Objective To observe the value of enhanced CT radiomics combined with deep learning(DL)algorithm for predicting cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC).Methods Totally 100 patients with single PTC were retrospectively enrolled and divided into training set(n=70)and test set(n=30)at the ratio of 7∶3.The optimal radiomics features and DL features of lesions were extracted and screened based on arterial phase cervical CT,and the radiomics score(Radscore)and DL score(Deepscore)were calculated to construct radiomics model and DL model,respectively.Clinical data,routine CT findings,Radscore and Deepscore were enrolled in multivariate logistic regression analysis to screen the independent predictors of PTC CLNM,and a combined model was then constructed.The receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for predicting PTC CLNM.Results Thirteen optimal radiomics features and 12 DL features were selected.Radscore(OR=1.698,P=0.002)and Deepscore(OR=1.872,P=0.021)were both independent predictors of PTC CLNM.The AUC of radiomics mode,l DL model and combined model for predicting PTC CLNM was 0.775,0.876 and 0.880 in training set,which in test set was 0.739,0.776 and 0.789,respectively.In training set,the prediction efficacy of combined model was better than that of radiomics model(Z=2.551,P=0.011).Conclusion Combined with DL algorithm could effectively increase the efficacy of enhanced CT radiomics for predict PTC CLNM.

Objective To investigate the relationship between the cross-sectional area of paravertebral muscles and spino-pelvic sagittal imbalance in patients with lumbar spondylolisthesis based on MRI-T2WI.Methods A retrospective analysis was conducted on the imaging data of 38 patients with lumbar spondylolisthesis(spondylolisthesis group)and the medical records of 38 patients with lumbar degeneration but without L4-L5 segments lumbar spondylolisthesis(non-spondylolisthesis group).The Annotate software was used to measure the cross-sectional areas of psoas major and erector spinae at the L4-L5 segments on the MRI-T2WI sequences in the included cases.Spino-pelvic sagittal parameters[pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL)]were measured based on the lateral lumbar X-ray images.The cross-sectional areas of psoas major and erector spinae and changes in spino-pelvic sagittal parameters were compared between the two groups.According to the degree of lumbar spondylolisthesis,patients in spondylolisthesis group were divided into different subgroups(group Ⅰ and group Ⅱ).The cross-sectional areas of psoas major and erector spinae,and changes in spino-pelvic sagittal parameters were compared among patients in the subgroups.The correlation between the cross-sectional areas of psoas major and erector spinae and changes in spino-pelvic sagittal parameters were analyzed by Pearson correlation analysis.Results The cross-sectional areas of psoas major and erector spinae at the L4-L5 segments were lower in the spondylolisthesis group than in the non-spondylolisthesis group(P<0.001).In the non-spondylolisthesis group,structures of lumbar spines and its surrounding tissues were clear,the segments were continuous,there was no lumbar spondylolisthesis but there was symmetrical distribution of muscles in bilateral spines.In the spondylolisthesis group,there was spondylolisthesis and dislocation at the L4-L5 segments,a small step-like change at the posterior vertebral margin and asymmetrical distribution of muscles in bilateral spines.The PI,PT,SS and LL were higher in the spondylolisthesis group than in the non-spondylolisthesis group(P<0.001).The cross-sectional areas of psoas major and erector spinae were lower in the group Ⅱ lumbar spondylolisthesis than in the group Ⅰ(P<0.05),and the PI,PT,SS and LL were higher than in the group Ⅰ(P<0.05).The cross-sectional areas of psoas major and erector spinae in patients with lumbar spondylolisthesis were negatively correlated with PI,PT,SS and LL(P<0.05).Conclusion MRI-T2WI can be used to observe changes in the cross-sectional area of paravertebral muscles in patients with lumbar spondylolisthesis,and these changes are correlated with spino-pelvic sagittal imbalance.

