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Objective:To analyze the clinical efficacy of treatment of cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures.Methods:A retrospective study was conducted to analyze the data of 13 patients who had been treated at Department of Orthopaedics, The First Affiliated Hospital of Soochow University for cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures from July 2013 to July 2022. There were 4 males and 9 females, with an average age of (76.5±8.6) years and a T value of bone mineral density of -3.3±0.6. By the CT and MRI features of cement dislodgement, their conditions fell in 4 types: cement loosening in situ (4 cases), anterior cement moving (6 cases), anterior cement moving with posterior bone mass moving (2 cases), and posterior cement moving (1 case). They were treated by percutaneous vertebroplasty (3 cases), pedicle screw fixation combined with bone graft fusion and decompression (7 cases), and conservative therapy (3 cases). The curative effects for surgical patients were evaluated by comparing their visual analogue scale (VAS), Oswestry dysfunction index (ODI) and cobb angle of kyphosis at preoperation, 1 week and 1 month postoperation, and the last follow-up, and Frankel grading for nerve injury as well. The curative effects for patients undergoing conservative treatment were evaluated by observing their symptoms.Results:This cohort was followed up for 7 (5, 12) months after treatment. The VAS scores [5.0 (4.0, 5.0) points, 3.0 (2.0, 3.0) points, and 3.0 (2.0, 3.0) points] in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value [8.5 (8.0, 9.0) points] ( P<0.05); the VAS scores at 1 month postoperation and the last follow-up were also significantly improved compared with that at 1 week postoperation ( P < 0.05), but there was no significant difference between the last follow-up and 1 month postoperation ( P > 0.05). The ODIs (50.6%±4.2%, 37.8%±4.5%, and 29.3%±5.6%) in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value (93.2%±3.6%), showing significant differences in pairwise comparisons ( P<0.05). The cobb angles [10.0 (9.0, 11.0)°, 9.0 (9.0, 11.0)°, and 10.0 (9.0, 12.0)°] in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value [12.5 (11.0, 14.0)°] ( P<0.05) , but there was no statistically significant difference between the time points after operation ( P>0.05). The Frankel grading was significantly improved in the 6 patients with nerve injury after operation. Of the 3 patients undergoing conservative treatment, the symptoms were cured in one, showed no change during follow-up in one, and aggravated in one. Conclusion:Surgical treatment can significantly relieve pain, improve spinal dysfunction and repair nerve injury in patients with bone cement dislodgement after vertebral augmentation.
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Objective:To explore the value of different machine learning models based on Gd-EOB-DTPA enhanced MRI hepatobiliary phase radiomics features in preoperative prediction of microvascular invasion (MVI) of hepatocellular carcinoma (HCC).Methods:The data of 132 patients with HCC confirmed by pathology in the First Affiliated Hospital of Soochow University from January 2015 to May 2020 were retrospectively analyzed, including 72 cases of positive MVI and 60 cases of negative MVI. According to the proportion of 7∶3, the cases were randomly divided into training set and validation set. The radiomics features of hepatobiliary phase images for HCC were extracted by PyRadiomics software. The clinical and radiomics features of the training set were screened by the least absolute shrinkage and selection operator (LASSO) regression with 5 fold cross-validation, and then the optimal feature subset was obtained. Six machine learning algorithms, including decision tree, extreme gradient boosting, random forest, support vector machine (SVM), generalized linear model (GLM) and neural network, were used to build the prediction models, and the ROC curves were used to evaluate the prediction ability of the models. DeLong test was used to compare the differences of area under the curve (AUC) for 6 machine learning algorithms.Results:Totally 14 features selected by LASSO regression were obtained to form the optimal feature subset, including 2 clinical features (maximum tumor diameter and alpha-fetoprotein) and 12 radiomics features. The AUCs of decision tree, extreme gradient boosting, random forest, SVM, GLM and neural network based on the optimal feature subset were 0.969, 1.000, 1.000, 0.991, 0.966, 1.000 in the training set and 0.781, 0.890, 0.920, 0.806, 0.684, 0.703 in the validation set, respectively. There were significant differences in the AUCs between extreme gradient boosting and GLM or neural network ( Z=2.857, 3.220, P=0.004, 0.001). The differences in AUCs between random forest and SVM, GLM, or neural network were significant ( Z=2.371, 3.190, 3.967, P=0.018, 0.001,<0.001). The difference in AUCs between SVM and GLM was statistically significant ( Z=2.621 , P=0.009). There were no significant differences in the AUCs among the other machine learning models ( P>0.05). Conclusion:Machine learning models based on Gd-EOB-DTPA enhanced MRI hepatobiliary phase radiomics features can be used to preoperatively predict MVI of HCC, particularly the extreme gradient boosting and random forest models have high prediction efficiency.
