OBJECTIVE: To summarize the advances in MRI-based bone quality scoring systems and their clinical applications. METHODS: A comprehensive literature review was conducted on recent studies related to the MRI-based bone quality scoring system, focusing on measurement methods, influencing factors, and clinical significance. RESULTS: Osteoporosis has a high incidence in China, significantly impacting patients' quality of life and the postoperative outcomes of related orthopedic surgeries. Early identification of osteoporosis holds important clinical significance. In recent years, both domestic and international research has enriched the MRI-based bone quality scoring systems, which includes vertebral bone quality scoring, endplate bone quality scoring, and pedicle bone quality scoring. Compared to the "gold standard" of bone density measurement, dual-energy X-ray absorptiometry, the bone quality scoring systems demonstrate good efficacy in identifying abnormal bone mass and predicting postoperative complications, while being less influenced by degenerative changes in the lumbar spine, indicating its important clinical application value. CONCLUSION The MRI-based bone quality scoring systems have good value in clinical applications. However, current studies are mostly retrospective cohort and case-control studies, which carry a risk of bias. The clinical application value needs further clarification through meta-analysis and large-scale prospective studies.
Humans ; Magnetic Resonance Imaging/methods* ; Bone Density ; Osteoporosis/diagnosis* ; Absorptiometry, Photon ; Bone and Bones/diagnostic imaging* ; Lumbar Vertebrae/diagnostic imaging* ; Quality of Life ; Postoperative Complications

OBJECTIVE: To investigate the prognostic significance of combined coagulation and fibrinolysis marker analysis in predicting the development of deep venous thrombosis (DVT) following proximal femoral anti-rotation intramedullary nail (PFNA) surgery in elderly patients with intertrochanteric femur fractures. METHODS: A retrospective analysis was conducted on the clinical data of 80 elderly patients who underwent PFNA treatment for intertrochanteric fractures between April 2019 and April 2023. There were 26 males and 54 females. The patients' ages ranged from 60 to 85 years old, with a mean age of (76.4±5.6) years old. According to the occurrence of DVT following PFNA, patients were categorized into two groups. The DVT group were 29 patients, comprising 10 males and 19 females with a mean age of (76.9 ± 6.1)years old. And the non-DVT group were 51 patients, consisting of 16 males and 35 females with a mean age of (75.3 ± 6.9 )years old. The prothrombin time (PT), activated partial thromboplastin time(APTT), thrombin time(TT), plasma fibrinogen (FIB), plasma thrombin-antithrombin complex(TAT), and D-dimer levels were compared between the two groups immediately post- PFNA surgery, as well as at 3 and 7 days postoperatively. Pearson correlation analysis was conducted to evaluate the relationship between plasma FIB, TAT, and D-dimer levels in patients who developed DVT. Multivariate logistic regression analysis was employed to assess the association between each coagulation and fibrinolysis index following PFNA surgery in elderly patients and the incidence of DVT. The area under the receiver operating characteristic (ROC) curve (AUC) was utilized to determine the predictive value of PT, APTT, TT, FIB, TAT, and D-dimer for postoperative DVT occurrence. RESULTS: There were no statistically significant differences in PT, APTT, and TT between the two groups immediately post-surgery, at 3 days, and at 7 days (P>0.05). At immediately, 3 days and 7 days postoperatively in DVT group, FIB were (4.68±1.77), (6.73±2.02), (8.81±2.86) g·L^-1, TAT were (10.64±2.30), (12.88±3.45), (14.96±4.87) μg·L^-1 respectively. D-dimer were (635.00±100.88), (720.02±168.09), (810.47±170.19) μg· L^-1, respectively.In the DVT group FIB were (3.46±0.47), (3.55±0.52), (3.67±0.48) g·L^-1, TAT were (8.58±3.37), (8.69±3.48), (8.80±3.50) g·L^-1, D-dimer were (588.36±96.68), (589.58±96.45), (591.11±95.50) g·L^-1. The difference between the two groups was statistically significant (P<0.05). Pearson correlation analysis revealed significant positive correlations between FIB and D-dimer(r=0.428, 0.523, P<0.05), FIB and TAT(r=0.517, 0.411, P<0.05), as well as TAT and D-dimer(r=0.602, 0.596, P<0.05). Multivariate Logistic regression analysis revealed that FIB OR=3.252, 95% CI(0.640, 3.975), P<0.01, TAT OR=1.461, 95% CI(1.059, 2.011), P<0.05, and D-dimer OR=3.830, 95%CI (2.032 to 7.213), P<0.01 were significantly associated with the development of DVT following PFNA surgery. The combined detection of PT, APTT, TT, FIB, TAT, and D-dimer demonstrates significantly greater predictive value for the occurrence of DVT following PFNA surgery compared to individual index detection (P<0.01). CONCLUSION The combined detection of PT, APTT, TT, FIB, TAT and D-D has a high predictive value for DVT in elderly patients with femoral intertrochanteric fracture after PFNA, which is of vital importance in the early diagnosis of DVT and early prevention of pulmonary embolism and other serious complications.
Humans ; Male ; Female ; Venous Thrombosis/diagnosis* ; Aged, 80 and over ; Aged ; Fibrinolysis ; Retrospective Studies ; Blood Coagulation ; Hip Fractures/blood* ; Fracture Fixation, Intramedullary/adverse effects* ; Middle Aged ; Postoperative Complications/blood* ; Bone Nails/adverse effects*

