Objective To investigate the role of cytokines combined with CLIF Consortium organ failure score (CLIF-COFs) in determining the prognosis of liver transplant in hepatitis B-related acute-on-chronic liver failure (HB-ACLF) patients.Methods Thirty-seven cases of HB-ACLF patients undergoing liver transplantation were divided into HB-ACLF patients with complications group (n =15) and those without complications (n =22).Plasma were prospectively collected immediately before LT and on the 1st,3rd,5th,7th day after LT in HB-ACLF patients.The serum levels of twenty-seven cytokines were determined by 200 LUMINEX liquid chip technology.Cytokines and CLIF-COFs were analyzed with logistic regression and the receiver operating characteristic to confirm the correlation with the total complications post-LT.Results The serum levels of post-transplant G-CSF and MCP-1 in HB-ACLF patients with complications were higher than those of without complications (P ＜ 0.05).The COX analysis indicated that MCP-1 and CLIF-COFs were predictors of post-LT complications [A UC:0.821,95％ CI:0.668-0.974;AUC:0.738,95％ CI:0.578-0.898].The discriminatory power of MCP-combined with CLIF-COFs [AUC:0.839,95％ CI:0.703-0.975] was better than that of either.Conclusions MCP-1 combined with CLIF organ failure score can better predict the short-term outcomes of liver transplantation in HB-ACLF patients.

Objective To evaluate the role of live webcast as a new medium in the propaganda and education of liver transplant recipients. Methods According to the contents of live webcast propaganda and education meeting for liver transplant recipients, relevant data of the live webcast meeting were counted and analyzed, including baseline data of participants, participation pattern, viewing frequency and duration, etc. The characteristics between live webcast and traditional propaganda and education meetings were compared. Results By the end of the live webcast meeting, 273 participants were registered, including 2 oversea participants and 271 from China. These domestic participants were from 26 provinces, autonomous regions and municipalities in China. The total number of views was 1 526. Participants attended the meeting by clicking direct link (n=243), WeChat group access (n=22), WeChat chat access (n=7) and Dingding App access (n=1). The viewing duration was (68± 5) min. Compared with the traditional method, the number and places of registers of the live webcast propaganda and education meeting were increased. The questioning methods and filling out follow-up information were more convenient. Participants could attend the meeting free from charge anywhere, and saved more time. The live webcast propaganda and education meeting was not affected by the COVID-19 pandemic, and data statistical method was optimized. Conclusions Live webcast as a new medium, has a wide range of advantages, which provides a novel form of propaganda and education for the recipients after liver transplantation. It is of significance to improve the long-term survival rate and to enhance the quality of life of recipients after liver transplantation.

Objective To study the impact of splenectomy and esophagogastric devascularization on the nutritional status of patients with cirrhosis and portal hypertension.Methods Sixty consecutive patients with cirrhosis and portal hypertension who underwent splenectomy and esophagogastric devascularization at the Beijing YouAn Hospital from April 5,2015 to January 23,2017 were included in this study.The body mass index (BMI),albumin (Alb),prealbumin (PA) and lymphocyte counts were prospectively collected at the end of 1-week,1-month,3-month,6-month and 1-year after surgery.The postoperative results were compared with the preoperative results in these patients.Results The BMI results obtained at 1-week and 1-month after surgery were significantly lower than the preoperative level [(22.14 ± 3.08)kg/m2 vs.(22.85 ± 3.14) kg/m2,(21.72 ± 3.05) kg/m2 vs.(22.86 ± 3.16) kg/m2,P ＜ 0.05].The BMI result at the end of 1-year after surgery was significantly elevated when compared with the preoperative level [(23.24 ± 3.64) kg/m2 vs.(22.68 ± 3.47) kg/m2,P ＜ 0.05].The ALB levels at 1-month and 3-month after surgery were significantly higher than the preoperative level [(39.87 ± 4.22)g/L vs.(35.35 ±5.15) g/L,(39.35 ± 4.75) g/L vs.(34.82 ± 5.50) g/L,P ＜ 0.05].The PA obtained at 1-week after surgery was significantly lower than the preoperative levels [(79.59 26.52)mg/L vs.(121.77 ±39.96)mg/L,P ＜ 0.05].The lymphocyte counts at all the points after surgery were significantly higher than the preoperative level (P ＜ 0.05).Conclusion Short term and long term nutritional status improved in patients with cirrhosis and portal hypertension after splenectomy and esophagogastric devascularization.

