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Objective:To explore the feasibility and effectiveness of four-dimensional analysis of wall thickness for judgment of femoral bone healing.Methods:The clinical data were retrospectively analyzed of the 29 patients who had been diagnosed with femoral bone malunion or bone nonunion at Department of Orthopaedics, Air Force Hospital of Eastern Military Theater of PLA from June 2014 to June 2019. They were 24 males and 5 females with an average age of 41.8 years (from 5 to 54 years). There were 25 cases of delayed union and 4 cases of nonunion (including 2 ones of hypertrophic nonunion and 2 ones of at-rophic nonunion). Mimics software 2.0 and the four-dimensional analysis of wall thickness were used to simulate and analyze the fracture bone healing of the patients at different time points. In comparison with the CT data of the contralateral healthy limb, the fracture bone healing was judged to assist the diagnosis of femoral union, delayed union and nonunion on the basis of the changing trends with time. The original clinical diagnoses were thus revised and the eventual clinical healing outcomes were observed.Results:All the patients were followed up for 1 to 4 years (mean, 14.9 months). Of them, bone union was clinically diagnosed in 13 (44.8%), delayed bone union in 12 (41.4%) and bone nonunion in 4 (13.8%). According to the judgment by four-dimensional analysis of wall thickness, the clinical diagnoses were modified as follows: 9 cases (31.0%) had bone union, 18 cases (62.1%) delayed bone union, and 2 cases (6.9%) bone nonunion. There were statistically significant differences between the 2 methods ( χ2=15.399, P=0.031). Conclusions:The four-dimensional analysis of wall thickness can be used to analyze quantitatively the femoral bone healing, providing a relatively objective basis for clinical diagnosis of bone nonunion and delayed bone union.
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BACKGROUND: CT scan and differential modeling are used to analyze the fracture end, which is an effective method to judge the degree of bone healing. To obtain the high precision of differential modeling and simulation, how to select the optimal CT scanning parameters needs further research and analysis. OBJECTIVE: To compare the effects of different CT scanning parameters on modeling accuracy in personalized differential modeling analysis, to verify the accuracy and effectiveness of personalized differential modeling in the reduction of simulated target bone segments, and to explore the research value of this method in judging the degree of bone healing of long canals of lower extremities. METHODS: The model of internal fixation was established with porcine femur. Four groups of 80 kV-300 mA (group A-low dose), 120 kV-335 mA (group B-automatic tube current control system), 140 kV-300 mA (group C-manual setting comparison) and 140 kV-80 mA (group D-high kV and low mA) were used to scan the same object with the same pitch, slice thickness and environment. The scanning data of each group were selected, the same CT value range was used, and the differential modeling analysis method was used to model the target bone segment. The average area and maximum area of metal artifacts in CT scanning images, the average CT value, volume and maximum wall thickness peak after differential modeling analysis, the radiation amount under four groups of scanning conditions were compared to determine the reduction of metal artifacts, modeling accuracy and radiation, so as to select the optimal CT scanning parameters. RESULTS AND CONCLUSION: (1) Artifact measurement method results: In group A, there were many metal artifacts, which obviously obstructed bone tissue, and had a possibility of missed diagnosis. In group D, there were minimal metal artifacts, less occlusion around bone tissue, but poor image contrast and high fog. The difference between group B and group C lay in the clarity of images, and the accuracy of diagnosis was basically the same. Therefore, the order of artifact size was as follows: group A > group B > group C > Group D. (2) Differential modeling analysis results: In group B, because of the smaller artifact and less loss of CT value, the simulated model was more close to the reality. Moreover, group B adopted the automatic tube current control system, which could obviously show that the radiation amount was smaller and more protective for patients. (3) It is confirmed that the CT scan under the condition of group B can effectively reduce the interference caused by metal artifacts, better retain the original information of CT gray value, and retain the density information of the target bone segment to the maximum extent. Therefore, when establishing differential modeling, the CT automatic tube current control system is used as the optimal CT scanning parameter, which not only improves the simulation accuracy of personalized differential modeling, but also increases the accuracy of calculation.
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Objective@#To determine health risk behaviors related to accidental injury of adolescent in Jiangxi province,and to provide a peference for taking targeted measures to prevent the occurence of adolescent’s risk behaviors. @*Methods@#By using the cluster stratified sampling, students of grade one and grade two from 10 classes in 5 middle schools in Nanchang city and from 1 middle school in Wuyuan county were selected. Health risk behaviors were investigated through questionnaire survey and were compared within the two areas.@*Results@#Regarding to safety, the rates of never or rarely wearing a helmet when riding a bicycle during the past 12 months, never or rarely wearing a seat belt, text or Email while driving a vehicle and in a physical fight were very high. In Wuyuan county, 35.2% of the students have ever tried cigarette smoking, 51.5% of the students have had at least one drink of alcohol, 4.0% of the students have ever had sexual intercourse, 32.7% of the students describe their weight as slightly or very overweight, 49.1% of the students trying to lose weight. After standardized, the rate of health risk behaviors in Nanchang city was higher than that in Wuyuan county.@*Conclusion@#here are more healthrisk behaviors found among middle school students in Nanchang than in Wuyuan county.The targeted measures should be taken to develop healthy behavior habits of the students to effectively reduce its occurence.
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OBJECTIVE To study the clinical characteristics of invasive pulmonary aspergillosis(IPA).METHODS Based on the clinical data from 14 IPA cases identified by pathologic examination in the 454th Hospital,the characteristics of IPA were discussed,including the underlying diseases,symptoms,X-ray,CT,the treatment methods and the curative effect.The related literatures were also reviewed.RESULTS All of the 14 patients had underlying diseases.From them 5 were with pulmonary cancer(35.7%),3 with chronic obstructive pulmonary disease(21.4%),2 with pulmonary abscess(14.3%),2 were after chemotherapy for leukemia(14.3%),1 with pulmonary tuberculosis(7.1%)and 1 with diabetes(7.1%).The common symptoms of the 14 cases were febricity,productive cough and hemoptysis.Some of them also suffered with short of breath,night sweat,fatigue,chest pain and losing weight.The air crescent sign showed on X-ray and CT.Soft tissue masses with halo-sign on the margin,dense shadow of small masses within the alveoli,and multi-nodular shadows were also observed.Among 10 patients treated by antifungal medications,only 4 treated otherwise with operation were cured,4 patients died,and 2 patients did not complete the treatment scheme.CONCLUSIONS The patients with immunodeficiency are susceptible to IPA.The clinical manifestations of IPA are non-specific.The final diagnosis depends on the pathologic examination.The only medication is not sufficient for IPA patients.Pulmonary resection should be considered if the prolonged illness or frequent hemoptysis exist.