Objective: To develop a quantitative evaluation software for three-dimensional morphology of pathological scars based on photo modeling technology, and to verify its accuracy and feasibility in clinical application. Methods: The method of prospective observational study was adopted. From April 2019 to January 2022, 59 patients with pathological scars (totally 107 scars) who met the inclusion criteria were admitted to the First Medical Center of Chinese PLA General Hospital, including 27 males and 32 females, aged 33 (26, 44) years. Based on photo modeling technology, a software for measuring three-dimensional morphological parameters of pathological scars was developed with functions of collecting patients' basic information, and scar photography, three-dimensional reconstruction, browsing the models, and generating reports. This software and the clinical routine methods (vernier calipers, color Doppler ultrasonic diagnostic equipment, and elastomeric impression water injection method measurement) were used to measure the longest length, maximum thickness, and volume of scars, respectively. For scars with successful modelling, the number, distribution of scars, number of patients, and the longest length, maximum thickness, and volume of scars measured by both the software and clinical routine methods were collected. For scars with failed modelling, the number, distribution, type of scars, and the number of patients were collected. The correlation and consistency of the software and clinical routine methods in measuring the longest length, maximum thickness, and volume of scars were analyzed by unital linear regression analysis and the Bland-Altman method, respectively, and the intraclass correlation coefficients (ICCs), mean absolute error (MAE), and mean absolute percentage error (MAPE) were calculated. Results: A total of 102 scars from 54 patients were successfully modeled, which located in the chest (43 scars), in the shoulder and back (27 scars), in the limb (12 scars), in the face and neck (9 scars), in the auricle (6 scars), and in the abdomen (5 scars). The longest length, maximum thickness, and volume measured by the software and clinical routine methods were 3.61 (2.13, 5.19) and 3.53 (2.02, 5.11) cm, 0.45 (0.28, 0.70) and 0.43 (0.24, 0.72) cm, 1.17 (0.43, 3.57) and 0.96 (0.36, 3.26) mL. The 5 hypertrophic scars and auricular keloids from 5 patients were unsuccessfully modeled. The longest length, maximum thickness, and volume measured by the software and clinical routine methods showed obvious linear correlation (with r values of 0.985, 0.917, and 0.998, P<0.05). The ICCs of the longest length, maximum thickness, and volume of scars measured by the software and clinical routine methods were 0.993, 0.958, and 0.999 (with 95% confidence intervals of 0.989-0.995, 0.938-0.971, and 0.998-0.999, respectively). The longest length, maximum thickness, and volume of scars measured by the software and clinical routine methods had good consistency. The Bland-Altman method showed that 3.92% (4/102), 7.84% (8/102), and 8.82% (9/102) of the scars with the longest length, maximum thickness, and volume respectively were outside the 95% consistency limit. Within the 95% consistency limit, 2.04% (2/98) scars had the longest length error of more than 0.5 cm, 1.06% (1/94) scars had the maximum thickness error of more than 0.2 cm, and 2.15% (2/93) scars had the volume error of more than 0.5 mL. The MAE and MAPE of the longest length, maximum thickness, and volume of scars measured by the software and clinical routine methods were 0.21 cm, 0.10 cm, 0.24 mL, and 5.75%, 21.21%, 24.80%, respectively. Conclusions: The quantitative evaluation software for three-dimensional morphology of pathological scars based on photo modeling technology can realize the three-dimensional modeling and measurement of morphological parameters of most pathological scars. Its measurement results were in good consistency with those of clinical routine methods, and the errors were acceptable in clinic. This software can be used as an auxiliary method for clinical diagnosis and treatment of pathological scars.
Female ; Humans ; Male ; Asian People ; Cicatrix, Hypertrophic/diagnostic imaging* ; Extremities ; Keloid/diagnostic imaging* ; Prospective Studies ; Adult

