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Background: Coronavirus disease (COVID-19) has spread rapidly since 2019. Approximately 15% of the patients will develop severe complications such as multiple organ disease syndrome related to cytokine release syndrome (CRS). Continuous renal replacement therapy (CRRT) can remove inflammatory cytokines through filtration or adsorption. We evaluated the effectiveness of CRRT in COVID-19 patients with CRS. Methods: This retrospective, multicenter, descriptive study included 83 patients with CRS from three hospitals in Wuhan. Results: In COVID-19 patients with CRS, the fatality rate was even higher in CRRT group (P=0.005). However, inflammatory markers such as C-reactive protein, neutrophil counts, and D-dimer decreased after CRRT (P

Aim: Coronavirus disease 2019 (COVID-19) has been associated with increased mortality and morbidity from thromboembolism, especially venous thromboembolism. There are more limited data for systemic thromboembolism. The present study aimed to investigate the prevalence of systemic and venous thromboembolism as well as major bleeding and mortality in relation to underlying risk factors and the impact of anticoagulation use in hospitalized patients with COVID-19. Methods and results: Patients with COVID-19 admitted to Union Hospital, Wuhan, Hubei, China between January 08, 2020 and April 7, 2020 were enrolled in this retrospective study. Cox proportional hazard models were utilized to determine associated risk factors for clinical events, adjusting for the severity of COVID-19 infection, drug therapies, comorbidities, surgery, and use of antithrombotic drugs. There were 1125 patients (49.9% male; mean age 58 years (standard deviation, SD, 15 years)) with a mean follow-up of 21 (SD 13) days. Approximately 25 (30%) patients with thromboembolism also suffered bleeding events. Age was an independent risk factor for thromboembolism, bleeding events, and death (all p

Background: Membranous nephropathy (MN), a major cause of nephrotic syndrome, has attracted people’s attention in recent years for its growing prevalence. It is the second or third leading cause of ESRD in patients with primary glomerulonephritis and is the leading glomerulopathy that recurs after kidney transplantation. Summary: MN can be classified as idiopathic membranous nephropathy (IMN) and secondary MN. The discovery of the M-type phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing 7A (THSD7A) provides the new diagnostic methods and treatment strategies for IMN on the molecular level. The study on single nucleotide polymorphism of IMN genes, such as the single M-type phospholipase A2 receptor 1 (PLA2R1) gene and human leukocyte antigen (HLA) gene, explains the pathogenesis of the disease from the perspective of genetics and conforms to the trend of the era of precision medicine. Key Messages: This review focuses on advances in the pathogenesis of IMN, including molecular and genetic pathogenesis, as well as discussing the diagnostic and treatment guiding value brought by these new discoveries.

Background/Objectives Many studies have suggested that probiotics may be applied as a therapeutic agent for non-alcoholic fatty liver disease (NAFLD). However, the effects of frequent yogurt consumption (as a natural probiotic source) on NAFLD remain poorly understood. This study was to examine the association of habitual yogurt consumption with newly diagnosed NAFLD in the general adult population. Subject/Methods Overall, 24,389 adults were included in this cross-sectional study. Yogurt consumption was estimated by using a validated self-administered food frequency questionnaire. NAFLD was diagnosed by abdominal ultrasonography. We used logistic regression models to assess the association between yogurt consumption categories and newly diagnosed NAFLD. Results The multivariable odds ratios with 95% confidence interval of newly diagnosed NAFLD were 1.00 (0.88, 1.14) for 1 time/week, 0.91 (0.81, 1.02) for 2–3 times/week, and 0.86 (0.76, 0.98) for ≥4 times/week (P for trend = 0.01), compared with those who consumed Conclusion Higher yogurt consumption was inversely associated with the prevalence of newly diagnosed NAFLD. These results are needed to be confirmed in randomized controlled trials or prospective studies.

