RESUMEN
Objective To utilize sophisticated CT-driven radiomics to prognosticate the mutation situation of KRAS in patients with colorectal cancer(CRC).Methods A total of 393 patients who underwent KRAS mutation testing and preoperative triphasic enhanced CT were analyzed retrospectively.All patients were divided into training group(n=276)and validation group(n=117)with a ratio of 7∶3.The characteristics tightly associated with KRAS mutation were extracted and screened to construct three models,include clinical,radiomics,and clinical-radiomics fusion models for prediction of KRAS mutation.The performance and clinical utility of these three models were assessed via receiver operating characteristic(ROC)curve and decision curve analysis(DCA).Results The study identified significant correlations between KRAS mutation and CEA,CA199,and a set of 13 radiomics features,respective-ly.Based on these clinical indicators and radiomics features,clinical,radiomics,and clinical-radiomics fusion models were constructed to prognosticate KRAS mutation.The radiomics model construc-ted in this study had good performance for the prediction of KRAS mutation status in CRC patients.Most notably,a clinical-radiomics nomogram that amalgamated both clinical risk factors and radiomics parameters emerged as the most effective predictor of KRAS mutation,with an area under the curve(AUC)of 0.782 and 0.744 in the training group and validation group,respectively.Conclusion The refined CT radiomics model serves as a robust,non-invasive,quantitative tool for the assessment of KRAS mutation status in CRC patients.
RESUMEN
Purpose To explore the value of three-dimensions densely connected convolutional networks(3D-DenseNet)in the differential diagnosis of high-grade gliomas(HGGs)and single brain metastases(BMs)via MRI,and to compare the diagnostic performance of models built with different sequences.Materials and Methods T2WI and T1WI contra-enhanced(T1C)imaging data of 230 cases of HGGs and 111 cases of BMs confirmed by surgical pathology in Lanzhou University Second Hospital from June 2016 to June 2021 were retrospectively collected,and the volume of interest under the 3D model was delineated in advance as the input data.All data were randomly divided into a training set(n=254)and a validation set(n=87)in a ratio of 7∶3.Based on the 3D-DenseNet,T2WI,T1C and two sequence fusion prediction models(T2-net,T1C-net and TS-net)were constructed respectively.The predictive efficiency of each model was evaluated and compared by the receiver operating characteristic curve,and the predictive performance of models built with different sequences were compared.Results The area under curve(AUC)of T1C-net,T2-net and TS-net in the training and validation sets were 0.852,0.853,0.802,0.721,0.856 and 0.745,respectively.The AUC and accuracy of the validation set of T1C-net were significantly higher than those of T2-net and TS-net,respectively,and the AUC and accuracy of the validation set of TS-net were significantly higher than those of T2-net.There was a significant difference between T1C-net and T2-net models(P<0.05),while there were no statistical differences between the models of TS-net and T2-net,T1C-net and TS-net(P>0.05).The T1C-net model based on 3D-DenseNet had the best performance,the accuracy of the validation set was 80.5%,the sensitivity was 90.9%,the specificity was 62.5%.Conclusion The 3D-DenseNet model based on MRI conventional sequence has better diagnostic performance,and the model built by T1C-net sequence has better performance in differentiating HGGs and BMs.Deep learning models can be a potential tool to identify HGGs and BMs and to guide the clinical formulation of precise treatment plans.
RESUMEN
Objective:To compare the effects of glenosphere offset positions on the impingement-free range of motion (ROM) in reverse total shoulder arthroplasty (RTSA).Methods:Shoulder joint models were reconstructed using shoulder CT scans of 6 patients with primary osteoarthritis. RTSA was performed virtually according to standard surgical procedures, and shoulder movements were simulated. Reverse shoulder models were constructed with 2 lateral offsets (0 and 4 mm) and 6 positional offsets (center, inferior, posterior, anterior, anterior-inferior, and posterior-inferior). The impingement-free ROM and impingement sites for abduction-adduction, flexion-extension, total rotation (sum of internal and external rotation), and total ROM (sum of ROM in all movement modes) were evaluated.Results:All the 12 combinations of different glenosphere offsets achieved 50% of the original shoulder ROM in all movements. In the abduction-adduction motion with 0 and 4 mm lateral offsets, the anterior-inferior offset provided the largest ROM (94.4°±8.7° and 105.3°±6.9°, respectively), but there was no significant difference between the positions ( P>0.05). In the flexion-extension motion with 0 and 4 mm lateral offsets, the posterior-inferior offset showed the largest ROM (194.1°±6.9° and 196.9°±9.7°, respectively), but there was no significant difference between the positions ( P>0.05). In the total rotation motion with 0 and 4 mm lateral offsets, the anterior-inferior offset had the largest ROM (141.5°±5.9° and 160.6°±8.5°, respectively), showing significant advantages over the center, anterior, and posterior offsets ( P<0.05), but insignificant advantages over the inferior and posterior-inferior offsets ( P>0.05). In total ROM, the anterior-inferior offset provided the largest ROM. When the lateral offset was 0 mm, the anterior-inferior offset provided a ROM of 421.8°±16.4°, showing significant advantages over the center and posterior offsets ( P<0.05). Compared with the lateral glenosphere offset of 0 mm, the lateral glenosphere offset of 4 mm significantly improved total shoulder ROM (122.8°±10.6° versus 145.8°±4.8°) and total ROM (390.9°±11.6° versus 428.4°±19.8°) ( P<0.05). Conclusions:The anterior-inferior, inferior, and posterior-inferior glenosphere offsets can improve ROM in all movement patterns. The position and lateral offset of the glenosphere significantly affect the total rotation and total ROM of the shoulder joint. Specifically, the anterior-inferior and inferior offsets show significant advantages over the center position in total rotation and total ROM of the shoulder joint.