BACKGROUND: Pathological scars are a disorder that can lead to various cosmetic, psychological, and functional problems, and no effective assessment methods are currently available. Assessment and treatment of pathological scars are based on cutaneous manifestations. A two-photon microscope (TPM) with the potential for real-time non-invasive assessment may help determine the under-surface pathophysiological conditions in vivo . This study used a portable handheld TPM to image epidermal cells and dermal collagen structures in pathological scars and normal skin in vivo to evaluate the effectiveness of treatment in scar patients. METHODS: Fifteen patients with pathological scars and three healthy controls were recruited. Imaging was performed using a portable handheld TPM. Five indexes were extracted from two dimensional (2D) and three dimensional (3D) perspectives, including collagen depth, dermo-epidermal junction (DEJ) contour ratio, thickness, orientation, and occupation (proportion of collagen fibers in the field of view) of collagen. Two depth-dependent indexes were computed through the 3D second harmonic generation image and three morphology-related indexes from the 2D images. We assessed index differences between scar and normal skin and changes before and after treatment. RESULTS: Pathological scars and normal skin differed markedly regarding the epidermal morphological structure and the spectral characteristics of collagen fibers. Five indexes were employed to distinguish between normal skin and scar tissue. Statistically significant differences were found in average depth ( t = 9.917, P <0.001), thickness ( t = 4.037, P <0.001), occupation ( t = 2.169, P <0.050), orientation of collagen ( t = 3.669, P <0.001), and the DEJ contour ratio ( t = 5.105, P <0.001). CONCLUSIONS Use of portable handheld TPM can distinguish collagen from skin tissues; thus, it is more suitable for scar imaging than reflectance confocal microscopy. Thus, a TPM may be an auxiliary tool for scar treatment selection and assessing treatment efficacy.
Humans ; Cicatrix/diagnostic imaging* ; Skin/pathology* ; Collagen ; Imaging, Three-Dimensional/methods*

OBJECTIVETo obtain information about the quality of scars of healed venous leg ulcers compared with intact skin on the opposite leg by using high-frequency ultrasound.

METHODSTwenty-eight patients (16 women, 12 men, aged 31 - 89 years) whose venous ulcers had healed and scars formed were included in this study. The echogenicities of scars were measured with a 20 MHz high-frequency ultrasound Dermascan. The thickness of epidermis and dermis was assessed and the number of low echogenic pixels (LEPs) in the papillary dermis and reticular dermis were counted using image analysis software.

RESULTSThe average epidermal thickness of the scars after 1 week to 20 years of healing was significantly increased compared to those of the control (P < 0.01), whereas the average dermal thickness of scars after healing was significantly decreased compared to the control (P < 0.01). The numbers of LEPs and the distributions of LEPs between scars and controls had no statistically significant differences. There were no correlations among scar echogenicities, age of healed venous ulcers, initial ulcer areas, age of venous ulcers or age of patients. In the control skin samples, the young group aged 31 - 69 years had fewer LEPs than did the elderly group aged 70 - 89 years.

CONCLUSIONOur study demonstrates that after the healing of venous leg ulcers, there are significant differences in the thickness of the epidermis and dermis, but no significant alterations in water content and distribution in the dermis when compared to the controls.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Cicatrix ; diagnostic imaging ; Female ; Humans ; Male ; Middle Aged ; Skin ; diagnostic imaging ; Time Factors ; Ultrasonography ; Varicose Ulcer ; diagnostic imaging

OBJECTIVE: To assess the predictive value of myocardial scar mass in malignant ventricular arrhythmia (MVA) after myocardial infarction. METHODS: Thirty myocardial infarction patients with complete electrophysiology and cardiac MRI data admitted from January 2012 to August 2017 were enrolled in the study. According to the results of intracavitary electrophysiological study, MVA developed in 16 patients (MVA group) and not developed in 14 patients (non-MVA group). The qualitative and quantitative analysis of left ventricular ejection fraction (LVFE) and scar mass was performed with CV post-processing software and predictive value of myocardial scar and LVEF for MVA after myocardial infarction was analyzed using ROC curves. RESULTS: LVEF in MVA group was significantly lower than that in non-MVA group, and scar mass in MVA group was significantly higher than that in non-MVA group (all <0.05). Regression analysis showed that LVEF (=1.580) and scar mass (=6.270) were risk factors for MVA after myocardial infarction. For predicting MVA, the area under ROC curve () of LVEF was 0.696 with a sensitivity of 0.786 and the specificity of 0.685; the of the scar mass was 0.839 with a sensitivity was 0.618 and the specificity of 0.929; the of LVEF combined with scar mass was 0.848 with a sensitivity of 0.688 and specificity of 0.857. CONCLUSIONS Myocardial scar assessed by late gadolinium enhancement MRI is more effective than LVEF in predicting MVA after myocardial infarction.
Arrhythmias, Cardiac ; diagnosis ; Cicatrix ; diagnostic imaging ; Contrast Media ; Gadolinium ; Humans ; Myocardial Infarction ; complications ; diagnostic imaging ; Predictive Value of Tests ; Ventricular Function, Left

