BACKGROUND: Cervical vertebra corpectomy decompression is one of the commonly used methods of anterior cervical decompression. In recent years, under the guidance of the principle of anterior cervical surgery, scholars propose the anterior cervical vertebra corpectomy decompression with preserving the posterior wall of the corpectomied vertebral body. It retains the posterior wall of the vertebral body, not only increases the stability of the cervical spine, but also increases the area of bone graft, which is conducive to the long-term fusion. At the same time, retaining posterior wall of the vertebral body can effectively prevent bone- and implant-induced spinal cord injury.OBJECTIVE: To evaluate the biomechanical stability of anterior cervical vertebra corpectomy decompression with preserving the posterior wall of the corpectomied vertebral body procedure on sheep by the establishment of finite element model with CT data.METHODS: Cervical vertebra specimens of adult sheep were selected, and scanned to capture its CT data. The geometrical model captured by CT was then transformed into finite element model through finite element software (without surgery). In the posterior wall preserving group, C4 corpectomy decompression was conducted while preserving its posterior wall followed by titanium-meshes and AO plate fixation. On the basis of posterior wall preserving group,corpectomy decompression was operated without preserving the posterior wall in another group; titanium mesh and plate were fixed. Finite element software was used to test and analyze the changes in stress and displacement of cervical vertebra under different conditions.RESULTS AND CONCLUSION: (1) The displacement was slightly small, and immediate postoperative stability was good in the posterior wall preserving group. However, the displacement and stress were not significantly different between posterior wall preserving group and posterior wall non-preserving group. (2) To sum up, a procedure preserving posterior wall of the vertebra body gains better immediate postoperative stability compared with conventional method.

Objective To evaluate the feasibility, methods and effectiveness of using a mechani-cal stapler for choledochojejunostomy.Methods The authors have operated on 118 patients in the management of carcinoma of head of pancreas, or periampullary tumor, or cholelithiasis.In the opera-tion, the bilio-enteric end-to-side, or end-to-end and side-to-side anastomosis was made by a circular stapler device, and then a Roux-en-Y or Brown's loop was formed for the preeedure.Results All the surgery of using stapler was done successfully.No postoperative complications such as stomal leak, bleeding and narrow were found.Meanwhile, no harmful consequences were observed through long-time follow-up.Conclusion Using mechanical stapler for bilio-intestinal anastomosis is time-saving, simple and reliable.It can be a choice for some diseases.

Objective To explore the value of gemstone spectral imaging (GSI)in quantitative evaluation of Lauren classification of gastric cancer.Methods Fifty-two patients with gastric cancer confirmed by gastroscopy underwent contrast-enhanced spectral CT imaging preoperatively.The monoergic and iodine-based images were obtained by GSI Viewer software,CT value and iodine concentration (IC)of the lesions were measured,and normalized iodine concentration (NIC)was calculated.With the reference of postoperative pathology,data were analyzed by LSD method of one-way analysis of variance.Results The IC,NIC,spectrum curve slope of 40-70 keV,40-140 keV and 70-140 keV energy range of intestinal type,mixed type and diffuse type carcinoma in the arterial phase were 12.86±6.80 (100 μg/mL),0.13±0.06 ,2.50±1.26 ,0.99±0.51 ,0.34±0.20 ,18.54±6.49 (100 μg/mL),0.19±0.07, 3.56±1.24,1.42±0.50,0.50±0.18 and 24.52±9.68 (100 μg/mL),0.24±0.09,4.73±1.76,1.90±0.73,0.68±0.29,respectively. The values of intestinal type were all significantly lower than those of diffuse type (P <0.05).Comparison between intestinal-mixed type and mixed-diffuse type,the other parameters were no significant differences except IC between intestinal-mixed type (P=0.037).Conclusion The slope of spectrum curve,iodine concentration,and normalized iodine concentration could be helpful for preoperative evaluation of Lauren classification of gastric cancer.