Objective:To investigate the effectiveness of the crisis management theory of reduction, readiness, response and recovery (4R) in the prevention of postoperative complications in patients with lower extremity varices.Methods:Convenience sampling was used to select 172 patients who underwent surgical treatment for lower extremity varices in the Hefei First People's Hospital from October 2022 to November 2023 as study subjects. Patients admitted from October 2022 to June 2023 were recruited in control group ( n=88) with routine nursing. Patients admitted from July to November 2023 were included in observation group ( n=84) , and nursing interventions based on the 4R crisis management theory were implemented on the basis of control group. Postoperative ulcer surface healing time, time for calf numbness to subside, pain scores and postoperative complications were compared between the two groups. Results:The time for disappearance of ulcer surface and the time for calf numbness to subside of the patients in observation group were shorter than those in control group, and the differences were statistically significant ( P<0.05) . Before the intervention, the pain score was (3.58±0.61) in observation group and (3.72±0.57) in control group, and the difference was not statistically significant ( P>0.05) . After the intervention, the pain score was (2.33±0.55) in observation group and (2.50±0.50) in control group, and the difference was statistically significant ( P<0.05) . The incidence of postoperative complications was 4.76% (4/84) in observation group and 19.32% (17/88) in control group, and the difference was statistically significant ( P<0.05) . Conclusions:Nursing interventions based on the 4R crisis management theory can effectively alleviate the pain of patients undergoing lower extremity varicose vein surgery, shorten the time of ulcer healing and calf numbness, and reduce the incidence of postoperative complications.

Clinically,hepatocellular carcinoma(HCC)is characterized by its high incidence and high malignancy,and in most patients the disease has already been in the middle-advanced stage when the diagnosis is confirmed.Transcatheter hepatic artery chemoembolization(TACE)has been the preferred treatment for patients with unresectable HCC,which can significantly reduce the pain of patients'suffering.So far,enhanced CT scan or enhanced MR scan are often used to evaluate the efficacy of TACE,but there are still certain difficulties in making accurate and objective evaluation of the early tumor response after TACE treatment.With the emergence of novel imaging methods such as cone beam CT,energy spectrum CT,functional MR imaging,contrast-enhanced ultrasonography,positron emission CT in recent years,the observation of microscopic and objective changes in tumors has become possible.This paper aims to make a comprehensive review about the recent advance in imaging examination techniques for HCC after TACE.

Objective To assess the clinical value of conventional contrast enhanced CT(CECT),multi parameter energy spectrum CT,and contrast enhanced MR(CEMR)imaging methods in evaluating hepatocellular carcinoma(HCC)after TACE treatment.Methods The clinical data of 66 HCC patients,who underwent TACE treatment at authors' hospital and received CECT,multi parameter energy spectrum CT and CEMR in 1-3 months after treatment,were retrospectively analyzed.Taking DSA results as the gold standard,the recurrent or residual lesions detected by DSA were classified as positive lesions,while the lesions having no obvious recurrence or residues were classified as negative lesions.The positive lesions that were detected by both DSA and other imaging methods were regarded as true positive lesions.The accuracy,sensitivity,specificity,Kappa value were used to compare the values of CECT,multi parameter energy spectrum CT and CEMR in evaluating the positive/negative lesions of HCC after TACE treatment,and the number of detected lesions and accuracy rate were used to evaluate the values of the above imaging methods in demonstrating the iodine oil deposition status and in diagnosing true positive lesions.Results A total of 133 positive lesions and 35 negative lesions were detected by DSA.The accuracy of CEMR in diagnosing lesions was highest,the accuracy rate was 88.70％(both P＜0.05);CEMR and energy spectrum CT had the highest diagnostic efficiency,the sensitivity for positive lesions was 92.31％and 81.95％respectively,and the difference between the two methods was not statistically significant(P＞0.05).No statistically significant difference in the ability of diagnosing negative lesions existed between each other among the three groups(all P＞0.05).The Kappa value suggested that the ability for diagnosing lesions after TACE treatment of CEMR was stronger than that of energy spectrum CT(Kappa value was 0.68 and 0.56 respectively,both P＜0.05).CECT and multi parameter energy spectrum CT had the same accuracy in evaluating the iodine oil deposition status(both were 91.7％).No statistically significant difference in diagnosing even iodine oil deposition of the true positive lesions existed between each other among the three groups(all P＞0.05).For diagnosing uneven iodine oil deposition of the true positive lesions,CEMR had the highest accuracy(92.50％,all P＜0.05).Conclusion CEMR and multi parameter energy spectrum CT have more reliable diagnostic performance than conventional CECT,besides,CEMR has the highest diagnostic performance.However,multi parameter energy spectrum CT and CECT are the better choice for evaluating the deposition status of iodine oil.