Objectives Non-alcoholic fatty liver disease (NAFLD) is one of the most common public health issues worldwide. Oranges are the most popular fruit consumed in the world. Admittedly, flavonoids in oranges act as antioxidants and improve liver steatosis. However, oranges also are rich in fructose, which is a risk factor in the progress of NAFLD. Therefore, we hypothesize that orange intake may be a double-edged sword in the development of NAFLD. To our knowledge, there currently is little evidence of the effect of dietary orange intake on NAFLD. The aim of this study was to investigate how orange intake is related to NAFLD in a general adult population. Methods We randomly recruited 27,214 adults into the Tianjin Chronic Low-Grade Systemic Inflammation and Health Cohort Study. NAFLD was diagnosed by liver ultrasonography. Raw orange intake was assessed by a validated self-administered food frequency questionnaire. Multiple logistic regression analysis was used to evaluate the association between orange intake and the prevalence of NAFLD. Results There was a 27.18% prevalence of NAFLD among the participants. Consumption of orange was positively associated with the prevalence of NAFLD after adjustment for all potential confounding factors (Ptrend = 0.04). The odds ratios (95% confidence interval) of the categories of orange intake in the NAFLD were 1.00 (reference) for less than once per week, 1.02 (0.95–1.11) for 1 to 6 times per week, and 1.17 (1.03–1.33) for ≥7 times per week, respectively. Conclusions The present study demonstrated that orange intake is positively associated with the prevalence of NAFLD.

OBJECTIVES The diagnostic value of axillary ultrasound (US) for level II and III axillary lymph node metastasis after axillary lymph node dissection for invasive breast cancer is currently not clear. The objectives of this study were to retrospectively analyze the diagnostic value of axillar US for level II and III axillary lymph node metastasis and compare it with palpation and to analyze the US features of level II and III axillary lymph nodes that are predictive of metastatic recurrence during follow-up. METHODS Cases with level II or III axillary lymph nodes detected by US between January 2005 and December 2017 at a cancer center were divided into 2 groups according to a retrospective analysis of US findings: potential malignancy group and follow-up group. Biopsy was performed in all patients in the potential malignancy group. In the follow-up group, the patients were followed for at least 2 years, and biopsy was performed if suspicious US features were detected. RESULTS The 401 enrolled cases were followed by axillary US and physical examination (PE) for comparison. Finally, 55 axillary metastases were pathologically confirmed (14%). The sensitivity, specificity, and area under the receiver operating characteristic curve for axillary US were 92.7%, 93.9%, and 0.933, respectively, and the corresponding values for PE were 49.1%, 91.3%, and 0.702 (P

Adenoid cystic carcinoma of the breast is a rare type of breast cancer. Most patients present with a bilateral palpable mass. Ultrasound and mammography are non-specific and can sometimes lead to misdiagnosis because of their variable imaging features. Pathological examination is the standard reference. Surgery is the mainstay of treatment for patients. Although adenoid cystic carcinoma has an excellent prognosis, metastatic cases have been reported. This report aims to discuss the clinical and imaging features of one case of adenoid cystic carcinoma with a poor prognosis and four cases with a good prognosis at our center.

Purpose We propose a 3-D tumor computer-aided diagnosis (CADx) system with U-net and a residual-capsule neural network (Res-CapsNet) for ABUS images and provide a reference for early tumor diagnosis, especially non-mass lesions. Methods A total of 396 patients with 444 tumors (226 malignant and 218 benign) were retrospectively enrolled from Sun Yat-sen University Cancer Center. In our CADx, preprocessing was performed first to crop and resize the tumor volumes of interest (VOIs). Then, a 3-D U-net and postprocessing were applied to the VOIs to obtain tumor masks. Finally, a 3-D Res-CapsNet classification model was executed with the VOIs and the corresponding masks to diagnose the tumors. Finally, the diagnostic performance, including accuracy, sensitivity, specificity, and area under the curve (AUC), was compared with other classification models and among three readers with different years of experience in ABUS review. Results For all tumors, the accuracy, sensitivity, specificity, and AUC of the proposed CADx were 84.9 %, 87.2 %, 82.6 %, and 0.9122, respectively, outperforming other models and junior reader. Next, the tumors were subdivided into mass and non-mass tumors to validate the system performance. For mass tumors, our CADx achieved an accuracy, sensitivity, specificity, and AUC of 85.2 %, 88.2 %, 82.3 %, and 0.9147, respectively, which was higher than that of other models and junior reader. For non-mass tumors, our CADx achieved an accuracy, sensitivity, specificity, and AUC of 81.6 %, 78.3 %, 86.7 %, and 0.8654, respectively, outperforming the two readers. Conclusion The proposed CADx with 3-D U-net and 3-D Res-CapsNet models has the potential to reduce misdiagnosis, especially for non-mass lesions.

