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To examine the longitudinal associations of sleep duration and sleep quality with coronary heart disease (CHD) risk among individuals aged ≥ 20 years. A systematic review and meta-analysis of observational cohort studies were performed to evaluate the association between sleep quality and duration, and the risk of CHD. We searched three databases including PUBMED, the Cochrane Library and EMBASE, selected relevant studies and used the classical and Net-work models to establish the hazard ratio (HRs) of the results. Data extracted from 11 studies including 769,452 participants and 14,769 patients with CHD events were reviewed. In the classical meta-analysis, night sleep duration of 8 h showed an increased risk of CHD (HR = 1.13, and 1.13, respectively) compared with reference sleep (7–8 h). However, the net-work model stratified sleep quality into good and poor subgroups, and there was no change in CHD risk in each subgroup despite different sleep hours. Furthermore, individuals with poor-quality sleep were at a greater risk of CHD than those with good-quality sleep (HR = 1.4, 1.3, and 1.4 for 8 h, respectively). Moreover, individuals with reference time sleep but that of poor quality were associated with an increased risk of CHD compared with good sleepers having short/long sleep duration (HR = 1.3 and 1.2, respectively). Poor-quality sleep was associated with great morbidity and mortality of CHD, independent of sleep duration. Sleep quality rather than sleep duration might be crucial for increased CHD risk, suggesting the potential importance of poor-quality sleep as a possible CHD risk factor.

To evaluate the value of renal diffusion kurtosis imaging (DKI) in the diagnosis of early diabetic nephropathy (DN) in a rat model. Forty male Zucker diabetic fatty rats that spontaneously developed type 2 diabetes mellitus (DM) and 20 age-matched nondiabetic lean Zucker rats were included. Renal DKI scans and histological examinations were performed on the rats in batches at the end of the 4th, 8th, 12th, 16th, and 20th week after DM model was built. Based on renal histopathological appearance, included animals were divided into three groups: a nondiabetic control group, a DM group without DN, and an early DN group. Mean kurtosis (MK) and mean diffusivity (MD) values of renal cortex and medulla were analyzed statistically. MK values of renal cortex and medulla tended to increase from the control group to the early DN group, respectively, while MD values tended to decrease. The cutoff MD and MK values of renal cortex and medulla showed different values in discriminating early DN from controls. Among them, cutoff MK value of medulla of 0.62 was the best parameter (sensitivity, 93.9%; specificity, 96.4%; and area under the curve, 0.95). For discriminate early DN from DM without DN and DM without DN from controls, cutoff MK value of renal cortex or medulla achieved an area under the curve of 0.76–0.85. MR DKI may be valuable for the noninvasive detection of early DN, and MK value might serve as a more sensitive biomarker of early DN than MD value. • In this article, diffusion kurtosis imaging (DKI) was used to detect the changes in the kidneys due to early diabetic nephropathy (DN). • MR DKI may be valuable for the noninvasive detection of early DN. • The mean kurtosis values of renal cortex and medulla might serve as a more sensitive biomarker of early DN than the mean diffusivity values.

Pancreatic cancer is a malignancy with a 5-year overall survival rate of less than 10% and is the third leading cause of death among cancers. Total resection is the only potentially curative treatment. Unfortunately, less than 20% of patients are candidates for surgery. High-throughput molecular analysis has revealed the intra- and inter-heterogeneity of pancreatic cancer, leading to a challenge for optimizing clinical treatment to reduce the morbidity and mortality. Currently, the AJCC TNM stage is associated with the outcome of patients with pancreatic cancer, but this clinicopathological factor cannot always predict the prognosis. Owing to the complex nature of this disease, a long-term goal includes the effective identification of different subgroups of patients with prognostic and predictive outcomes to enable precision medicine. Evidence has made it clear that information extracted from the transcriptome is promising and plays an important role in clinical decision-making. In this review, we simply summaries the molecular subtypes and its molecular features based on the transcriptome of pancreatic cancer. Besides, we provide a brief discussion on the impact of molecular classification on prognosis and therapy based on the transcriptome of pancreatic cancer. In addition, the challenges and opportunities for translation from bench to bedside will also be discussed.

Autologous liver transplantation (ALT) to cure end-stage hepatic alveolar echinococcosis (HAE) requires that hepatobiliary surgeons understand the invasion of intrahepatic structure and adjacent tissues or organs. Triphase contrast-enhanced CT of the liver has been widely used for diagnosis and preoperative evaluation of HAE. Three-dimensional (3D) reconstruction allows for accurate measurement of remnant liver volume (RLV). The objective of the study was to evaluate value of triphase contrast-enhanced CT together with 3D reconstruction in preoperative evaluation of indications for ALT in patients with end-stage HAE. This cohort include twenty-one consecutive patients with end-stage HAE, who preoperatively underwent triphase enhanced CT together with 3D reconstruction for ALT. To depict the indications, the 2D image data were reviewed statistically focusing on porta hepatis invasion, retrohepatic vena cava (RHVC) involvement and degrees of intrahepatic vessel invasion, and the 3D reconstruction was performed to obtain ratio of RLV to standard liver volume (SLV). The results showed that 95.24% patients (20/21) had porta hepatis invasion. When lesions located in right liver lobe, porta hepatis invasion occurred most commonly in the second and third porta hepatis (7/10), whereas the first, second and third porta hepatis were most commonly invaded by lesions in the right and caudate / left medial liver lobes (7/11) (P P