OBJECTIVE: To determine the accuracy of two dismensional sonography and color doppler in diagnosing placenta previa accreta in patients with previous cesarean section. METHODS: Forty-one patients with previous cesarean sections were confirmed to have partial or total placenta previa in the current pregnancy and were given ultrasound examinations after the 28th week of gestation. Specific ultrasound features of the placenta and its interphase with the uterus and the bladder for placenta accreta were checked by two-dimensional ultrasonography and color Doppler. All the patients were traced until delivery. The golden standard in diagnosis was the intraoperative finding and the pathologic exam. RESULTS: Twenty-two patients had ultrasonographic evidence of placenta previa, 20 of which were later confirmed placenta previa accreta intraoperatively. Nineteen patients had no ultrasound evidence of placenta previa, and 1 of which was later confirmed placenta previa accreta. The sensitivity and specificity of antenatal ultrasound diagnosis of placenta previa accreta were 95.24% and 94.74% respectively. The most prominent feature to suggest placenta accreta in twodismensional sonography was the presence of multiple lakes that represented dilated vessels extending from the placenta through the myometrium. The most prominent color Doppler feature was the presence of interphase hypervascularity with abnormal vessels linking the placenta to the bladder, and the rate was 95.24%. CONCLUSION Placenta previa accreta can be diagnosed made with a thorough two dimensional ultrasonographic and color Doppler examination in patients with previous cesarean scar and placenta previa.
Adult ; Cesarean Section ; Cicatrix ; complications ; Female ; Humans ; Placenta Accreta ; diagnostic imaging ; Placenta Previa ; diagnostic imaging ; Pregnancy ; Ultrasonography ; methods ; Ultrasonography, Doppler, Color ; Uterus ; pathology ; Young Adult

OBJECTIVETo compare the morphological difference between dermal tissue of normal skin and that of scar in rat, and to explore its structural pattern.

METHODSThe full-thickness skin and the scar tissue formed 3 weeks after wound healing from SD rats were harvested as samples, which were prepared appropriately afterwards. Samples were scanned and imaged with synchrotron radiation technology, micro-CT, and phase-contrast imaging technology. The images were rebuilt with three-dimensional software.

RESULTSThe micro-CT was materialized by using X-ray generated by synchrotron radiation light source. The structure of dermal tissues was clearly shown with the assistance of phase-contrast imaging technology in the process. It was demonstrated that the dermal tissues of normal skin of rat were mainly composed of collagenous fibers, which twined together to form an olive-like structure. These olive-like structures as basic units were arranged randomly in a certain way. The collagenous fibers in dermal tissue of the scar were arranged in a parallel manner, while some fibers were crooked and arranged in a disorderly manner.

CONCLUSIONSDermal tissue of normal skin in rat has stable three-dimensional structure, and its basic structure and manner of composition are obviously different from those of scar dermal tissue.

Animals ; Cicatrix ; diagnostic imaging ; Dermis ; diagnostic imaging ; pathology ; Imaging, Three-Dimensional ; methods ; Male ; Microscopy, Phase-Contrast ; Rats ; Rats, Sprague-Dawley ; Skin ; diagnostic imaging ; Synchrotrons ; Tomography, X-Ray Computed ; Wound Healing

OBJECTIVETo investigate the clinical value of ultrasonography in predicting massive haemorrhage during Cesarean scar pregnancy.

METHODSThe clinical and ultrasonograhic data of 119 Cesarean scar pregnancy patients were retrospective analyzed. According to the amount of bleeding, these patients were divided into two groups:massive hemorrhage group and non-massive hemorrhage group. The potential risk factors of massive hemorrhage were analyzed with Logistic regression analysis.