RESUMEN
Objective:To explore the current status of the artificial intelligence (AI) developments in medical imaging in China, and to provide data for the development of AI.Methods:In May 2022, the Radiology Branch of the Chinese Medical Association and the China Medical Imaging AI Industry-University-Research Innovation Alliance jointly launched a nationwide survey on the application status and development needs of medical imaging AI in China in the form of a questionnaire. This survey was carried out for different groups of people, focusing on the clinical applications of medical imaging AI, enterprise development, and educational needs in colleges and universities, with the descriptive statistical analysis performed.Results:China′s medical imaging AI has made great progress in clinical applications, in enterprise developments, as well as in the education and teaching areas. In terms of clinical application, 90.8% (5 765/6 347) of the survey respondents had a preliminary understanding of AI. There were 62.1% (3 798/6 119) doctors confirmed the applications medical imaging AI products in their departments. AI products were applied in the whole process of medical imaging examination, especially in assistance of the diagnosis. The application of pulmonary nodules screening accounted for 89.5% (3 401/3 798) of all medical imaging AIs. The main factors restricting the rapid development of medical imaging AI included lack of experts [47.3% (3 002/6 347)], poor data quality [45.7% (2 898/6 347)] and imperfect function of the products [40.4% (2 566/6 347)]; in terms of enterprises, there were 65.4% enterprises with a scale of less than 100 employees (17/26), and 34.6% with a scale of more than 100 employees (9/26). The main group of the customers were the hospitals above the second level, accounting for about 92.3% (24/26); in terms of education, the number and quality of AI courses, practical operations and lectures currently carried out by schools vary between different levels. The AI courses for graduated students accounted for about 22.5% (86/381), which were the largest in number; while the proportion of AI courses for junior college students, undergraduates and regular trainees were less than 15%. More than 60% of the students thought it necessary for schools to establish AI courses. Among all the students, the master′s and doctoral candidates had the greatest demand for additional AI courses [84.8% (323/381)].Conclusions:The development and popularization of medical imaging AI in China continues to prosper, with opportunities and challenges coexisting. It is necessary to adhere to the orientation of clinical needs, and to realize the coordinated development of clinical application, enterprise development, as well as education and teaching.
RESUMEN
Objective:To explore the value of a deep learning model based on MRI in predicting the methylation status of MGMT in WHO Ⅱ, Ⅲ gliomas.Methods:The clinical and imaging data of 121 patients with WHO grade Ⅱ, Ⅲ glioma confirmed by surgical pathology and molecular pathology in the Second Hospital of Lanzhou University from June 2016 to June 2020 were retrospectively analyzed. Among them, the MGMT promoter was methylated. A total of 78 cases were metabolized and 43 cases were unmethylated. T 2WI and T 1WI enhanced sequence images of 121 cases of WHO Ⅱ, Ⅲ gliomas were collected, and all the images of each patient including the lesion level were selected manually, and were randomly divided into training set and validation set according to 7∶3. The EfficientNet-B3 convolutional neural network was used to build independent prediction models (T 2-net, T 1C-net, TS-net) based on T 2WI, T 1WI enhancement, T 2WI combined with T 1WI enhancement, and the prediction performance of each model was evaluated separately through the ROC curve. Results:The T 2-net model in the validation set presented an accuracy of 72.3%, a sensitivity of 64.7%, a specificity of 73.3%, and an area under the curve (AUC) of 0.72 for predicting the methylation status of the MGMT promoter in WHO Ⅱ, Ⅲ gliomas. The T 1C-net model showed an accuracy of 66.8%, a sensitivity of 68.3%, a specificity of 66.9%, and an AUC of 0.72. The TS-net model showed an accuracy of 81.8%, a sensitivity of 63.1%, a specificity of 85.0%, and AUC of 0.78. Conclusions:The EfficientNet-B3 convolutional neural network based on MRI can predict the methylation status of the MGMT promoter of WHO Ⅱ, Ⅲ gliomas; the TS-net model has the best prediction performance.