BACKGROUND: Postoperative pulmonary complications (PPCs) are major adverse events in neurosurgical patients. This study aimed to develop and validate machine learning models predicting PPCs after neurosurgery. METHODS: PPCs were defined according to the European Perioperative Clinical Outcome standards as occurring within 7 postoperative days. Data of cases meeting inclusion/exclusion criteria were extracted from the anesthesia information management system to create three datasets: The development (data of Huashan Hospital, Fudan University from 2018 to 2020), temporal validation (data of Huashan Hospital, Fudan University in 2021) and external validation (data of other three hospitals in 2023) datasets. Machine learning models of six algorithms were trained using either 35 retrievable and plausible features or the 11 features selected by Lasso regression. Temporal validation was conducted for all models and the 11-feature models were also externally validated. Independent risk factors were identified and feature importance in top models was analyzed. RESULTS: PPCs occurred in 712 of 7533 (9.5%), 258 of 2824 (9.1%), and 207 of 2300 (9.0%) patients in the development, temporal validation and external validation datasets, respectively. During cross-validation training, all models except Bayes demonstrated good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.840. In temporal validation of full-feature models, deep neural network (DNN) performed the best with an AUC of 0.835 (95% confidence interval [CI]: 0.805-0.858) and a Brier score of 0.069, followed by Logistic regression (LR), random forest and XGBoost. The 11-feature models performed comparable to full-feature models with very close but statistically significantly lower AUCs, with the top models of DNN and LR in temporal and external validations. An 11-feature nomogram was drawn based on the LR algorithm and it outperformed the minimally modified Assess respiratory RIsk in Surgical patients in CATalonia (ARISCAT) and Laparoscopic Surgery Video Educational Guidelines (LAS VEGAS) scores with a higher AUC (LR: 0.824, ARISCAT: 0.672, LAS: 0.663). Independent risk factors based on multivariate LR mostly overlapped with Lasso-selected features, but lacked consistency with the important features using the Shapley additive explanation (SHAP) method of the LR model. CONCLUSIONS: The developed models, especially the DNN model and the nomogram, had good discrimination and calibration, and could be used for predicting PPCs in neurosurgical patients. The establishment of machine learning models and the ascertainment of risk factors might assist clinical decision support for improving surgical outcomes. TRIAL REGISTRATION ChiCTR 2100047474; https://www.chictr.org.cn/showproj.html?proj=128279 .
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Algorithms ; Lung Diseases/etiology* ; Machine Learning ; Neurosurgical Procedures/adverse effects* ; Postoperative Complications/diagnosis* ; Risk Factors ; ROC Curve

