OBJECTIVE: To investigate ideal screw implant angle in reconstruction of tibiofibular syndesmosis injury by using a biomechanical test. METHODS: A total of 24 ankle specimens from adult cadavers were used as the tibiofibular syndesmosis injury model. According to the angle of screw placement, the tibiofibular syndesmosis injury models were randomly divided into groups A (0°), B (10°-15°), C (20°-25°), and D (30°-35°), and the screws were placed at a level 2 cm proximal to the ankle joint. The displacement of fibula was measured by biomechanical testing machine at neutral, dorsiflexion (10°), plantar flexion (15°), varus (10°), and valgus (15°) positions, with axial load of 0-700 N (pressure separation test). The displacement of fibula was also measured at neutral position by applying 0-5 N·m torque load during internal and external rotation (torsional separation test). RESULTS: In the pressure separation test, group C exhibited the smallest displacement under different positions and load conditions. At neutral position, significant differences were observed ( P<0.05) between group A and group C under load of 300-700 N, as well as between group B and group C under all load conditions. At dorsiflexion position, significant differences were observed ( P<0.05) between group A and group C under load of 500-700 N, as well as between groups B, D and group C under all load conditions, and the displacements under all load conditions were significantly smaller in group A than in group B ( P<0.05). At plantar flexion position, significant differences were observed ( P<0.05) between group D and group C under all load conditions. At valgus position, significant differences were observed ( P<0.05) between group A and group C under load of 400-700 N, as well as between groups B, D and group C under all load conditions. In the torsional separation test, group C exhibited the smallest displacement and group B had the largest displacement under different load conditions. During internal rotation, significant differences were observed ( P<0.05) between group B and group C under all load conditions, as well as between group D and group C at load of 3-5 N·m. During external rotation, significant differences were observed between groups B, D and group C under all load conditions ( P<0.05). No significant difference was detected between groups at the remaining load conditions ( P>0.05). CONCLUSION The ideal screw implant angle in reconstruction of tibiofibular syndesmosis injury was 20°-25°, which has a small displacement of fibula.
Humans ; Bone Screws ; Biomechanical Phenomena ; Fibula/injuries* ; Fracture Fixation, Internal/methods* ; Adult ; Ankle Joint/surgery* ; Ankle Injuries/surgery* ; Tibia/surgery* ; Male ; Range of Motion, Articular ; Weight-Bearing ; Female ; Cadaver ; Plastic Surgery Procedures/methods*

Objective:To design an intelligent measurement program of detection parameters of quality control of imaging system of multi-slice spiral computed tomography (MSCT) based on MATLAB software platform,so as to achieve intelligent detection for quality control of MSCT imaging system. Methods:We designed an intelligent measurement program for the detection parameters of quality control of MSCT imaging system (referred to as the intelligent measurement program) bases on the function of graphical user interfaces (GUI) of MATLAB software. A series of algorithms such as image reading,binarization,and circular detection based on the Hough transform were employed to conduct automatic measurement and calculation for CT values (water),noise and uniformity of the parameters of MSCT quality control. The Intraclass Correlation Coefficient (ICC) was adopted to analyze the consistency of the detection results between the manual measurement method and the designed intelligent detection program. Results:The designed intelligent measurement program in this study can automatically assess the detection parameters of quality control of the MSCT imaging system,which included CT values (water),noise and uniformity. There was favorable consistency in the detection results between the manual measurement method and the intelligent measurement program (range of ICC values was from 0.881 to 0.985). Conclusion:The intelligent measurement program of detection parameters of quality control of MSCT imaging system can simplify the process of calculating detection parameters of quality control of MSCT imaging system,and provide a reliable detection tool for quality control of MSCT imaging equipment,which can effectively improve the detection efficiency of quality control.

Objective:To design an intelligent measurement program of detection parameters of quality control of imaging system of multi-slice spiral computed tomography (MSCT) based on MATLAB software platform,so as to achieve intelligent detection for quality control of MSCT imaging system. Methods:We designed an intelligent measurement program for the detection parameters of quality control of MSCT imaging system (referred to as the intelligent measurement program) bases on the function of graphical user interfaces (GUI) of MATLAB software. A series of algorithms such as image reading,binarization,and circular detection based on the Hough transform were employed to conduct automatic measurement and calculation for CT values (water),noise and uniformity of the parameters of MSCT quality control. The Intraclass Correlation Coefficient (ICC) was adopted to analyze the consistency of the detection results between the manual measurement method and the designed intelligent detection program. Results:The designed intelligent measurement program in this study can automatically assess the detection parameters of quality control of the MSCT imaging system,which included CT values (water),noise and uniformity. There was favorable consistency in the detection results between the manual measurement method and the intelligent measurement program (range of ICC values was from 0.881 to 0.985). Conclusion:The intelligent measurement program of detection parameters of quality control of MSCT imaging system can simplify the process of calculating detection parameters of quality control of MSCT imaging system,and provide a reliable detection tool for quality control of MSCT imaging equipment,which can effectively improve the detection efficiency of quality control.