Objective To investigate the role of cytokines combined with CLIF consortium organ failure score (CLIF-COFs) for predicting the occurrence of acute respiratory distress syndrome (ARDS) in for post-liver transplant for hepatitis B-related acute-on-chronic liver failure (HB-ACLF) patients.Methods From Jul.2014 to Oct.2017,there were 37 cases of HB-ACLF undergoing liver transplantation in Beijing YouAn Hospital,Capital Medical University.According to whether the patients happened ARDS or not,37 cases were divided into ARDS group (n =9) and non-ARDS group (n =28).All patients' plasma was prospectively collected immediately before liver transplantation and on the I st,3rd,5th,7th day post-liver transplantation.The serum levels of twenty-seven cytokines were determined by 200 LUMINEX liquid chip technology.Cytokines,CLIF-COFs,clinical and biochemical indexes were analyzed with logistic regression and the receiver operating characteristic (ROC) to confirm the correlation with ARDS post liver transplantation.Results There were significant differences between HB-ACLF patients between ARDS group and non-ARDS group in age and pre-transplant infection (P ＜ 0.05).The CLIF-COFs was higher in ARDS non-without than that in non-ARDS group (P =0.019).The serum levels of vascular endothelial growth factor and platelet-derived growth factor bb were lower but IL-6 was higher post transplantation in ARDS group.The COX analysis indicated that CLIF-COFs and post liver transplantation PDGF-BB were predictors of post-LT ARDS.The area under the receiver operating characteristic (AUROC) curves was 0.728 and 0.175,respectively.The area under the curve of the discriminatory power of CLIF-COFs combined with PDGF-BB was 0.913,and the maximum Youden index is 0.786.Conclusion CLIF-COFs combines with PDGF-BB can predict the occurrence of ARDS post-liver transplantation in HB-ACLF patients.

Objective:To study the impact and the mechanism of splenectomy combined with pericardial devascularization on cirrhotic livers.Methods:Serum samples and clinical data were collected preoperatively and postoperatively from 54 patients with cirrhosis who underwent splenectomy combined with pericardial devascularization from May 2013 to Oct 2014 at Beijing You’an Hospital, Capital Medical University. Changes in hepatic arterial and portal venous blood flow, liver function and fibroscan results were analyzed. The levels of nitric oxide (NO), endothelin-1 (ET-1), interleukin-6 (IL-6), hepatocyte growth factor (HGF), transforming growth factor-β1 (TGF-β1) and matrix metalloproteinase 1 (MMP1) were measured.Results:There were 31 males and 23 females, aged(45.48±10.21)years. Free portal vein pressure decreased significantly from (37.0±7.1) cmH 2O (1 cmH 2O=0.098 kPa) to (26.1±5.7) cmH 2O after surgery ( P<0.05). Significant increases in postoperative lumen diameter (4.0±1.0) mm vs (3.1±0.7) mm were observed, accompanied by increase in peak flow velocity and blood flow of the hepatic artery. Significant deductions in lumen diameter (11.9±2.0) mm vs (13.1±1.9) mm, accompanied by reduction of peak flow velocity and blood flow of the portal vein were observed following surgery (all P<0.05). The NO level was significantly elevated immediately after splenectomy and was subsequently remained at high levels. The ET-1 level decreased 2 days after surgery and became fluctuated at low levels. The IL-6 and HGF levels increased significantly 2 days after surgery and decreased gradually after 7 days and 1 month, respectively. The TGF-β1 and the MMP1 levels increased after surgery. The endotoxin level decreased significantly after surgery (all P<0.05). Conclusion:Splenectomy combined with pericardial devascularization induced hepatic blood flow restoration, hepatocyte regeneration and reversal of fibrosis in cirrhotic livers. Splenectomy has a protective effect on cirrhotic liver when combined with pericardial devascularization.

