Objective:To investigate the predictive value of enhanced computed tomography (CT) combined with magnetic resonance imaging (MRI) examination on prognosis of clear cell renal cell carcinoma (ccRCC) and its correlation with clinical features. Methods:The postoperative follow-up data of enhanced CT and MRI of 80 patients with suspected (ccRCC) who admitted to Bozhou People's Hospital from March 2019 to May 2023 were selected,and they were divided into disease progression group (24 cases) and disease progression-free group (56 cases) according to the condition of disease progression. The disease progression of them were diagnosed through relevant examinations (collection of disease history,physical examination,enhanced CT,MRI,laboratory examination,pathological examination and so on). According to the information of clinical imaging,the age,gender,tumor diameter,with or without tumor thrombus,the location of tumor and surgical method were used to conduct single factor logistic regression analysis,so as to confirm independent predictors. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of enhanced CT combined with MRI to the prognosis of ccRCC. The Pearson linear correlation was adopted to analyze the correlation between the results of enhanced CT combined with MRI and prognosis. Results:Based on the results of the follow-up study,CT value of cortex phase,CT value of medullary phase and apparent dispersion coefficient (ADC) in the disease progression group were significantly smaller than those in the disease progression-free group,and the differences of them between two groups were statistically significant (t=10.610,4.697,2.901,P<0.05),respectively. The diffusion coefficient (K value) of disease progression group was significantly larger than that of disease progression-free group,and there was significant difference between the two groups (t=6.375,P<0.05),while there was no significant in diffusion rate (D) between the two groups (P>0.05). The area under curve (AUC) values of ROC curve of single enhanced CT examination,single MRI examination and the combined examination of them were larger than 0.5 in predicting the prognosis of ccRCC,which indicated that both the two examinations had a certain value in predicting the prognosis of ccRCC,and the AUC value of combined examination was the highest (0.940),which indicated the value of combined examination was the highest in predicting the prognosis of ccRCC. There were not significant differences in gender,surgical method,tumor thrombus and tumor location between the two groups (P>0.05). The age and tumor diameter of the disease progression group were significantly larger than those of the disease progression-free group (t=4.292,3.219,P<0.05),respectively. The results of the logistic regression analysis showed that the age and tumor diameter were respectively independent influencing factor on the prognosis of ccRCC (HR=2.167,0.689,P<0.05). The results of Pearson correlation analysis indicated that there was negative correlation between enhanced CT examination and prognosis (r=-0.65,P<0.05),and there was positive correlation between MRI examination and prognosis (r=0.72,P<0.05). In addition,there was a negative correlation in the results between enhanced CT examination and MRI examination (r=-0.58,P<0.05). Conclusion:The prediction of enhanced CT combined with MRI examination is higher than that of each single examination of them for the prognosis of ccRCC,and there is a certain correlation between that and clinical features,but it is still necessary to conduct comprehensive judgement after combines other influence factors in clinical practice.

Objective:To investigate the predictive value of enhanced computed tomography (CT) combined with magnetic resonance imaging (MRI) examination on prognosis of clear cell renal cell carcinoma (ccRCC) and its correlation with clinical features. Methods:The postoperative follow-up data of enhanced CT and MRI of 80 patients with suspected (ccRCC) who admitted to Bozhou People's Hospital from March 2019 to May 2023 were selected,and they were divided into disease progression group (24 cases) and disease progression-free group (56 cases) according to the condition of disease progression. The disease progression of them were diagnosed through relevant examinations (collection of disease history,physical examination,enhanced CT,MRI,laboratory examination,pathological examination and so on). According to the information of clinical imaging,the age,gender,tumor diameter,with or without tumor thrombus,the location of tumor and surgical method were used to conduct single factor logistic regression analysis,so as to confirm independent predictors. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of enhanced CT combined with MRI to the prognosis of ccRCC. The Pearson linear correlation was adopted to analyze the correlation between the results of enhanced CT combined with MRI and prognosis. Results:Based on the results of the follow-up study,CT value of cortex phase,CT value of medullary phase and apparent dispersion coefficient (ADC) in the disease progression group were significantly smaller than those in the disease progression-free group,and the differences of them between two groups were statistically significant (t=10.610,4.697,2.901,P<0.05),respectively. The diffusion coefficient (K value) of disease progression group was significantly larger than that of disease progression-free group,and there was significant difference between the two groups (t=6.375,P<0.05),while there was no significant in diffusion rate (D) between the two groups (P>0.05). The area under curve (AUC) values of ROC curve of single enhanced CT examination,single MRI examination and the combined examination of them were larger than 0.5 in predicting the prognosis of ccRCC,which indicated that both the two examinations had a certain value in predicting the prognosis of ccRCC,and the AUC value of combined examination was the highest (0.940),which indicated the value of combined examination was the highest in predicting the prognosis of ccRCC. There were not significant differences in gender,surgical method,tumor thrombus and tumor location between the two groups (P>0.05). The age and tumor diameter of the disease progression group were significantly larger than those of the disease progression-free group (t=4.292,3.219,P<0.05),respectively. The results of the logistic regression analysis showed that the age and tumor diameter were respectively independent influencing factor on the prognosis of ccRCC (HR=2.167,0.689,P<0.05). The results of Pearson correlation analysis indicated that there was negative correlation between enhanced CT examination and prognosis (r=-0.65,P<0.05),and there was positive correlation between MRI examination and prognosis (r=0.72,P<0.05). In addition,there was a negative correlation in the results between enhanced CT examination and MRI examination (r=-0.58,P<0.05). Conclusion:The prediction of enhanced CT combined with MRI examination is higher than that of each single examination of them for the prognosis of ccRCC,and there is a certain correlation between that and clinical features,but it is still necessary to conduct comprehensive judgement after combines other influence factors in clinical practice.

