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Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.
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Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, the orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of suspected or confirmed COVID-19 patients, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of OVCF patients diagnosed with COVID-19, the authors jointly develop this expert consensus to systematically recommend the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures.
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Objective ToinvestigatetheimpactofCTimagequalityforfilteringbackprojection(FBP),conventionalmodel-based iterativereconstruction(MBIRC)andnewgeneration model-basediterativereconstruction (MBIRN)onchest.Methods Thirtypatientswith chestCTscanwerecollected.FBP,MBIRCandMBIRN wereusedtoreconstructtheimage.Objectivequality[standarddeviation(SD) valueoftheROI,SNR],thenoisereductionrateandSNRimprovementrateofMBIRCand MBIRN withrespecttoFBP werecom-paredacrossthethreeimages.Atthesametime,tworadiologistsusedtheblind methodtoevaluatetheintrapulmonarystructurein thelungalgorithm FBP,MBIRC,MBIRN,andthemediastinalstructure (5-pointsystem)inthestandardalgorithmsFBP,MBIRC, MBIRN.Results ComparedwithFBP,theimagemusclenoisesofMBIRCand MBIRN were76.71% and86.06%lowerthanFBP,respectively, andthefatnoiseswere66.91% and78.18%lowerthanFBP,respectively.Thedifferencewasstatisticallysignificant(P<0.05).The imageSNRofMBIRCandMBIRN were74.12% and84.97% higherthanthatoftheFBPgroup,respectively.ThefatSNRwere65.63% and 76.02% higherthanthatoftheFBPgroup (P<0.05).Thethreealgorithmsshowedstatisticallysignificantdifferencesinsubjective noise,intrapulmonaryvascular,bronchialresolution,mediastinalbloodvessels,andlymphnodes.MBIRN hadthelowestsubjective noise,andthehighestSNR,mediastinalstructure,andintrapulmonaryvesselsandbronchi.Conclusion Comparedwith MBIRC and FBPwithnormaldosechestCTscan,MBIRN cansignificantlyreducethenoiseofchestCTscanimages,improveSNR,and more clearlyshowthedetailsofthescanrangeandlesionedgefeatures.
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Objective To evaluate the necessity and clinical significance of multi-slice spiral CTA (MSCTA) in preoperative examination of complex craniocervical junction (CCJ) malformation.Methods Totally 30 patients of complex CCJ malformation were enrolled,among them 16 underwent routine CT and MRI before surgery (routine group),and the other 14 underwent MSCTA of head and neck after routine CT and MRI (CTA group).The anatomical relationship between the V3 segment of VA and the bone in CCJ was observed,and then individualized operation scheme was formulated,MSCTA data in preoperative CTA group was reconstructed.The operation time,intraoperative blood loss and complications were compared between the two groups.Results CCJ malformation and VA V3 segment variation showed obvious individual characteristics in CTA group.The average operation time was (182.86 ± 27.37)min,and the loss of intraoperative blood was (165.71 ± 42.19)ml.No obvious complications occurred,and the therapeutic effect was satisfactory during follow-up period.In routine group,the average operation time was (205.31± 29.86)min,the loss of intraoperative blood was (246.25 ± 155.22)ml.Vertebral artery injury occurred in 1 case during operation,then bleeding was controlled,and improvement was achieved during follow-up period.There was no significant difference of operation time between the two groups (t=1.878,P=0.057),while the loss of intraoperative blood in CTA group was less than that of routine group (t =2.136,P=0.042).Conclusion MSCTA is a reliable method to investigate the anatomy and variation of bone and blood vessels in CCJ.It is necessary to carry out MSCTA examination before operation in patients with complex CCJ malformation,so as to reduce the complications and avoid the risk of surgery.