Objective:To analyze the clinical characteristics and surgical treatment of patients with cervical bronchogenic cyst.Methods:This study enrolled 14 cases of cervical bronchogenic cysts confirmed by surgery and pathology in our hospital from Sep 2015 to Sep 2020 to discuss clinical, imaging features and diagnosist.Results:Cysts lay in the left neck in 8 cases and in the right side in 6 cases, with the largest diameter of 5.8 cm and the smallest of 0.8 cm (3.4±1.7) cm. Cysts were closely related to the thyroid in 10 cases, adjacent to the recurrent laryngeal nerve in 2 cases. The postoperative pathology established the diagnosis of bronchogenic cyst, and no patients suffered from recurrence during the follow-up period.Conclusions:Cervical bronchogenic cyst is a rare congenital malformation of extrathoracic bronchogenic cyst. Final diagnosis is dependent upon pathology. Complete surgical resection is the key to prevent recurrence.

Objective:To investigate the predictive value of the ratio of tricuspid annulus plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) in the progression of heart failure with reduced ejection fraction (HFrEF) patients.Methods:A total of 172 patients with HFrEF in the First Affiliated Hospital of Zhengzhou University from January to December 2022 were prospectively selected. All participants underwent routine echocardiography, the routine cardiac ultrasound parameters, left atrial volume index (LAVi), right ventricular fractional area change (RVFAC) were measured. The ratio of early diastolic velocity E peak of the mitral valve orifice to the early diastolic mean velocity e′ of the mitral valve annulus (E/e′) and TAPSE/PASP were calculated. The online quantitative analysis software of the ultrasound instrument were used to obtain the left ventricular global longitudinal strain (LVGLS), left atrial reservior strain (LASr), left atrial conduit strain (LAScd), left atrial contraction strain (LASct), right ventricular global systolic strain (RVGLS), and right ventricular free wall strain (RVFWS). According to the median of TAPSE/PASP, the patients were divided into TAPSE/PASP≥0.50 mm/mmHg group(group 1, 85 cases) and TAPSE/PASP<0.50 mm/mmHg group(group 2, 87 cases). The endpoint events were recorded. The differences of the above parameters in two groups were compared, the correlation analysis was used to analyze the correlations between myocardial mechanical parameters and TAPSE/PASP. The Kaplan-Merier method was used to draw survival curves, and the Log-rank method was used to compare the differences in survival curves in the two groups. The univariate and multivariate Cox regression models were used to analyze the predictive value of TAPSE/PASP for end-point events.Results:There were no significant differences in age, gender, body mass index, complications and left ventricular end-diastolic volume (LVEDV) between the two groups (all P>0.05). Compared with group 1, patients in group 2 showed a significant decrease in RVFAC and TAPSE (all P<0.05), while the LAVi, left ventricular end-systolic volume (LVESV), right ventricular end-diastolic diameter (RVDd-base), E/e′ and PASP were increased (all P<0.05), the absolute values of LVGLS, LASr, LASct, RVGLS, and RVFWS were significantly decreased (all P<0.05). Correlation analysis showed that LVGLS, LASr, RVGLS, RVFAC and 6-min walking distance were linearly correlated with TAPSE/PASP ( r/ rs=-0.176, 0.181, -0.496, 0.472, 0.421; all P<0.05). The follow-up time was (11.71±1.80) months, and the incidence of death events in group 2 (28.73%) was higher than that in group 1 (10.61%), with a significant difference ( P<0.05). The results of multivariate Cox regression analysis showed that TAPAE/PASP was one of the independent predictive factors for endpoint events in HFrEF patients, with adjusted HR: 0.306, 95% CI=0.141-0.663, P=0.003. Conclusions:TAPSE/PASP can monitor the progression of chronic heart failure and is one of the independent predictive factors, providing a new reference indicator for clinical diagnosis and treatment.

