Intraoperative assessment of blood supply to the femoral head after femoral neck fracture / 中华创伤骨科杂志

Objective:To explore intraoperative assessment of blood supply to the femoral head after femoral neck fracture, and the correlation between the blood supply and postoperative osteonecrosis of the femoral head.Methods:A retrospective analysis was performed of the 63 patients with femoral neck fracture who had been treated at Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University by open reduction and internal fixation with hollow compression screws from April 2016 to March 2021. They were 39 males and 24 females with an age of (44.9±13.6) years. There were 42 cases of Garden type Ⅲ and 21 cases of Garden type Ⅳ. Time from injury to operation was (4.1±2.4) days. After internal fixation, a hole was drilled using a 2.0 mm Kirschner wire at 2.0 cm above the femoral head-neck junction to observe the velocity, color, and characteristics of the blood oozing at the drill hole. The patients were divided into a good oozing group of 51 cases in whom bright red blood oozing was observed within 15 seconds after drilling and a poor oozing group of 12 cases in whom dark red blood oozing was observed beyond 15 seconds after drilling. The incidence of postoperative femoral head necrosis, Harris hip score, and visual analogue scale (VAS) for pain were compared between the 2 groups. Single factor and multi factor analyses were conducted using the Cox regression model to analyze the factors influencing postoperative femoral head necrosis in the patients.Results:The 63 patients were followed up for 24 (18, 36) months. The 2 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). Femoral head necrosis was observed in 3 cases in the good oozing group and in 5 cases in the poor oozing group, showing a significant difference between the 2 groups ( P<0.05). The Harris hip score [90.0 (86.0, 92.0)] and the VAS pain score [1.0 (1.0, 2.0)] at 1 year after surgery in the good oozing group were significantly better than those in the poor oozing group [85.5 (71.3, 88.8) and 2.5 (1.0, 3.8)] ( P<0.05). Multivariate Cox regression analysis showed that Garden type Ⅳ ( HR=6.784, 95% CI: 1.324 to 35.664, P=0.023) and intraoperative poor blood oozing ( HR=10.744, 95% CI: 2.359 to 51.774, P=0.003) were risk factors for femoral head necrosis after cannulated compression screw fixation of fractures of displaced femoral neck ( P<0.05). Conclusions:The blood supply to the femoral head after femoral neck fracture can be directly assessed by drilling a hole in the femoral head after open reduction and internal fixation. Intraoperative poor blood oozing is a risk factor for the femoral head necrosis after cannulated compression screw fixation of fractures of displaced femoral neck.

Application of deep learning image reconstruction algorithm in low-dose abdominal CT / 西安交通大学学报(医学版)

【Objective】 To investigate the value of deep learning image reconstruction (DLIR) in improving image quality and reducing beam-hardening artifacts of low-dose abdominal CT. 【Methods】 For this study we prospectively enrolled 26 patients (14 males and 12 females, mean age of 60.35±10.89 years old) who underwent CT urography between October 2019 and June 2020. All the patients underwent conventional-dose unenhanced CT and contrast-enhanced CT in the portal venous phase (noise index of 10; volume computed tomographic dose index: 9.61 mGy) and low-dose CT in the excretory phase(noise index of 23; volume computed tomographic dose index: 2.95 mGy). CT images in the excretory phase were reconstructed using four algorithms: ASiR-V 50%, DLIR-L, DLIR-M, and DLIR-H. Repeated measures ANOVA and Kruskal-Wallis H test were used to compare the quantitative (skewness, noise, SNR, CNR) and qualitative (image quality, noise, beam-hardening artifacts) values among the four image groups. Post hoc comparisons were performed using Bonferroni test. 【Results】 In either quantitative or qualitative evaluation, the SNR, CNR, overall image quality score, and noise of DLIR images were similar or better than ASiR-V 50%. In addition, the SNR, CNR, and overall image quality scores increased as the DLIR weight increased, while the noise decreased. There was no statistically significant difference in the distortion artifacts (P=0.776) and contrast-induced beam-hardening artifacts (P=0.881) scores among these groups. 【Conclusion】 Compared with the ASiR-V 50% algorithm, DLIR algorithm, especially DLIR-M and DLIR-H, can significantly improve the image quality of low-dose abdominal CT, but has limitations in reducing contrast-induced beam-hardening artifacts.