RESULTSThe size and type of lesions, flow grade, and residual muscular thickness were screened as the risk factors of massive haemorrhage by Logistic regression model. When P=0.3 was applied as the cutoff value,the diagnostic accuracy was 90.75%;meanwhile,the sensitivity,specificity,positive predictive value, and negative predictive value were 88.23%, 91.76%, 81.08%, and 95.12%,respectively.

CONCLUSIONUltrasonography can accurately predict the risk of massive hemorrhage during the Cesarean scar pregnancy.

Cesarean Section ; Cicatrix ; Female ; Hemorrhage ; diagnostic imaging ; Humans ; Logistic Models ; Postoperative Complications ; Pregnancy ; Retrospective Studies ; Risk Factors ; Ultrasonography

OBJECTIVETo investigate the early diagnosis and treatment of cesarean scar pregnancy (CSP).

METHODSClinical data of 28 patients with CSP in Peking Union Medical College Hospital from January 1994 to April 2007, including age, interval from the last cesarean delivery to diagnosis, clinical presentation, location of the lesion, process of diagnosis and treatment, outcome, and follow-up, were retrospectively analyzed.

RESULTSCSP constituted 1.05% of all ectopic pregnancies, and the ratio of CSP to pregnancy was 1:1221. The mean age of the group was 31.4 years. Twenty-six women had only one prior cesarean delivery. The interval from the last cesarean delivery to diagnosis ranged from 4 months to 15 years. The most common presenting symptoms of CSP were amenorrhoea and vaginal bleeding. Seventeen cases were misdiagnosed as early intrauterine pregnancies and 2 were misdiagnosed as gestational trophoblastic tumor. The other 9 were diagnosed definitely before treatment The diagnosis was made based on cesarean delivery history, gynecologic examination, ultrasound, and magnetic resonance imaging (MRI). The treatment of CSP included systemic or local methotrexate administration, conservative surgery, and hysterectomy. The conservative treatment was successful in 24 cases. All of the 28 women were cured through individual therapies.

CONCLUSIONSCSP is rare and usually misdiagnosed as other diseases. Ultrasound is valuable for diagnosing CSP, and MRI can be used as an adjunct to ultrasound scan. Early diagnosis offers the options of conservative treatment and greatly improves the outcome of patients. Individual therapy is strongly recommended.

Adult ; Cesarean Section ; Cicatrix ; Combined Modality Therapy ; Female ; Gynecologic Surgical Procedures ; Humans ; Magnetic Resonance Imaging ; Methotrexate ; administration & dosage ; therapeutic use ; Pregnancy ; Pregnancy, Ectopic ; diagnosis ; diagnostic imaging ; therapy ; Ultrasonography