Objective To monitor the dynamic changes of radiation-induced parotid damage using T2 ? mapping.Methods Thirty-four patients with nasopharyngeal carcinoma (NPC)were enrolled.All patients underwent T1 WI,T2 WI and T2 ? mapping for bilateral parotid glands at pre-RT (2 weeks before radiotherapy),mid-RT (5 weeks after the beginning of radiotherapy)and post-RT (4 weeks after the completion of radiotherapy).Parotid MR parameters,mean radiation dose and xerostomia degrees of the patients at different time points were recorded.Furthermore,nine healthy volunteers were enrolled,who undergone T2 ? mapping twice with an interval of 4 weeks in order to analyze the reproducibility of T2 ? value.Results From pre-RT to mid-RT and post-RT,parotid volume decreased [atrophy rates,(25.34±11.33)％ and (25.74±9.93)％,respectively]and T2 ? values decreased [change rates,(-5.63±8.86)％ and (-4.81±10.67)％, respectively]significantly (all P < 0.01 ).Parotid normalized T1 signal intensity decreased significantly from pre-RT to post-RT [change rate,(-7.43±10.61)％,P =0.007],and the change rate was correlated inversely with mean radiation dose significantly (r =-0.646, P <0.001).Parotid volume and T2 ? value changed correspondingly with xerostomia degrees of the patients during radiotherapy.Parotid MR parameters showed excellent reproducibility (intraclass correlation coefficient,0.843 -0.993).Conclusion The dynamic changes of radiation-induced parotid damage in patients with NPC can be noninvasively evaluated by routine MRI and T2 ? mapping.

Objective:To establish a nomogram for preoperative differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) based on clinical, ultrasound, and contrast-enhanced ultrasound (CEUS) data.Methods:A retrospective analysis was conducted on ultrasound and CEUS data of 462 patients who underwent hepatectomy in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2023, including 262 cases of HCC (56.7%) and 200 cases of ICC (43.3%). The data were randomly divided into training set ( n=324) and validation set ( n=138) in a 7∶3 ratio. Univariate analysis was used to initially screen for variables with statistically significant differences between HCC and ICC groups in the training set, and LASSO regression was performed to select the variables with higher coefficients. Logistic regression analyses were then used to predict independent risk factors for ICC. A nomogram was drawn using R software. The performance of the nomogram was then validated using ROC curve, calibration curve, and decision curve analysis (DCA). Results:Univariate analysis showed that there were significant differences in age, gender, liver cirrhosis, HBsAg (+ ), ALP >185 U/L, CA19-9 >27 kU/L, CA242>10 kU/L, irregular shape, border, cholangiectasis, portal vein tumor thrombus, enhanced pattern in arterial phase, clearance time <60 s, intra-tumoral vein between ICC and HCC groups (all P<0.05). The top 10 features were selected for LASSO regression analysis. Logistic regression analysis revealed that gender, cirrhosis, CA19-9>27 kU/L, CA242>10 kU/L, cholangiectasis, clearance time <60 s, intra-tumoral vein and enhanced pattern in arterial phase were risk factors for ICC (all P<0.05). The area under the ROC curve in the training and validation groups were 0.963 and 0.914, respectively. In the training group, the specificity and sensitivity of the nomogram were 0.926 and 0.917, respectively, and in the validation group, they were 0.875 and 0.871, respectively. The calibration curve showed that the prediction effect of the model was in good agreement with the actual situation. DCA showed that the nomogram could increase the net benefit to the different diagnosis of ICC in patients. Conclusions:The nomogram based on clinical, ultrasound and CEUS features has a good predictive value for preoperative identification of ICC and provides reliable evidence for clinical practice.