OBJECTIVE: To investigate the incidence and potential influence factors that contribute to chronic post-surgical pain (CPSP) in elderly patients with urinary tract tumors who underwent laparoscopic procedures. METHODS: A retrospective study was conducted to collect the clinical data of 182 elderly patients with urinary tract tumors who were ≥65 years and underwent laparoscopic surgery from October 2021 to March 2022 in Peking University Third Hospital. The patients'demographic information, medical history and the severity of postoperative pain were collected. Telephone follow-ups were made 6 months after surgery, and the patients' CPSP conditions were recorded. The diagnostic criteria of CPSP were referred to the definition made by the International Association for the Study of Pain (IASP): (1) Pain that developed or increased in intensity after surgical procedure and persisted for at least 3 months after surgery; (2) Pain that localized to the surgical field or projected to the innervation territory of a nerve situated around the surgical area; (3) Pain due to pre-existing pain conditions or infections and malignancy was excluded. The patients were divided into two groups based on CPSP diagnosis. Risk factors that predisposed the patients to CPSP were identified using univariate analysis. A multivariate Logistic regression model using back-forward method was designed, including both variables that significantly associated with CPSP in the univariate analysis (P < 0.1), and the variables that were considered to have significant clinical impact on the outcome. RESULTS: Two hundred and sixteen patients with urinary tract tumors who had undergone laparoscopic surgery were included, of whom, 34 (15.7%) were excluded from the study. For the remaining 182 patients, the average age was (72.6±5.2) years, with 146 males and 36 females. The incidence of CPSP at the end of 6 months was 31.9% (58/182). Multiva-riate regression analysis revealed that age ≥75 years (OR=0.29, 95% CI: 0.12-0.73, P=0.008) was the protecting factors for postoperative chronic pain in the elderly patients with urinary tract tumors undergoing surgical treatment, while renal cancer (compared with other types of urinary tract tumors) (OR=3.68, 95% CI: 1.58-8.58, P=0.003), and the 24 h postoperative moderate to severe pain (OR=2.57, 95% CI: 1.14-5.83, P=0.024) were the independent risk factors affecting CPSP. CONCLUSION Age < 75 years, renal cancer and the 24 h postoperative moderate to severe pain are influence factors of the occurrence of CPSP after laparoscopic surgery in elderly patients with urinary tract tumors. Optimum postoperative multimodal analgesia strategies are suggested to prevent the occurrence of CPSP.
Male ; Female ; Humans ; Aged ; Retrospective Studies ; Chronic Pain/diagnosis* ; Laparoscopy/adverse effects* ; Pain, Postoperative/etiology* ; Kidney Neoplasms/complications* ; Carcinoma, Renal Cell/complications* ; Risk Factors

Anastomotic leak is one of inevitable postoperative complications of rectal cancer. With the improvement of surgical techniques, the enhancement of the cognization of rectal cancer, and the development of surgical instruments, surgical procedures of rectal cancer are getting more sophisticated. The anastomosis is performed lower and lower, however the incidence of anastomotic leak is not significantly decreased. In addition, different from intraperitoneal anastomotic leak, the low rectal anastomotic leak after low anterior resection has many special issues in the diagnosis and treatment in clinic. The incidence of peritonitis caused by low anastomotic leak is low, the onset time is late, and symptoms of peritonitis are mild. So most low anastomotic leak is treated conservatively, second surgical repair or resection of anastomotic site is rarely performed, and proximal intestinal diversion is commonly performed. In the prevention of low anastomotic leak, some techniques and precautions during the perioperative period and identification of high risk factors might play important roles. Combined our clinical experiences, we introduced the diagnosis, treatment, prevention and research progression of low anastomotic leak after anterior resection of low rectal cancer, we hope it would be helpful.
Anastomosis, Surgical ; Anastomotic Leak/diagnosis* ; Humans ; Postoperative Complications/diagnosis* ; Proctectomy ; Rectal Neoplasms/surgery* ; Retrospective Studies ; Risk Factors

Aged ; Cholecystectomy, Laparoscopic ; methods ; Cholelithiasis ; complications ; diagnosis ; surgery ; Clinical Laboratory Techniques ; Coronavirus Infections ; complications ; diagnosis ; Elective Surgical Procedures ; methods ; Follow-Up Studies ; Humans ; Infection Control ; methods ; Male ; Pandemics ; Patient Safety ; Pneumonia, Viral ; complications ; diagnosis ; Postoperative Care ; methods ; Risk Assessment ; Singapore ; Treatment Outcome