RESUMEN
Objective:To report the diagnosis and surgical treatment of a special type of Maisonneuve injury.Methods:A total of 4 patients were treated at Department of Orthopaedics, Beijing Chao Yang Hospital from January 2015 to July 2019 for Maisonneuve injury. They were 3 males and one female, aged from 34 to 61 years (average, 45.3 years). All injuries were closed, initially manifested as posterior dislocation of the ankle on X-ray films and X-ray and CT re-exams after manual reduction showed fine reduction with no obvious fracture of the ankle joint. Consequently the diagnosis of their Maisonneuve injury was missed in emergency visits, but re-exams in outpatient visits showed separation of distal tibiofibular syndesmosis. All the patients were treated by restoration of the fibular length, fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate functional recovery of the ankle joint at 12 months after operation.Results:All the 4 patients were followed up for 12 to 14 months (average, 12.7 months). The fractures united after 110 to 185 days (average, 149.3 days). No post-operative complications like infection, delayed union or nonunion were observed. The AOFAS score at 12 months ranged from 82 to 96 points (average, 90.5 points), giving 3 excellent and one good cases.Conclusions:The Maisonneuve injury which is clinically manifested as posterior dislocation of the ankle with no obvious fracture of the ankle joint is likely to be missed in clinical diagnosis. Therefore, X-ray exam of the full length tibia and fibula should be taken in physical examination after reduction for the patients with simple posterior dislocation of the ankle. Once the special type of Maisonneuve injury is diagnosed, surgical treatment is indicated. Satisfactory treatment efficacy can be achieved by fixation of the distal tibiofibular syndesmosis and repair of the triangular ligament.
RESUMEN
Objective To verify the reliability of novel 3D classification of intertrochanteric fractures by comparing the consistency between conventional and novel classifications.Methods Included for the present study were the preoperative X-ray and CT images of 189 patients with intertrochanteric fracture who had been hospitalized at Department of Orthopaedics,Beijing Chao Yang Hospital,Capital Medical University from 1 January,2017 to 1 January,2019.The patients' intertrochanteric fractures were classified by 6 orthopedic surgeons independently using Evans classification,Jensen classification,AO classification and novel 3D classification,respectively.One month later,the original images of the 189 patients were renumbered and classified again in the same way.The Kappa values between observers and within observers were calculated for the classifications of intertrochanteric fractures based on X-ray and CT images.Results In Evans classification,Jensen classification,AO classification and novel 3D classification,the interobserver Kappa values of X-ray films were 0.54 ± 0.03,0.53 ± 0.03,0.45 ± 0.03 and 0.63 ± 0.02,respectively,and the interobserver Kappa values of the CT images were 0.49 ± 0.03,0.49 ± 0.03,0.44 ± 0.04 and 0.63 ± 0.03.The intraobserver Kappa values of the X-ray films were 0.53 ± 0.02,0.54 ± 0.03,0.44 ±0.04 and 0.65 ± 0.02,respectively,and the intraobserver Kappa values of the CT images were 0.52 ± 0.03,0.52 ±0.03,0.41 ±0.02 and 0.64 ±0.03.In the novel classification based on X-ray and CT images,the interobserver and intraobserver Kappa values were both significantly higher than those in Evans,Jensen and AO classifications (P ＜ 0.05).Conclusion The novel 3D classification of intertrochanteric fractures is more reliable than the conventional ones.
RESUMEN
Objective To investigate MRI features of cystic oligodendrocytoma.Methods MRI features of 10 patients with oligodendroglial tumors proved with operation and pathology were analyzed retrospectively.Results Among 10 patients,lesionslocated on the supratentorium in 8 patients,while on the cerebellar vermis in 2 patients.Solitary lesion was found in 9 cases,and multiple lesions were found in 1 case.Complete cystic lesions were observed in 4 cases,large cystic lesions with solid nodules were found in 3 cases,and multi-cystic lesions were found in 3 cases.Smooth cyst wall of lesions were found in 7 cases,locally depressed and rough wall were found in 3 cases.Calcifications were found in 3 cases.Mild peritumoral edema was found in 9 cases,moderate to severe edema was found in 1 case.The lesions significantly enhanced in 3 cases,ring enhanced in 3 cases,and locally enhanced in 1 case.Conclusion COD is difficult to diagnose,but has certain MRI characteristics.COD should be considered when supratentorial complete cystic lesion or large cystic lesion with septum and/or solid nodule was found with MRI.
