Objective:To evaluate the efficacy of preoperative prediction of regional lymph node (RLN) metastasis in renal cell carcinoma (RCC) using a machine learning model based on habitat imaging radiomics from renal MRI.Methods:This cross-sectional study retrospectively analyzed 220 patients with RCC who underwent nephrectomy and RLN dissection at four medical centers of Chinese PLA General Hospital from January 2010 to August 2023. The cohort included 65 patients with RLN metastasis and 155 without. A stratified random sampling method was used to divide 175 patients from the first medical center into a training set ( n=140) and an internal test set ( n=35) in an 8∶2 ratio, while 45 patients from the third, fourth, and fifth medical centers constituted the external test set. The primary RCC lesions were categorized into 15 habitat subregions based on corticomedullary-phase enhancement and T 2WI signal intensity on MRI, and the volume fractions of different subregions were analyzed. In the training cohort, radiomics features derived from the habitat subregions were used to construct a radiomics model employing various machine learning algorithms, including extremely random trees (ET), gradient boosting decision trees (GBDT), random forest (RF), and support vector machine (SVM). The optimal model was selected and combined with RLN short-axis diameter to develop a combined model. The efficacy of each model in predicting RLN metastasis was evaluated using the receiver operating characteristic (ROC) curve. Results:The volume fraction of hyper-enhanced hyper-intense regions in the non-metastatic group was significantly higher than that in the metastatic group (0.05±0.09 vs. 0.02±0.03; t=3.00, P=0.003). Among the machine learning models constructed using 15 optimal habitat radiomics features, the SVM model demonstrated the best performance, with area under the ROC curve (AUC) values of 0.85 (95% CI 0.72-0.98) in the internal test set and 0.82 (95% CI 0.67-0.98) in the external test set, surpassing those of the ET, GBDT, and RF models. The combined model, integrating the SVM model with RLN short-axis diameter, achieved AUC values of 0.94 (95% CI 0.85-1.00) in the internal test set and 0.89 (95% CI 0.78-1.00) in the external test set, with RLN short-axis diameter contributing AUC values of 0.81 (95% CI 0.66-0.96) and 0.81 (95% CI 0.68-0.94), respectively. The diagnostic sensitivity of the combined model was 91.7% in the internal test set and 85.7% in the external test set, with specificities of 78.3% and 67.7%, respectively. Conclusion:The combined model based on MRI habitat imaging radiomics and RLN short-axis diameter demonstrates excellent preoperative assessment capability for RLN metastasis in RCC.

Objective:To evaluate the efficacy of preoperative prediction of regional lymph node (RLN) metastasis in renal cell carcinoma (RCC) using a machine learning model based on habitat imaging radiomics from renal MRI.Methods:This cross-sectional study retrospectively analyzed 220 patients with RCC who underwent nephrectomy and RLN dissection at four medical centers of Chinese PLA General Hospital from January 2010 to August 2023. The cohort included 65 patients with RLN metastasis and 155 without. A stratified random sampling method was used to divide 175 patients from the first medical center into a training set ( n=140) and an internal test set ( n=35) in an 8∶2 ratio, while 45 patients from the third, fourth, and fifth medical centers constituted the external test set. The primary RCC lesions were categorized into 15 habitat subregions based on corticomedullary-phase enhancement and T 2WI signal intensity on MRI, and the volume fractions of different subregions were analyzed. In the training cohort, radiomics features derived from the habitat subregions were used to construct a radiomics model employing various machine learning algorithms, including extremely random trees (ET), gradient boosting decision trees (GBDT), random forest (RF), and support vector machine (SVM). The optimal model was selected and combined with RLN short-axis diameter to develop a combined model. The efficacy of each model in predicting RLN metastasis was evaluated using the receiver operating characteristic (ROC) curve. Results:The volume fraction of hyper-enhanced hyper-intense regions in the non-metastatic group was significantly higher than that in the metastatic group (0.05±0.09 vs. 0.02±0.03; t=3.00, P=0.003). Among the machine learning models constructed using 15 optimal habitat radiomics features, the SVM model demonstrated the best performance, with area under the ROC curve (AUC) values of 0.85 (95% CI 0.72-0.98) in the internal test set and 0.82 (95% CI 0.67-0.98) in the external test set, surpassing those of the ET, GBDT, and RF models. The combined model, integrating the SVM model with RLN short-axis diameter, achieved AUC values of 0.94 (95% CI 0.85-1.00) in the internal test set and 0.89 (95% CI 0.78-1.00) in the external test set, with RLN short-axis diameter contributing AUC values of 0.81 (95% CI 0.66-0.96) and 0.81 (95% CI 0.68-0.94), respectively. The diagnostic sensitivity of the combined model was 91.7% in the internal test set and 85.7% in the external test set, with specificities of 78.3% and 67.7%, respectively. Conclusion:The combined model based on MRI habitat imaging radiomics and RLN short-axis diameter demonstrates excellent preoperative assessment capability for RLN metastasis in RCC.