Objective:To improve the quality of 18F-fluorodeoxyglucose (FDG) PET images at different acquisition times through deep learning (DL) PET image reconstruction methods. Methods:A total of 45 patients (20 males, 25 females; age (52.0±13.6) years) with malignant tumors and PET/CT scans from September 2020 to October 2020 in the Department of Nuclear Medicine of the First Hospital of Shanxi Medical University were included in this retrospective study. The short acquisition time 30 s/bed PET images from the raw list mode were selected as the input of DL model. DL image reconstruction model, based on the Unet algorithm, was trained to output imitated PET images with full dose standard acquisition time (3 min). The image quality evaluation and quantitative analysis were carried out for four groups of images: DL images, 30 s, 90 s, and 120 s images, respectively. The quality of PET images in four groups was evaluated using the five-point method. Liver background activities, lesions quantification parameters (maximum standardized uptake value (SUV max), mean standardized uptake value (SUV mean), standard deviation (SD), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)), and first-order texture features (skewness, kurtosis, uniformity, entropy) were measured. Kappa test, χ2 test and one-way analysis of variance (least significant difference t test) were used for data analysis. Results:The image quality scores between four groups were highly consistent ( Kappa=0.799, P<0.001). The number of patients with scores≥3 in DL, 30 s, 90 s and 120 s groups were 6, 4, 7 and 8, respectively ( χ2=125.47, P<0.001). The liver SD of DL group was significantly lower than that of 30 s group (0.26±0.07 vs 0.43±0.11; F=3.58, t=-7.91, P<0.05). The liver SNR of DL group was higher than that of 30 s group (11.04±4.36 vs 5.41±1.41; F=10.22, t=5.40, P<0.05). The liver SD and SNR of DL group were similar to those of 90 s group (0.39±0.16, 8.46±3.34; t values: -0.87 and 2.17, both P>0.05). In 18 tumor lesions with high uptake, SNR and CNR of DL group were significantly higher than those of 30 s group (60.21±29.26 vs 38.38±16.54, 22.26±15.85 vs 15.41±9.51; F values: 13.09 and 7.05; t values: 5.20 and 4.04, both P<0.001). There were statistically significant differences among four groups in the first-order texture features ( F values: 4.30-9.65, all P<0.05), but there was no significant difference between DL group and 120 s group ( t values: from -1.25 to 0.15, all P>0.05). Conclusion:DL reconstruction model can improve the quality of short-frame PET images, which meets the needs of clinical diagnosis, efficacy evaluation and radiomics research.

Objective:To compare the effect of different β values on the semi-quantitative accuracy and image quality of 68Ga-prostate specific membrane antigen (PSMA) PET/CT imaging after partial volume effect correction (PVC). Methods:In the model experiment, image reconstruction was carried out based on block sequential regularized expectation maximization algorithm (BSREMA) with the range of β values from 100 to 1 000. Recovery coefficient (RC), contrast recovery (CR) and background variability (BV) were measured to evaluate semi-quantitative accuracy and image quality. In the clinical study, image data of 21 prostate cancer patients (age 45-78 years) who underwent 68Ga-PSMA PET/CT examination in the First Hospital of Shanxi Medical University from March 2019 to February 2020 were retrospectively collected. A total of 29 abdominal imaging positive lymph nodes were divided into the small lymph node group (diameter <10 mm; n=12) and the large lymph node group (10 mm≤diameter≤30 mm; n=17). SUV parameters including SUV max, SUV mean and peak of SUV (SUV peak) and the influence of different β values on the SUV parameters were evaluated. The signal to noise ratio (SNR) and subjective scores were used to evaluate image quality. Independent-sample t test, Kappa test and Pearson correlation analysis were used to analyze data. Results:The model experiment showed that CR, RC and BV decreased with the increase of β values. The image quality, image clarity, lesion significance, and total image scores given by nuclear medicine physicians showed strong consistency ( Kappa values: 0.65-0.87, P values: 0.026-0.043). The small lymph node group had the highest score (13 and 14) with β value of 600, while the large lymph node group had the highest score (13 and 14) with β value of 700. SNR of the two groups increased steadily within β values from 100 to 600 ( t values: 2.49-8.99, P values: 0.023-0.038). When the β value was higher than 600, SNR of the small lymph node group reached a plateau ( t values: 1.28-2.00, P values: 0.072-0.098), while the SNR of the large lymph node group continued to increase ( t values: 2.98-4.63, P values: 0.012-0.029). Before PVC, there were significant negative correlations between SUV parameters and β values ( r values: from -0.94 to -0.64, P values: 0.039-0.046). After PVC, it was found that SUV mean and SUV max still had significant negative correlation with β values ( r values: from -0.78 to -0.68, P values: 0.035-0.042), while the SUV peak showed no significant correlation with β values ( r values: -0.22, -0.28, P values: 0.069, 0.126). Conclusions:Based on subjective scores and semi-quantitative indicators, 68Ga-PSMA PET/CT is superior to select β values of 600 and 700 for image reconstruction based on BSREMA. The SUV peak of small lesions is stable after PVC and the clinical value should be explored in further.