Inflammasomes, multiprotein complex induced by harmful factors in the body, play a crucial role in innate immunity. Activation of inflammasomes lead to the activation of casepase-1 and then the secretion of inflammatory cytokines, including IL-1β and IL-18, subsequently leading to a type of cell death called pyroptosis. There are two types of signaling pathways involved in the process of inflammasome activation: the canonical and the non-canonical signaling pathway. The canonical signaling pathway is mainly dependent on casepase-1; the non-canonical signal pathway, which was recently discovered, is mainly dependent on caspase-11, but is also meditated by caspase-4, caspase-5, and caspase-8. Kidney inflammation is basically associated with inflammatory factor exudation and inflammatory cell infiltration. Several studies have showed that inflammasomes are closely related to kidney diseases, especially the NOD-, LRR- and pyrin domain-containing 3 (NLRP3) inflammasome, which play a role in regulating kidney inflammation and fibrosis. In this review, we focus on the relationship between inflammasomes and kidney diseases, especially the role of the NLRP3 inflammasome in different kinds of kidney disease via both canonical and non-canonical signal pathways.

To explore the value of hand-held ultrasound (HHUS) for diagnosing complex cystic and solid breast lesions, 472 pathologically proven lesions were analyzed. The lesions were divided into four types based on ultrasound features. Positive predictive values (PPVs) for lesion types and risk factor performances were assessed. Furthermore, HHUS and mammography (MAM) performances were compared: 27 lesions missed in MAM were detected in HHUS. Ultrasound feature analysis revealed higher PPVs for type III and IV lesions than for type I and II lesions. In patients older than 51 y, a type III or IV lesion with a diameter greater than 18 mm, an irregular shape, a non-parallel orientation, an uncircumscribed margin, calcification, vascularity and abnormal axillary lymph nodes were suggestive of malignancy; the area under the curve reached 0.869. Thus, ultrasound is useful in diagnosing complex cystic and solid breast lesions, which should be categorized as Breast Imaging Reporting and Data System (BI-RADS) 4B or 4C.

Background and Aims The protective effect of garlic against nonalcoholic fatty liver disease (NAFLD) has been reported in animal studies. However, in humans, the association between garlic consumption and NAFLD is unclear. The study sought to explore the association between habitual raw garlic intake and newly diagnosed NAFLD among Chinese adults. Methods We performed a study of 11,326 men and 12,780 women aged 20–90 years. Habitual food intake was assessed using a validated and standardized 100-item food frequency questionnaire. Diagnosis of NAFLD was based on the liver ultrasonography and self-reported alcohol intake. Multiple logistic regression was used to evaluate the association of raw garlic intake with newly diagnosed NAFLD. Results The prevalence of newly diagnosed NAFLD was 28.9% in men and 10.1% in women, respectively. In men, the fully adjusted odds ratios (95% confidence interval) of having NAFLD across increasing frequency of raw garlic intake were 1.00 (reference) for P for trend Conclusions Frequent consumption of raw garlic is inversely associated with NAFLD in Chinese men. Further investigations are needed to confirm this finding.

