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Objective:To evaluate the clinical efficacy of staged surgery in treatment of calf Gustilo-Anderson type IIIC fracture.Methods:A retrospective case series was conducted to analyze clinical data of 16 patients with calf Gustilo-Anderson type IIIC fracture admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January 2017 to December 2019. There were 12 males and 4 females, with the age of (38.6±8.2)years (range, 18-53 years). All patients had limb salvage treatment at one stage in the emergency department. The survival of the limb and the occurrence of vascular crisis were examined within one week after limb salvage. The second stage involved the repair of skin and soft tissue defects with the defect area from 12.0 cm×5.0 cm to 20.0 cm×8.0 cm using free flaps. The survival of the flap, vascular crisis, and donor site healing within two weeks after the flap procedure. The third stage used bone graft revision and bone lengthening technology to repair bone tissue. The lower extremity functional scale (LEFS) and Mazur ankle joint function score were used to evaluate the function of the affected limb before bone repair and at the last follow-up. The fracture healing and related complications were observed at the last follow-up.Results:All patients were followed up for (14.2±4.6)months (range, 8-20 months). At one stage, the limb-saving surgery was successful in all patients, among which one had vascular crisis. At second stage, free flaps survived in all patients, among which two had vascular crisis. All donor areas were healed by first intention. At third stage, the LEFS of the affected limb was increased from (32.0±7.4)points before bone repair to (48.0±10.2)points at the last follow-up ( P<0.01) and the Mazur score was increased from (50.9±15.3)points before bone repair to (73.8±11.9)points at the last follow-up ( P<0.01). All bone defects were repaired and healed without complications such as infection or osteomyelitis at the last follow-up. Conclusion:For calf Gustilo-Anderson type IIIC fracture, the staged strategy can effectively save limbs and restore limb function.
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Idiopathic thrombocytopenic purpura (ITP) is a common bloody disease with a high incidence in children, but its diagnostic method is exclusive diagnosis, and the existing detection techniques are mostly invasive, which may cause secondary injury to patients and also may increase the risk of disease. In order to make up for the lack of the detection method, this study made a preliminary exploration on the diagnosis of children's ITP from the perspective of infrared thermography. In this study, a total of 11 healthy children and 22 ITP children's frontal infrared thermal images were collected, and the pattern characteristic (PFD), average temperature (Troi) and maximum temperature (MAX) characteristics of 7 target areas were extracted. The weighted PFD parameters were correlated with the platelet count commonly used in clinical diagnosis, and the sensitivity and specificity of the weighted PFD parameters for children's ITP were calculated through the receiver operating characteristic curve (ROC). The final results showed that the difference of the weighted PFD parameters between healthy children and ITP children was statistically significant, and the parameters negatively correlated with platelet count. Under the ROC curve, the area under the curve (AUC) of this parameter is as high as 92.1%. Based on the research results of this paper, infrared thermography can clearly show the difference between ITP children and healthy children. It is hoped that the methods proposed in this paper can non-invasively and objectively describe the characteristics of ITP infrared thermal imaging of children, and provide a new ideas for ITP diagnosis.
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Criança , Humanos , Área Sob a Curva , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática , TermografiaRESUMO
Objective: To explore the application value of quantitative evaluation on liver function in patients with hepatitis B cirrhosis based on texture features of liver parenchyma from high frequency ultrasound images. Methods: Two-dimensional high-frequency ultrasonograms of liver parenchyma in 95 patients with different levels of liver function (37 cases in Child-Pugh A group, 33 in Child-Pugh B group and 25 cases in Child-Pugh C group) and 21 healthy volunteers (control group) were collected. Based on the idea of machine learning, the defect detection method of computer technology was used to locate the defect in liver parenchyma images, and the defect maps of liver parenchyma were obtained. Then three parameters, i.e. the maximum number per unit area of defect maps x(D), the mean value of defect maps mean (D) and the entropy of defect maps ε(D) were extracted. The differences of three parameters among different groups were compared. Results: There were significant differences of x(D), mean (D) and ε(D) among 4 groups (all P<0.001). The value of x(D) and mean (D) in Child-Pugh A group, B group and C group were higher than those in control group (all P<0.05). The value of mean (D) in Child-Pugh A group and Child-Pugh B group were higher than that in control group (both P<0.05). The value of mena (D) and ε(D) in Child-Pugh B group were higher than those in Child-Pugh C group (both P<0.05). Conclusion: Texture features analysis of liver parenchyma based on high-frequency ultrasonic images can accurately assess liver cirrhosis with Child-Pugh A and Child-Pugh B, while the evaluation of liver cirrhosis with Child-Pugh C still needs to combine with other features of the liver.