Objective:To compare four reconstruction algorithms of 18F-fluorodeoxyglucose (FDG) PET/CT on standardized uptake value (SUV) of pulmonary nodules. Methods:A total of 46 patients (27 males, 19 females; median age: 66 (range: 44-82) years) with solid pulmonary nodules from February 2018 to July 2019 in the First Hospital of Shanxi Medical University who performed 18F-FDG PET/CT imaging were enrolled. All PET/CT images were retrospectively reconstructed by using four algorithms reconstructions including ordered subset expectation maximization (OSEM), OSEM+ time of flight (TOF), OSEM+ TOF+ point spread function (PSF) and block sequential regularized expectation maximization (BSREM) (G1-G4). Nodule and background parameters were analyzed semi-quantitatively and visually. The maximum of SUV(SUV max), mean of SUV(SUV mean) and peak of SUV (SUV peak) were collected by the region of interest (ROI). Nodules were divided into small nodule group (diameter ≤10 mm) and large nodule group (10 mm < diameter ≤30 mm). Kruskal-Wallis rank sum test and Bonferroni method were performed to compare the differences of SUVs between G1-G4, and Spearman correlation analysis was used to analyze the correlation between the change rate of SUV (%ΔSUV) and the diameter of nodules. The receiver operating characteristic (ROC) curve analysis was used to analyze the diagnostic efficacy of SUV for the differential diagnosis of pulmonary nodules and to get the optimal threshold. Results:There were 114 pulmonary nodules (large nodules, n=55; small nodules, n=59). In visual analysis, the visual detection rates of small nodules in G4 were 55.93%(33/59), 44.07%(26/59), 20.34%(12/59) higher than those in G1-G3. Of 114 pulmonary nodules in 46 patients, there were differences in SUV max and SUV mean between G1-G4 (median SUV max : 2.65-5.29, median SUV mean: 2.05-2.99; H values: 20.628 and 17.749, respectively, both P<0.001), G4 had significant increases compared to G1 in SUV max (median 5.29 and 2.65, P<0.001) and SUV mean (median 2.99 and 2.05, P<0.001). The %ΔSUV max (median: 4.45%-52.96%) and %ΔSUV mean (median: 1.69%-47.56%) were negatively correlated with the diameter of nodules (9.75(6.20, 16.58) mm; r s values: -0.371 to -0.354, -0.371 to -0.320, all P<0.001). In 59 small nodules, G1 significantly increased the SUV max of G4 (median 4.05 and 2.14, H=18.327, P<0.001), while G4 significantly increased the SUV mean of G1 and G3 (median 2.31, 1.26 and 1.53, H=16.808, P<0.05). There was no significant difference in SUVs between G1-G4 in 55 large nodules ( H values: 0.812-7.290, all P>0.05). The optimal threshold values of SUV max in G1-G4 were 4.335, 5.185, 5.410, 5.745 and the area of under curves (AUCs) were 0.747, 0.699, 0.756, 0.778 respectively. The AUC of SUV mean and SUV peak also showed a similar trend. Conclusion:Among the four reconstruction algorithms, BRERM can not only enhance the image quality, but also significantly improve the SUV max and SUV mean of lung nodules diameter below 10 mm, and thus its diagnostic threshold of SUV should be appropriately increased.