Objective To explore the clinical application value of multimodal radiomics in differentiating parotid pleomorphic adenoma(PA)from adenolymphoma(AL).Methods The clinical and imaging data of 68 cases of PA and 52 cases of AL were retrospectively analyzed.All patients underwent ultrasound examination,enhanced CT scan and enhanced MRI scan of the neck before the operation.All patients were randomly divided into training group(n=84)and validation group(n=36)according to the ratio of 7∶3.The 3D Slicer software was used to manually draw the lesion area of the preoperative images and perform radiomics feature extraction.The best feature subset was selected to establish the radiomics model,and the diagnostic efficacy of different models was evaluated by the receiver operating characteristic(ROC)curve.Results The study found that age,gender,and smoking history were effective in differentiating parotid PA from AL,and were used to construct a clinical diagnostic model.Eighteen features were selected through dimensionality reduction to establish the radiomics model.A multimodal combined diagnostic model was then constructed by integrating the radiomics model with gender,age,and smoking history.Compared to the clinical model and the radiomics model,the multimodal combined diagnostic model demonstrated the highest area under the curve(AUC)for distinguishing PA from AL in both the training group and the validation group.Conclusion The combination of radiomics based on neck ultrasound,CT,and MRI with clinical characteristics shows significant clinical application value in the preoperative differentiation of PA and AL.

Objective To explore the clinical application value of multimodal radiomics in differentiating parotid pleomorphic adenoma(PA)from adenolymphoma(AL).Methods The clinical and imaging data of 68 cases of PA and 52 cases of AL were retrospectively analyzed.All patients underwent ultrasound examination,enhanced CT scan and enhanced MRI scan of the neck before the operation.All patients were randomly divided into training group(n=84)and validation group(n=36)according to the ratio of 7∶3.The 3D Slicer software was used to manually draw the lesion area of the preoperative images and perform radiomics feature extraction.The best feature subset was selected to establish the radiomics model,and the diagnostic efficacy of different models was evaluated by the receiver operating characteristic(ROC)curve.Results The study found that age,gender,and smoking history were effective in differentiating parotid PA from AL,and were used to construct a clinical diagnostic model.Eighteen features were selected through dimensionality reduction to establish the radiomics model.A multimodal combined diagnostic model was then constructed by integrating the radiomics model with gender,age,and smoking history.Compared to the clinical model and the radiomics model,the multimodal combined diagnostic model demonstrated the highest area under the curve(AUC)for distinguishing PA from AL in both the training group and the validation group.Conclusion The combination of radiomics based on neck ultrasound,CT,and MRI with clinical characteristics shows significant clinical application value in the preoperative differentiation of PA and AL.

Objective:To evaluate the diagnostic value of intestinal regional oxygen saturation（rSO 2）and fecal calprotectin in the occurrence and severity of necrotizing enterocolitis（NEC）in premature infants. Methods:A prospective observational study was conducted among premature infants admitted to Quanzhou Children's Hospital from October 2019 to December 2022. Intestinal rSO 2 was monitored within two hours of diagnosis of NEC，and fecal calprotectin was measured. Results:A total of 60 patients were included, including 30 cases with NEC and 30 cases without NEC, 14 cases of medical NEC, 16 cases of surgical NEC, and eight infants died due to NEC. Infants with NEC had lower intestinal rSO 2 [49（30，60）% vs. 66（60，69）%] and higher calprotectin levels [479（297，886）μg/g vs. 203（113，275）μg/g] than those in infants without NEC ( P<0.01). The levels of intestinal rSO 2 were lower in surgical NEC than those in medical NEC，and were lower in the death group than that in the survival group ( P<0.01)，but no similar difference was found in the levels of calprotectin. ROC curve analysis showed that intestinal rSO 2 combined with calprotectin had a sensitivity of 73%，a specificity of 100%，and the largest area under curve of 0.91 in the diagnosis of NEC. Intestinal rSO 2 had an optimal cut-off value of 31% in predicting death in infants with NEC，with a sensitivity of 100%，a specificity of 95%，and an area under curve of 0.99. Conclusion:Intestinal rSO 2 and fecal calprotectin can effectively identify the presence of NEC，and their combined detection can improve the diagnostic efficiency. Intestinal rSO 2 is a good predictor of the severity of NEC，but not fecal calprotectin.

Chronic liver diseases can progress to liver fibrosis and cirrhosis and may lead to portal hypertension and even hepatocellular carcinoma. In recent years, more and more studies have shown that statins can improve liver histology, delay progression to liver fibrosis, and reduce the risk of decompensation and hepatocellular carcinoma in patients with nonalcoholic fatty liver disease. This article introduces the advances in the application of statins in patients with chronic liver diseases, so as to provide a basis for the prevention and treatment of chronic liver diseases.

The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America published the hepatitis C guidance in 2015, then updated in 2018, the recommendation of antiviral therapy was emphasized. A major update of the HCV guidance was released electronically in November 2019. This article summarizes the recommendations of the latest updated guide.

Inflammatory bowel disease (IBD) is often accompanied by chronic liver diseases in a variety of situations. Due to the overlapping factors in the pathogenesis of IBD and autoimmune liver diseases including primary sclerosing cholangitis (PSC), primary biliary cholangitis, and autoimmune hepatitis, the co-existence of these diseases is not uncommon, among which PSC with IBD has the highest probability of more than 80%. The probability of IBD with chronic hepatitis B virus (HBV)/hepatitis C virus (HCV) infection is associated with local infection rate, and if the screening for HBV/HCV infection is ignored before the application of immunosuppressive agents, there may be a risk of aggravated HBV/HCV infection or HBV reactivation. Long-term treatment with antibiotics, steroids, and immunosuppressants may cause drug-induced liver injury in patients with IBD. Although IBD patients often have weight loss due to the factors including diarrhea and absorption disorders, these patients may have a higher probability of nonalcoholic fatty liver disease than the general population.