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Objective@#To explore the prognostic value of the international prognostic index (IPI), the national comprehensive cancer network IPI(NCCN-IPI)and the age-adjusted IPI (aa-IPI) in diffuse large B cell lymphoma.@*Methods@#A total of 311 patients with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2003 to 2012 in Nanfang hospital were included. All patients were divided into CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) and R-CHOP (rituximab, CHOP) groups. Survival analysis was compared among IPI, NCCN-IPI and aa-IPI models. Discrimination of three different prognostic models was assessed using the Harrell’s C statistic.@*Results@#A total of 311 patients were analyzed. Among them, 128 patients were treated with CHOP regimen and other 183 patients were treated with R-CHOP regimen. In CHOP groups, both NCCN-IPI (5-year OS: 59.7% vs 26.8%, P<0.001) and aa-IPI (5-year OS: 71.0% vs 25.0%, P<0.001) showed better risk stratification for low-intermediate and high-intermediate group than the IPI (5-year OS: 47.6% vs 36.6%, P=0.003). However, in the patients treated with R-CHOP, NCCN-IPI showed better risk stratification in low, low-intermediate, high-intermediate groups (5-year OS: 96.0% vs 83.0% vs 66.5%, P=0.009). According to the Harrell’s C statistic, C-index of IPI, NCCN-IPI and aa-IPI for overall survival (OS) were 0.546, 0.667, 0.698 in CHOP group and 0.611,0.654, 0.695 in R-CHOP group respectively. In patients younger than 60 years old, C-index of IPI, NCCN-IPI and aa-IPI for OS were 0.534, 0.675, 0.698 in CHOP group and 0.584, 0.648, 0.695 in R-CHOP respectively.@*Conclusion@#The NCCN-IPI is more powerful than IPI and aa-IPI in DLBCL patients receiving R-CHOP. aa-IPI is a preferable model in predicting prognosis than IPI and NCCN-IPI in anthracycline-based chemotherapy without rituximab.
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Objective To explore the feasibility of quantitative evaluation in fibrosis by geometrical characteristics of hepatic capsule based on computer technology . Methods Fifty-nine rabbits models of fibrosis were established and then were divided into four groups according to the results of pathologic examination:S0-S1 ,S2 ,S3 and S4 groups . Two-dimensional high-frequency ultrasound images of hepatic capsule of the rabbits were collected at 6th week ,12th week and 18th week . All the images were collected to obtain the contour line of the capsule and its shape control points by combining manual monitoring and gradient optimization methods . Subsequently ,the mean value and variance of angles between adjacent seed points and the number of continuous segments of the contour line ,were extracted to evaluate the smoothness and continuity of the contour line of the hepatic capsule . Results With aggravating fibrosis ,the mean value and variance of the angles were gradually increased ,and the differences between S0-S1 and other 3 groups were all statistically significant( P <0 .05) . Similarly ,the number of segments required to make the sum of lengths of continuous segments reach up to 80％ of the total width of the imaging section was gradually increased . The differences between S0-S1 and S4 group( P =0 .025) ,S2 and S4 group( P =0 .004) were also statistically significant . Conclusions Analysis of geometrical characteristics of the hepatic capsule partially indicates the presence of early-stage fibrosis ,and is expected to provide a quantitative method for non-invasive assessment of fibrosis .
