univariate analysis. Stepwise multiple regression analysis revealed that only hsCRP was the independent risk factor for CAC progression in HD patients. Kaplan‐Meier survival analysis revealed that cardiovascular events (P<0.0001), cardiovascular deaths (P=0.039), and all‐cause deaths (P=0.026) were significantly associated with CACS. In conclusion, CAC had significantly progressed in HD patients during the 15‐month observation period. Microinflammation was the only independent risk factor for CAC progression in HD patients. The advanced CAC was a significant prognostic factor in HD patients, i.e., which was strongly associated with future cardiovascular events, cardiovascular deaths, and all‐cause deaths.     

Coronary artery bypass grafting versus percutaneous coronary intervention in end-stage kidney disease: A systematic review and meta-analysis of clinical studies

The most significant complication of end-stage kidney disease (ESKD) is cardiovascular disease, mainly coronary artery disease (CAD). Although the effective treatment of CAD is an important prognostic factor, whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is better for treating CAD in this group of patients is still controversial. We searched Pubmed/Medline, Web of Science, Embase, the Cochrane Central Register of Controlled Trials articles that compared the outcomes of CABG versus PCI in patients with ESKD requiring dialysis. A total of 10 observational studies with 39,666 patients were included. Our analysis showed that when compared to PCI, CABG had lower risk of need for repeat revascularization (relative risk [RR] = 2.25, 95% confidence interval [CI] 2.1–2.42, p < 0.00001) and cardiovascular death (RR = 1.19, 95% CI 1.14–1.23, p < 0.00001) and higher risk for short-term mortality (RR = 0.43, 95% CI 0.38–0.48, p < 0.00001). There was no statistically significant difference between the PCI and CABG groups in the risk for late mortality (RR = 1.05, 95% CI 0.97–1.14, p = 0.25), myocardial infarction (RR = 1.05, 95% CI 0.46–2.36, p = 0.91) or stroke (RR = 1.02, 95% CI 0.64–1.61, p = 0.95). This meta-analysis showed that in ESKD patients requiring dialysis, CABG was superior to PCI in regard to cardiovascular death and need for repeat revascularization and inferior to PCI in regard to short term mortality. However, this meta-analysis has limitations and needs confirmation with large randomized controlled trials.     

超声心动图在早期高血压性心脏病患者中的诊断价值分析

目的:研究超声心动图诊断早期高血压性心脏病的临床价值。方法:回顾性收集我院2020年1月-2020年12月收诊的早期高血压性心脏病患者80例的临床资料,并选取同期健康体检的志愿者80名,分别设为实验组、对照组。收集两组的超声心动图资料,对比两组的LVEF、LVEDD、ISV等超声心动图资料,并收集整理超声心动图对实验组患者的诊断准确率以及不同血压分级患者的超声心动图资料。结果:超声心动图诊断早期HHD的准确率为95.0%。实验组患者的LVEDD与对照组健康志愿者比较差异不明显,P>0.05;实验组的ISV、LVPW、LAD值均高于对照组健康志愿者,P<0.05;且实验组的LVEF和E/A比值明显低于对照组,P<0.05;在实验组患者中,随着血压分级的增加,ISV、LVPW、LAD值也随之提高,二者呈正相关关系,P<0.05;随着血压分级增加,LVEF水平和E/A比值随之下降,二者呈负相关关系,P<0.05;血压分级与LVEDD无明显关系,P>0.05。结论:超声心动图在早期高血压性心脏病患者的诊断中应用价值高,能早期检测出左室舒张功能受损、左房扩大等,利于临床医师早期诊断高血压性心脏病,同时指导临床治疗,值得推广。     

Dipyridamole stress echocardiography in diagnosis and prognosis of hemodialysis patients with asymptomatic coronary disease

The prevalence of coronary artery disease (CAD) is high in hemodialysis (HD) patients. The aim of the study was to assess the diagnostic and prognostic value of dipyridamole stress echocardiography (DSE) in nondiabetic HD patients without signs or symptoms of CAD. In 51 out of 158 evaluated HD patients (21 females, age 67 [33–85] years, HD duration 38 [9–271] months), resting echocardiography and DSE were performed. Exclusion criteria were known CAD, diabetes mellitus, and pulmonary and oncologic pathologies. Logistic regression analysis was carried out to identify predictors of abnormal DSE response, while Cox regression analysis was performed to determine variables associated with total and cardiovascular mortality, after 43.3 (11–60) months of follow‐up. Seven patients (14%) showed a positive response to DSE (DSE+). In 5/7, CAD was documented by angiography: All of them underwent coronary revascularization. DSE+ patients had significantly smaller body mass index than patients with a negative response (DSE‐): 21.7 ± 1.9 vs. 25.1 ± 3.4 kg/m² (p = 0.018). During follow‐up, 16 (31%) patients died. Older age hazard ratio [HR = 1.07; confidence interval (CI) = 1.01–1.12; p = 0.02] and higher plasma phosphate levels (HR = 10.41; CI = 2.30–47.17; p < 0.01) were predictors of total mortality. Male gender (HR = 22.7; CI = 1.45–354.4; p = 0.03), older age (HR = 1.24; CI = 1.03–1.50; p = 0.02), longer HD duration (HR = 1.13; CI = 1.01–1.26; p = 0.04), and positive response to DSE (HR = 5.82; CI = 1.04–32.65; p = 0.04) were associated with cardiovascular mortality. Ten percent of asymptomatic HD patients had significant CAD, but timely diagnosis did not seem to improve their prognosis. Total survival was associated with age and higher levels of plasma phosphate, while male gender, older age, longer HD duration, and DSE+ were predictors of cardiovascular mortality.