Objective To investigate features of crush extremity fractures associated with massive earthquake on digital radiography (DR) and multidetector computed tomography (MDCT). Materials and methods Six hundred and twenty-three consecutive patients with clinically confirmed crush extremity fractures arising from the 2008 Sichuan earthquake were enrolled into our study. Six hundred and eleven patients with suggested extremity fractures underwent DR, and 12 patients with possible knee fractures underwent MDCT. Image data were retrospectively reviewed, with the focus on anatomic sites, numbers, and status of the fractures. Results Extremity fractures occurred in lower extremities in 428 patients, upper extremities in 151, and both lower and upper extremities in 44. Lower extremity fractures were more common than upper extremity fractures (P

Perfusion CT has been applied in many clinical areas, but few studies have addressed gastric cancer. This study is to investigate the feasibility of first-pass perfusion CT with volume-based technique to assess microcirculation of gastric adenocarcinoma.Perfusion CT of gastric adenocarcinoma was performed with 64-section MDCT in 58 patients, which were subdivided into three subgroups according to the location of the tumor. Perfusion, peak enhancement, time to peak, and blood volume were computed in the tumor and in normal gastric wall. Mean values of perfusion parameters were compared between the tumor and normal stomach, between tumors with and without lymph node metastases, and between different stages.Blood volume was significantly increased in gastric adenocarcinoma compared with normal stomach (19.75 +/- 14.74 vs. 13.59 +/- 11.46 mL/100 g, in total stomach, P = 0.004). A total of 10.55 mL/100 g of blood volume was employed as the cut-off value to discriminate the microcirculation of the tumor from that of the normal stomach. There were no significant differences of any perfusion parameters between the subgroups with and without lymph node metastases, or between early and advanced cancer.The first-pass perfusion CT with whole tumor acquisition technique is a feasible technique for quantifying tumor vascularity and angiogenesis in gastric adenocarcinoma.

Background: There are no reports regarding entire gastric fundic and esophageal varices evaluated with 64-row multidetector CT (MDCT). We attempt to clarify the feasibility of portal venography with this scanner in evaluation of these varices. Methods: A total of 33 patients, with clinically confirmed gastric fundic and esophageal varices secondary to posthepatitic cirrhosis, underwent thoracicoabdominal triphasic enhancement scans using 64-row MDCT along with conventional angiographic portography. CT portography and conventional portography were compared by statistical agreement to determine whether CT maximum intensity projection (CT-MIP) portography is useful in evaluation of entire gastric fundic and esophageal varices. Results: CT-MIP portography demonstrated gastric fundic and esophageal varices, and the inflowing and outflowing vessels of the varices. Gastric fundic varices were shown in 32 cases (97.0%), and esophageal varices were in 27 (81.8%). The inflowing vessels including the left gastric vein and posterior gastric vein/short gastric vein were illustrated in 31 (94.0%) and 17 (51.5%) cases, respectively. The outflowing vessels including the azygos vein, hemiazygos vein, and gastro-renal shunts were seen in 30 (90.9%), 8 (24.2%), and 12 (36.4%) cases, respectively. Findings of CT-MIP portography and conventional angiographic portography were in close agreement (Kappa value ranged from 0.621 to 1.000). Conclusion: CT-MIP venography with 64-row MDCT could be considered as a method for detecting entire gastric fundic and esophageal varices developed from posthepatitic cirrhosis.

Background Hepatoblastoma (HBL) and hepatocellular carcinoma (HCC) are respectively the first and the second most common pediatric malignant liver tumors. The purpose of this study was to evaluate the combined use of the ultrasound examination and the assessment of the patients' clinical features for differentiating HBL from HCC in children. Methods Thirty cases of the confirmed HBL and 12 cases of the confirmed HCC in children under the age of 15 years were enrolled into our study. They were divided into the HBL group and the HCC group according to the histological types of the tumors. The ultrasonic features and the clinical manifestations of the two groups were retrospectively analyzed, with an emphasis on the following parameters: onset age, gender (male/female) ratio, positive epatitis-B-surface-antigen (HBV), alpha-fetoprotein increase, and echo features including septa, calcification and liquefaction within the tumors. Results Compared with the children with HCC, the children with HBL had a significantly younger onset age (8.2 years vs. 3.9 years, P < 0.001) and a significantly smaller frequency of positive HBV (66.7% vs. 13.3%, P < 0.001). The septa and liquefaction were more frequently found in HBL than in HCC (25/30, 83.3% vs. 2/12, 16.7%, P < 0.001; 17/30, 56.7% vs. 3/12, 25%, P = 0.02). When a combination of the liquefaction, septa, negative HBV and onset age smaller than 5 years was used in the evaluation, the sensitivity was raised to 90%, the accuracy was raised to 88%, and the negative predictive value was raised to 73%. Conclusion Ultrasonic features combined with clinical manifestations are valuable for differentiating HBL from HCC in children.