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Objective:To explore the value of spectral CT radiomics quantitative features on differentiating lung cancer nodule from inflammatory nodule.Methods:The spectral CT imaging data of 96 lung cancer nodules and 45 inflammatory nodules from the First Affiliated Hospital of Soochow University were analyzed retrospectively. According to a ratio of two to one, patients were randomly assigned to the training group and validation group, including 64 lung cancer nodules and 30 inflammatory nodules in the training group, 32 lung cancer nodules and 15 inflammatory nodules in the validation group. MaZda software was used for radiomic feature extraction from the 70 keV monochromatic images in arterial phase and venous phase for lung cancer nodules and inflammatory nodules in the training group. Fisher coefficients (Fisher), classification error probability combined average correlation coefficients (POE+ACC) and mutual information (MI) were used to select 10 optimal features for the optimal feature subsets. The optimal feature subsets were analyzed by using linear discriminant analysis (LDA) and nonlinear discriminant analysis (NDA) to calculate the area under the receiver operating characteristic (ROC) curve (AUC), accuracy, sensitivity, specificity, precise and F1 score in differentiating lung cancer nodule from inflammatory nodule. The prediction model was established using the optimal feature subsets in the training group with artificial neural network (ANN). Then the established prediction model was used to differentiate lung cancer nodule from inflammatory nodule in the validation group. Delong test was used to compare the differences in the AUC of different optimal feature subsets.Results:In arterial phase, the optimal feature subset obtained from MI-NDA had the highest AUC of 0.888 [95% confidence interval (CI) 0.806-0.943], accuracy rate of 88.3%, sensitivity of 87.5% and specificity of 90.0%, on the differential diagnosis of lung cancer nodule and inflammatory nodule in the training group. There was no significant difference in AUC between MI-NDA and Fisher-NDA or (POE+ACC)-NDA method ( Z=1.941, P=0.052; Z=1.683, P=0.092). In venous phase, the optimal feature subset obtained from (POE+ACC)-NDA had the highest AUC of 0.846 (95%CI 0.757-0.912), accuracy rate of 87.2%, sensitivity of 92.2% and specificity of 76.7%, on the differential diagnosis of lung cancer nodule and inflammatory nodule in the training group. There was no significant difference in AUC between(POE+ACC)-NDA and MI-NDA method ( Z=1.354, P=0.18), but significant difference between (POE+ACC)-NDA and Fisher-NDA method ( Z=2.423, P=0.015). In the validation group and training group, the optimal feature subset selected by MI-NDA method had the highest AUC of 0.888(95%CI 0.806-0.943) and 0.871(95%CI 0.741-0.951). Conclusion:Spectral CT radiomics quantitative features have great value on the differential diagnosis of lung cancer nodule and inflammatory nodule.
