Research Progress of Age Estimation in the Living by Knee Joint MRI / 法医学杂志

Bone development shows certain regularity with age. The regularity can be used to infer age and serve many fields such as justice, medicine, archaeology, etc. As a non-invasive evaluation method of the epiphyseal development stage, MRI is widely used in living age estimation. In recent years, the rapid development of machine learning has significantly improved the effectiveness and reliability of living age estimation, which is one of the main development directions of current research. This paper summarizes the analysis methods of age estimation by knee joint MRI, introduces the current research trends, and future application trend.

Pelvic Injury Discriminative Model Based on Data Mining Algorithm / 法医学杂志

OBJECTIVES@#To reduce the dimension of characteristic information extracted from pelvic CT images by using principal component analysis (PCA) and partial least squares (PLS) methods. To establish a support vector machine (SVM) classification and identification model to identify if there is pelvic injury by the reduced dimension data and evaluate the feasibility of its application.@*METHODS@#Eighty percent of 146 normal and injured pelvic CT images were randomly selected as training set for model fitting, and the remaining 20% was used as testing set to verify the accuracy of the test, respectively. Through CT image input, preprocessing, feature extraction, feature information dimension reduction, feature selection, parameter selection, model establishment and model comparison, a discriminative model of pelvic injury was established.@*RESULTS@#The PLS dimension reduction method was better than the PCA method and the SVM model was better than the naive Bayesian classifier (NBC) model. The accuracy of the modeling set, leave-one-out cross validation and testing set of the SVM classification model based on 12 PLS factors was 100%, 100% and 93.33%, respectively.@*CONCLUSIONS@#In the evaluation of pelvic injury, the pelvic injury data mining model based on CT images reaches high accuracy, which lays a foundation for automatic and rapid identification of pelvic injuries.

Percutaneous transhepatic choledochoscopic lithotripsy versus open hepatectomy for treatment of complicated hepatolithiasis - a propensity score matching study / 中华肝胆外科杂志

Objective:To study minimally invasive treatment using percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) to treat complicated hepatolithiasis.Methods:Patients with complicated hepatolithiasis who were treated at the Second Affiliated Hospital of Kunming Medical University from July 2017 to September 2021, were included into this study. There were 48 patients treated with PTCSL (the PTCSL group) and 150 patients treated with conventional open hepatectomy (the OH group). Propensity score matching (PSM) was used to match 40 patients in the PTCSL group with 40 patients in the OH group. There were 11 males and 29 females, aged 32 to 85 (59.3±12.7) years in the PTCSL group and 15 males and 25 females, aged 20 to 74 (55.4±10.9) years in the OH group. Theoperation time, intraoperative blood loss, hospitalization time, hospitalization cost, incidences of major complications (including pleural effusion, biliary bleeding), residual stone rates and recurrence rates were analyzed.Results:Baseline data were comparable between groups after PSM. For the PTCSL group, the operation time was (135.8±42.6) minutes, intraoperative bleeding volume 32.5(20.0, 50.0) ml, hospitalization time 13.5(11.0, 18.0) days, and hospitalization expense 3.4(2.9, 5.0) wanyuan compared with the corresponding figures in the OH group with operation time (350.7±113.8) minutes, intraoperative bleeding volume 475.0(200.0, 900.0) ml, hospitalization time 24.0(17.3, 28.8) days, and hospitalization expense 6.6(5.0, 8.9) wanyuan. The differences between the two groups were statistically significant (all P<0.05). The overall complication rate was 2.5%(1/40) in the PTCSL group and 22.5%(9/40) in the OH group (χ 2=7.31, P=0.007). The residual stone rate of 20.0%(8/40), stone recurrence rate of 17.5%(7/40), compared with the OH group with the stone residual rate of 27.5%(11/40), stone recurrence rate of 12.5%(5/40). There was no significant difference between the two groups in both the stone residual rates and stone recurrence rates (both P>0.05). Conclusion:In treatment of complex hepatolithiasis, the stone residual rate after repeated PTCSL was comparable to traditional open hepatectomy. PTCSL had the advantages of shorter operation time, less bleeding, lower hospitalization time, lower complication rate and lower hospitalization cost. PTCSL is worthy of wider application and popularization.

