Objective To compare the clinical effect of digital orthopedic three-dimensional visualization technology combined with image-based computer navigation and simple image-based computer navigation for percutaneous screw fixation of acetabulum anterior column fractures.Methods A retrospectivecase-control analysis was made on 19 cases undergone percutaneous screw fixation of acetabular anterior column fractures under image-based computer navigation from January 2015 to 2016 March.There were 12 males and 7 females,aged from 21 to 66 years (mean,39.3 years).AO fracture classification was A3 type in 17 cases and B1 type in 2.Based on the application of three-dimensional digital programming,the cases were assigned to two groups:group A (n =9),virtual three-dimensional model was reconstructed and the virtual screw were inserted to uninjured side by software Mimics and group B (n =10),patients were only prepared for routine preoperative preparation.Time of anterior column screw insertion,intraoperative bleeding,intraoperative fluoroscopy frequency,fracture reduction and Majeed score were compared between the two groups.Results All cases were followed up for mean 8.4 months (range,3-12 months).There were no significant differences between groups A and group B in iutraoperative bleeding [(14.1 ± 3.0) ml,(15.1 ± 2.2) ml],good to excellent rate of reduction (89％,80％),good to excellent rate of Majeed score (89％,80％) (P ＞ 0.05).Time of anterior column screw insertion [(22.4-± 3.4) min] and intraoperative fluoroscopy frequency [(24.9 ± 3.8)times] in group A were significantly less than those[(29.4 ± 4.5)min,(30.5 ± 5.8)times] in group B (P ＜ 0.05).Conclusion Digital orthopedic three-dimensional visualization technology is associated with shortened time of anterior column screw insertion and reduced intraoperative fluoroscopy frequency,indicating an effective adjuvant technique for percutaneous screw fixation of acetabulum anterior column under navigation.

Objective To explore the application of low-dose prospective ECG-triggering dualsource CT (DSCT) angiography in infants and children with Kawasaki disease (KD).MethodsNineteen children diagnosed of Kawasaki disease underwent low-dose prospective ECG- triggering DSCT angiography (DSCTA) with free breathing and transthoracic echocardiogram (TTE).The overall imaging quality was graded on a five-point scale. Interobserver agreement in subjective image quality grading was assessed by Kappa statistics.The location,number and size of the aneurysms and dilations were recorded and compared with those of TTE.Pearson correlation analysis was used to evaluate the agreement on measurements between DSCTA and TTE.The average effective dose of DSCTA in all 19 children was calculated.ResultsDSCTA was performed successfully in all 19 children.A total of 91.5 ％ (226/247) segments permitted visualization with diagnostic image quality. Fifteen patients were diagnosed with coronary artery lesions. A total of 28 aneurysms and 15 arterial aneurysmal dilations were detected by DSCTA,while 19 aneurysms and 13 arterial aneurysmal dilations were found by TTE.TTE failed to detect 9 aneurysms (2 in the distal right coronary artery,2 in the posterior descending artery,1 in the middle of left anterior descending artery,1 in the middle of left circumflex artery,2 in the distal of LCX and 1 in the obtuse marginal branch)and 2 arterial aneurysmal dilations (1 at the diagonal branch and 1 at obtuse marginal branch). The concordance of DSCTA and TTE in measurement of diameter and length of these aneurysms and aneurysmal dilatations are good (0.63 ± 0.20) and (0.58 ± 0.20) cm vs ( 1.49 ± 0.83 ) and ( 1.22 ± 0.66) cm ( r =0.989 and 0.965,P ＜ 0.05 ).There was a good agreement on overall image quality ( Kappa =0.87 ). The mean effective dose was(0.24 ± 0.08) mSv.ConclusionProspective ECG-triggering DSCTA with very low effective radiation dose is safe,reliable and more sensitive than TTE on diagnosing of coronary artery lesions,especially in the distal lesions,in infants and children with KD.