Intrauterine adhesion (IUA) is caused by damage of the basal layer of endometrium, which leads to fibrosis of the endometrium and the formation of adhesion, resulting in partial or complete occlusion of the uterine cavity, abnormal menstruation, infertility or recurrent miscarriage. The prevalence of IUA in women has been increasing in recent years, and the high recurrence rate of moderate to severe IUA makes IUA treatment more challenging. Iatrogenic endometrial injury is the main cause of IUA. However, the incidence of IUA and the severity of IUA vary among patients who have received similar uterine operations, suggesting that there may be other synergistic factors in the development of IUA. There is a certain correlation between the pathogenesis and the microbiota of the gential tract. In many IUA patients, it has been observed that the probiotics such as Lactobacillus in the vagina is significant reduced, and the pathogenic bacteria such as Gardnerella and Prevotella are excessive growth. The reproductive tract microbiota can be involved in the development and progression of IUA via impacting immune function and metabolism.
Humans ; Female

Objective:To report the surgical techniques and clinical outcomes of multi-dimensional fixation of patellar multi-fragmentary fractures with locking plates.Methods:A retrospective study was performed in the 26 patients with patellar multi-fragmentary fracture who had undergone open reduction and 3-D internal fixation with locking plates from November 2016 to July 2020 at Department of Orthopaedic Surgery, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University. There were 17 males and 9 females, with an average age of 62.6 years (from 31 to 90 years). The patellar fractures were exposed and reduced via the longitudinal anterior midline incision of the knee. After the reduction was initially maintained with a cerclage wire, a trimmed and pre-contoured 3.5 mm locking plate was applied onto the patellar surface. After-wards, locking screws were inserted from the lower pole to the upper pole of the patella, from the anterior to the posterior and from the lateral to the medial, respectively, to complete the multi-planar fixation. Follow-ups assessed the B?stman score, knee pain visual analogue scale (VAS), radiographic image and fracture healing, range of motion of the knee, and complications.Results:All the 26 patients were followed up for 12 to 56 months (average, 28 months). Crutches were used while walking until an average of 1.6 months (from 1 to 3 months) after operation in all patients. At the last follow-up, the B?stman score averaged 27.5 points (from 17 to 30 points), yielding 12 excellent, 13 good and 1 poor case with an excellent to good rate of 96.2% (25/26); the knee pain VAS averaged 1.2 points (from 0 to 5 points); the active knee flexion averaged 125° (from 100° to 150°). No breakage, loosening or displacement of the patellar plates or screws was observed during follow-up, but cerclage wire breakage occurred without any symptom in 11 cases. Four patients complained of hardware irritation, and 4 patients underwent hardware removal after fracture union.Conclusion:Multi-dimensional fixation with locking plates is a viable and safe surgical option for patellar multi-fragmentary fractures, due to its satisfactory therapeutic outcomes.

