Objective To evaluate the clinical efficiency of posterior unilateral open-door laminoplasty and leverage titanium plate internal fixation in the treatment of cervical spondylotic myelopathy ( CSM ) with multi-segmental spinal stenosis.Methods Between Mar 2011 and May 2015, 25 patients with multi-segmental CSM with multi-segmental spinal stenosis were treated by posterior unilateral open-door laminoplasty and leverage fixation .There were 16 males and 9 females, whose mean age was 60.6 ±9.9 years during the surgery.The change of clinical symptoms and signs was recorded during follow-up,and they all received X-ray and MRI.In all the patients, the preoperative and postoperative neurological function, the cervical curvature,cervical vertebra tube volume and axial symptoms were measured , recorded and analyzed. There was statistically significant difference (P<0.05) in the mean Japanese Orthopaedic Association (JOA) score, and Visual Analogue Scale ( VAS) .Results All the 25 patients were followed up for more than 6 months ( 6-24 months ) .No symptoms of C5 nerve root were found in our series .According to the JOA score and VSA score ,the neurological functions of each patient were significantly improved .The preoperative JOA score was 10.16 ±1.35 and the improvement rate 61.24%. There was statistically significant difference between the preoperative VSA score and the postoperative one (6.68 ±1.12 vs 2.32 ±0.84) ( P<0.05).The preoperative and postoperative meansurement of the spinal vertebrai canal diameter was (9.22 ±2.01) and (15.64 ±2.08) mm, respectively,so there was statistically significant difference (P <0.05), indicating that the cavical spinal canal was increased after operation .Conclusion Leverage titanium plate internal fixation can effectively help maintain the expanded vertebral canal after unilateral open -door laminoplasty ,reduce the incidence of postoperative axial symptoms , and maintain the cervical physical curvature .

Objective To investigate the effect of tube voltage and iodine concentration of contrast medium (CM) on abdominal dynamic enhanced CT image quality.Methods Six miniature pigs underwent repeated upper abdomen dynamic contrast-enhanced CT scans in 4 scanning protocols with different concentration of CM and tube voltage,namely,protocol 1,CM with iodine concentration of 270 milligrams iodine per milliliter (mg/ml) and 80 kV tube voltage;protocol 2,270 mg/ml and 120 kV;protocol 3,370 mg/ml and 80 kV and protocol 4,370 mg/ml and 120 kV.The same iodine dose (600 mg/ml) and iodine delivery rate (IDR) (920 mg/s) were used in all protocols.The CM with iodine concentration of 270 mg/ml were injected at a flow rate of 3.4 ml/s,and 370 mg/ml CM injected at 2.5 ml/s.Image reconstruction was performed with iterative reconstruction (iDose4) in protocol 1 and 3,filtered back projection (FBP) was used in protocol 2 and 4.A subjective scoring system for image quality,image noise and sharpness was conducted by 2 radiologists independently.The measured values (peak of enhanced CT values,image noise of aorta,inferior vena cava,portal vein,hepatic vein and liver parenchyma) as well as the calculated values [their time-to-peak,signal-to-noise (SNR) and contrast-to-noise (CNR) ratios] were compared between among 4 protocols.The CT volume dose index (CDTIvol) and dose length product (DLP) were recorded from the CT console after each scanning.Factorial designed ANOVA was used for comparison of enhanced CT values of vessels and liver parenchyma,noise,SNR and CNR.The Kruskal-Wallis test was used for comparison of values among the 4 protocols,including the time-to-peak enhancement of vessels and liver parenchyma,the subjective scores of image quality indices.Result There was no significant differences in subjective scores of the image quality,image noise and image sharpness (P＞0.05).The scored were more than 3,and the images with 4 scanning protocols were all acceptable for diagnosis.There was no significant differences between protocol 1 and 3,protocol 2 and 4 in the peak enhancement CT values of aorta [(729±46) HU vs.(707±59)HU,(515±84)HU vs.(513±53)HU],inferior vena cava [(366±95)HU vs.(368±92)HU,(282±39)HU vs.(262 ± 67)HU],portal vein [(213± 18)HU vs.(201 ±29)HU,(180±21)HU vs.(176±27)HU],hepatic vein [(207±18)HU vs.(193±10)HU,(179±24)HU vs.(170±14)HU] and liver parenchyma [(128±7) HU vs.(127±4) HU,(135±5)HU vs.(135±6)HU] (P＞0.05).But the CT values of vessels (aorta,inferior vena cava,portal vein and hepatic vein) in protocol 1 and 3 were significantly higher than those in protocol 2 and 4 (P＜0.05),the CT values of liver parenchyma in protocol 1 and 3 were significantly lower than values in protocol 2 and 4 (P＜0.05).The image noises of vessels were higher in protocol 1 and 3 than noises in other protocols (P＜0.05),but there was no significant difference in liver parenchyma noise among protocols (P＞0.05).No significant differences were observed on the peak times,SNR and CNR in aorta,inferior vena cava,portal vein,hepatic vein and liver parenchyma among 4 protocols (P＞0.05).The CDTIvol and DLP were 199.67 mGy,1 597.4 mGy· cm respectively in protocol 1 and 3,585.12 mGy and 4 680.9 mGy· cm in protocol 2 and 4 (scanning with 120 kV).Conclusions CM with different iodinated concentration could achieve the same enhancement in the abdominal vessels and liver parenchyma by using the proper scan protocols,which have the same IDR and iodine dose per kilogram body weight.Higher vessel enhanced peak values were achieved when using the protocols with 80 kV tube voltage than 120 kV.By using a low dose protocol of 80 kV tube voltage with the iterative reconstruction algorithm,the quality of image can be warranted.