Objective To compare the accuracy, image quality and radiation dose between prospective ECG?gated sequential and high?pitch acquisition on 128?slice dual?source CT (DSCT) angiography in infants and children with congenital heart disease (CHD). Methods Ninety?two children with CHD from October 2011 to February 2013 were prospectively enrolled and assigned into two groups according to random number table. Forty?six patients underwent DSCT angiography with sequential mode, and the other 46 patients were examined with high?pitch mode. With surgical and/or DSA results as the standard, the diagnostic accuracy and sensitivity of the two groups for the intracardiac structures, extracadiac and coronary artery anomalies were evaluated, and the comparison was analyzed by Fisher exact test. A 5?grade scoring system was used to interpret the image quality of intracardiac structures, great vessels and the proximal and middle segments of coronary arteries. Interobserver agreement on grades of image quality was assessed by Kappa statistics. The image quality scores were compared using the Mann?Whitney U test. The Student t test or the Mann?Whitney U test was used to analyze the differences between the two groups regarding to patients' age, weight , heat rate, CT attenuation, image noise and SNR in the ascending aorta and the pulmonary trunk as well as radiation dose. Results All 92 patients successfully underwent DSCT angiography. The diagnostic accuracies of intracardiac anomalies by high?pitch group and sequential group were 95.65%(88/92) and 99.28%(274/276), showed significant difference between the two groups (P<0.05), but no significant difference in the sensitivity of intracardiac anomalies (P>0.05) .There was no significant difference in the diagnostic accuracy and sensitivity of extracadiac anomalies between the two groups (P>0.05). The diagnostic accuracies of coronary artery anomalies by high?pitch group and sequential group were 93.48%(43/46) and 100.00%(46/46), showed no significant difference between the two groups (P>0.05), but there was significant difference in the sensitivity of coronary artery anomalies (50.00%(3/6) , 100.00% (11/11)) (P<0.05). There was excellent agreement for image quality scoring of the intracardiac structures, great vessels and the proximal and middle coronary arteries between the two observers (Kappa=0.81, 0.85, 0.85, P<0.05). The median image quality scores of extracardiac great vessels were both 5.00 in high?pitch group and sequential group, and there was no significant difference between the two groups (U=981.000, P>0.05). The median image quality scores of intracardiac structures and proximal and middle segments of coronary arteries respectively by high?pitch group were 4.00 and 3.00, and 5.00 and 4.00 respectively by sequential group. The image quality of intracardiac structures (U=594.500, P<0.05) and proximal and middle segments of coronary arteries (U=397.500, P<0.05) was significantly better in the sequential group than that in the high?pitch group. There was no significant difference between the two groups in CT attenuation, noise and SNR of the ascending aorta and pulmonary trunk. The mean effective doses of the high?pitch group and the sequential group were(0.27±0.11)and(0.39±0.17)mSv, and showed significant difference between the two groups (t=4.316, P<0.05). Conclusions Both sequential and high?pitch mode of 128?slice DSCT angiography provide high accuracy for the assessment of CHD in infants and children, while the high?pitch mode, though with some image quality declined, shows further significantly lower radiation dose.

Objective To explore the clinical value of prospective electrocardiography-triggering high-pitch spiral acquisition by dual-source CT (HP mode ) in children with congenital heart diseases (CHD).MethodsThirty-six patients ( mean age:0.67 years,range:1 month to 2 years and 6 months; 25 males;mean weight:7.7 kg)underwent prospective ECG-triggering high-pitch spiral acquisition.The dose length product (DLP) was recorded to calculate effective dose ( ED ).Two experienced radiologists made diagnosis and assessed the overall image quality by a five-point scale independently.The consistency of their judgment was determined by Kappa statistics.Surgeries were performed in 29 patients,and conventional cardiac angiography(CCA) was performed in 7 patients.The accuracy,sensitivity and specificity of HP mode were calculated based on the surgical or CCA findings.ResultsThe DLP was (5.12 ± 1.64) mGy.cm with a range of 2.4 mGy · cm to 9.2 mGy · cm and ED was (0.125 ± 0.027 ) mSv ranging from 0.078 mSv to 0.179 mSv.The average subjective image quality score was 4.2 ± 0.7.All images were diagnosable.Two radiologists made good agreement ( K =0.774,P ＜ 0.05 ).The accuracy,sensitivity and specificity of HP mode were 98.9％,94.2％ and 99.8％,respectively.ConclusionLow radiation dose with the accurate diagnosis of anomalies makes HP mode a new choice for children with CHD.