Objective To observe the value of enhanced CT radiomics combined with deep learning(DL)algorithm for predicting cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma(PTC).Methods Totally 100 patients with single PTC were retrospectively enrolled and divided into training set(n=70)and test set(n=30)at the ratio of 7∶3.The optimal radiomics features and DL features of lesions were extracted and screened based on arterial phase cervical CT,and the radiomics score(Radscore)and DL score(Deepscore)were calculated to construct radiomics model and DL model,respectively.Clinical data,routine CT findings,Radscore and Deepscore were enrolled in multivariate logistic regression analysis to screen the independent predictors of PTC CLNM,and a combined model was then constructed.The receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of each model for predicting PTC CLNM.Results Thirteen optimal radiomics features and 12 DL features were selected.Radscore(OR=1.698,P=0.002)and Deepscore(OR=1.872,P=0.021)were both independent predictors of PTC CLNM.The AUC of radiomics mode,l DL model and combined model for predicting PTC CLNM was 0.775,0.876 and 0.880 in training set,which in test set was 0.739,0.776 and 0.789,respectively.In training set,the prediction efficacy of combined model was better than that of radiomics model(Z=2.551,P=0.011).Conclusion Combined with DL algorithm could effectively increase the efficacy of enhanced CT radiomics for predict PTC CLNM.

Objective To investigate the relationship between the cross-sectional area of paravertebral muscles and spino-pelvic sagittal imbalance in patients with lumbar spondylolisthesis based on MRI-T2WI.Methods A retrospective analysis was conducted on the imaging data of 38 patients with lumbar spondylolisthesis(spondylolisthesis group)and the medical records of 38 patients with lumbar degeneration but without L4-L5 segments lumbar spondylolisthesis(non-spondylolisthesis group).The Annotate software was used to measure the cross-sectional areas of psoas major and erector spinae at the L4-L5 segments on the MRI-T2WI sequences in the included cases.Spino-pelvic sagittal parameters[pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL)]were measured based on the lateral lumbar X-ray images.The cross-sectional areas of psoas major and erector spinae and changes in spino-pelvic sagittal parameters were compared between the two groups.According to the degree of lumbar spondylolisthesis,patients in spondylolisthesis group were divided into different subgroups(group Ⅰ and group Ⅱ).The cross-sectional areas of psoas major and erector spinae,and changes in spino-pelvic sagittal parameters were compared among patients in the subgroups.The correlation between the cross-sectional areas of psoas major and erector spinae and changes in spino-pelvic sagittal parameters were analyzed by Pearson correlation analysis.Results The cross-sectional areas of psoas major and erector spinae at the L4-L5 segments were lower in the spondylolisthesis group than in the non-spondylolisthesis group(P<0.001).In the non-spondylolisthesis group,structures of lumbar spines and its surrounding tissues were clear,the segments were continuous,there was no lumbar spondylolisthesis but there was symmetrical distribution of muscles in bilateral spines.In the spondylolisthesis group,there was spondylolisthesis and dislocation at the L4-L5 segments,a small step-like change at the posterior vertebral margin and asymmetrical distribution of muscles in bilateral spines.The PI,PT,SS and LL were higher in the spondylolisthesis group than in the non-spondylolisthesis group(P<0.001).The cross-sectional areas of psoas major and erector spinae were lower in the group Ⅱ lumbar spondylolisthesis than in the group Ⅰ(P<0.05),and the PI,PT,SS and LL were higher than in the group Ⅰ(P<0.05).The cross-sectional areas of psoas major and erector spinae in patients with lumbar spondylolisthesis were negatively correlated with PI,PT,SS and LL(P<0.05).Conclusion MRI-T2WI can be used to observe changes in the cross-sectional area of paravertebral muscles in patients with lumbar spondylolisthesis,and these changes are correlated with spino-pelvic sagittal imbalance.

