Objective To explore the predictive value of spectral CT quantitative parameters combined with radiomics for early liver fibrosis using rat models.Methods Prospective animal experiments were conducted,and the intervention models were constructed for liver fibrosis in rats.A total of 112 spectral CT plain samples were collected from 56 rats,and quantitative parameters(40,60 and 100 keV CT values,slope of the spectral curve)were measured in the spectral CT images to assess the value of each parameter in the staging of liver fibrosis.The regions of interest were sketched out in the 60 keV monoenergetic images using 3D Slicer software,and from which the radiomics features were extracted.The t-test,correlation analysis and the least absolute contraction and selection operator algorithms were used for radiomics feature screening,and the Rad-score was calculated.According to the pathological results,they were classified into non-significant liver fibrosis and significant liver fibrosis,and 3 Logistic regression models(spectral CT model,radiomics model and combined model)were established using the selected spectral CT parameters and radiomics features.The predictive value of these models was evaluated using receiver operating characteristic curves,and calibration curves were plotted to evaluate model fit.Results Except for 100 keV CT value,spectral CT parameters and Rad-score differed statistically between non-significant and significant liver fibroses(P<0.05).The spectral CT model,radiomics model and combined model had AUC of 0.850,0.895,0.939 in the training set,and 0.818,0.803,0.883 in the test set.The calibration curves showed that the 3 models were well fitted,without significant deviation.Conclusion The model constructed with spectral CT and radiomics performes well,worthy of further optimization.

Objective To explore the predictive value of spectral CT quantitative parameters combined with radiomics for early liver fibrosis using rat models.Methods Prospective animal experiments were conducted,and the intervention models were constructed for liver fibrosis in rats.A total of 112 spectral CT plain samples were collected from 56 rats,and quantitative parameters(40,60 and 100 keV CT values,slope of the spectral curve)were measured in the spectral CT images to assess the value of each parameter in the staging of liver fibrosis.The regions of interest were sketched out in the 60 keV monoenergetic images using 3D Slicer software,and from which the radiomics features were extracted.The t-test,correlation analysis and the least absolute contraction and selection operator algorithms were used for radiomics feature screening,and the Rad-score was calculated.According to the pathological results,they were classified into non-significant liver fibrosis and significant liver fibrosis,and 3 Logistic regression models(spectral CT model,radiomics model and combined model)were established using the selected spectral CT parameters and radiomics features.The predictive value of these models was evaluated using receiver operating characteristic curves,and calibration curves were plotted to evaluate model fit.Results Except for 100 keV CT value,spectral CT parameters and Rad-score differed statistically between non-significant and significant liver fibroses(P<0.05).The spectral CT model,radiomics model and combined model had AUC of 0.850,0.895,0.939 in the training set,and 0.818,0.803,0.883 in the test set.The calibration curves showed that the 3 models were well fitted,without significant deviation.Conclusion The model constructed with spectral CT and radiomics performes well,worthy of further optimization.

OBJECTIVETo improve the treatment for severe open tibia-fibular fracture.

METHODSFrom 1994 to 2000, 146 patients with severe open tibia-fibular fracture were treated. According to Gustilo classification, all patients were of type III. Among them, 96 patients belonged to III A, 36 III B, and 18 III C. One hundred and eight patients were male and 38 female, aged from 11 to 68 years, with an average of 31. All patients were treated with unilateral external fixator combined with simple internal fixation (general screw or Kirschner wire). Thirty patients were treated with secondary flap operation. Among them, 19 patients received pedicle gastrocnemius muscle flaps, 9 free vastus lateralis muscle flaps, and 2 free latissimus dorsi muscle flaps.

RESULTSThree patients of type IIIB were subjected to amputation because of advanced age and associated cerebral or thoraco-abdominal injury. Five patients of type III C had amputation because of insufficient postoperative blood supply and necrosis. The rupture of other 138 patients was well reduced, and firmly fixed. They were followed up for 6 months-6 years, with an average of 2.5 years. The average time of fracture-union was 27 weeks, and the average time for removal of fixtors was 28 weeks. The motion of knee joint ranged from 0 to 120 degree in 110 patients; from 0 to 100 degrees in 25, and from 0 to 90 degrees. The motion of ankle joint was approximately normal.

CONCLUSIONSFor patients with severe open tibia-fibular fracture, comprehensive analysis should be made for preservation of the wounded limb or amputation as for elderly patients with vessel-nerve injury or with cerebral- thoracoabdominal injury, emergency amputation should be done. Unilateral external fixator combined with simple internal fixation (general screw or Kirschner wire) for severe open tibia-fibular fracture is advantageous for a simple and reliable fixation. It is less traumatic.

Adolescent ; Adult ; Aged ; Child ; External Fixators ; Female ; Fibula ; Fracture Fixation, Internal ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged ; Tibial Fractures ; surgery