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Objective To explore the diagnostic value of MR elastography and diffusion?weighted imaging in patients with liver fibrosis in the context of chronic hepatitis B. Methods Twenty?four patients with chronic hepatitis B, whose course of liver disease was more than 6 months and hepatitis B surface antigen was positive, were prospectively enrolled in the First Affiliated Hospital of Soochow University from July to December 2017. All of the patients underwent abdominal transient elastography (TE), routine MRI, magnetic resonance elastography (MRE) and DWI examination, TE and MRI were performed within one week. TE liver stiffness was measured, the MRE liver stiffness and ADC value were measured on MR imagings. All patients were divided into three groups: mild and non fibrosis (F0 to 1), significant fibrosis(F2 to 3) and cirrhosis (F4), according to the recommended standard of FibroTouch. Correlation between TE liver stiffness, MRE liver stiffness and ADC values were identified by using Spearman correlation test. The difference of the MRE liver stiffness and ADC value among the three groups was tested using independent sample t test. The overall predictive ability of MRE and DWI in assessment of liver fibrosis and cirrhosis was analyzed by constructing ROC curve. Results TE and MRI were successfully performed in all subjects, and the image quality was good. The MRE liver stiffness in mild and non fibrosis, significant fibrosis and cirrhosis was (2.32±0.31),(3.43±1.05),(4.77±0.68) kPa with statistically significant difference(F=61.690, P<0.01). The ADC values in three groups were (1.31 ± 0.14)×10-3, (1.23 ± 0.15)×10-3,(1.22±0.12)×10-3mm2/s without significant difference(F=1.074,P=0.360). The TE liver stiffness in three groups was (5.61±1.05),(9.56±0.57),(17.25±3.55)kPa, respectively, there was significant correlation between the MRE liver stiffness and the TE liver stiffness(t=0.858, P<0.01), but no significant correlation between the TE liver stiffness and the ADC value was found (r=-0.326,P=0.120). The area under ROC of MRE liver stiffness in diagnosing liver fibrosis grade (≥F2 and F4) was 0.96 and 1.00 respectively, while the AUC of ADC value was less than 0.70, which were 0.67 and 0.62 respectively. Conclusion MRE is a non?invasive promising tool for assessing liver fibrosis with chronic hepatitis B, while DWI has limited role.
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Objective To investigate the difference of niacin skin flush response between patients with major depressive disorder (MDD) and healthy controls (HCs), and its sensitivity and specificity for the diagnosis of MDD. Methods Twenty-one untreated patients with MDD and 28 age- and gender-matched HCs were enrolled in this study. The severity of depressive symptoms was assessed mainly by using the 17-item Hamilton Depression Rating Scale (HDRS-17). Methyl Nicotinate (MN) solution at 8 different concentrations (10-5 mol/L, 10-4 mol/L, 10-3.5 mol/L, 10-3 mol/L, 10-2.5 mol/L, 10-2 mol/L, 10-1.5 mol/L, 10-1 mol/L) were applied on subjects' forearms. Signals of blood flow were collected using the Doppler Laser Flowmetry to detect the skin flushing of the test. Results Under the concentrations of 10-2.5 mol/L, 10-2 mol/L, 10-1.5 mol/L and 10-1 mol/L MN solution, the blood flow was significantly higher in depressive patients than in HCs (P<0.01). The MN sensitivity (logEC50) was inversely correlated to the severity of depressive symptoms (r=-0.57, P<0.05). ROC curve analysis implied that the maximum blood flow (MBF) caused by the niacin skin flush response, could efficiently discriminate MDD from HCs (AUC=0.90, P<0.01). Conclusion The presence of enhanced niacin skin flush response may be helpful in the diagnosis of MDD.
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Objective To evaluate the diagnostic value of prostate imaging reporting and data system version 1 (PI-RADS V1) and version 2 (PI-RADS V2) for detection of prostate cancer (PCa) in the transition zone (TZ).Methods Seventy-seven patients with suspicious lesions in TZ on mpMRI were scored according to the PI-RADS system (V1 and V2) before MR-TRUS fusion guided biopsy prospectively.In all of the patients with suspicious tumors,respectively at least one lesion with a PI-RADS V1 assessment category of ≥3,was selected for biopsy.Independent sample t test was used to compare scores of PI-RADS V1 and V2 between PCa and benign prostatic hyperplasia (BPH).The diagnostic performance of PI-RADS V 1 and V2 for detection of PCa in the transition zone was compared by analyzing ROC basing on the results of MR-TRUS fusion guided biopsy.Results A cohort of 77 patients was performed including 31 cases of PCa (32 cores) and 46 cases of BPH (51 cores).PCa (V1:1 1.50±2.79;V2:4.28±0.99) had significantly higher scores of both PI-RADS V1 and PI-RADS V2 than BPH(V1:7.51± 1.63;V2∶2.61 ±0.67) (P＜0.05).Using a PI-RADS V1 score cut-off ≥ 11,sensitivity and specificity in group PCa and BPH were calculated,which were 68.8％(22/32) and 96.1％(49/51) with a area under curve of 0.869;using a PI-RADS V2 score cut-off ≥4,which were 75.0％ (24/32) and 90.2％ (46/51) with a area under curve of 0.888,respectively.Conclusions PI-RADS system can indicate the likelihood of PCa of suspicious lesions in TZ on Mp-MRI.PI-RADS V2 perform better than V 1 for the assessment of prostate cancer in TZ.