Objective:To anatomically study the external bone graft axis from the pedicle (canal) to the endplate designed for compression healing fractures of the anterior vertebral column in freshly dried vertebral specimens from T10 to L5.Methods:Eight groups of freshly dried vertebral specimens from T10 to L5 (128 vertebral bodies and 256 lateral pedicles and lateral vertebral bodies) were used to observe the vertebral axis of the pedicle (canal), the internal sagittal diameter of the pedicle (canal), and the sagittal diameter of the vertebral body, and the position of vertebral pedicle (canal) axis (f-angle) before design of the external bone graft axis from the pedicle (canal) to the endplate of the compression healing vertebral body. (1) The internal sagittal diameter of the pedicle (canal) was divided into 3 segments. The lateral segment of the vertebral plate was wide, the middle segment of the isthmus of the vertebral arch was narrow and the medial segment of the terminal segment of the vertebral arch was wide. The narrow isthmus of the middle arch (canal) was used as a transposition axis in the design of the axis of the bone graft from the vertebral arch (canal) to the endplate of the compression healing vertebral body. (2) The axis of the vertebral body of the pedicle (canal) was located medial to the transposition axis, parallel to the f-angle at 0° as described by Saillant G. (3) The compression degree of the vertebral body was measured at the outer edge of the lateral anterior column, with Ⅰ° for less than 1/4 compression of the anterior column of the vertebral body, Ⅱ° for 1/4 to 2/4, Ⅲ° for 2/4 to 3/4 and Ⅳ° for more than 3/4 of the compression. (4) The f-angle described by Salliant G at the entry end which was corresponding to the endplate of the compression healing vertebral body was used to design the pedicle (canal) to the outer implant axis of the endplate of the compression healing vertebral body.Results:At an f-angle of 8° to 10°, the bone graft axis was aligned with the Ⅱ° compression healing vertebral endplate on the superior endplate side of the vertebral body axis of the arch; at an f-angle of 16° to 18°, the bone graft axis corresponded to the superior endplate of the Ⅰ° compression healing vertebral body. At an f-angle of -10°~-8°, the bone graft axis corresponded to the Ⅲ° compression healing vertebral endplate on the inferior endplate side of the vertebral body axis of the arch; at an f-angle of -18°~-16°, the bone graft axis corresponded to the inferior endplate of the Ⅳ° compression healing vertebral body.Conclusions:The external axis from the pedicle (canal) to the endplate designed in the present anatomic study for compression healing fractures of the anterior vertebral column allows for safe and easy granular bone implantation due to the toughness of the cortical bone around the arch root (canal) in addition to the precise design of the bone graft axis from the pedicle to the endplate from T10 to L5.

Objective:To explore the relationship between the ratio of serum creatinine and cystatin C (Creatinine/Cystatin C, Cr/CysC) and the risk of fracture in diabetic patients, and to provide a basis for evaluating the risk of fracture in diabetic patients.Methods:Prospectively selected 216 patients with type 2 diabetes (T2DM) who were treated in our hospital from Apr. 2019 to Apr. 2021. Among them, they were divided into fracture group (56 cases) and non-fracture group (160 cases) according to whether they were combined with fractures.Collected two groups of baseline data, general clinical data, laboratory, imaging data, use sarcosine oxidase method to detect serum creatinine (Cr) content, use immunoturbidimetric method to determine serum cystatin C (CysC) level, and calculate The ratio of the two, After matching the propensity scores for age, gender, body mass index, diabetes course, etc., multi-factor Logistic regression analysis was used to evaluate the influencing factors of fracture risk in diabetic patients, and the restrictive cubic spline was used to evaluate the relationship between Cr/CysC and diabetic fracture risk. Relationship.Results:After the two groups were matched by propensity scores, 42 groups were successfully matched, and there was no statistically significant difference in baseline data after matching ( P>0.05) ; Compared with the fracture group, the AGEs (129.13±37.51) ng/mL andALP (97.50±23.80) U/L in the fracture group were higher than those in the non-fracture group (108.41±29.33) ng/mL, (84.35±25.66) U/L higher; Cr/CysC (0.87±0.15) , limb skeletal muscle mass (19.58±3.99) kg were higher than those in the non-fracture group (0.99±0.21) , (21.81±4.38) kg low ( P<0.05) ;Multivariate logistic regression analysis showed that the skeletal muscle mass of extremities ( OR=0.865, 95% CI0.761~0.985) and Cr/CysC ( OR=0.048, 95% CI0.002~0.933) were protective factors for diabetes complicated with fractures; ALP ( OR=1.023, 95% CI1.002~1.044) , AGEs ( OR=1.022, 95% CI1.006~1.039) risk factors for diabetes and fracture (all P<0.05) ,Restricted cubic spline showed a significant non-linear relationship between Cr/CysC and diabetic fractures ( P<0.05) . Conclusion:Cr/CysC is related to the occurrence of fractures in diabetic patients and can be used as a potential predictor of the occurrence of diabetic fractures.