RESUMEN
Objective To compare the clinical effect of Multiloc nailing and Philos locking plate for treating proximal humerus fracture.Methods A retrospective analysis of 34 surgery treated proximal humeral fractures patients in Department of Orthopedics,Beijing Haidian Hospital and Department of Orthopedics,Beijing Chaoyang Hospital,Capital Medical University from January 2015 to June 2016,in which 3 cases of high-energy injury and multiple fractures andonecase of humerus head replacement and onecase of non-surgical treatment were excluded.Finally,29 patients were included and clinical followed up to 12 months after surgery.The 29 paients were divided into the locking plate group (n =13) and intramedullary nail group (n =16),The operative time,volume of intraoperative blood loss,preoperative to postoperative 24 patients were compared between the locking plate group and intramedullary nail group underwent open reduction and internal fixation with philos locking plate hemoglobin changes,24 h postoperative visual analogue scale and 3,6,12 months postoperative Constant-Murley shoulder function score.SPSS13.0 statistical software was used to analyze the data.Measurement data were expressed as ((x) ± s).Comparison of groups used independent samples t test,repeated measurement data used repeated measures analysis of variance.Results The age of the locking plate group was (65.7 ± 9.3) years,and the age of the intramedullary nailing group was (65.6 ± 11.1) years.In the locking plate group,the operation time was (150 ± 17) minutes,the intraoperative blood volume was (300 ± 53) ml,the change of blood pigment between before surgery to 24 hours after surgery was (26 ± 8) mg/L,and the vision algetic standard of 24 hours after surgery was (3.4 ± 0.8) scores.In intramedullary nailing group,the operation time was (119 ± 13) minutes,the intraoperative blood volume was (130 ± 25) ml,and the change of blood pigment between before surgery to 24 hours after surgery was (11 ± 5) g/L,the vision algetic standard of 24 hours after surgery was (2.3 ± 0.5) scores.No serious postoperative complications occurred in either group,including infection,internal fixationfailure,and humeral head necrosis.In locking plate group,for the Constant-Murley shoulder joint function score,3 months after surgery was (76.0 ± 11.6) scores,6 months was (78.0 ± 13.4) scores,12 months was (88.0 ± 12.1) score.In intramedullary nailing group 3 months was (85.0 ± 9.7) scores,6 months was (87.0 ± 8.9) scores,12 months was (89.0 ± 10.3) scores.There were no statistical difference between the two groups at incidence of serious complications after surgery,postoperative 12 months Constant-Murley shoulder joint function score.Muhiloc intramedullary nailing group was better than Philos locking plate group in the operation time,the intraoperative blood volume,etc.Conclusion Multiloc intramedullary nail is an effective method for treating proximal humerus fracture,and it has the advantages of less surgical injury and early postoperativesatisfactory than the locking plate.
RESUMEN
Purpose To explore the value of hydroxyapatite (HAP) in the measurement of bone mineral density (BMD) based on the quantitative material decomposition images of spectral CT on healthy adult females.Materials and Methods A total of 128 healthy females who underwent upper abdominal CT examination with spectral CT at the Second Hospital of Lanzhou University from September 2013 to February 2016 were enrolled as the research group.Those patients with trauma,surgery,tumor or other diseases affecting BMD were excluded.The patients (ages ranged from 18 to 87 years) were divided into 6 groups according to their ages:＜30 years (n=23),30-39 years (n=20),40-49 years (n=22),50-59 years (n=24),60-69 years (n=19) and ≥ 70 years (n=20).The HAP and calcium concentration at central part of L2 centrum of spongy bone were measured.Meanwhile,119 healthy females who underwent dual energy X-ray absorption (DEXA) examination were selected as the controls and also divided into groups according to the same criteria as the research group.The BMD of the controls was also measured at L2 centrum and showed as areal density (g/cm2).The measurements of the research group were analyzed.The correlation analysis was done between hydroxyapatite,calcium concentration and age.The correlations between hydroxyapatite,calcium concentration and BMD obtained by DEXA were also analyzed.Results There were significant differences in the HAP and calcium concentration among different age groups (P＜0.05).The results of spectral CT and the DEXA showed correlations.Both HAP and calcium concentration showed positive relationship with BMD obtained by DEXA (r=0.874 and 0.796,respectively,both P＜0.05).The HAP and calcium concentration showed positive relationship with age in the groups (ages ranged from 18-39 years) (r=0.538 and 0.416,P＜0.05) and negative relationship with age in the groups (ages over 40 years) (r=-0.629 and-0.562,P＜0.05).Conclusion Material decomposition images of spectral CT can reflect bone changes,and HAP is a new base material for BMD measurement.