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Objective To evaluate the prostate imaging reporting and data system(PI-RADS) version 1 and version 2 for detection of prostate cancer (PCa) by multiparametric magnetic resonance imaging (MpMRI) in a consecutive cohort of patients with magnetic resonance imaging/transrectal ultrasonography (MRI-TRUS) fusion-guided biopsy.Methods 30 suspicious lesions including 15 prostate cancer and 15 non cancer at 3.0 T MpMRI were scored according to the PI-RADS V1(≥ 3 scores in at least one MRI sequence)system before MRI-TRUS fusion guided biopsy and correlated to histopathology results.PI-RADS V2 and Likert scores were determined retrospectively,diagnostic accuracy was determined using receiver operating characteristic curve analysis.Results The PI-RADS score of the dominant lesion was significantly higher in patients with PCa compared to patients with negative histopathology (PI-RADS V1:12.10±2.60 vs 7.47±1.98,P<0.05;PI-RADS V2:4.21±1.18 vs 2.79±0.92,P<0.05);Using a Likert score cut-off ≥ 4,a sensitivity of 73.7%,a specificity of 78.9%, positive predictive value of 77.74% and a negative predictive value of 75.00% (AUC=0.778,95%CI:0.63-0.93), a PI-RADS V1 cut-off ≥ 10,a sensitivity of 73.7%,a specificity of 94.7%,positive predictive value of 93.29% and a negative predictive value of 78.26% (AUC=0.911,95%CI:0.82-1.00) and PI-RADS V2 cut-off ≥ 4,a sensitivity of 57.9%, a specificity of 100%, positive predictive value of 100% and a negative predictive value of 73.37% (AUC=0.837,95%CI:0.70-0.97) were achieved.Conclusion The described fusion system is dependable and efficient for targeted MRI-TRUS fusion-guided biopsy.MpMRI PI-RADS scores combined with a novel real-time MRI-TRUS fusion system facilitate sufficient diagnosis of PCa with high sensitivity and specificity,PI-RADS scores appears to be the preferable method for the evaluation of prostate cancer than Likert score, while V2 does not perform better than V1.
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Atherosclerosis is a chronic inflammatory vascular disease developing from early fatty streaks to highly rupture-prone unstable plaques.Many cellular and molecular events are involved in each step.With the development of targeting probe technology,molecular magnetic resonance imaging techniques are expected to revolutionize the treatment strategies of atherosclerosis in the near future.Many desirable molecular probes targeting various components of plaque have emerged in recent years.This article reviews the molecular magnetic resonance imaging techniques of atherosclerosis and their application.
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@#Objective To identify the reliability and validity of Chinese version of expanded and revised Gross Motor Function Classification System (GMFCS E&R). Methods 101 children with cerebral palsy aged 6～18 from 2 special schools in Shanghai and Guangzhou participated in this study. The interrater reliability was identified by analyzing the assessment results among different raters, including rehabilitation doctors, physical therapists, teachers and parents. Gross Motor Function Measure (GMFM) was used as the criterion to identify the parallel validity. Results GMFCS E&R had good interrater reliability (ICC=0.79～0.91) as well as the parallel validity (Spearman rank correlation coefficient is -0.46～-0.86). Conclusion Chinese version of GMFCS E&R has good reliability and validity. It is suitable for children with cerebral palsy as the tool of function classification in China.
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Objective: To study the expression of F1 ATPase-α in non-small cell lung cancer and its clinical significance. Methods: expression level of F1 ATPase-α was examined by immunohistochemical Envision method in 38 NSCLC samples and the adjacent normal tissues, 7 benign tumors and chronic pneumonia samples. (2) F1 ATPase-α mRNA expression were detected in 12 fresh samples of NSCLC and the adjacent normal tissues by PT-PCR. (3) The expression of F1 ATPase-α on the pericellular membrane of A549 cells was observed by immunofluorescence. Results: (1) Immunohistochemistry analysis showed median and higher expression of F1 ATPase-α in 36 of NSCLC specimens and 11 adjacent normal tissues; lower expression was detected in all the benign samples. The overexpression of F1ATPase-α in lung adenocarcinoma tissues were significantly higher than that in the lung squamous cancer (P<0.05). The expression of F1 ATPase-α in NSCLC was not associated with the histology type, location, differentiation degree, size, invasion and metastasis. (2) The relative level of ECTO-F1ATPase-α was 0.31±0.12 in the adjacent normal tissues and 0.54±0.19 in NSCLC tissues (P<0.01). (3)The conspicuous positive expression of F1 ATPase-α on the pericellular membrane of A549 cells was not observed on normal bronchial epithetial cells. Conclusion: (1) NSCLC has a higher expression of F1 ATPase-α and the expression is on the pericellular membrane of A549 cells, which may provide a new target for molecular therapy of NSCLC.