Contrast-enhanced ultrasound and MRI in post-treatment evaluation of hepatocellular carcinoma after TACE / 中华肝胆外科杂志

Objective:To study the use of contrast-enhanced ultrasonography (CE-US) and contrast-enhanced MRI(CE-MRI) in evaluation of therapeutic effect of transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC).Methods:A retrospective study was conducted on 60 patients with HCC (with 114 lesions), who were treated with TACE in Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018. There were 53 males and 7 females, age ranged from 47 to 84 (mean age 61.9) years. CE-US, CE-MRI and digital subtraction angiography (DSA) were performed in all these patients within one week after TACE. Using DSA as the gold standard, the sensitivity, specificity and accuracy in the detection of residual lesions were compared between the two imaging methods. The consistency of results between CE-US and CE-MRI was analyzed.Results:CE-MRI and CE-US showed presence of active tumor foci (residual and/or recurrent lesion) in 78 lesions, and complete inactivation of HCC foci in 26 lesions. Ten lesions were diagnosed as active foci by CE-MRI, which were missed by CE-US. The diagnostic accuracy of CE-MRI was 100.0% (114/114), which was significantly better than the 91.2% (104/114) of CE-US ( P<0.05). The Kappa value between CE-US and CE-MRI was 0.781. The diagnostic coincidence between CE-MRI and CE-US was quite high. Among small lesions of less than 5 cm, the diagnostic accuracy of CE-MRI was 100.0% (78/78), which was significantly better than the 88.5% (69/78) of CE-US ( P<0.05). In large lesions of greater than 5 cm, the diagnostic accuracy of CE-MRI was comparable to that of CE-US. The difference was not significant ( P>0.05). The sensitivity of CE-MRI in detection of active lesions was higher than that of CE-US, and the specificity of the two imaging methods was consistent. The Kappa value between CE-US and CE-MRI was 0.747 for small lesions of less than 5cm, and 0.873 for large lesions of greater than 5 cm. The diagnostic coincidence between CE-MRI and CE-US was quite high. Conclusion:CE-MRI and CE-US can both be used as reliable imaging methods for evaluating the therapeutic effect of TACE for HCC.

Sex Estimation of Typical Adult Vertebrae Morphology in Central China Based on CT Technique / 法医学杂志

Objective The morphological data of the second thoracic vertebra and the third lumbar vertebra were measured by computerized tomography （CT）. The sex differences were analyzed and the discrimination equation was obtained. Methods The data of 274 adults （203 cases from experimental group and 69 cases from validation group） from central China were collected. Four linear data （maximum transverse length of vertebral body, maximum longitudinal length of vertebral body, maximum transverse length of vertebral foramen, maximum longitudinal length of vertebral foramen）, one angle data （angle between spinous processes） and two area （vertebral foramen area, total cross-sectional area of vertebral body） data of the second thoracic vertebra and the third lumbar vertebra were collected, respectively. Then three ratios ［maximum transverse length/　maximum longitudinal length of vertebral body, maximum transverse length/ maximum longitudinal length of vertebral foramen, vertebral foramen area/ （total cross-sectional area of vertebral body-vertebral foramen area）］ and one angle （angle between spinous processes） were obtained. The discriminant equation was established for sexual discriminant analysis. Results The morphology of the second thoracic vertebra and the third lumbar vertebra was related with gender. Four single index discriminant formulae and eleven multi-index discriminant formulae were established. The 69 validation group samples were substituted into the formula for testing, and the maximum discriminant accuracy rate of the single-index discriminant formula was 75%. The maximum discriminant accuracy rate of multi-index discriminant formula was 83%. Conclusion It is feasible to conduct individual sex analysis by the morphological indexes of second thoracic vertebra and the third lumbar vertebra. The indexes have important application values in practice.

