Objective To investigate thickness of the hilar periportal space and caudate-right lobe ratio in the patients with chro-nic hepatitis B and liver cirrhosis after hepatitis B .Methods Eighty-four patients who were clinically and histologically diagnosed with chronic hepatitis B or cirrhosis and 18 healthy subjects without history of liver disease underwent abdominal MRI .The rela-tionship among liver fibrosis degree ,hilar periportal space and caudate-right lobe ratio were observed .Results There was signifi-cant correlation between the hilar periportal space and hepatic fibrosis for chronic hepatitis and cirrhosis (rs = 0 .546 ,P< 0 .01) . There was significant difference between S2 and S3 for thicknesses of the hilar periportal space(P<0 .01) ,and no significant differ-ence among S3 ,S4 and cirrhosis(P=0 .188) .A cutoff value of 9 mm for the hilar periportal space had a sensitivity of 85 .37% and a specificity of 76 .79% for a diagnosis of hepatic fibrosis with S3 or higher .There was no significant correlation between the caudate-right lobe ratio and hepatic fibrosis(rs = -0 .155 ,P=0 .119) .Conclusion Thicknesses of the hilar periportal space increase gradu-ally with hepatic fibrosis in patients with chronic hepatitis B and cirrhosis ,with a high sensitivity and specificity for a diagnosis of hepatic fibrosis with S3 or higher .

Objective To evaluate the characteristics of left ventricular systolic longitudinal strain in uremic patients and its relationship with dialysis time using three-dimensional speckle tracking echocardiography (3D-STE).Methods Forty-six uremic patients were divided into three groups according dialysis time (ranged 0-5 years):group A (≤1 year),group B (1 year＞time ≤3 years),group C (3 years ＞time≤5 years),group D was control group.The dynamic images of apical four chamber view were displayed and apical full-volume images were obtained and saved in all subjects using a full volume matrix probe.The original data was recorded and was analyzed by using off-line 3DT analysis software (TomTec 4D MV-Assessment).The longitudinal peak systolic strain and 16 segment systolic strains and strain mean value in 16 segment of left ventricular were acquired and compared.Results The peak strain of apical segment was lower than that of the basal segment and the middle segment and it had an increasing trend from the apical segment to the basal segment in three uremia groups.Instead,it had a decreasing trend from the apical segment to the basal segment in control group.But the differences were not statistically significant.The longitudinal peak systolic strain value,16 segment strain value and mean value of 16 segment strain all were lower in three uremic groups than those of control group.Every segment of 16 segment stain value in group A was higher than those of group B and C.There was no difference in every segment between B and C group in addition to basal and middle segment of anterior septum.Conclusions 3D-STE could evaluate the left ventricular systolic function in uremic patients and the cardiac function could be partly protected by regular dialysis treatment.

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Purpose To investigate the features of 64-slice spiral computerized tomography (CT) on collateral circulation of pancreatic portal hypertension (PPH).Material and Methods the abdominal CT images of 52 patients with PPH confirmed by pathology the Affiliated Hospital of Southwest Medical University from August 2013 to May 2015 were analyzed retrospectively.The collateral circulations of portal vein were recorded.Results There were 21 (40.4％) patients with isolated splenic vein occlusion (ISVO),and 32 (59.6％) patients with non isolated splenic vein occlusion (NISVO) in the total 52 patients.There was no significant difference in the occurrence rate between ISVO and NISVO (x2=1.92,P＞0.05).The main collateral pathways of PPH were pathway Type Ⅰ (28 patients)and pathway Type Ⅲ (22 patients),and 2 patients belonged to pathway Type Ⅱ.The patients in pathway Type Ⅰ or Ⅲ were significantly more than patients in pathway Type Ⅱ(P＜0.01).There were 92.3％ (48/52) of patients with gastroepiploic varicosity,which is significantly higher than other varicose veins (P＜0.001).The significant difference was found between the patients (21.2％) with gastric fundus varicosity and the patients (1.9％)with inferior segment esophageal varices (x2=9.42,P＜0.01).The patients with gastric fundus varicosity and right superior colic varicosity in NISVO were more than those in ISVO (x2=4.15,7.44,P＜0.05).Conclusion For PPH patients,the valuable features of collateral circulation can be revealed by multi-slices CT.

Objective To evaluate early dynamic contrast enhancement CT on multiple organ failure in acute pancreatitis.Methods 333 cases of acute pancreatitis identified by clinical and early dynamic contrast enhancement CT were collected.Patients were divided into organ failure group(OF group,124 cases) and non-organ failure group (notn-OF group,209 cases).All variables including duration of hospitalization,need for intensive care unit,infection,need for operation,mortality and MCTSI,EPIC score were analyzed by U test and x2 test firstly.The variables with significance (P＜0.05) were analyzed by Stepwise Logistic regression further.Results On U test and x2 test,there were significant differences(P＜0.001) between two groups in duration of hospitalization,need for intensive care unit,infection,need for operation,mortality,MCTSI score and EPIC score and APFC + ANC＞ 100 mL,and bilateral pleural effusion/ pulmonary atelectasis.The Stepwise Logistic regression analysis demonstrated that increased MCTSI and EPIC score,APFC+ANC＞ 100 mL and bilateral pleural effusion/pulmonary atelectasis were 4 independent risk factors of multiple organ failure in acute pancreatitis.Conclusion Multiple organ failure in acute pancreatitis can be judged with early dynamic contrast enhancement CT for improved treatment.