RESUMEN
Objective To explore the clinical efficacy and indications of kyphoplasty with movement and secondary en?largement of balloon for the compression fracture of vertebral body with ruptured posterior wall. Methods A retrospective analy?sis was carried out on the data of 29 patients (10 males, 19 females;age range:55-86 years old;mean age:71 years old;29 verte?bral bodies in total) who suffered from compression fracture of the thoracolumbar spine and below, and underwent kyphoplasty through the movement and secondary enlargement of balloon within the vertebral body and were followed up from January 2011 to November 2014. These patients had backache, accompanied by lowered support, limitation of movement, no symptom of nervous lesion on both lower extremities and no past history of balloon kyphoplasty. All fractured vertebral bodies were at T 11 or below, in?cluding 1 case at T11, 4 cases T12, 11 cases L1, 9 cases L2 and 4 cases L3. The causes of injury included fall (19 cases), car accident (8 cases) and unknown reasons (2 cases). All patients underwent kyphoplasty with the movement and secondary enlargement of bal?loon within the vertebral body. Photos were taken immediately after the surgery, at 1 month, 3 months, 6 months and 12 months, and these patients were assessed and analyzed in terms of vertebral height, Cobb angle, visual analogue score (VAS) and Oswestry disability index (ODI). Results The operation time (including the formation and solidification of bone cement) of 29 patients was 40 to 65 min and the mean time was 55 ± 7 min;the blood loss during operation was 2 to 15 ml and the mean blood loss was 5 ± 2 ml;the injected volume of bone cement was 2.5-7.5 ml and the mean volume was 5.5±0.5 ml. Post?operative pain was relieved and ambulation was performed under the protection of lumbar orthosis brace. Statstical analysis was conducted on VAS, ODI, vertebral height and Cobb angle before operation and at 1 month, 3 months, 6 months and 12 months after operation, showing statistically significant differences. X ray examination found that there was no alternation or displacement of bone cement location, and no change in vertebral morphology, the vertebral height and cobb angle remained the post?operative status, and posterior wall rupture of the vertebral body was recovered well. CT revealed that the morphology of bone cement was irregular and closely integrated with bone substance, and no cavity or fissure was seen. Conclusion Kyphoplasty with movement and secondary enlargement of bal?loon within the vertebral body has a good, definite clinical efficacy in treating compression vertebral fracture with incomplete pos?terior wall of the vertebral body without obvious displacement of fractured bone and symptom of nervous lesion on both lower ex?tremities. This surgery is easy to operate, and has an immediate analgesic effect, which could recover vertebral height as well as re?duce kyphosis deformity and improve patient’s prognosis.
RESUMEN
Objective To investigate the value of CT spectral imaging in differential diagnosis of atypical pheochromocytoma and adrenal adenoma.Methods The energy spectrum CT data of 13 cases of atypical pheochromocytoma and 15 cases of adrenal cortical adenoma confirmed by surgery pathology were retrospectively analyzed.All images processed by spectrum software.The CT value of different energy levels (40-140 keV) in arterial,venous and delayed phase,energy spectrum curve and spectrum curve type,base material of concentration (water-iodine,grease-iodine,blood-iodine) were obtained,and the CT value of different energy were standardize in the same period.Data were compared with samples t test.Results For arterial phase,the standardization CT values of pheochromocytoma on monochromatic images of 40 keV,70 keV to 140 keV had statistical difference with those of adenoma (all P＜0.05).For venous phase,the standardization CT values of pheochromocytoma on monochromatic images of 70 keV to 140 keV had statistical difference with those of adenoma (all P＜0.05).For delayed phase,the standardization CT values of the two tumors on monochromatic image of 40 keV to 140 keV had significant difference (all P＜0.05).Both the energy spectrum of the three periods of type curve was falling,pheochromocytoma always located above compared with adenoma.The standardization concentration of base materials including water (iodine),fat (iodine) and blood (iodine) of pheochromocytoma were higher than those of adenoma in three phases (all P＜0.001).The standardization concentration of base materials including iodine (water),iodine (fat) and iodine (blood) had no significant difference in three phases between pheochromocytoma and adenoma (all P＞ 0.05).Conclusion Atypical pheochromocytoma and adrenal adenoma have different spectral curve and spectrum characteristics of the material content.Spectral CT imaging provides a method of multiple parameters to identify atypical adrenal pheochromocytoma and adenoma.