Comparison of Three CNN Models Applied in Bone Age Assessment of Pelvic Radiographs of Adolescents / 法医学杂志

Objective To compare the performance of three deep-learning models （VGG19, Inception-V3 and Inception-ResNet-V2） in automatic bone age assessment based on pelvic X-ray radiographs. Methods A total of 962 pelvic X ray radiographs taken from adolescents （481 males, 481 females） aged from 11.0 to 21.0 years in five provinces and cities of China were collected, preprocessed and used as objects of study. Eighty percent of these X ray radiographs were divided into training set and validation set with random sampling method and used for model fitting and hyper-parameters adjustment. Twenty percent were used as test sets, to evaluate the ability of model generalization. The performances of the three models were assessed by comparing the root mean square error （RMSE）, mean absolute error （MAE） and Bland-Altman plots between the model estimates and the chronological ages. Results The mean RMSE and MAE between bone age estimates of the VGG19 model and the chronological ages were 1.29 and 1.02 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-V3 model and the chronological ages were 1.17 and 0.82 years, respectively. The mean RMSE and MAE between bone age estimates of the Inception-ResNet-V2 model and the chronological ages were 1.11 and 0.84 years, respectively. The Bland-Altman plots showed that the mean value of differences between bone age estimates of Inception-ResNet-V2 model and the chronological ages was the lowest. Conclusion In the automatic bone age assessment of adolescent pelvis, the Inception-ResNet-V2 model performs the best while the Inception-V3 model achieves a similar accuracy as VGG19 model.

Therapeutic effect of transcatheter arterial chemoembolization combined with iodine-125 seed strand implantation for treating hepatocellular carcinoma with portal vein tumor thrombus / 中华肝胆外科杂志

Objective To study the efficacy of combined transcatheter arterial chemoembolization(TACE)with iodine-125 seed implantation in treating hepatocellular carcinoma(HCC)with portal vein tumor thrombus(PVTT).Methods From January 2015 to January 2019,eighty patients with HCC and PVTT who were treated at Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.A total of 71 patients were male and 9 were female.aged(53.1±9.9)years.The patients included 48 patients(group A)who were treated with TACE alone and 32 patients(group B)with TACE combined with iodine-125 seed implantation.The survival time and disease control rate(DCR)of the intrahepatic lesions and PVTY in the two groups were compared.Results There were 32 patients who were successfully implan-ted with portal vein iodine-125 seed and stents.The DCR of PVTT in group B was significantly better than in group A(90.6％ vs.81.3％,P＜0.05).The DCR of the intrahepatic lesions in the two groups was 77.1％(group A)and 90.6％(group B).There was no significant difference between the two groups(P＞0.05).The survival times of group A and group B were(8.0±0.6)and(16.0±2.1)months,respectively.The median survival times were(7.6±1.0)and(14.8±1.5)months respectively.Group B had significantly better survival time than Group A,(both P＜0.05).Univariate and multivariate analysis showed that tumor size was an independent risk factor of prognosis(Regression coemcient:0.960,HR:0.383,95％CI:0.158-0.926,P＜0.05).125I treatment was a protective factor of prognosis(Regression coefficient:-1.525,HR:0.218,95％CI:0.100-0.473,P＜0.05).Conclusion For patients with HCC and PVTT.compared with TACE alone,TACE combined with iodine-125 seed implantation could safe-ly and effectively control portal vein tumor thrombus,and prolonged patient survival.

