A diagnostic model for differentiating tuberculous spondylitis from pyogenic spondylitis: a retrospective case-control study.

The purpose of this study was to describe and compare the clinical data, laboratory examination and imaging examination of tuberculous spondylitis (TS) and pyogenic spondylitis (PS), and to provide ideas for diagnosis and treatment intervention. The patients with TS or PS diagnosed by pathology who first occurred in our hospital from September 2018 to November 2021 were studied retrospectively. The clinical data, laboratory results and imaging findings of the two groups were analyzed and compared. The diagnostic model was constructed by binary logistic regression. In addition, an external validation group was used to verify the effectiveness of the diagnostic model. A total of 112 patients were included, including 65 cases of TS with an average age of 49 ± 15 years, 47 cases of PS with an average of 56 ± 10 years. The PS group had a significantly older age than the TS group (P = 0.005). In laboratory examination, there were significant differences in WBC, neutrophil (N), lymphocyte (L), ESR, CRP, fibrinogen (FIB), serum albumin (A) and sodium (Na). The difference was also statistically significant in the comparison of imaging examinations at epidural abscesses, paravertebral abscesses, spinal cord compression, involvement of cervical, lumbar and thoracic vertebrae. This study constructed a diagnostic model, which was Y (value of TS > 0.5, value of PS < 0.5) = 1.251 * X1 (thoracic vertebrae involved = 1, thoracic vertebrae uninvolved = 0) + 2.021 * X2 (paravertebral abscesses = 1, no paravertebral abscess = 0) + 2.432 * X3 (spinal cord compression = 1, no spinal cord compression = 0) + 0.18 * X4 (value of serum A)-4.209 * X5 (cervical vertebrae involved = 1, cervical vertebrae uninvolved = 0)-0.02 * X6 (value of ESR)-0.806 * X7 (value of FIB)-3.36. Furthermore, the diagnostic model was validated using an external validation group, indicating a certain value in diagnosing TS and PS. This study puts forward a diagnostic model for the diagnosis of TS and PS in spinal infection for the first time, which has potential guiding value in the diagnosis of them and provides a certain reference for clinical work.

Application research on three-dimensional ultrasonic skeletal imaging mode in detecting fetal upper jaw bone.

OBJECTIVE: To detect three-dimensional (3D) ultrasound appearance of fetal normal and abnormal supermaxilla bone's anatomy using skeletal rendering mode, and to compare the success rate of 3D images in different gestational age groups. METHODS: Using three-dimensional ultrasound skeletal rendering mode of voluson 730 and voluson E8 ultrasound systems, the fetal supermaxilla bones were reconstructed, the supermaxilla bones include two hundred and sixty-one cases with the range from 12 to 40 gestaional weeks that were normal supermaxilla proved by 2D ultrasound exam, three cases that were the specimens of fetal normal supermaxilla, and eight cases that were abnormal supermaxilla. The normal supermaxilla's imaging success rates of different gestational ages were contrasted. RESULTS: The success rate of normal fetal supermaxilla bone's formation and structure with the 3D image was 97.9% during the gestation of 12~15(+6) weeks, 96.0% of 16~21(+6) weeks, 98.4% of 22~27(+6) weeks, 68.6% of 28~35(+6) weeks, 27.5% of 36~40 weeks. Through the X(2) test, there was no significant difference in the success rate of displaying among the gestation of 12~15(+6) weeks, 16~21(+6) weeks and 22~27(+6) weeks. The success rate during the gestation of 36~40 weeks was the lowest among all the gestation. Big anatomic structures of fetal supermaxilla in 3D images can be shown, but detail cannot. The success rate of cleft palate with 3D image was 100% (8 cases). CONCLUSIONS: 3D ultrasound can supply more detailed and comprehensive information of fetal supermaxilla bone. The better fit examine weeks for obtaining 3D images are within 12~35(+6) weeks, the best fit examine weeks are within 16~27(+6) weeks. The function of 3D skeletal rendering mode image can display cleft palate clearly.