Liver resection is one of the important treatments of liver diseases,especially hepatocellular carcinoma.In China,the vast majority of liver cancer patients suffer from generalized damage of the liver parenchyma such as cirrhosis,lead to liver reserve function reducing in various degrees.Liver dysfunction or even liver failure after liver resection becomes an important reason of perioperative death and influences the patients' long-term survival.Therefore,accurate preoperative evaluation of liver reserve function is very important.Though there are seveal kinds of assessment of liver reserve function in recent years,it still lack of a clinically recognized,comprehensive assessment method.This paper reviewed the clinical commonly used preoperative liver reserve function evaluation methods,summarizes and analyzes the value and the insufficiency of several important methods,and prospects the development of evaluation methods about preoperative liver reserve function.

Objective To determine the values of gadoxetate disodium-enhanced MRI for quantitatively evaluating the liver function reserve.Methods Forty consecutive liver cirrhosis patients were enrolled in this retrospective study.All the patients underwent complete routine laboratory tests and the gadoxetate disodium-enhanced MR imaging with the same parameters.Liver volume and the relative enhancement index of the whole liver in hepatocellular phase were used to calculate liver relative uptake value,which is supposed to represent the total liver function reserve.And the function reserve of all liver segments was evaluated respectively by the relative enhancement index of each liver segment.One-way ANOVA was used for statistical analyses.Results The patient number in Child-Pugh A,B and C group was 23,10 and 7,respectively.Significant differences was observed in liver relative uptake value among patients in different Child-Pugh classes (F =122.05,P ＜ 0.01).Mean liver relative uptake value was highest in Child-Pugh A group(1212 ± 168),followed by B group and C group (695 ± 161,234 ±55).In Child-Pugh A group,the relative enhancement index of S1 to S8 was 1.13 ± 0.22,1.12 ± 0.50,0.81 ± 0.24,1.08 ± 0.32,1.41 ± 0.25,1.10 ± 0.30,1.16 ± 0.41 and 1.17 ± 0.23,respectively (F =5.93,P ＜ 0.01).There was no significant difference in B and C group (F =1.95,1.83 ; P ＞ 0.05).Conclusion Gadoxetate disodiumenhanced MRI can be used for evaluating whole liver function reserve quantitatively.This technique also has a potential value for evaluating of the segmental liver function reserve before partial hepatectomy.

Objective To investigate the dynamic changes of vascular endothelium secreted factors after oral fatty meal test and the correlation of the factors with blood lipid in elderly diabetic patients. Methods Thirty-six elderly diabetic patients (diabetic group) and twenty heahhy elderly subjects(control group) were selected into the study and received oral fatty meal test for 6 hours. Diabetic group was divided into three subgroups, including fasting hypertriglyceridemia subgroup, postprandial hypertriglyceridemia subgroup and postprandial normotriglyceridemia subgroup. Serum nitric oxide (NO), endothelin-1 (ET-1), plasminogen activator inhibitor-1 (PAl-1) and tissue plasminogen activator (t-PA) were measured before and after oral fatty meal test. Results (1) The level of serum NO was significantly increased and ET-1 was significantly reduced in control group 2 hours after oral fatty meal test and were returned to basal state 6 hours after the test. But in diabetic group, postprandial serum NO level were decreased and ET-1 were increased gradually and reached to the peak 6 hours after oral fatty meal test. The ratio of NO/ET-1 was lower in diabetic group than that in control group (P< 0.01). There were important differences among fasting hypertriglyceridemia subgroup, postprandial hypertriglyceridemia subgroup and postprandial normotriglyeeridemia subgroup(P<0.05 or<0.01). (2) The level of PAl-1 was increased and t-PA was decreased slightly 4 hours after oral fatty meal test in control and diabetic groups. Compared with control group, PAI-1/ t-PA obviously increased in diabetic group. Meanwhile, PAI-1/t-PA in fasting hypertriglyeeridemia and postprandial hypertriglyceridemia subgroups were significantly higher than that in postprandial normotriglyceridemia subgroup(P<0. 05 or<0.01). (3) In the diabetic group, TG was negatively correlated with NO and t-PA(r=-0.360 P<0.05; r=-0.649, P<0.01) and positively correlated with ET-1 and PAI-1(r=0.421,P<0.01;r=0.520,P<0.01). Conclusions The elderly diabetic patients suffer from the imbalance of vascular endothelium secreted factors. The postprandial abnormal TG metabolism may aggravate the change and further damage the vascular endothelial function.