Therapeutic effect of transcatheter arterial chemoembolization combined with iodine-125 seed strand implantation for treating hepatocellular carcinoma with portal vein tumor thrombus / 中华肝胆外科杂志

Objective@#To study the efficacy of combined transcatheter arterial chemoembolization (TACE) with iodine-125 seed implantation in treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).@*Methods@#From January 2015 to January 2019, eighty patients with HCC and PVTT who were treated at Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. A total of 71 patients were male and 9 were female, aged (53.1±9.9) years. The patients included 48 patients (group A) who were treated with TACE alone and 32 patients (group B) with TACE combined with iodine-125 seed implantation. The survival time and disease control rate (DCR) of the intrahepatic lesions and PVTT in the two groups were compared.@*Results@#There were 32 patients who were successfully implanted with portal vein iodine-125 seed and stents. The DCR of PVTT in group B was significantly better than in group A (90.6% vs. 81.3%, P<0.05). The DCR of the intrahepatic lesions in the two groups was 77.1% (group A) and 90.6% (group B). There was no significant difference between the two groups (P>0.05). The survival times of group A and group B were (8.0±0.6) and (16.0±2.1) months, respectively. The median survival times were (7.6±1.0) and (14.8±1.5) months respectively. Group B had significantly better survival time than Group A, (both P<0.05). Univariate and multivariate analysis showed that tumor size was an independent risk factor of prognosis (Regression coefficient: 0.960, HR: 0.383, 95% CI: 0.158-0.926, P<0.05). 125I treatment was a protective factor of prognosis (Regression coefficient: -1.525, HR: 0.218, 95% CI: 0.100-0.473, P<0.05).@*Conclusion@#For patients with HCC and PVTT, compared with TACE alone, TACE combined with iodine-125 seed implantation could safely and effectively control portal vein tumor thrombus, and prolonged patient survival.

Automated Assessment for Bone Age of Left Wrist Joint in Uyghur Teenagers by Deep Learning / 法医学杂志

Objective To realize the automated bone age assessment by applying deep learning to digital radiography(DR)image recognition of left wrist joint in Uyghur teenagers, and explore its practical ap-plication value in forensic medicine bone age assessment. Methods The X-ray films of left wrist joint after pretreatment, which were taken from 245 male and 227 female Uyghur nationality teenagers in Uygur Autonomous Region aged from 13.0 to 19.0 years old, were chosen as subjects. And AlexNet was as a regression model of image recognition. From the total samples above, 60% of male and fe-male DR images of left wrist joint were selected as net train set, and 10% of samples were selected as validation set. As test set, the rest 30%were used to obtain the image recognition accuracy with an error range in ±1.0 and ±0.7 age respectively, compared to the real age. Results The modelling results of deep learning algorithm showed that when the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the net train set was 81.4% and 75.6% in male, and 80.5% and 74.8% in female, respectively. When the error range was in ±1.0 and ±0.7 age respectively, the accuracy of the test set was 79.5% and 71.2% in male, and 79.4% and 66.2% in female, respectively. Conclusion The combination of bone age research on teenagers' left wrist joint and deep learning, which has high accuracy and good feasi-bility, can be the research basis of bone age automatic assessment system for the rest joints of body.

Effects of ultrasound-guided low-power microwave ablation for the treatment of liver cancer in special sites / 实用放射学杂志

Objective To investigate the curative effect and clinical application value of ultrasound-guided low-power microwave ablation in treating liver cancer with special sites (including the leiosn near the gallbladder,diaphragmatic dome,gastrointestine, heart,blood vessels and hepatic portal canal with the shortest distance between the tumor and the organs or lumen less than 0.5 cm). Methods Forty patients with liver cancer with special sites including neighboring the gallbladder in 9 cases,diaphragmatic dome in 7 cases,gastrointestine in 5 cases,portal vein in 1 1 cases,hepatic vein in 3 cases,inferior vena cava in 3 cases and heart in 2 cases were selected as the treatment group and other 40 cases with primary liver cancer with common site were selected as the control group by stratified random selection,during the same period.Ultrasound-guided microwave ablation was performed,all patients were followed up at 6 months,12 months,18 months and 24 months,and the survival rate was calculated.Results The negative rate of AFP in the treatment group and control group was 83.0% and 82.0%,respectively.The survival rates of the treatment group and the control group at 6 months,12 months,18 months and 24 months were 100.0%,95.0%,90.0%,80.0% and 100.0%,97.5%,92.5%,85.0%. Conclusion Ultrasound-guided low-power microwave ablation in treating the liver cancer with special sites is very effective and safe. The curative effect is similar to that of liver cancer with common site and can be widely used in clinic.