Deep learning reconstruction algorithm in improving portal vein CT image quality / 西安交通大学学报(医学版)

【Objective】 To explore the value of deep learning reconstruction algorithm (DLIR) in improving image quality of portal vein. 【Methods】 We retrospectively enrolled 32 patients who underwent double-phasic enhanced abdominal CT scanning. Images at the portal venous phase were reconstructed using the 50% adaptive statistical iterative reconstruction (ASIR-V), DLIR at medium (DLIR-M) and high strength (DLIR-H). The CT value and image noise (standard deviation) of the main portal vein, the right portal vein branch, the left portal vein branch, and the paravertebral muscle were measured, and the contrast-noise-ratio (CNR) for vessels were calculated. Moreover, the edge-rising-slope (ERS) of the main portal vein edge was measured to evaluate image spatial resolution. The overall image noise, image contrast, and portal vein branch display were evaluated using a 5-point grading scale and image artifacts using a 4-point grading scare by two experienced radiologists. In addition, we calculated the display rate of small branches of the portal vein in the three reconstruction algorithms. 【Results】 Image noise of the DLIR images in the main portal vein, right branch and left branch was significantly lower than that of ASIR-V 50% images, of which the DLIR-H images had the lowest noise and highest CNR. The ERS of the DLIR images in the main portal vein was significantly higher than that of the ASIR-V 50% images. For qualitative analyses, the DLIR images were significantly better than the ASIR-V 50% ones (P<0.01). In addition, the display rates of small branches of the portal vein in DLIR images were (DLIR-M: 93.75%; DLIR-H: 100%), significantly higher than that of ASIR-V 50% (68.75%). 【Conclusion】 Compared with ASIR-V 50% images, DLIR images can significantly reduce the image noise and improve the spatial resolution of the portal vein and the display rate of small branches of the portal vein.

The effect of CT reconstruction kernels and display window settings on the detection and measurement of pulmonary solid nodules / 西安交通大学学报(医学版)

【Objective】 To assess the effect of reconstruction kernels and window settings on the detection and measurement of pulmonary solid nodules and their measurement variability and repeatability. 【Methods】 We retrospectively recruited 49 patients with pulmonary solid nodules who had undergone low-dose CT scanning. Images were reconstructed using five reconstruction kernels： lung， bone， chest， detail and standard kernels. Two radiologists independently assessed the detection rate， diameter and CT number measurement of nodules under the five kernels and two window settings （lung-window and mediastinal-window）. Bland-Altman plots and relative average deviation （RAD） were used to evaluate the repeatability and variability of nodule diameter and CT number measurement. 【Results】 Seventy-seven nodules were detected on lung-window regardless of reconstruction kernels， while the detection rates （75.3%-98.7%） were significantly different （P<0.001） on the mediastinal-window， with the lung kernel significantly improving the detection of nodules with the diameter below 6 mm. In both display windows， the diameter and CT number measurements among reconstruction kernels were similar except for the lung kernel. The lung-window had better variability in the diameter measurement while mediastinal-window was better in CT number measurement among various reconstruction kernels. Although the variability in the diameter of the nodule on the lung-window and mediastinal-window was similar， there was a significant difference in the variability in the diameter measurement among different reconstruction kernels on the mediastinal-window （P=0.004）. No significant difference in the variability in the CT number measurement was found among the different reconstruction kernels （lung-window P=0.163； mediastinal-window P=0.201）， and the variability in the CT number measurements on the mediastinal-window was smaller than that of the lung-window. Both window displays had acceptable repeatability in diameter and CT number measurement； however， the mediastinal-window was better in CT number measurement. 【Conclusion】 The lung kernel can improve the detection of pulmonary solid nodules below 6 mm， but is limited in the CT number measurement. The lung-window display provides better variability in measuring nodule diameter， while mediastinal-window display is better at measuring CT numbers.