Objective To investigate the value of arterial spin labeling (ASL) MRI in evaluation of renal cortex perfusion in patients with type 2 diabetes.Methods Fifty patients with type 2 diabetes were enrolled and divided into simple diabetes (SD) group (n=25) and diabetes kidney disease (DKD) group (n=25) according to suffering from DKD or not.Based on estimated glomerular filtration rate (eGFR),DKD group were further divided into mild disease subgroup (n=11,eGFR≥ 60 ml/[min · 1.73m2]) and moderate-severe disease subgroup (n=14,eGFR＜60 ml/[min · 1.73m2]).Twenty-five healthy volunteers were recruited as control group at the same time.ASL MRI were performed on all participants.The cortical renal blood flow (RBF) of bilateral kidneys were measured by 2 radiologists.The consistency between 2 radiologists was analyzed.Statistical analysis were conducted to analysis the differences in cortical RBF among different groups.Correlation analysis were performed to evaluate the relationship between RBF and eGFR in type 2 diabetes patients.Results Cortical RBF values measured by two radiologists showed high consistency (all ICC＞0.90).There was significant difference in cortical RBF among control group ([269.71±33.28]ml/[100 g · min]),SD group ([258.52±42.30]ml/[100 g · min]),mild disease group ([242.86±56.86]ml/[100 g · min]) and moderate-severe disease group ([173.39±27.16]ml/ [100 g· min];F=20.66,P＜0.01).Moreover,the RBF in moderate-severe disease group was significantly lower than those in other groups (all P＜0.01).And no significant differences of RBF was found among the remainder groups (P=0.064,0.320).RBF in type 2 diabetes patients was positively correlated to eGFR (r=0.646,P＜0.001).Conclusion ASL MRI is a valuable tool to quantitatively assess the renal perfusion in patients with type 2 diabetes mellitus,which can provide potential imaging indicator as RBF for the functional evaluation of kidney.

Objective To evaluate the potential cerebral cortical volume alterations in type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment (MCI) compared with T2DM patients and healthy controls,and to observe the correlations with the scores of neuropsychological scales.Methods Cortical volume based on high-resolution MR T1WI data from 30 healthy controls (HC),30 T2DM patients and 30 T2DM with MCI patients were evaluated with FreeSurfer software and compared with variance analysis.The correlations between cerebral cortical volume which had statistical difference and the scores of neuropsychological scales were analyzed.Results There were significant differences in auditory verbal learning test (AVLT) scores,complex figure test-delayed recall (20 min) scores,digit symbol-coding subtest scores,MoCA scores and higher trail-making test-A scores,as well as trail-making test-B scores between T2DM and T2DM with MCI patients (all P＜0.05).Compared with T2DM patients,cortical volume of left entorhinal cortex,left lateral orbitofrontal gyrus,left posterior cingulate gyrus and the right lateral orbitofrontal gyrus,right pars orbitalis,right insula reduced in T2DM with MCI patients (all P＜0.05).In T2DM with MCI patients,AVLT scores were positively correlated with volume of the left entorhinal cortex (r=0.452,P=0.018).Conclusion Several cortical volume reductions are exhibited in T2DM patients with MCI.The volume of the left entorhinal cortex may be a potential biomarker to diagnose and evaluate MCI in T2DM.

Objective:To investigate the alteration of right ventricular function after catheter ablation in patients with persistent atrial fibrillation(PAF) and concomitant heart failure with preserved ejection fraction (HFpEF).Methods:The prospective observational study was performed in patients with HFpEF-PAF and undergoing first-time radiofrequency ablation procedures in the First Affiliated Hospital of Nanjing University between May to December 2019. Right ventricular functional parameters were measured before and 5 days, 1, 3, 6 and 12 months after the ablation by transthoracic echocardiography, respectively, including the right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion(TAPSE), tricuspid annular diameter (TVAD), tricuspid annular peak systolic speed(TDI-S′) and longitudinal strain of right ventricular free wall (RVFLS). Meanwhile, routine ECG and Holter recordings were performed at each follow-up time point.Results:In this study, atrial fibrillation (AF) recurrence occurred in 4 patients at the 3rd month after ablation, and 7 patients failed to follow up due to the Covid-19. Finally, 19 patients were followed up for the evaluation of cardiac function after catheter ablation. Compared with pre-ablation, right ventricular structural and functional paramters(RVFAC, TAPSE, TVAD, TDI-S′, RVFLS) improved significantly at all stages of follow-up( all P<0.05). Patients with atrial fibrillation recurrence had lower RVFLS and TDI-S′ at the baseline( P=0.039, P=0.019). Conclusions:Right ventricular function could improve in HFpEF-PAF patients who maintain sinus rhythm after radiofrequency ablation.