RESUMEN
Objective To observe the curative effect of open reduction and internal fixation for capitellum and trochlea fractures.Methods A retrospective case series study was performed on 14 patients with capitellum and trochlea fractures without involving lateral and lateral column treated by open reduction and internal fixation from April 2008 to August 2016.There were four males and 10 females, aged from 24 to 62 years (mean, 41.4 years).Dubberley classification was type ⅠA in four patients, type ⅠB in three, type ⅡA in two, type ⅡB in one, type ⅢA in two, type ⅢB in two.Three patients were combined with ipsilateral capitulum radius fractures, and one patient with ipsilateral ulna olecranon fracture.Visual analogue scale (VAS) for elbow pain, elbow activity and Mayo elbow performance score (MEPS) were evaluated.Postoperative complications were also observed.Results All patients were followed up for 24-55 months (mean, 27.2 months).Fracture healed after (21.3±2.1)weeks.VAS was (2.1±1.9) points at 24 months postoperatively, with painless in three patients, mild pain in seven and moderate pain in four.Elbow flexion and extension angle was (93.4±15.2)°, elbow flexion angle was (114.3±11.1)°, elbow extension angle was (33.6±20.7)°, forearm front rotation angle was (75.2±12.5)°, and forearm back rotation angle was (83.2±8.2)°.No patients had elbow instability, ischemic necrosis or internal fixation loosening.MEPS was (74.2±17.8)points, including excellent results in 3 cases, good in 8, fair in 2 and poor in 1.One case of Dubberley type ⅢA developed mild ulnar nerve symptom and alleviated after 3 months.Five cases (two type ⅢA, one type ⅢB, one type ⅡA, one type ⅡB) had a small amount of heterotopic ossification 6 month after operation, but elbow flexion and extension activity was good.One case of Dubberley type ⅢB combined with fracture of the olecranon process had elbow heterotopic ossification 1 month after operation, further developed large displaced ossification around the elbow 6 months after operation, and showed elbow flexion and extension of 30° 2 years after operation that was significantly limited compared to the contralateral side.Conclusion Open reduction and internal fixation of capitellum and trochlea fractures can improve elbow activity and reduce incidence of postoperative complication.
RESUMEN
Objective To evaluate the value of spectral CT in risk classification of gastrointestinal stromal tumor (GIST).Methods Forty-one patients with GIST were collected,including 1 3 in high risk,1 2 in medium risk,1 1 in low risk and 5 in very low risk. All of the patients underwent plain and triple phases contrast enhanced CT with spectral CT scanning mode.CT value of 70 keV monochromatic images,the slope of spectral curve and normalized iodine concentration (NIC)were measured and calculated.Then, data was correlated with the risk of GIST.Results ①The CT value of 70 keV monochromatic images was negative correlation in the arterial phase (r=-0.173),positive correlation in delayed phase (r=0.552),and no correlation in venous phase with the risk of GIST.②The slopes of spectral curves in delayed phase were significantly different in GISTs with the different risk (χ2= 6.641,P= 0.036).③The NIC values of GISTs with different risk were significantly different in the triple phases (F=3.646,χ2=6.046,F=57.233,P=0.035, P=0.049,P<0.001),and correlated with the risk of GIST (r=-0.564)in the delayed phase.Conclusion Quantitative paremeters of spectral CT imaging such as the CT value of 70 keV,the slopes of spectral curves and iodine concentration are valuable for the risk classification of GIST,and can be used as a preoperative reference.
RESUMEN
The current treatment of medical implant-associated infections is still challenging.The infections are particularly persistent because the bacteria attaching to the implant surfaces produce a protective matrix which establishes itself as biofilms,shielding the bacteria from antibiotics.Biofilm bacteria are resistant to antimicrobics at levels 500 to 5,000 times higher than those needed to kill non-biofilm bacteria.In vitro experiments have shown that electric current has anti-infection effect and can enhance the activity of some antimicrobial agents against certain bacteria in the biofilms.Direct electrical stimulation has already been safely used in humans for fracture healing.In this article,we review the current state and development in research on the anti-infection effect of electrical stimulation.
RESUMEN
Objective To investigate the selection of operative method and peri operative managements for osteoporotic femoral intertrochanteric fracture in elderly patients aged over 75 years.Methods A total of 132 consecutive patients aged 75-91 years with osteoporotic intertrochanteric fractures from July 2009 to July 2012 were retrospectively analyzed.47 patients were treated with dynamic hip screw (DHS group),44 patients with proximal femoral nail anti-rotation (PFNA group) and 41 patients with Gamma Ⅲ nail (Gamma Ⅲ group).The peri-operative managements,operation circumstance,the time for fracture union,postoperative complications and the degree of functional recovery were analyzed and compared between the 3 groups.Results The mean surgical time was shorter in Gamma Ⅲ nail and PFNA groups than in DHS group [(68.7±9.1) min,(80.5±11.3) min vs (112.2±18.4) min,both P＜0.01].The mean blood loss was less in the Gamma Ⅲ nail and PFNA groups than in DHS group[(156.9±18.5) ml,(183.4±21.3) ml vs (296.2±29.6) ml,both P＜0.01].The mean time for fracture healing was shorter in Gamma [Ⅲ nail and PFNA groups than inDHSgroup [(12.6±2.4) weeks,(13.1±2.4) weeks vs (15.3±3.2) weeks,both P＜ 0.05],and it has no obvious difference between Gamma Ⅲ nail and PFNA groups (P＞0.05).There were significant differences in postoperative complications between Gamma Ⅲ nail,PFNA groups and DHS group (2 cases,3 cases vv 11 cases,P＜0.05,respectively).The mean Harris hip score had no significantly difference among DHS,Gamma Ⅲ nail and PFNA groups (87.4±11.6,90.2±13.0 vs 88.9±12.3,both P＞0.05).Conclusions The 3 operative methods for stable intertrochanteric fracture are feasible and effective in elderly patients,but for unstable intertrochanteric fractures,the treatment with Gamma Ⅲ nail and PFNA has advantages.