Clinical analysis of 42 primary hyperthyroidism patients complicated with thyroid microcarcinoma / 中国基层医药

Objective:To analyze the clinical data of primary hyperthyroidism patients complicated with thyroid microcarcinoma, and to guide clinical diagnosis and treatment.Methods:From January 2013 to March 2019, the clinical data of 42 cases of hyperthyroidism with thyroid microcarcinoma(study group) and 410 cases of thyroid microcarcinoma without hyperthyroidism(control group) who underwent surgical treatment in the People's Hospital Affiliated to Hubei University of Medicine were retrospectively analyzed.The epidemiological characteristics, clinical diagnosis and treatment, clinical stage, B-ultrasound characteristics, thyroid function and antibody, pathological data and prognosis of the two groups were compared.Results:In study group and control group, the proportion of microcalcification detected by B-ultrasonography was 61.9%(26/42) and 33.4%(137/410), respectively, the difference was statistically significant between the two groups(χ 2=13.411, P<0.05). In study group and control group, 47.62%(20/42) and 69.02%(283/410) of multifocal nodules were detected by B-ultrasound, the difference was statistically significant between the two groups(χ 2=7.899, P<0.05). The diagnostic rates of intraoperative frozen-section examination of the study group and the control group were 61.9%(26/42) and 66.1%(271/410), respectively, the difference was statistically significant between the two groups(χ 2=4.460, P<0.05). The lymph node metastasis rates of the study group and the control group were 9.5%(4/42) and 26.8%(110/410), respectively, the difference was statistically significant between the two groups(χ 2=6.049, P<0.05). The middle follow-up period was 37 months(1 month to 74 months). There was no recurrence of thyroid cancer in the study group, 2 cases with recurrence of hyperthyroidism after operation, and 3 cases with recurrence in the control group, with secondary surgical resection.There were no deaths in the two groups during follow-up. Conclusion:Thyroid cancer should be paid attention to when hyperthyroidism combined with nodules, but the prognosis of hyperthyroidism with microcarcinoma is better.The operation method tends to be bilateral lobectomy, which can prevent the recurrence of hyperthyroidism.In order to reduce the chance of parathyroid gland and recurrent laryngeal nerve injury, there may be no need of preventive lymph node dissection in area VI.

Diffusion tensor imaging in assessing the neonatal neurobehavioral development / 中华放射学杂志

Objective To explore the value of diffusion tensor imaging (DTI)-metrics (fractional anisotropy, FA; mean diffusivity, MD; axial diffusivity, AD and radial diffusivity, RD) in assessing the neonatal neurobehavioral development. Methods From November 2010 to September 2017, 101 neonates (gestational age range, 30-42 weeks;male/female, 69/32) with no abnormalities on conventional MRI were retrospectively included. DTI scalar maps (FA, MD, AD and RD) were calculated by using FMRIB's diffusion toolbox. The tract-based spatial statistics (TBSS) was used to investigate the relationships between white matter (WM) DTI-metrics and neurobehavioral scores (i.e. behavioral and active tone). Automated fiber quantification (AFQ) was used to extract the CST (corticospinal tract), OR (optic radiation), AR (auditory radiation) and thal-PSC (thalamus-primary somatosensory cortex); Pearson correlation was further used to explore the relationships between neurobehavioral scores and DTI-metrics along the four tracts. Results TBSS results indicated that behavior scores showed significant correlations with DTI-metrics in almost the whole WM, e. g. corpus callosum, CST, OR, AR and etc (P<0.05, TFCE-FWE corrected). Significant correlations of active tone with MD, AD and RD were just observed in local WM regions, i. e. cerebral peduncle, anterior and posterior limb of internal capsule (P<0.05, TFCE-FWE corrected); while FA just showed boundary significant correlations in the above regions (P=0.055, TFCE-FWE corrected). AFQ results indicated that DTI-metrics along the almost entire CST, OR and thal-PSC showed significant correlations with behavior scores (P<0.05); while significant correlations mainly located in the initial and middle segments of AR (P<0.05). For active tone, significant correlations were only observed in the initial and middle segments of CST. Conclusions Neonatal brain WM DTI-metrics in specific sensorimotor regions, to a certain extent, could reflect the corresponding neurobehavior abilities, suggesting the potential value of DTI in assessing the neonatal neurodevelopment.

Intravenous Drip Combined with Oral Administration Versus Sequential Therapy of Amoxicillin/Clavulanate Potassium for Lower Respiratory Tract Infection / 中国药房

0.05),respectively.CONCLUSION:Intravenous drip combined with oral administration of Amoxicillin/Clavulanate Potassium can replace intravenous dip of Amoxicillin/Clavulanate Potassium bid.For those ?-Lactams drugs with short t1/2,the unreasonable intravenous drip of which qd can be replaced by the intravenous drip combined with N-time oral administration or with N-time intramuscular injection.