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Objective To represent the high-resolution ultrasonic profiles of diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC) and highlight the importance of ultrasound examination for detecting this rare entity. Methods The document of clinical presentations and thyroid ultrasound imaging information leading to correct diagnosis were reviewed in association with the microscopic findings of excised thyroid specimen. Results The average age of the eight patients was (18.88 ± 3.59) years(range from 12 to 24) with a gender ratio of 2 males to 6 females. Their predominant clinical presentations were enlargement (8/8) and hardening(6/8) of the involved thyroid lobes. The ultrasound imaging features were increase in the width and thickness of involved thyroids, hypoechoic and heterogeneous internal echoes, containing multiple,diffuse,and fine hyperechoic spots but without formation of any masses, and multiple enlarged lymph nodes in the bilateral jugular chains due to cancer cell metastasis. Ultrasound diagnosis of the first case was malignant thyroid tumor, but the following consecutive 7 patients were all definitely interpreted as DSVPTC. Conclusions The clinical presentations alone is less valuable in diagnosis of DSVPTC, but the characteristic features on high-resolution ultrasonography are highly sensitive and indicative.
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Objective To establish a treatment proposal of thyroid adenoma by using percutaneous radiofrequency ablation(RFA) and investigate its techniques and skills, means and steps, and safety and efficacy. Methods Contrast-enhanced ultrasound-guided percutaneous RFA of thyroid adenomas were conducted on 202 patients by using an auto-controlled bi-polar electrode system. The indications of thyroid RFA,the optimal puncture route,the ways of anesthesia administration, protection of vital neck vessels and recurrent laryngeal nerve(RLN) and reduction of bleeding from core biopsy, indicators of ending ablation procedure following a complete ablation were investigated and analyzed. Resalts An adenoma smaller than 20 mm in maximal diameter was the optimal candidate for RFA. Either of two puncture routes could be selected upon the target lesion's location. Areas surrounding to the thyroid capsule needed adequate local anesthesia to kill pain. Liquid-isolating maneuver could effectively protect carotid artery and RLN from core needle cutting and electrode heating injury. Advanced block of supplying arteries with heating markedly reduced bleeding involved in the biopsy. Multipoint and multicenter ablation was essential to a complete coagulation. Filling-defect in the ablated adenoma on CEUS was the key sign to terminate ablation procedure. Conclusions Percutaneous bi-polar RFA was proved feasible, effective, safe and supermicroinvasive for treating thyroid adenoma under the way stated here of puncture and technical points and use of CEUS for monitoring.
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Objective To investigate the technical feasibility and clinical significance of non-vascular contrast-enhanced ultrasound(NVCEUS) in screening pyelogenie cyst out of simple renal cysts so as to avoid damage to the urinary tract from absolute ethanol while undergoing percutaneous aspiration and ethanol sclerotherapy(PAEST). Methods Following an inclusion criteria 23 patients with renal cysts were selected to receive NVCEUS scanning by means of administrating SonoVue contrast agents through puncture needle into their renal cyst lumen prior to the injection of absolute ethanol for sclerosing treatment. By the demonstration of hyperechoic contrast agents leaving from intra cyst into renal collecting system,a pyelogenic cyst was defined. The patients with this kind of cyst was not allowed for further ethanol sclerotherapy. Results NVCEUS made 3 patients with pyelogenic cyst resembling simple ones free from ethanol selerotherapy,and 4 patients suspicious of pyelogenic cyst due to weird cyst configuration remain in the list of simple cyst for further selerotherapy. Conclusions NVCEUS of renal cyst is highly capable of differentiating pyelogenie cyst from simple cyst and highly valuable in increasing the safety for the procedure of PAEST.
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To assess right ventricular free wall longitudinal myocardium deformation and examine the changes with normal age by speckle tracking imaging (STI), myocardial systolic peak strain (epsilon), systolic peak strain rate (SRs), early diastolic peak strain rate (SRe), late diastolic peak strain rate (SRa), the ratio of SRe/SRa were measured in the basal, middle and apical segments of right ventricular free wall in 75 healthy volunteers (age range: 21-71 y) by STI from the apical 4-chamber view. RV longitudinal strain and strain rate were highest in the basal segment of the free wall. Older subjects had lower early diastolic strain rate (SRe) than younger subjects, but they had higher late diastolic strain rate (SRa). A negative correlation between age and the ratio of SRe/SRa was found in all RV free wall segments (r=-0.466 - -0.614, P<0.01). It is concluded that RV diastolic strain rate changes with age and STI can be used for the study of RV myocardial deformation.