To evaluate the anti-cicatricial and anti-restenosis effect of verapamil on anterior urethral stricture.
 Methods: A total of 32 patients received anterior urethral stricture were enrolled in this study. They were divided into 4 blocks according to the duration of previous urethral operations and dilations. Every block was further randomly divided into an experimental group and a control group. Experimental groups received 2 mL injection of verapamil around the anastomosis site of urethra before and after the surgery (2, 4, 6, 8, and 10 weeks after the surgery), while the control groups only received the anastomosis surgery. After surgery, maximal urinary flow rate (Qmax) was examined for all patients once the catheter was removed. In addition, they were also conducted palpation of urethral scar range. The sum of long transverse diameters of urethral scar was measured, and the narrowest urethral inner diameter was examined. The Qmax was rechecked and the urethral scar range was assessed by penis color Doppler elastography after 12 weeks of surgery. The above 4 indexes were used to evaluate the inhibitory effect of verapamil on urethral scar.
 Results: The length of palpated urethral scar in the Block 1 to 4 of the experimental groups was (22.75±1.03), (21.25±0.25), (20.75±1.03), and (20.0±0.58) mm, respectively; and those in the control groups (26.00±0.82), (24.5±1.04), (25.75±1.65), and (28.25±1.75) mm, respectively. The Qmax rates in the Block 1 to 4 of the experimental groups were (11.85±0.77), (11.33±0.81), (10.23±0.26), and (10.35±0.17) mL/s, respectively; and those in the control groups were (10.85±0.39), (10.50±0.76), (10.53±1.00), (12.60±0.39) mL/s, respectively. The Qmax rates in the Block 1 to 4 of the experimental groups were (11.73±0.87), (10.65±0.25), (10.23±0.19), and (10.35±0.29) mL/s, respectively; and those in the control groups were (8.05±0.28), (7.73±0.68), (7.53±0.92), and (9.60±0.32) mL/s, respectively. The narrowest diameters of urethral in the Block 1 to 4 of the experimental groups were (9.00±0.58), (7.50±2.89), (7.00±0.10), and (7.00±0.41) mm, respectively; and those in the control groups were (5.50±0.29), (5.00±0.41), (4.75±0.48), and (6.75±0.48) mm, respectively. The ultrasound strain ratio in the Block 1 to 4 of the experimental groups were 6.10±0.22, 6.10±0.17, 5.10±0.16, and 6.90±0.19, respectively; and those in the control groups were 8.00±0.25, 10.60±0.29, 11.30±0.16, and 8.90±0.33, respectively. Compared with the control groups, the experimental groups displayed smaller urethral scar range, less severe scarring, improved Qmax rates and wider inner diameters (all P<0.05).
 Conclusion: Urethral regional injection of verapamil intraoperatively or postoperatively can prevent overgrowth of urethral scar tissues after the transperineal anastomosis surgery, and reduce the tendency of postoperative restenosis of anterior urethral stricture.
Anastomosis, Surgical ; adverse effects ; Cicatrix ; diagnostic imaging ; drug therapy ; prevention & control ; Dilatation ; adverse effects ; Humans ; Male ; Penis ; diagnostic imaging ; Postoperative Complications ; diagnostic imaging ; drug therapy ; prevention & control ; Secondary Prevention ; Ultrasonography ; Urethra ; diagnostic imaging ; surgery ; Urethral Stricture ; prevention & control ; surgery ; Urination ; Urological Agents ; therapeutic use ; Verapamil ; therapeutic use

OBJECTIVETo analyze the clinical features, renal damage and prognosis of primary vesicoureteric reflux (VUR) in children, hoping to give more attention to early recognition and treatment of the disease.

METHODSBetween June 1995 and December 2006, 974 patient were admitted in our hospital because of urinary tract infection (UTI), 139 primary VUR children were enrolled in the retrospective study. VUR grades, renal scar development, renal ultrasound and urinalysis were evaluated.

RESULTSThe incidence of VUR in UTI children was 14.3% (139/974), however, the incidence in infants and toddlers (younger than two years of age) was 17.2% (79/458), which was greatly higher than that in school children. Of the 139 children, 79(56.8%) were younger than two years and the number of boys was much larger than that of girls (P = 0.001). Bilateral reflux was found in 69 cases, unilateral in 70 cases; the percentages of mild reflux (grade I-II) was 19.7% (41/208), moderate reflux (grade III) was 35.6% (74/208), severe reflux (grade IV-V) was 44.7% (93/208). Dimercaptosuccinic acid (DMSA) scanning was performed for 135 patients, and renal scar was found in 37% (50/135), and the rate of scar in infants was the highest (42.4%), and 30 (60%) patients with renal scar were younger than two years of age. Among them five patients were found to have renal scar during the follow up period, four of them were younger than two years. The rate of renal scar in moderate and severe reflux was much higher than that in mild reflux cases, the risk of occurring renal scar would increase with its severity of reflux (P < 0.001). The sensitivity and specificity of renal ultrasound in suggesting VUR were 24.8% and 94.3%, respectively. The positive outcome of urinary N-acetyl-beta-glucosaminidase was a bit high, but there were no associations between renal scar and urinary microprotein (P > 0.05). Thirty-one cases were followed up for long time (> 1 year); and 90% of urinary infection was controlled and in 44.4% of patients VUR disappeared with medical treatment. No child had decreasing renal function in follow-up period.

CONCLUSIONChildren with primary VUR need early diagnosis and treatment. Insisting on normal therapy and long-term follow-up will protect renal function effectively.

Child ; Child, Preschool ; Cicatrix ; Female ; Humans ; Infant ; Kidney ; pathology ; Male ; Retrospective Studies ; Ultrasonography ; Urinary Tract Infections ; epidemiology ; Vesico-Ureteral Reflux ; diagnostic imaging ; epidemiology ; pathology