Objective:To establish and evaluate a clinical and ultrasound parameters-based nomogram for the preoperative differentiating diagnosis of intrahepatic cholangiocarcinoma (ICC).Methods:A total of 723 patients undergoing hepatectomy in Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2016 to August 2022 were retrospectively screened. A total of 399 patients with hepatocellular carcinoma (HCC, 198 cases) or ICC (201 cases) were enrolled in this study, including 284 males and 115 females, aged (60.5±10.5) years. Through random sampling using computer-generated random numbers, patients were divided into training ( n=279) and validation groups ( n=120) in a ratio of 7∶3. Univariate and multivariate logistic regression were performed to identify factors differentiating ICC, and a nomogram was established using R software based on independent risk factors for ICC. The accuracy of the nomogram was evaluated by receiver operating characteristic curve and calibration curves. Decision curve analysis was performed to assess the net benefit of the model. Results:Multivariate logistic regression analysis showed that irregular shape, cholangiectasis, female, cirrhosis, carbohydrate antigen 242 >10 U/ml, carbohydrate antigen 125 >30 U/ml and alpha-fetoprotein >10 μg/L were independent differentiating factors for ICC (all P<0.05). A nomogram was constructed based on those factors. The nomogram showed a better discrimination between ICC and HCC. The area under the curve of the training group and the validation group were 0.966 and 0.956, respectively. The calibration curve showed that the prediction effect of the model is in good agreement with the actual situation. Decision curve analysis showed that the nomogram was more effective than diagnosing all patients as either HCC or ICC, which yielded a net benefit at the most reasonable threshold probabilities. Conclusion:The nomogram for the preoperative diagnosis of ICC based on clinical and ultrasound features showed a good diagnostic performance.

OBJECTIVETo compare the accuracy of CT and MR including diffusion-weighted imaging(DWI) in preoperative diagnosis and T staging of gastric cancer.

METHODSForty-one patients with gastric cancers proved by gastroscopy biopsy from November 2011 to August 2012 were prospectively enrolled. They underwent contrast enhanced CT and MR imaging (including DWI, T2 weighted and dynamic enhanced imaging) preoperatively. Two radiologists interpreted CT and MR images for detecting and staging each patient independently. With the reference of post-operative histopathological findings, T staging accuracy of CT and MR imaging was calculated and compared. Inter-observer agreement was also evaluated.

RESULTSOverall T staging accuracy in MR including DWI was significantly higher than that in CT imaging(87.8% vs. 65.9%, P=0.004). MR had a better inter-observer agreement than CT(Kappa=0.813, 0.603, respectively).

CONCLUSIONMR including DWI can improve preoperative T staging accuracy of gastric cancer significantly, which deserves recommendation for clinical application.

OBJECTIVETo explore the preoperative diagnostic value of MR diffusion weighted imaging (DWI) for metastatic lymph nodes in patients with gastric cancer.

METHODSBetween December 2011 and December 2012, 52 gastric cancer patients(34 men, 18 women) underwent preoperative MR DWI. The apparent diffusion coefficient(ADC) and short diameter of lymph nodes were measured and compared with the postoperative histopathological findings. Diagnostic value of ADC and short diameter for metastatic lymph nodes in patients with gastric cancer was investigated by receiver characteristic curve(ROC) analysis.

RESULTSA total of 180 metastatic and 57 non-metastatic lymph nodes were detected as hyperintense on DWI obtained from 52 patients. The ADC of metastatic lymph nodes [(1.059±0.196)×10(-3) mm(2)/s] was significantly lower than that of non-metastatic nodes [(1.402±0.285)×10(-3) mm(2)/s, P<0.001]. With ADC threshold of 1.189×10(-3) mm(2)/s, the sensitivity, specificity and area under the curve(AUC) were 78.9%, 72.8% and 0.840, respectively. The overall diagnostic accuracy of preoperative N staging of ADC was 75%(39/52). The short diameter of metastatic lymph nodes [(8.08±3.99) mm] was significantly longer than that of non-metastatic lymph nodes [(6.75±2.70) mm, P=0.005]. With short diameter threshold of 5.05 mm, the sensitivity, specificity and AUC were 88.3%, 29.8% and 0.602, respectively. The overall diagnostic accuracy of short diameter in preoperative N staging was 67.3%(35/52).

CONCLUSIONSMR DWI is a useful technique in diagnosing metastatic lymph nodes in patients with gastric cancer. ADC value and short diameter can be used as diagnostic criterion for the diagnosis of preoperative N staging.