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Fatores Etários , Diagnóstico por Imagem/métodos , Ecocardiografia/métodos , Coração/fisiologia , Modelos Estatísticos , Contração Miocárdica , Miocárdio/patologia , Reprodutibilidade dos Testes , Estresse Mecânico , Disfunção Ventricular Direita , Função Ventricular DireitaRESUMO
Speckle tracking imaging (STI) was employed to investigate the effect of right ventricular (RV) volume and pressure overload on left ventricular (LV) rotation and twist in 35 patients with atrial septal defect (ASD), 18 of which with pulmonary hypertension, and 21 healthy subjects serving as controls. The peak rotations of 6 segments at the basal and apical short-axises and the average peak rotation and interval time of the 6 segments in the opposite direction during early systolic phase were measured respectively. LV twist versus time profile was drawn and the peak twist and time to peak twist were calculated. LV ejection fraction (EF) was measured by Biplane Simpson. Compared to ASD patients without pulmonary hypertension and healthy subjects, the peak rotations of posterior, inferior and postsept walls at the basal level were lower (P<0.05), and the average counterclockwise peak rotation of 6 segments at the basal level during early systolic phase was higher (P<0.05), and the average interval time was delayed (P<0.05). LV peak twist was also lower (P<0.05), and had a significant negative correlation with pulmonary arterial systolic pressure (r=-0.57, P=0.001). No significant differences were found in LVEF among the three groups. It was suggested that although RV volume overload due to ASD has no significant effects on LV rotation and twist, LV peak twist is lower in ASD patients with pulmonary hypertension. Thus LV twist may serve as a new indicator of the presence of pulmonary hypertension in ASD patients.
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Cardiologia/métodos , Ecocardiografia/métodos , Ecocardiografia Doppler/métodos , Comunicação Interatrial/metabolismo , Comunicação Interatrial/patologia , Ventrículos do Coração/patologia , Hipertensão , Proteínas Nucleares/metabolismo , Sístole , Proteína 1 Relacionada a Twist/metabolismo , Função Ventricular EsquerdaRESUMO
Objective To investigate the effect of right ventricular(RV)volume and RV pressure overload on left ventricular(LV)rotation and twist in patients with atrial septal defecl(ASD).Methods Using speckle tracking imaging(STI),the peak rotation of 6 segments in basal and apical short-axises was measured respectively in 35 patients with ASD(18 of which with pulmonary hypertension)and 21 healthy subjects as controls.The average peak rotation and duration time of the 6 segments in basal and apical short-axises in negative direction during early systolic phase were also measured respectively.LV twist versus time profile was drawn and the peak twist and time to peak twist were calculated.LV ejection fraction(EF)was measured by biplane Simpson method.Results Compared to ASD patients without pulmonary hypertension and healthy subjects,the peak rotation of posterior wall,inferior wall and postsept wall in basal was lower(P＜0.05).And at the basal level,the averagepeak rotation of 6 segments in negative direction during early systolic phase was higher(P＜0.05),and the average duration time was delayed(P＜0.05).LV peak twist was also lower(P＜0.05),and had a significant negative correlation with pulmonary arterial systolic pressure(r=-0.57,P=0.001).There were no significant differences in LVEF among 3 groups.Conclusions Although RV volume overload due to ASD has no significant effects on LV rotation and twist,LV peak twist is lower in ASD patients with pulmonary hypertension.Thus LV twist may be a new index which predicting whether ASD patients also has pulmonary hypertension or not.
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The research on anti-aging technology is always a foreland in the field of researches into human health. Based on a review of the researches for anti-aging, this paper described all kinds of theory of aging and laid the emphasis on the status quo of researches on the use of Traditional Chinese Medicine(TCM) moxibustion for anti-aging, including the research on the theory of the moxibustion in anti-aging, the research on selecting acupoints of moxibustion for anti-aging, and the clinical application of moxibustion in anti-aging in detail. The significance of herbalist theory in anti-aging and the wider development foreground were high-lighted.