Objective To investigate the efficacy of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in the treatment of refractory septic shock in children.Methods From January 2016 to December 2018,the clinical data of children with refractory septic shock (RSS) treated by VA-ECMO in Department of Critical Medicine Affiliated Children's Hospital of Shanghai Jiao Tong University were retrospectively analyzed.The patients with refractory septic shock (RSS) treated by VA-ECMO were compared with those with non-refractory septic shock (NRSS).Results There were 8 cases in the RSS-ECMO group and 6 cases in the NRSS-ECMO group.The sex,age,PRISM score,complication showed no significant difference in the two groups.The median time of ECMO in the RSS-ECMO group was 182 (141,216) h,and 5 patients were survived and were discharged from the hospital.The blood lactic acid and vasoactive drug index in the RSS-ECMO group was significantly higher than that in the NRSS-ECMO group (P＜0.05 or P＜0.01).The time of vasoactive drugs use and the ratio of combined continuous renal replacement therapy (CRRT) in the RSS-ECMO group were higher than those in the NRSS-ECMO group,but there was no significant difference (P ＞ 0.05).Atter ECMO establishment,the mean invasive arterial pressure increased significantly at 6 h,and lactic acid decreased significantly at 12 h after ECMO support.SCVO2 returned to normal at 24-h ECMO therapy.Conclusions The success rate of VA-ECMO treatment in children with refractory septic shock complicated with MODS is similar to that of children with non-refractory septic shock.The relationship between ECMO and hemodynamic indexes in sepsis should be further explored.

Objective To study the significance of leptin and its receptor(OB-R) in the occurrence and development of pulmonary arterial hypertension(PAH) induced by monocrotaline(MCT).Methods Fifteen SD rats were divided into the control group(n=5) and two experimental groups(n=10).The experimental groups were intraperitoneally injected by MCT for constructing the PAH model and the control group was injected by the same dose of solvent groups.The venous blood was extracted at 2,4 weeks after MCT injection in the two experimental groups.The mean pulmonary artery pressure(mPAP) and right ventricular hypertrophy index(RVHI) were measured and then the lung tissue was removed.The pathological change of lung blood vessels was observed.The expression of serum leptin was detected by ELISA.The expression of OB-R in lung tissue was tested by Western blot.Results Compared with the control group,mPAP and RVHI in the experimental groups were significantly increased(P＜0.05);the expression levels of serum leptin and lung tissue OB-R were increased significantly(P＜0.05),moreover,which were positively correlated with mPAP(r=0.912,P＜0.05;r=0.861,P＜0.05).Conclusion Leptin and OB-R may play an important role in the occurrence and development of PAH induced by MCT.

Objective To summarize the therapeutic effects of extracorporeal membrane oxygenation (ECMO) on critically ill children with severe cardiopulmonary failure.Methods The pediatric patients supported with ECMO admitted to pediatric intensive care unit (PICU) from December 2015 to August 2017 were enrolled in this study.The data of demographics of patients,diagnosis,indication for ECMO,the procedure of ECMO support,complications,and survival status were analyzed.Results A total of 17 pediatric patients including 9 male and 8 female with severe cardiopulmonary failure treated with ECMO were studied.The median of age was 24 (2,117) months,and the median of body weight was 12 (5,33) kg.The indications for initiation of ECMO were cardiovascular failure with poor response to conventional therapy and severe acute respiratory distress syndrome (ARDS) without any beneficial effect obtained from mechanical ventilation.The percutaneous cannulation was done under ultrasound guidance by a team of trained intensivists through right cervical vein and internal carotid artery resulting in veno-arterial extracorporeal membrane oxygenation support.The mean duration of ECMO support was 212.5 h with median 188.5 (3-924) h.All patients were treated with mechanical ventilation for prevention from pulmonary atelectasis.Of 17 patients,10 were coupled with continuous renal replacement therapy (CRRT) to keep fluid balance.As a result,11 children (64.7％) were successfully weaned from ECMO defined as survival for 24 h after ECMO,and 10 children (58.8％) were alive to discharge from hospital.One of 2 cardiac arrest cases treated with extracorporeal cardiopulmonary resuscitation (ECPR) was alive.During ECMO support,there were 41 adverse events happened including pressure ulcers (64.7％),thrombocytopenia (52.9％),bleeding (35.3％).Conclusions The survival rate at discharge was 58.8％ in pediatric patients with severe cardiopulmonary failure with poor response to conventional therapy.Our data suggest that ECMO support is an important rescue technique for pediatric critical illness.

Recently, the International Club of Ascites (ICA) has developed a new expert consensus on the diagnosis and treatment of acute kidney injury (AKI) in patients with liver cirrhosis, which reflects the new concept of AKI management in patients with liver cirrhosis. This consensus emphasizes the increase in the absolute value of serum creatinine (SCr) and establishes a new staging system for AKI, which may help to evaluate disease progression and recovery. In addition, the new management concept also emphasizes that when AKI progresses to stage 2/3 or still progresses after comprehensive treatment, a diagnosis can be made and vasoconstrictors and albumin can be used as long as the patient meets the other diagnostic criteria for hepatorenal syndrome, regardless of SCr level.