Objective To analyze the perioperative clinical character of the severe neurological complications in intracranial aneurism treated with stent-assisted coiling(SAC). Methods 203 cases of intracranial aneurysms patients treated by SAC were enrolled retrospectively(ruptured aneurysm group 45 cases and un-ruptured,aneurysm group 158 cases)and the perioperative clinical character of the serious neurological complications(11 cases)was further analyzed. Results The total rate of serious neurological complication was 5. 4%,11 cases of patients with 13 aneurysms got 13 stents. In the ruptured aneurysm group, 5 cases(11. 1%)suffered severe neurological complications,including intraoperative bleeding in one case, postoperative stent-related ischemia in one case,both 2. 2% . Postoperative bleeding 2 cases(4. 4%),and one case of bleeding during anesthesia induced stage(2. 2%). In the unruptured aneurysm group,intraoperative bleeding in three cases,and postoperative stent-related ischemia in three cases,both 1. 9% . No bleeding case during anesthesia induced stage or postoperative period. Although active rescue treatments were performed, 8 patients eventually died,and the total mortality rate was 3. 9% . Conclusion Intracranial aneurysms patients following SAC treatment may suffer from bleeding,ischemia,severe neurological complications, severe disability,and even die. So,we have to strengthen perioperative management.

Objective:To explore the effect of hydrotherapy combined with breathing training on lung function and mobility of patients with thoracolumbar spinal cord injury.Methods:A total of 80 patients with thoracolumbar spinal cord injury admitted to Beijing Rehabilitation Hospital Affiliated to Capital Medical University from April 2018 to March 2020 were selected as observation objects.A prospective cohort study was conducted and randomly divided into observation group and control group with 40 cases in each group.The control group was given routine rehabilitation therapy combined with respiratory training.On the basis of the control group, the observation group was treated with water therapy.The indexes of lung function, motor function, lower limb muscle tension, function evaluation and activities of daily living were compared between the two groups.Results:After intervention, the observation group′s forced vital capacity (FVC) was (3.86±0.82) L, the forced expiratory volume in the first second (FEV1) was (3.76±0.68) L, the maximum ventilation (MVV) was (102.34±10.38) L/min, the maximum suction pressure (MIP) is (50.36±4.62) cmH 2O; the control group FVC was (3.41±0.76) L, and FEV1 was ( 3.35±0.63) L, MVV was (90.67±11.68) L/min, MIP was (44.38±4.85) cmH 2O, the difference between the two groups is statistically significant ( t=2.546, 2.797, 4.723, 5.646, respectively, all P<0.05). After the intervention, the motor function score of the american spinal injury association (ASIA) of the observation group was (58.62±7.56) points, and the modified ashworth scale (MAS) score was (2.74±0.89) points; The ASIA motor function score of the control group was (42.24±6.40) points, and the MAS score was (3.36±0.94) points.The difference between the two groups was statistically significant ( t=10.459 and -3.029, respectively, all P<0.05). After intervention, the observation group′s spinal cord independence measure (SCIM III) score was (75.33±10.72) points, and the modified barthel index (MBI) was (66.64±6.34) points; the SCIM III score of the control group was (68.34±9.55) points, and the MBI score was (57.52±6.77) points, the difference between the two groups was statistically significant ( t=3.079 and 6.219, respectively, all P<0.05). Conclusion:Hydrotherapy combined with breathing training can significantly improve lung function and respiratory muscle strength in patients with thoracolumbar spinal cord injury, and improve motor function and ability of daily living.