Objective:To study the dynamic changes of cortical functional reorganization in striatocapsular infarction (SCI) by blood oxygenation level dependent-functional MR imaging (BOLD-fMRI) and its relation with recovery of motor function in the upper extremity of the hemiplegia.Methods:A total of 17 patients with SCI at first onset and combined with upper extremity of the hemiplegia, admitted to our hospital from June 2015 to December 2017, were included; 15 healthy volunteers recruited at the same time were selected as control group. Within 1 week of onset, and 1 and 3 months after onset, BOLD-fMRI was performed under passive finger flexion and extension task on hemiplegia side, and the activation of brain functional areas at different stages was observed by SPM8 software. The Xjview software was used to observe the activation of the corresponding brain activation areas in BOLD-fMRI and make dynamic comparison with the standard brain activation areas. The upper limb part of Fugl-Meyer (FM-UL) scale was used to track the motor function of the upper limb.Results:The activation in the control group was mainly located in the contralateral sensorimotor cortex (SMC) and bilateral supplementary motor area (SMA). The regions of interest in early BOLD-fMRI for stroke patients at early stage can be divided into 3 types. The activation in patients with type I was mainly at the affected side, enjoying bilateral SMC and SMA activation; 1 and 3 months after onset, activation at the contralateral SMC decreased gradually, and activation at the ipsilateral SMC region gradually increased. The activation in patients with type Ⅱ was merely at the ipsilateral SMC and SMA regions; 1 month after onset, bilateral SMC area and SMA area were significantly activated, mainly at the contralateral side; 3 months after onset, the SMC area was further activated at the ipsilateral side and weakened at the ipsilateral side. The activation in patients with type Ⅲ was only at SMC or M1 at the ipsilateral side; 1 month after onset, activation at the ipsilateral SMC area increased slightly; 3 months after onset, activation at the ipsilateral SMC area further enhanced, and SMA area was without activation performance. The FM-UL scores of the affected limbs of patients with type I, type II and type III at the early onst were 10.0±3.3, 10.6±5.7 and 9.2±4.0, respectively, without statistical differences ( P>0.05); 1 month after onset, the FM-UL scores of patients with type I, type II and type III were 52.3±4.6, 36.6±2.4 and 12.5±3.0, respectively, with significant differences ( P<0.05); 3 months after onset, FM-UL scores of patients with type I, type II and type III were 63.7±2.9, 59.2±3.1 and 13.3±5.0, respectively, with statistical differences ( P<0.05). Conclusions:Intracranial functional reorganization is a dynamic process. The early and dynamic activation of the affected SMC region and the early activation of the contralateral SMC region and bilateral SMA regions are of great significance in the process of stroke rehabilitation.

Objective:To explore the value and significance of sensorimotor cortex (SMC) in the recovery of upper limb motor function after cerebral infarction in the striatum with blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI).Methods:A total of 17 patients with primary onset of striatal intracapsular infarction (SCI) with unilateral severe upper limb paralysis, who were strictly screened from the Department of Neurology, Affiliated Hospital of Yangzhou University from June 2015 to December 2017, were selected as research subjects, and 15 healthy volunteers were selected as controls. BOLD-fMRI under the passive finger extension (FE) task on the hemiplegic side was performed within one week, one month and three months after the onset of the disease. The activation of SMC was observed by SPM8 software. The activation of corresponding brain activation areas in BOLD-fMRI was observed by Xjview software and compared with the standard brain activation areas dynamically. The upper limb section of the Fugl-Meyer Scale (FM-UL) was used to track the motor function of the upper limb. The upper limb motor function of the selected patients was evaluated before functional magnetic resonance imaging (fMRI) scanning, at one month and three months after onset of the disease.Results:In the controls, fMRI showed that the main brain activation areas were located in the contralateral SMC and bilateral supplementary motor area. According to the activation time course of the affected side SMC and the comparison results with the standard brain activation area, the study patients were divided into three groups: group 1 (six patients), in which the activation intensity of SMC was stronger than that of standard brain activation area in the early stage of onset; group 2 (five patients), in which the activation intensity of SMC in the affected side was stronger than that in the standard brain activation area at one month after onset; group 3 (six patients), in which the activation intensity of SMC in the affected side increased gradually in three months, but still did not exceed the standard brain activation area. The activated voxel values of the affected side SMC in group 1 patients at the first time, one month and three months were 3 570.2±1 125.9, 1 205.8±328.2 and 1 121.5±407.5, respectively, the difference within the group being statistically significant ( F=12.8, P=0.001); the activated voxel values of the affected SMC in group 2 patients were 556.2±171.7, 648.6±177.3 and 993.2±182.9, respectively, and the differences within the group were statistically significant ( F=6.5, P=0.018); the activated SMC values of the affected SMC in group 3 patients were 520.0±375.9, 573.5±375.0 and 680.9±359.8, respectively, and there was no statistically significant difference within the group ( P>0.05). The three times FM-UL scores corresponding to group 1 patients were (10.0±3.3) points, (52.3±4.6) points and (63.7±2.9) points; the three times FM-UL scores corresponding to group 2 patients were (10.6±5.7) points, (36.6±2.4) points and (59.2±3.1) points; and the three times FM-UL scores corresponding to group 3 patients were (9.2±4.0) points, (12.5±3.0) points and (13.3±5.0) points; FM-UL scores in group 1 and group 2 patients showed statistically significant differences within the groups ( F=348.4, 183.6; P<0.001), whereas that in group 3 patients showed no statistically significant difference within the group ( P>0.05). There was no statistically significant difference in the initial FM-UL score among the groups ( P>0.05), while the differences among the groups at one month and three months were statistically significant ( F=191.7,304.5; P<0.001). Conclusions:The survival of SMC on the affected side after cerebral infarction is a prerequisite for the rehabilitation of limb motor function. Its early activation cannot predict the clinical prognosis, but the dynamic enhancement of SMC activation on the affected side is related to the rehabilitation speed of the affected limb.