Objective:To investigate the effect of hyperuricemia on acute kidney injury in sepsis patients.Methods:It is a retrospective cohort study of 459 adult sepsis patients who were admitted to the Department of Intensive Care Unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from March 2014 to June 2019, and the Second Affiliated Hospital of Guangxi Medical University from January 2017 to June 2019. The patients were divided into the hyperuricemia group and the non-hyperuricemia group according to the first serum uric acid level within 24 h after ICU admission, and the incidence of AKI within 7 days after ICU admission was compared between the two groups. The effect of hyperuricemia on sepsis-associated AKI was analyzed by univariate analysis and binary logistic regression analysis.Results:Among the 459 sepsis patients, 81 patients (17.6%) had hyperuricemia, and 127 patients (27.7%) had AKI. The incidence of AKI in the hyperuricemia group and the non-hyperuricemia group were 60.5% (49/81) and 20.6% (78/378), respectively, which showed significantly statistical difference ( χ2=52.954, P<0.01). After adjusting for gender, associated diseases (diabetes, coronary heart disease), sequential organ failure score (SOFA) on the day of ICU admission, the use of diuretics within one week before and after ICU admission, invasive mechanical ventilation, basal renal function, lactic acid, and procalcitonin, binary logistic regression analysis showed that hyperuricemia was an independent risk factor for AKI in sepsis patients ( OR=5.091, 95% CI: 2.768-9.362, P<0.01); For every 1 mg/dL increase in serum uric acid in sepsis patients, the risk of developing AKI increased by 28.4% ( OR=1.284, 95% CI: 1.165-1.414, P<0.01). Conclusions:AKI is a common complication in sepsis patients admitted to ICU, and hyperuricemia is an independent risk factor for AKI in sepsis patients.

Objective:To explore the effect of serum lactic acid (Lac) level on acute kidney injury (AKI) in patients with sepsis and whether Lac level affects the in-hospital mortality of patients with sepsis-associated AKI.Methods:A retrospective cohort study was conducted. Clinical data of patients with sepsis admitted to the internal intensive care unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from March 2014 to June 2019 and the ICU of the Second Affiliated Hospital of Guangxi Medical University from January 2017 to June 2020 were collected. According to the first quartile of Lac within 24 hours of admission to ICU, the patients were divided into Lac ≤ 1.4 mmol/L group (group Q1), Lac 1.5-2.4 mmol/L group (group Q2), Lac 2.5-4.0 mmol/L group (group Q3), and Lac ≥ 4.1 mmol/L group (group Q4). The incidence of sepsis-associated AKI after admission to ICU and hospital mortality were compared among four groups. The effect of elevated Lac on the incidence and mortality of sepsis-associated AKI was investigated by binary Logistic regression analysis. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of Lac on the incidence and mortality of sepsis-associated AKI, and the cut-off value was obtained to analyze the incidence and death risk of sepsis-associated AKI at different Lac levels. Results:A total of 655 sepsis patients were enrolled, of which 330 patients (50.4%) developed AKI and 325 patients (49.6%) did not. Among 330 patients with sepsis-associated AKI, 134 (40.6%) died and 196 (59.4%) survived. With the increase of Lac level, the incidence of sepsis-associated AKI increased gradually (34.5%, 41.0%, 58.4%, 66.3%, respectively, in group Q1- Q4), meanwhile, the in-hospital mortality also increased gradually (23.4%, 29.2%, 33.1%, 43.4%, respectively, in group Q1- Q4), the differences were statistically significant (both P < 0.01). Compared with the non-AKI group, the Lac level in the AKI group was significantly increased [mmol/L: 3.08 (1.84, 5.70) vs. 1.91 (1.20, 3.10), P < 0.01]. After adjustment for factors such as gender (male), site of infection (abdominal cavity), vasoactive drugs, basal mechanical ventilation, mean arterial pressure (MAP), basal renal insufficiency, uric acid, procalcitonin (PCT), platelet count (PLT), basal serum creatinine (SCr) and basal estimated glomerular filtration rate (eGFR), and other influencing factors, multivariate Logistic regression analysis showed that elevated Lac was an independent risk factor for sepsis-associated AKI [odds ratio ( OR) = 1.096, 95% confidence interval (95% CI) was 1.022-1.175, P = 0.010]. Compared with the survival group, the Lac level in the death group was significantly increased [mmol/L: 3.55 (2.00, 6.76) vs. 3.00 (1.70, 4.50), P < 0.01]. After adjusting for age, diabetes, vasoactive drugs, basal eGFR, and other factors, multivariate Logistic regression analysis suggested that increased Lac was an independent risk factor for in-hospital mortality in sepsis-associated AKI patients ( OR = 1.074, 95% CI was 1.004-1.149, P = 0.037). ROC curve analysis showed that the area under the ROC curve (AUC) of Lac for predicting the incidence and mortality of sepsis-associated AKI was 0.653 (95% CI was 0.611-0.694) and 0.593 (95% CI was 0.530-0.656, both P < 0.01), respectively, and the cut-off values were 2.75 mmol/L (sensitivity was 57.8%, specificity was 69.2%) and 5.95 mmol/L (sensitivity was 56.7%, specificity was 83.7%). When the Lac ≥ 2.75 mmol/L, the risk of sepsis-associated AKI was 2.772 times higher than that of < 2.75 mmol/L ( OR = 2.772, 95% CI was 1.754-4.380, P < 0.001). When the Lac ≥ 5.95 mmol/L, the patients with sepsis-associated AKI had a 2.511 times higher risk of in-hospital death than those with Lac < 5.95 mmol/L ( OR = 2.511, 95% CI was 1.378-4.574, P = 0.003). Conclusions:Elevated Lac level is an independent risk factor for the incidence and mortality of sepsis-associated AKI. When Lac ≥ 2.75 mmol/L, the risk of AKI in patients with sepsis increased by 1.772 times; when Lac ≥ 5.95 mmol/L, the risk of in-hospital death in patients with sepsis related AKI increased by 1.511 times.