Objective:To investigate the effectiveness of the crisis management theory of reduction, readiness, response and recovery (4R) in the prevention of postoperative complications in patients with lower extremity varices.Methods:Convenience sampling was used to select 172 patients who underwent surgical treatment for lower extremity varices in the Hefei First People's Hospital from October 2022 to November 2023 as study subjects. Patients admitted from October 2022 to June 2023 were recruited in control group ( n=88) with routine nursing. Patients admitted from July to November 2023 were included in observation group ( n=84) , and nursing interventions based on the 4R crisis management theory were implemented on the basis of control group. Postoperative ulcer surface healing time, time for calf numbness to subside, pain scores and postoperative complications were compared between the two groups. Results:The time for disappearance of ulcer surface and the time for calf numbness to subside of the patients in observation group were shorter than those in control group, and the differences were statistically significant ( P<0.05) . Before the intervention, the pain score was (3.58±0.61) in observation group and (3.72±0.57) in control group, and the difference was not statistically significant ( P>0.05) . After the intervention, the pain score was (2.33±0.55) in observation group and (2.50±0.50) in control group, and the difference was statistically significant ( P<0.05) . The incidence of postoperative complications was 4.76% (4/84) in observation group and 19.32% (17/88) in control group, and the difference was statistically significant ( P<0.05) . Conclusions:Nursing interventions based on the 4R crisis management theory can effectively alleviate the pain of patients undergoing lower extremity varicose vein surgery, shorten the time of ulcer healing and calf numbness, and reduce the incidence of postoperative complications.

Objective To analyze the factors influencing the occurrence of post-embolization syndrome(PES)after transhepatic arterial chemoembolization(TACE).Methods A total of 107 patients with hepatocellular carcinoma(HCC),who received TACE treatment at authors'hospital between February 2021 and March 2023,were included in the study.Among them,56 patients developed PES(PES group)and 51 patients did not develop PES(non-PES group).The demographic data,medical history,pathological findings,laboratory indicators and operation-related materials were compared between the two groups,and the risk factors for PES were analyzed.Results There were statistically significant differences in tumor diameter,albumin(ALB)level,preoperative physical condition(ECOG)score,type of embolization agent,drug-loaded microspheres,number of microspheres,and dosage of loaded drug between the two groups(all P＜0.05).Multivariate Logistic analysis revealed that drug-loaded microspheres,number of microspheres,and dosage of loaded drug were the independent risk factors for PES occurring after TACE(all P＜0.05).Conclusion HCC patients treated with TACE using drug-loaded microspheres,large amount of microspheres and high dosage of loaded drug have a higher risk of PES occurring after TACE.For patients having the above risk factors,the formulation of corresponding perioperative intervention strategies is necessary so as to avoid the occurrence of PES and to improve the safety of TACE.

Objective To explore the application value of a special fence in percutaneous transhepatic cholangial drainage(PTCD)under the guidance of C-arm CT.Methods A total of 43 patients who underwent PTCD were randomly divided into observation group and control group.The intervention operation in the observation group was guided by C-arm CT and located by special fence;in the control group,the intervention operation was only performed under digital subtraction angiography(DSA)fluoroscopy.Respectively,the differences in operation time,number of puncture needles and number of complications between the two groups were compared.Results The operation time,puncture times and complications in the observation group were(39.33±12.96)min,(1.67±0.80)times and 3 cases respectively;in the control group were(86.77±22.70)min,(3.41±1.26)times and 13 cases respectively;There were significant differences between the two groups(P<0.05).Conclusion The application of special fence in PTCD under the guidance of C-arm CT can short the operation time,reduce the number of punctures and reduce complications,which has important clinical application value.