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Objective To determine the reliability of hand-held electronic dynamometer (HHD) tests for lower limb muscle strength measurement in children with spastic cerebral palsy (CP). Methods Twenty-eight children ( 15 boys and 13 girls; mean age 5 years 8 months) with different types of CP (2 with spastic quadriplegia,8 spastic diplegia, 6 hemiplegia, 1 triplegia and 1 monoplegia) , and at different functional levels ( 19 graded at gross motor function classification system level Ⅰ, 6 level Ⅱ, 2 level Ⅲ and 1 level Ⅳ ) were recruited from the Rehabilitation Center of the Children's Hospital of Fudan University. Standardized HHD protocols were used to measure the strength of their hip, knee and ankle muscles. The HHD test was performed by the same examiner twice with an interval of 10 min in between. The HDD test was also performed with 15 randomly selected CP children by 2 examiners with an interval of 10 min in between. The test-retest and inter-rater reliabilities of the HDD readings were determined by calculating the intra- and inter-class correlation coefficients. Results The HHD measurements showed fine testretest reliability ( ICC = 0.74-0.97 ) and inter-rater reliability ( ICC = 0.63-0.97 ) in measuring lower-limb muscle strength of children with spastic CP, with the highest test-retest reliability for the hip flexion, foot plantar flexion and knee extension muscle groups. The highest inter-rater reliability was achieved with the hip flexion and foot dorsiflexion muscle groups. Conclusions Standardized HHD testing of lower-limb muscle strength in children with spastic CP shows fine test-retest and inter-rater reliability. The HHD can reliably assess the lower-limb muscle strength of children with spastic CP.
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@#Objective To investigate the development and the risk factor of hip dislocation about children with cerebral palsy. Methods 90 children with cerebral palsy were divided with Chinese version of Gross Motor Function Classification System （GMFCS） and type of cerebral palsy. Their femoral head migration percentage was measured. Results The quadriplegia children were in the biggest risk of hip dislocation, hemiplegia children were the minimum; GMFCS Ⅰ children were in the lowest risk of hip dislocation, GMFCS Ⅴ children were the highest. Conclusion The abnormal development of the hip is correlative with the type of cerebral palsy and motor function in spastic cerebral palsy children.
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@# Objective To explore the characteristics of gross motor development in 1～6-year-old children with cerebral palsy at different levels. Methods 708 children (487 males and 221 females, age range: 1～6 years, from 6 rehabilitation centers in Shanghai) with cerebral palsy (CP) were assessed with Chinese version of Gross Motor Function Classification System （GMFCS） and Gross Motor Function Measure (GMFM). Distributions of GMFM scores at different GMFCS levels in children with cerebral palsy were analyzed. Results The GMFM-66 scores increased most in children with GMFCS Level Ⅰ, and more than 75% of them would be greater than 67 points in GMFM-66 score after the age of 48～50 months. The children with GMFCS Level Ⅱ～Ⅳ appeared similar increasing range of GMFM-66 scores in 1～6 years old. Less than 25% of the children at GMFCS Level Ⅱ would be greater than 67 points in GMFM-66 score before the age of 6 years, more than 50% of those at GMFCS Level Ⅲ would be less than 56 points, more than 75% of those at GMFCS Level Ⅳ couldn't exceed 46 points （except groups of 54～56 months and 66～68 months）. Compared with the children with other GMFCS levels, the GMFM-66 scores were always at very low level in children with GMFCS Level V, and trended to decrease with time after 5 years old. Conclusion The characteristics of gross motor development are different in children with cerebral palsy at different GMFCS levels.