Application of three-dimensional digital subtraction angiography on hepatic artery chemoembolization / 中华肝脏病杂志

Objective@#To explore the clinical value of 3D-DSA technology in the diagnosis and treatment guidance of hepatic artery chemoembolization.@*Methods@#Liver cancer patients in the treatment groups were collected to receive 3D-DSA imaging guidance at the Affiliated Hospital of Xuzhou Medical University between March and May 2017. In addition, routine 2D-DSA imaging was selected for treatment-received group. Intra-operative blood vessels and tumor-like lesions were observed. The total exposure dose (CAK, unit mGy), cumulative irradiation intensity per unit area (DAP, unit mGy.cm2) and dosage of contrast agent (ml) were calculated separately for two groups of patients. The same senior physicians and technicians operated both groups of patients. Comparisons of measurement were analyzed by t-test and chi-square test was used for count data.@*Results@#Data of twenty patients were collected from the two groups. Tumor location, target vessels structure and shape of development were clear in all patients in the treatment group. The control group had 17 cases of tumor development and the target vascular structure was clear in 16 cases. CAK mean treatment group was lower than control group (554.11 + 38.87) mGy and (644.53 + 26.70) mGy, and DAP mean treatment group was lower than the control group (125.25 + 7.54) mGy·cm2 and (143.49 + 6.18) mGy·cm2. The two groups were compared (P value < 0.05), and the differences were statistically significant. The mean dose of contrast agent in the two groups were lower than control group (64.42 + 3.92) ml, (70.79 + 4.47) ml, and the differences between the two groups were statistically significant (P < 0.05).@*Conclusion@#3D-DSA imaging technology can provide effective diagnosis and guidance in the treatment of hepatic artery chemoembolization. It can effectively reduce the radiation exposure dose and radiation intensity, and it is of high clinical value for interventional embolization of liver cancer.

Advantages and Application Prospects of Deep Learning in Image Recognition and Bone Age Assessment / 法医学杂志

Deep learning and neural network models have been new research directions and hot issues in the fields of machine learning and artificial intelligence in recent years. Deep learning has made a breakthrough in the applications of image and speech recognitions, and also has been extensively used in the fields of face recognition and information retrieval because of its special superiority. Bone X-ray images express different variations in black-white-gray gradations, which have image features of black and white contrasts and level differences. Based on these advantages of deep learning in image recognition, we combine it with the research of bone age assessment to provide basic datum for constructing a forensic automatic system of bone age assessment. This paper reviews the basic concept and network architectures of deep learning, and describes its recent research progress on image recognition in different research fields at home and abroad, and explores its advantages and application prospects in bone age assessment.

Therapeutic effect of transcatheter arterial chemoembolization combined with ultrasound-guided microwave ablation for treatment of liver cancer in special sites / 中华肝脏病杂志