ObjectiveTo investigate the value of prospective ECG-gated dual-source CT (DSCT)in the diagnosis of coarctation of aorta ( CoA ).MethodsSixteen patients clinically suspected of CoA underwent prospective ECG-gated DSCT angiography and color Doppler flow imaging (CDFI). The diagnostic accuracy of DSCT and CDFI were compared according to the results of operation or DSA.The nonparametric chi-square test was used for the statistics.ResultsSixteen patients were diagnosed as CoA by DSCT,4 were complicated with artial septal defect (ASD),9 with ventricular septal defect (VSD),1 with transposition of the great arteries,3 with dysplasia of aortic arch,7 with patent ductus arteriosus (PDA),1 with abnormal origin of the coronary artery, 1 with bronchus artery dilation. Fifteen patients were diagnosed as CoA by CDFI,1 was diagnosed as interruption of aortic arch. Four were complicated with ASD,9 with VSD,2 with bicuspid aortic valve (BAV),1 with transposition of the great arteries,2 with dysplasia of aortic arch,7 with PDA,1 with bronchus artery dilation.Abnormal origin of the coronary artery was not found.The diagnostic accuracy of DSCT and CDFI were 97.2％ ( 140/144)and 97.9％ (141/144)respectively,there was no significant difference (x2 =0.00,P ＞ 0.05 ).The sensitivity of DSCT and CDFI were both 93.2％ ( 41/44 ),the specificity were 99.0％ (99/100) and 100.0％ (100/100).The mean effective radiation dose was 0.42 mSv. Conclusion Prospective ECG-gated DSCT is a good imaging technique for the diagnosis of aortic coarctation in children.

Objective:To investigate the incidence of hypoalbuminemia in elderly patients undergoing endovascular treatment(EVT)for large vessel occlusion and to analyze the correlation between hypoalbuminemia and prognosis of EVT.Methods:A total of 640 elderly patients receiving EVT due to acute large vessel occlusion, aged(71.5±7.4)years with 377 males(58.9%), were enrolled into the prospective multicenter cohort study from July 2018 to May 2019.The patients were grouped as the low albumin group(serum albumin levels within 24 h after EVT <35 g/L, n=191, 29.8%)and as the normal albumin group(serum albumin levels≥35 g/L, n=449, 70.2%). The primary outcome was 90-day nerve functional independence defined by the modified Rankin Scale score 0-2.Outcomes were assessed as odds ratio( OR)by using multivariable logistic regression analysis. Results:The proportion of prognosis of good nerve functional independence at 90 d was lower in the low albumin group than in the normal albumin group[22.5%(43 cases) vs.41.9%(188 cases), OR=1.88, 95% CI: 1.20~2.95, P=0.01]. The incidence of early neurological deterioration was higher after treatment( OR=0.57, 95% CI: 0.37~0.88, P=0.01), and the proportions of multiple systemic complications were higher( P<0.01)in the low albumin group than in the normal albumin group. Conclusions:Hypoalbuminemia after EVT is correlated with the poor prognosis at 90 d in elderly patients.Elderly patients with hypoalbuminemia after EVT have higher incidences of multiple systemic complications.