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Objective To explore the viscoelasticity of relaxed myocardium in vivo through indentation method with an intervention ultrasound indentation system (IUIS). Methods Old myocardial infarction (OMI) models of canine were established by ligating left anterior descending branch of coronary artery for 3 months. The indentation creep tests were used respectively in OMI group and shame group (n=8, each) by IUIS in middle and advanced diastole stage in vivo. Test data were processed with three-parameter solid viscoelasticity model, and the viscoelastic parameters, such as instantaneous elastic modulus (E1), relaxation modulus (E∞), creep elastic modulus (E2) and viscous damping coefficient (η) in normal and infarcted myocardium were obtained and compared. Results All the parameters of E1, E∞, E2 and η increased obviously in OMI group than in sham group shown as follows: 27.81±6.74kPa vs. 6.78±2.43kPa; 17.87±3.59kPa vs. 4.52±1.56kPa; 49.54±14.35kPa vs. 16.82±12.37kPa and 1.97±0.78Pa.s vs. 0.66±0.40Pa.s. The differences were statistically significant (P<0.05). Conclusions IUIS is a feasible method to assess the viscoelasticity of relaxed myocardium in vivo. Three-parameter viscoelasticity model can be used to describe creep properties of relaxed myocardium. Both elastic modulus and viscosity resistance have increased in infarcted myocardium.
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Objective To investigate the value of CT pulmonary artery obstruction index (PAOI)in evaluating the severity in patients of pulmonary embolism (PE)by a correlation study between CT PAOI and right ventricular function parameters and arterial blood gas analysis index.Methods CT PAOI,right ventricular function parameters and arterial blood gas analysis index were collected from 70 patients with PE,who had received CT pulmonary angiography (CTPA)examination in our hospital.Spearman rank correlation coefficient was used to evaluate the correlation between the PAOI and right ventricular/left ventricular maximum short axis diameter ratio (RVd/LVd),main pulmonary artery diameter (MPAd),superior vena cava diameter (SVCd),arterial oxygen partial pressure (PaO2 ),arterial carbon dioxide into pressure (PaCO2 ),oxygen saturation (SaO2 ),Alveolar arterial oxygen partial pressure difference (P(A-a)O2 ).Results PAOI and PaO2 were negative correlation,the correlation coefficient was -0.442;PAOI and RVd/LVd, MPAd,SVCd,P(A-a)O2 were positively related,correlation coefficients ranged between 0.163-0.675;PAOI was not related to SaO2 .Conclusion CT PAOI can be used to evaluate the severity of PE,it is not consistent with the severity of the patient’s clinical condition.
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Objective To investigate the diagnostic accuracy factors for CT-guided percutaneous biopsy of spine lesions.Methods The clinical and pathological data of 128 patients who were undergone CT-guided percutaneous biopsy of spine lesions were collected.The multivariate stepwise Logistic retrospective study was performed to study the influence of the patient-related factors (sex,age),lesion-related factors (location,bone destruction characteristics,with or without necrosis,with or without calcification),and procedure factors (punc-ture target spot,tissue specimen size)on the diagnostic accuracy.Results The diagnostic accuracy rate of CT-guided percutaneous biopsy of spine lesions was 86.7% (1 1 1/128 ).By multi-factor analysis,bone destruction characteristics (OR = 3.428,P = 0.038 ),with or without necrosis (OR=0.1 93,P =0.012),with or without calcification (OR=0.266,P =0.036),tissue specimen size (OR=0.200, P =0.01 5)were incorporated into the regression equation of the diagnostic accuracy.Conclusion CT-guided percutaneous biopsy of spine lesions has a high diagnostic accuracy.Bone destruction characteristics,with or without necrosis,with or without calcification, tissue specimen size are the independent factors.
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Objective To analyze the characteristics of TCM syndromes of children abnormal sweating;To investigate the correlation between diseases and primary and secondary syndromes. Methods Through a multi-center epidemiology investigation, 400 cases were collected to statistically analyze the five TCM syndromes of children abnormal sweating, and characteristics of each syndrome were analyzed. Results In the 400 cases of children abnormal sweating, there were 129 cases (32.25%) of dysfunction of lung-wei pattern, 50 cases (12.50%) of nutrient qi and defensive qi discordance, 84 cases (21.00%) of qi and yin deficiency pattern, 57 cases (14.25%) of dampness heat forced steamed pattern, and 80 cases (20.00%) of qi and yang deficiency pattern. Spontaneous sweating and night sweating were found in the four patterns besides qi and yin deficiency pattern, and night sweating can be mainly found in qi and yin deficiency. Each type is consistent in the syndrome differentiation and cluster analysis. Conclusion Spontaneous sweating and night sweating, each has the certification of yin and yang. Spontaneous sweating can be caused by yin deficiency while night sweating can be caused by yang deficiency. Each pattern of children abnormal sweating has its own syndrome characteristic, which can provide the basis for clinical diagnosis and treatment.