Objective@#To investigate the efficacy and clinical value of transcatheter arterial chemoembolization (TACE) combined with ultrasound-guided microwave ablation for the treatment of liver cancer in special sites.@*Methods@#The patients with liver cancer in special sites (the liver cancer was adjacent to the gallbladder, dome of diaphragm, gastrointestinal tract, heart, great vessels, and portal vein, with the shortest distance from the tumor to the organ/lumen < 0.5 cm ) were enrolled as treatment group, and the patients with primary liver cancer in normal sites treated in our hospital during the same period were randomly enrolled as control group. They underwent TACE combined with ultrasound-guided microwave ablation. The 6-month, 12-month, 18-month and 24-month survival rates of the patients in two groups were analyzed.@*Results@#The clinical data of 40 patients with liver cancer in special sites, including 9, 7, 5, 11, 3, 3, and 2 patients with liver cancer adjacent to the gallbladder, dome of diaphragm, gastrointestinal tract, portal vein, hepatic vein, inferior vena cava, and heart, respectively, and another 40 patients in control group were collected in the study. The negative rate of alpha-fetoprotein (AFP) was 83.3% in the treatment group and 82.8% in the control group. The 6-month, 12-month, 18-month, and 24-month survival rates were 100.0%, 95.0%, 90.0%, and 80.0%, respectively, in the treatment group, and 100.0%, 97.5%, 92.5%, and 85.0%, respectively, in the control group.@*Conclusion@#TACE combined with ultrasound-guided microwave ablation is as effective for liver cancer in special sites as for those in normal sites, with high safety, and is feasible in clinical application.

The physiological and biochemical mechanism of nitrate-nitrogen removal by water hyacinth from agriculture eutrophic wastewater

ABSTRACT Large amount of agriculturl wastewater containing high level nitrate-nitrogen (NO3 --N) is produced from modern intensive agricultural production management due to the excessive use of chemical fertilizers and livestock scale farming. The hydroponic experiment of water hyacinth was conducted for analyzing the content of NO3 --N, soluble sugar content, N-transported the amino acid content and growth change in water hyacinth to explore its purification ability to remove NO3 --N from agriculture eutrophic wastewater and physiological and biochemical mechanism of this plant to remove NO3 --N. The results showed that the water hyacinth could effectively utilize the NO3 --N from agriculture eutrophic wastewater. Compared with the control, the contents of NO3 -change to NO3 --N in the root, leaf petiole and leaf blade of water hyacinth after treatment in the wastewater for a week was significantly higher than that in the control plants treated with tap water, and also the biomass of water hyacinth increased significantly, indicating that the accumulation of biomass due to the rapid growth of water hyacinth could transfer some amount of NO3 --N.13C-NMR analysis confirmed that water hyacinth would convert the part nitrogen absorbed from agriculture eutrophic wastewater to ammonia nitrogen, which increased the content of aspartic acid and glutamic acid, decreased the content of soluble sugar, sucrose and fructose and the content of N-storaged asparagine and glutamine, lead to enhance the synthesis of plant amino acids and promote the growth of plants. These results indicate that the nitrate in agriculture eutrophic wastewater can be utilized by water hyacinth as nitrogen nutrition, and can promote plant growth by using soluble sugar and amide to synthesis amino acids and protein.

Ethical Issues in the Teaching of Forensic Medicine / 中国医学伦理学

Forensic science is a cross discipline,involving both the subjects of natural sciences and the humanities & social sciences.It needs not only the application of forensic techniques and other theoretical results of natural sciences,but also be bounded by moral and ethical guidance.This paper discusses ethical issues involved in the teaching of forensic medicine in medical colleges,exploring the relationship between the teaching of forensic medicine and ethics,so as to promote the development of forensic science education.

Effect of Chinese Herbs on ?-Globin Gene Cluster Locus Control Hepersensitive site 2 Site Binding with Nucleoprotein / 实用儿科临床杂志

Objective To explore molecular mechanism and the curative effect of Yisuishengxue powder and its function of the hepersensitive site 2 (HS2) in ?-globin gene cluster locus control region binding with nucleoprotein.Methods After 3 months treatment of Yisuishengxue powder, nucleoprotein was extracted from the morrow cell before and after treatment. The HS2 DNA probes was combined with nucleoproteins.Electrophoresis gel mobile lag was utilized for observing the mobile velocity of DNA segment.Observe the mobile velocity of DNA probes.Results The mobile velocity of probes combined with nucleoproteins before treatment was different form that of the controls, while it was very close to the controls after treatment.Conclusions It is suggested that this compounding medicine might affect the DNA segment of HS2 site in ?-LCR binding with nucleoprotein GATA-1, which may be one molecular mechanism of Chinese herb therapy.