Objective To evaluate complications from two anal stapling operations of anorectal surgery,the procedure for prolapse and hemorrhoids (PPH) and the stapled transanal rectal resection (STARR).Methods The data of 1 276 patients undergoing PPH for hemorrhoids and 149 patients having STARR for ODS from January 2010 to January 2015,in Beijing Chaoyang Hospital were studied.More than six months of follow-up was done.Statistics used included t Test and Chi-square test,Logistic regression analysis.Results Complications of PPH and STARR included hemorrhage in 27 cases (2.1％) vs.3 cases (2.0％);pain in 285 cases (22.3％) vs.6 cases (4.0％);uroschesis in 96 cases (7.5％) vs.12 cases (8.1％);edema in 227 cases (17.8％) vs.16 cases (10.7％);defecatory urgency in 194 cases (15.2％) vs.38 cases (25.5％);anastomotic infection in 17 cases (1.3％) vs.2 cases (1.3％);mild anal incontinence in 11 cases (0.9％) vs.2 cases (1.3％);anastomotic stenosis in 11 cases (0.9％) vs.1 case (0.7％).There was a positive correlation between dry stool,defecatory urgency and hemorrhage after PPH.PPH compared to STARR:The post-operative pain,edema and defecatory urgency and overall complication rate was significantly different (t =26.51,x2 =4.69,x2 =10.38,x2 =37.12,P ＜ 0.05).Conclusions PPH and STARR have rare serious complications and easy to handle.Abnormal defecation such as dry stool and defecatory urgency is an important risk of hemorrhage.

Objective To explore the advantages of Argus method by comparing the accuracy and timeliness of Argus and artificial methods for measuring femoral head necrosis area in MRI scanning.Methods Totally 17 patients (31 hips) were measured with Argus and artificial methods respectively for the necrosis area, and then the measuring results and time were compared, and the correlation was investigated between the results and the patients' pain degree, along with that between the results and the extent of femoral head collapse.Results The necrosis area ratios determined by Argus and artificial methods were (33.5±4.08)%and (34.6±4.06)%respectively, with no statistical difference between the ratios (P>0.05). The time consumed by artificial method was (21.3 ±3.62)min, significantly longer than (7.89 ±1.03)min by Argus method, with P<0.001. Regression analysis proved that the necrosis areas were positively correlated with the patients' pain degree, and the correlation coefficient by Argus method was 0.807 8, more than 0.740 9 by artificial method. The femoral heads of 11 cases(16 hips) collapsed in the follow-up period, the necrosis areas were positively correlated with the patients collapse level, but the correlation coefficient by Argus method was 0.783 8, more than 0.726 7 by artificial method.Conclusion Argus method gains high accuracy and timeliness when used in MRI scanning of femoral head necrosis area, and thus is worth popularizing clinically.

To investigate the value of MRI for the diagnosis of achilles tendon closed rupture. 1.5T Maestro Class MRI scanner was used for the conventional scanning of 15 patients confirmed with achilles tendon closed ruptures by operation, and then the findings by imaging were compared with those by operation. The 15 patients proved with achilles tendon closed rupture, including 4 cases of incomplete rupture and 11 cases of complete rupture. MRI could display clearly the changes in morphology and signal of incomplete or complete closed ruptures of Achilles tendon, and the results were consistent with those by operation. MRI can make an accurate display of the lo-cation and extent of achilles tendon rupture.

Objective:To evaluate the effects of dibutyl phthalate on rat sperm production and quality. Methods:Totally 150 male rats were randomly divided into the low dose group (50 mg·kg-1), the middle dose group (200 mg·kg-1), the high dose group (1 000 mg·kg-1 ) , the blank control group and the solvent control group ( peanut oil as the control) with 30 ones in each. After continu-ous administration for every 30 days, 10 rats from each group were anatomized, the weight of testes and epididymides were determined, and one side of epididymis was used to carry out the sperm analysis including counting, survival rate and morphology. Results:After intragastric administration for 90 days, the sperm count and survival rate, the weight of testis and epididymis and organ coefficient in the middle dose group and high dose group were decreased significantly(P<0. 05 or 0. 01). Conclusion:The long-term administration of dibutyl phthalate at high dose exhibits notable toxicity on rat reproductive function.