OBJECTIVE: To investigate the association of genetic polymorphisms of norepinephrine metabolizing enzymes with postpartum depression and analyze the risk factors for postpartum depression in women following cesarean section. METHODS: A total of 591 Chinese woman of Han Nationality undergoing caesarean section were enrolled in this study. The diagnosis of postpartum depression was established for an Edinburgh Postnatal Depression Scale (EPDS) score ≥9. For all the women without antepartum depression, the genotypes of catechol-O-methyltransferase (COMT; at 5 sites including rs2020917 and rs737865) and monoamine oxidase A (rs6323) were determined using Sequenom Mass Array single nucleotide polymorphism (SNP) analysis. We analyzed the contribution of the genetic factors (SNPs, linkage disequilibrium and haplotype) to postpartum depression and performed logistic regression analysis to identify all the potential risk factors for postpartum depression and define the interactions between the genetic and environmental factors. RESULTS: The incidence of postpartum depression was 18.1% in this cohort. Univariate analysis suggested that COMT polymorphism at rs2020917 (TT genotype) and rs737865 (GG genotype) were significantly correlated with the occurrence of postpartum depression ( < 0.05). Logistic regression analysis showed that COMT polymorphism at rs2020917 (TT genotype) and rs737865 (GG genotype), severe stress during pregnancy, and domestic violence were the risk factors for postpartum depression ( < 0.05); no obvious interaction was found between the genetic polymorphisms and the environmental factors in the occurrence of postpartum depression. CONCLUSIONS The rs2020917TT and rs737865GG genotypes of COMT, stress in pregnancy, and domestic violence are the risk factors for postpartum depression.
Catechol O-Methyltransferase ; genetics ; Cesarean Section ; adverse effects ; Depression, Postpartum ; diagnosis ; enzymology ; genetics ; Domestic Violence ; psychology ; Female ; Gene-Environment Interaction ; Genotype ; Haplotypes ; Humans ; Linkage Disequilibrium ; Monoamine Oxidase ; genetics ; Norepinephrine ; metabolism ; Polymorphism, Single Nucleotide ; Postoperative Complications ; diagnosis ; enzymology ; genetics ; Pregnancy ; Pregnancy Complications ; etiology ; psychology ; Risk Factors ; Stress, Psychological

BACKGROUND: Lipomas are common benign soft tissue tumors composed of mature white adipocytes, with histological features including a well-circumscribed and lobular mass covered with a thin fibrous capsule. However, lipomas that are poorly demarcated from the surrounding fat are often encountered during surgery despite a postoperative histological diagnosis. We investigated the complications associated with different types of lipomas. METHODS: This retrospective study included 119 patients who underwent lipoma excision and computed tomography (CT) imaging at our clinic between January 2011 and August 2018. We classified the lipomas as encapsulated or nonencapsulated according to the histology, CT findings, and clinical criteria. Nonencapsulated lipomas were defined as relatively heterogeneous without a distinct capsule, whereas encapsulated lipomas were homogeneous with a distinct capsule. The analyzed complications included delayed wound healing, which can cause prominent scarring, hematoma or seroma, and recurrence. RESULTS: Encapsulated and nonencapsulated lipomas were diagnosed in 89 (74.8%) and 30 (25.2%) patients, respectively. Encapsulated lipomas occurred most commonly on the head, whereas nonencapsulated lipomas occurred most commonly on the neck and trunk (P=0.000, P=0.002, and P=0.031, respectively). The Fisher exact test showed a significantly higher incidence of delayed wound healing for nonencapsulated than encapsulated lipomas (P=0.014). CONCLUSIONS: Preoperative classification of lipomas using CT imaging is important for predicting the incidence of postoperative complications. Direct excision is adequate for removing encapsulated lipomas. However, nonencapsulated lipomas might require alternative methods, such as ultrasonic liposuction, to prevent postoperative complications. Our results will help reduce the incidence of scarring by providing guidance on surgical methods.
Adipocytes, White ; Cicatrix ; Classification ; Diagnosis ; Head ; Hematoma ; Humans ; Incidence ; Lipectomy ; Lipoma ; Neck ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Seroma ; Ultrasonics ; Wound Healing

Cholecystocolic fistula (CCF) is a rare and late complication of gallbladder disease. The cause of CCF is known to be peptic ulcer, gallbladder disease, malignant tumor, trauma, and postoperative complications. The proper treatment method is to perform cholecystectomy and to identify and alleviate the CCF. However, cholecystectomy is not always possible owing to technical difficulties and disease severity. CCF is difficult to diagnose preoperatively, and CCF operation without an accurate preoperative diagnosis can lead to a more complicated surgery and cause surgeons to face more difficult situations or to endanger patients' lives. We report a case of asymptomatic CCF successfully treated with laparoscopic surgery after accurate diagnosis before surgery.
Cholecystectomy ; Diagnosis ; Fistula ; Gallbladder Diseases ; Laparoscopy ; Methods ; Peptic Ulcer ; Postoperative Complications ; Surgeons

Candidiasis ; diagnosis ; Cervical Vertebrae ; surgery ; Esophageal Diseases ; diagnosis ; microbiology ; Esophagus ; microbiology ; Humans ; Postoperative Complications ; microbiology ; Spinal Fusion ; adverse effects