Objective:To investigate the application value of baseline MRI multi-parametric imaging radiomics in prediction of neoadjuvant chemoradiotherapy (NCR) efficacy of rectal mucinous adenocarcinoma (RMAC).Methods:Retrospective analysis was performed in the Sixth Affiliated Hospital of Sun Yat-sen University from August 2012 to October 2018. A total of 79 patients were included in this study, including 52 males and 27 females, aged 20-78 years (median age 52 years). According to the classification criteria of pathological regression, all patients were divided into NCR responsiveness group ( n=31) and nonresponsiveness group ( n=48). And 701 imaging features of T 2WI, diffusion weighted imaging (DWI) and enhanced T 1WI images of baseline MRI were extracted, and feature subsets were selected by repeatability analysis and feature dimensionality reduction to construct the radiomics prediction model. The tumor features from baseline MRI between the NCR responsiveness group and the nonresponsiveness group were compared, and the features of P<0.05 were combined with the radiomics to construct a model. Using pathology as the gold standard, the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of the prediction model, and the area under the curve (AUC), 95% confidence interval, sensitivity and specificity were calculated, and the DeLong test was used to compare the diagnostic efficacy of different prediction models. Results:By comparing the conventional tumor imaging characteristics of the NCR responsiveness group and the nonresponsiveness group, the differences in lymph node stage and mucinous nodule status between the two groups were statistically significant (χ2 =6.040, 5.870, P<0.05). The AUC of ROC curves based on T 2WI, DWI, and enhanced T 1WI radiomics were 0.816, 0.821, and 0.819, respectively, which were higher than those of conventional tumor characteristics (lymph node staging, mucinous nodule status) (AUC=0.607), and the differences were statistically significant ( Z=-2.391, -2.580 and -2.717, P<0.05). Among the joint prediction models of T 2WI, DWI and contrast-enhanced T 1WI radiomics and conventional tumor features, the DWI combined model had the largest AUC (0.843), and there was no statistically significant difference between the three combined models (all P>0.05). Conclusion:The baseline T 2WI, DWI, and contrast-enhanced T 1WI radiomics model can be used to predict the NCR efficacy of RMAC, which is better than the predictive efficacy of conventional features, and the combination with conventional features can further improve the predictive efficacy.

To build a CT-based radiomics predictive mode to evaluate the differentiation degree of the esophageal squamous carcinoma.
 Methods: A total of 160 patients with surgical pathology, complete clinical data and chest CT scanning before operation were retrospectively collected from January 2008 to August 2016. All patients were assigned randomly to a primary data set and an independent validation. Texture analysis was performed on CT images, while the carcinomas were performed by manual segmentation to extract the radiomics features. Radiomics features were extracted and 9 radiomics signatures were finally selected after dimension reduction. Radiomics features were extracted and established via Matlab. Multivariable logistic regression analysis was performed to build the predictive model. A 10-fold cross-validation was used for selecting parameters in the least absolute shrinkage and selection operator (LASSO) model by minimum criteria. The receiver operating characteristic (ROC) curves and areas under ROC curve (AUC) were used to compare the model performance in the primary validation and the independent validation for evaluating the differentiation degree of esophageal squamous carcinoma.
 Results: Radiomics signature showed great effect in discriminating primary data set and independent validation. The predictive model had a good performance in primary data set. The AUC was 0.791, the sensitivity was 81.6%, and specificity was 72.3%. In the independent validation, the AUC was 0.757, the sensitivity was 70.0%, and the specificity was 73.0%.
 Conclusion: The predictive model can be used for evaluating the differentiation degree of esophageal squamous carcinoma efficiently, which can be helpful to clinicians in diagnosis and choice of treatment for esophageal squamous carcinoma.
Carcinoma, Squamous Cell ; Esophageal Neoplasms ; Humans ; ROC Curve ; Retrospective Studies ; Tomography, X-Ray Computed