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Based on a small-scale questionnaire survey, the study analyzed the dilemma of medical students in clinical training, discussing how young teachers should guide the students get out of the dilemma, including how to resolve the conflict between further study and career, acquire more practicing opportunity, improve their communication ability with patients, and value their lives finally.
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Objective To observe the effects of indole-3-carbinol on neointimal hyperplasia and restenosis of rat artery after balloon injury and the possible mechanisms.Methods Balloon dilation was used to establish the neointimal injury model of left carotid artery in rats.Twenty Sprague-Dawley rats were randomly divided into single balloon dilation group(control group)and balloon dilation followed by indole-3-carbinol therapy group(therapeutic group).After balloon dilation,indole-3-carbinol(12.5,25,50 mg/d)was applied to the rats for 7 days respectively.The rats were killed two weeks after balloon dilation and the injured vascular specimens were harvested for pathologic examination and immunohistochemical staining.Results ①The neointimal thickness,neointimal area in the therapeutic groups were significantly less than that of the control group(P
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Objective To study multi-slice spiral CT(MSCT) manifestations of spondyloschisis.Methods 40 patients with spondyloschisis were examined with MSCT scan and 3D reconstruction.Results In the 40 cases,CT scans showed spondyloschisis of the lumbar in L_2(1/40),L_3(1/40),L_4(10/40),L_5 spondyloschisis of the lumbar in L_2(1/40),L_3(1/40),L_4(10/10),L_5(28/40).MSCT displayed:the ring-scission sign(100%),the pseudo-bulging of lumbar intervertebral disc and the elongated sign of spinal canal(95%),and the wavered sign of vertebral body(12.5%).The location,shape of spondyloschisis and the degree of spondylolisthesis were demonstrated by MSCT on multiplanar and 3D.Conclusion The ring-scission sign is the specific sign in diagnosing the spondyloschisis of the lumbar by MSCT.It is of significant value in the detection of spondyloschisis
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Objective To evaluate the clinical application of multi-slice spiral CT(MSCT) and X-ray plain film in congenital scoliosis.Methods 40 cases with congenital scoliosis were undergone MSCT scan,the imaging data were reconstructed with maximum intensity projection(MIP),multiple planar reconstruction(MPR),surface shaded display(SSD) and surface volume rendering(SVR),the applied value of these various reconstructed images were analysed comparatively with X-ray plain film.Results Based on the preoperative X-ray plain films,the spinal formation failure,segmentation failure and mixed failure of spine were found in 18,15 and 7 cases respecitvely.However MSCT scan showed that 13 cases had formation failure,12 cases had segmentation failure and 15 cases were mixed failure of spine,and in combination with spinal bifida in 6,rib deformity in 8 and bony ridge inside vertebral canal in 4.The relative features of congenital scoliosis could be comprehensively evaluated by SVR images.Conclusion The reformatted images of MSCT is remarkedly superior to conventional X-ray images in judging the classification and area of spinal deformity accurately.
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Objective To evaluate the diagnostic value of three-dimensional CT(3DCT)in atlantoaxial lesions.Methods The findings of 3DCT were analyzed and compared with conventional CT and radiography in 124 patients with atlantoaxial disease.Results 124 cases of atlantoaxial lesion included fracture in 42,atlantoaxial rotatory dislocation in 73,hypoplasia of the dens in 4,and congenital atlantoaxial deformity in 5.Among the 124 cases,89 cases were diagnosed by X-ray,109 cases by conventional CT,121 cases by MIP,122 cases by SSD,124 cases by MPR and VR.Conclusion 3DCT can find the slight rotatory dislocation,so it is the most effective means for the diagnosis of atlantoaxial rotatory dislocation.3D and MPR of spiral CT are useful in the diagnosis of atantoaxial fracture.Combining conventional CT and X-ray film with 3DCT can improve the acuracy of the diagnosis.