Background:Renal involvement by systemic amyloidosis is one of the most common poor outcomes of the disease, usually manifested as nephrotic range proteinuria and can progress to end-stage renal disease (ESRD) with negative effects on the quality of life and survival of the patients. The objective of this meta-analysis was to determine prognostic factors of poor renal outcome in renal amyloidosis patients. The findings of this study may provide a clearer indication of the possibility of worsening state of renal function, which affect monitoring and therapeutic decisions. Methods:We searched for studies reporting on the renal outcomes in systemic amyloidosis, and cohort studies related to systemic amyloidosis prognosis and/or outcomes.Pooled mean differences, odds ratios and 95% confidence intervals were computed using random-effect approach in Rev Man5.3®. Clinical, laboratory and renal biopsy prognostic factors were tested for heterogeneity and for overall effect. P-value

Hepatitis C virus (HCV) infection is very common in maintenance hemodialysis patients, causing high morbidity and mortality. This study aimed to evaluate the effectiveness and adverse events of direct-acting antivirals (DAAs) in maintenance hemodialysis patients complicated with chronic hepatitis C in real-world clinical practice. In this retrospective observational study, hemodialysis patients with chronic hepatitis C infection in the Third Central Hospital of Tianjin outpatient were screened, and appropriate treatment plans were selected accordingly. Totally 25 patients diagnosed with chronic hepatitis C and treated with DAAs for 12 weeks or 24 weeks were included. The sustained virologic response (SVR) rate obtained 12 weeks post-treatment (SVR12) was evaluated. Laboratory indexes and adverse reactions during the treatment process were also assessed. A total of 25 cases met the eligibility criteria and provided informed consent. Except for 1 patient who discontinued the treatment due to gastrointestinal bleeding, the remaining 24 cases completed the treatment cycle with 100% rapid virologic response (RVR) and 100% SVR12, with no serious adverse reactions recorded. Maintenance hemodialysis patients complicated with chronic hepatitis C in Chinese real-world setting tolerate DAAs very well, with a viral response rate reaching 100%.

Objective To evaluate the interobserver agreement, diagnostic value, and associated clinical factors of automated breast ultrasound (ABUS) coronal features in differentiating breast lesions. Materials and Methods This study enrolled 457 pathologically confirmed lesions in 387 female (age, 46.4 ± 10.3 years), including 377 masses and 80 non-mass lesions (NMLs). The unique coronal features, including retraction phenomenon, hyper- or hypoechoic rim (continuous or discontinuous), skipping sign, and white wall sign, were defined and recorded. The interobserver agreement on image type and coronal features was evaluated. Furthermore, clinical factors, including the lesion size, distance to the nipple or skin, palpability, and the histological grade were analyzed. Results Among the 457 lesions, 296 were malignant and 161 were benign. The overall interobserver agreement for image type and all coronal features was moderate to good. For masses, the retraction phenomenon was significantly associated with malignancies (p < 0.001) and more frequently presented in small and superficial invasive carcinomas with a low histological grade (p = 0.027, 0.002, and < 0.001, respectively). Furthermore, continuous hyper- or hypoechoic rims were predictive of benign masses (p < 0.001), whereas discontinuous rims were predictive of malignancies (p < 0.001). A hyperechoic rim was more commonly detected in masses more distant from the nipple (p = 0.027), and a hypoechoic rim was more frequently found in large superficial masses (p < 0.001 for both). For NMLs, the skipping sign was a predictor of malignancies (p = 0.040). Conclusion The coronal plane of ABUS may provide useful diagnostic value for breast lesions.

BACKGROUND & AIMS Increased nut consumption has been associated with reduced inflammation, insulin resistance, and oxidative stress. Although these factors are closely involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD), few studies have focused on the association between nut consumption and NAFLD in the general population. We aimed to investigate the association of nut consumption and NAFLD in an adult population. METHODS A total of 23 915 participants from Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) Cohort Study were included in this study. Information on dietary intake was collected using a validated food frequency questionnaire. Abdominal ultrasonography was done to diagnose NAFLD. Multivariable logistic regression was used to assess the association of nut consumption with NAFLD. RESULTS After adjusting for sociodemographic, medical, dietary, and lifestyle variables, the odds ratios (95% confidence interval) for NAFLD across categories of nut consumption were 1.00 (reference) for