RESUMEN
Objective To evaluate the clinical effectiveness of double balloon dilation in percutaneous kyphonplasty on curing vertebral?compression fractures. Methods From January 2009 to September 2013, 84 patients (94 vertebral bodies) with vertebral compression were treated by percutaneous kyphonplasty. All were fresh fractures and were injured or obvious low back pain 1 month, accompanied by local tenderness, kowtow attack painful, lumbar mobility, but no lower extremity injury numbness, activities and defecation disorders. After randomization, the double balloon dilation in percutaneous kyphonplasty method was used to treat 44 patients (49 vertebrae). In the process of performing percutaneous unilateral pedicle puncture and balloon dilata?tion of the vertebral body, the balloon has been moved some distance in the vertebral body. Then completed the perfusion of bone cement, vertebral body forming. 40 cases (45 vertebrae) were used conventional unilateral percutaneous kyphonplasty to vertebtal compression fractures. Recorded the operation time, amount of bleeding, bone?cement injection volume. Used visual analogue scale (VAS), the height of the vertebral body and Cobb angle to evaluated the curative effect. Results All 84 patients completed the operation, follow?up time was 22 months (18-24 months). In two mobile open expansion group, the operation time was about 48 min. The amount of bleeding was 8-15 ml. The average bone?cement injection volume was 5.1 ml. No patients quit the study and no bone cement?leakage cases or other side effects were observed , and no clinical accidents occurred. In a single stretching group, 40 cases (45 vertebrae) completed conventional vertebroplasty, the time of 44 min, bone cement average injection rate 3.2 ml, bleeding 10-15 ml. In two mobile open expansion group, the VAS score was 8.5 points, the height of the vertebral body height was 2.1cm, and the Cobb angle was 34°. After operation, the VAS score 2.9 points, the height of the vertebral body 2.8 cm, and Cobb 20° . In the other group, the pain was significantly relieved and the relief was satisfactor after operation.Vertebral height of 2 cm turned to the last follow?up of 2.4 cm. The Cobb angle was 32°, and the last follow?up was 27°. The VAS score, operation time and bleeding volume of the two groups were not statistically significant, and a statistically significant difference of the average bone ce?ment injection volume, postoperative vertebral height and cobb angle improved with statistical significance. A single open group were 2 cases of bone cement leakage and leakage, 1 cases of bone cement tail, the complication rate was 5.6%. Conclusion The application of double balloon dilation in percutaneous kyphonplasty to vertebral?compression fractures improve relocation of verte?bral compression fractures, increase recovery of vertebral height, and more effectively strengthen and stiffen pathological vertebral bodies, while improving kyphosis. Moreover, it can reduce pressure during bone?cement injections, minimizing the chance of over?flow and leakage, as well as the related side effects, but it will also result in an increase of bone cement?injection volume.
RESUMEN
Objective To investigate the effect of low dose lipopolysaccharide ( LPS ) preconditioning on prevention of incision infection by drug-resistant bacteria.Methods Methicillin-resistant Staphylococcus aureus ( MRSA) suspension with concentration of 1.8 ×109 CFU/mL was prepared.Sixty BALB/c mice were randomly divided into five groups (12 in each group, half male and half female).A medical longitudinal incision of the right thigh was made in mice in group 1-4, and 1, 0.5, 0.25 and 0 mL bacteria suspension was dropped on the surface of the incision and the incision was observed 4d after the model established.Group 5 was the blank control.Then 112 BALB/c mice were randomly divided into 7 groups ( each group had sixteen mice, half male and half female ): group A ( preconditioned with LPS 0.25 mg· kg-1· time-1), group B ( preconditioned with LPS 0.5 mg · kg-1 · time-1 ), group C (preconditioned with LPS 1 mg· kg-1 · time-1 ), group D (preconditioned with LPS 1.5 mg· kg-1 · time-1 ) , group E ( preconditioned with sterile normal saline) , group F ( incision infected) , and group G ( blank control) .LPS was given by intraperitoneal injection 48 h and 24 h before the establishing of the infection model.Body temperature was monitored every day after the model established, blood routine examination was performed on d3 and d7, and serum cytokines was detected on d7.All the mice were sacrificed on d7, and soft tissues around the incision were taken for hematoxylin-eosin staining.Repeated measures ANOVA and univariate ANOVA were performed for data analysis. Results Redness and suppuration were observed in 6 mice infected with 0.5 mL bacteria suspension, respectively, then 0.5 mL bacteria suspension was used for LPS preconditioning experiments.With LPS preconditioning, the body temperatures of mice in group B were with relatively minor changes, and the rises of white blood cells and lymphocytes on d3 and d7 were relatively modest.Granulocytes in group B returned to the normal level on d7.Besides, the rises of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-αin group B were also less, while IL-10 was increased greatly.Suppuration was observed in 4 mice in group B ( 4/16, 25.00%), and the rate was lower than group D, E and F (χ2 =7.988, 19.940 and 19.940,P<0.01). Conclusion LPS (0.5 mg· kg-1 · time-1 ) preconditioning can reduce the severity of incision infection caused by MRSA in mice.