Objective To observe the effect of epidermal growth factor receptor (EGFR) signal pathway inhibitor gefitinib on femoral fracture healing in rats.Methods Eighty SD rats were divided into experimental group (n =40) and control group (n =40) by random number table.An open femur fractured model was established by cutting the middle part of the femoral shaft and placing 1 mm Kirschner wire through medial and lateral femoral patella incision.Rats in the experimental group were given gefitinib (100 mg · kg-1 · d-1),an inhibitor of epidermal growth factor receptor (EGFR) signaling pathway,and rats in the control group were given equal doses of methylcellulose.The X-ray examination was performed before femoral and serum specimens were collected at 1,2,3,4,and 6 weeks.Bone fracture healing was evaluated by Lane and Sandhu X ray scoring and biomechanical test.Then the tissue morphology was observed by HE staining,safranin fast green staining,and microCT detection.The bone volume (BV),bone volume fracture (BV/TV),trabecular number (Tb.N),trabecular thickness (Tb.Th),and trabecular separation (Tb.Sp) were measured by MicroCT.The levels of serum BALP,PINP,TRACP5b,and CTX were measured by Elisa.Results The X-ray scores of the experimental group (1.26 ±0.54,4.94 ± 1.16,and 8.23 ± 1.17) were significantly higher than those in the control group (0.91 ± 0.52,4.11 ± 1.18,and 7.08 ± 0.86) at 1,2 and 3 weeks after the fracture (P ＜ 0.05).The failure load of experimental group at 3 and 4 weeks after fracture [(38.65 ± 1.07) N,(63.63 ± 7.74)N] were significantly larger than those of the control group [(29.47 + 1.00)N,(45.42 + 3.26) N] (P ＜ 0.05).The callus formation in the experimental group was obvious and the healing process of the fracture was faster than that of the control group according to HE and safranin fast green staining.The results of microCT showed that in the experimental group,BV was significantly higher at 2 and 3 weeks after fracture [(59.30 ± 6.54) mm3 and (43.08 ± 2.33) mm3] than those in control group [(42.39 ± 7.82) mm3 and (33.43 ± 5.94) mm3];BV / TV at 2,3,and 4 weeks after fracture [(0.61 ±0.06)％,(0.55 ±0.05)％,and (0.53 ±0.04)％] were significantly higher than those in the control group [(0.48±0.07)％,(0.44±0.07)％,and (0.43±0.03)％];Tb.N at 2,3,and 4 weeks after fracture [(2.05 ± 0.11)/mm,(1.86 ± 0.18)/mm,and (2.034 ± 0.26)/mm] were significantly higher than those in control group [(1.63 ±0.21)/rmm,(1.32 ±0.21)/rmm,and (1.65 ± 0.08)/mm)];Tb.Th at 2,3,and 4 weeks after fracture [(0.33 ± 0.02) mm,(0.33 ± 0.03) mm,and (0.27 ± 0.02) mm] were significantly higher than those in the control group [(0.27 ±0.03)rmm,(0.28 ± 0.02)mm,and 0.23 ±0.01)mm];Tb.Sp at 3 weeks after fracture [(0.39 ±0.07)mm] was significantly higher than that in the control group [(0.30 ± 0.03) mm] (P ＜ 0.05).The levels of serum BALP in experimental group at 2 and 3 weeks after fracture [(2.57 ±0.14) ng/ml,(3.47 ±0.26) ng/ml] were significantly higher than those of control group [(2.07 ±0.19)ng/ml,(2.77 ±0.29)ng/ml];the PINP at 1,2,and 3 weeks after fracture in the experimental group [(2 216.50 ±96.68)pg/ml,(2 692.33 ± 136.76)pg/ml,and (3 196.75 ± 221.90)pg/ml] were significantly higher than those of the control group [(1 969.50 ± 89.34) pg/ml,(2 241.33 ± 107.86) pg/ml,and (2 603.25 ± 361.60) pg/ml];the levels of TRACP5b [(11.58 ± 0.47) ng/ml] and CTX [(8.02 ± 0.40) ng/ml] at 1 week after fracture were higher than those of the control group [(10.33 ± 0.53) ng/ml,(7.11 ± 0.36) ng/ml] (P ＜ 0.05).Conclusion Gefitinib can promote the maturation of osteoblasts and the early reabsorption function of osteoclasts to induce bone formation in advance and accelerate the fracture healing.

BACKGROUND: Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia. METHODS: In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared. RESULTS: A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94-0.99), 0.93 (95% CI: 0.85-0.98), and 0.94 (95% CI: 0.87-0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63-0.83), 0.72 (95% CI: 0.62-0.82), and 0.73 (95% CI: 0.62-0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers' interpretation and clinical factor model ( P <0.05). CONCLUSIONS The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.
Humans ; Retrospective Studies ; Pneumonia/diagnostic imaging* ; Analysis of Variance ; Tomography, X-Ray Computed ; Lymphoma/diagnostic imaging*