RESUMEN
BACKGROUND:Previous studies have found that endogenous gaseous signaling molecules such as NO, CO, H2S and SO2 play an important role in acute lung injury;there also have other gases participation, such as carbonyl sulfide. OBJECTIVE:To investigate the effect of carbonyl sulfide for limb ischemia-reperfusion induced acute lung injury and its mechanism in rats. METHODS:A total of 64 Sprague-Dawley rats were randomly divided into eight groups. Control group:without treatment;model group:limb ischemia for 4 hours and then reperfusion for 2 hours. Low-, moderate-and high-dose carbonyl sulfide groups were intraperitoneal y injected with 0.2, 0.5, 1.0 mL carbonyl sulfide respectively at 20 minutes before ischemia for 4 hours and reperfusion for 2 hours. Low-, moderate-and high-dose air groups were intraperitoneal y injected with 0.4, 1.0, 2.0 mL air respectively at 20 minutes before ischemia for 4 hours and reperfusion for 2 hours. 2 hours after reperfusion, the morphological changes of lung tissues and the change of lung coefficient were observed. The expressions of tumor necrosis factor-a, interleukin-1βand interleukin-6 both in lung tissue and serum were detected by enzyme linked immunosorbent assay. Cel apoptosis was measured by TUNEL assay. RESULTS AND CONCLUSION:(1) Compared with the control group, significant damage of lung tissue was seen, and the lung coefficient increased significantly in the model group (P<0.05). The expressions of tumor necrosis factor-a, interleukin-l and interleukin-6 both in lung tissue and plasma increased (P<0.05), and apoptotic rate increased. (2) Compared with the model group, low-, moderate-and high-doses of carbonyl sulfide could mitigate the degree of lung injury, and reduce pulmonary coefficient and apoptotic rate. The low dose showed the most obvious effect. Low-and moderate-dose carbonyl sulfide could significantly decrease expressions of tumor necrosis factor-a, interleukin-1βand interleukin-6 both in lung tissue and plasma (P<0.05). (3) No significant difference in each index was visible in the low-, moderate-and high-dose air groups compared with the model group. (4) Results suggested that low dose of exogenous carbonyl sulfide through anti-inflammatory, anti-oxidant effects plays the protective role on limb ischemia/reperfusion-induced acute lung injury in rats.
RESUMEN
Objective To investigate the atypical CT ,MRI findings of pancreatic neuroendocrine tumors (PanNETs) ,in order to improve diagnosis .Methods The clinical ,imaging and pathological data of 6 patients with PanNETs confirmed by pathology were analyzed retrospectively .Results In all 6 cases ,2 lesions were located in the pancreatic head ,3 lesions in the pancreatic body ,and 1 lesion in the pancreatic tail .There were 2 functional PanNETs with an average size of 2 .1 cm × 2 .6 cm ,which showed homogeneous density or signal .There were 4 nonfunctional PanNETs with an average size of 2 .7 cm × 4 .3 cm ,one of which had calcification ,and two of which had obviously cystic change ,including intracapsular bleeding in one case .Contrast‐enhanced examinations showed that all 6 lesions had mild or moderate enhancement .Three lesions were manifested as relatively intense enhancement in the arterial and portal venous phase ,but decreased enhancement in the delayed phase ,including annular envelope enhancement in one case .Two le‐sions were manifested as progressive enhancement .The last case was manifested as inwardly filled enhancement .Three lesions had unclear boundaries ,while one lesion had splenic vein invasion .Two cases accompanied with mild expansion of the common bile duct or pancreatic duct .Conclusion PanNETs can be ma+nifested as atypical findings such as obviously cystic changes ,and(or) mild to moderate enhancement .It is suggested that the atypical imaging findings of PanNETs should be recognized well to improve the diag‐nostic accuracy .