Objective:To investigate the clinical characteristics of patients with lymphoplasmacytic lymphoma/Waldenstr?m macroglobulinemia (LPL/WM), and the diagnosis and optimal treatment of LPL/WM.Methods:The clinical data of 13 LPL/WM patients treated in Zhongnan Hospital of Wuhan University from January 2013 to June 2018 were retrospectively analyzed, and the literature was reviewed.Results:The median age of 13 patients was 60 years old (35-79 years old). There were 12 males and 1 female. Initial symptom was fatigue or edema of both lower limbs for majority of patients. All patients had immunoglobulin M (IgM) monoclonal, 3 of them had elevated immunoglobulin G (IgG) level, including 1 patient with monoclonal IgG. LDH was increased in 2 patients. Coombs test was positive in 5 patients. MyD88 gene mutation status was detected in 8 patients, of which gene mutation in 5 patients was positive. Among 13 patients, 1 patient lost follow-up, 3 patients died, 9 patients were alive with the median survival of 36 months (19-81 months).Conclusions:Incidence of LPL/WM is relatively low with a generally indolent evolution, but heterogeneity is not negligible. Few patients have poor treatment response with a quick disease progress. The high-risk patients undergoing hematopoietic stem cell transplantation after remission-induction chemotherapy may improve the prognosis.

Objective:To investigate the mediating and moderating effects of resilience on frailty and depression in the community-dwelling old adults.Methods:Totally 871 community-dwelling old adults chosen from different communities were investigated by the geriatric depression scale, Tilburg frailty indicator and 10-item Connor-Davidson resilience scale.SPSS 22.0 and AMOS 24.0 were used for data analysis, including descriptive analysis, correlation analysis, structural equation modeling and hierarchical regression analysis.Results:(1)The score of frailty (3.72±2.89)was positively correlated with the score of depression (2.63±2.57, r=0.16-0.58, P<0.01). The score of resilience(28.24±6.80) was negatively correlated with the score of frailty and depression ( r=-0.10~-0.49, both P<0.01), and frailty predicted 35% of the total variation of depression in the elderly.(2)The mediating effect of resilience was significant and the indirect effect was 0.10, accounting for 12.66% of the total variance.(3) Resilience moderated the relationship between frailty and depression ( β=-0.12, t=-4.11, R2=0.41, P<0.001). The frailty of old adults with lower resilience played a stronger predictive role in depression (simple slope=0.50, t=14.73, R2=0.01, P<0.001). Conclusion:There is a close relationship between frailty and depression in the community-dwelling older adults, and resilience plays both mediating and moderating role in the relationship.

Objective: To study the efficacy of relieving the postoperation pain by using mesh to stuture and fixate tissue during transabdominal preperitoneal hernioplasty (TAPP) in inguinal hernia patients. Metholds: A retrospective analysis of 156 patients with inguinal hernia who underwent TAPP in Nanhai Hospital Affiliated to Southern Medical University from January 2016 to January 2017 was conducted, they were males, the average age was 50.84 years and the age range was from 33 to 62 years. Patients were divided into sacral nail group (n=120) and absorbable line group (n=36) according to the different methods of fixation of the iliac crest. Among them, the patients in the sacral nail group were fixed with iliac screws, and the patients in the absorbable line group were sutured with absorbable sutures. Pain visual analog scale (VAS) was used to compare the extent of postoperative pain in both groups. After the operation, through the outpatient review and telephone follow-up for 1 year, observed the recurrence of inguinal hernia in both groups. Measurement data were expressed as mean ± standard deviation (Mean±SD), t-test was used for comparison between groups; the Chi-square test was used to compare the count data between the two groups. Results: Among them, 19 patients with moderate pain after operation in the nail group had an incidence of 15.8%. Two patients with moderate pain in the absorbable line group had an incidence of 5.6%. The difference between the two groups was statistically significant (χ²=2.511, P=0.013). The pain VAS of the patients in the sacral nail group was (3.08±1.36), and the absorbable line group was (2.50±0.91), the difference between the two groups was statistically significant (t=2.973, P=0.001). All patients had no recurrence after outpatient review and telephone follow-up for 1 year. Conclusion In TAPP, the application of absorbable suture fixed patch can effectively reduce postoperative pain.

BACKGROUND:A few of studies have showed similar efficacy and safety between domestic clopidogrel (Talcom?) and imported clopidogrel (Plavix?) in patients after percutaneous coronary intervention, but there is lack of large-scale, large sample, and prospective clinical comparative study in China.
OBJECTIVE:To compare the efficacy and safety of Talcom?and Plavix?on percutaneous coronary intervention.
METHODS:Total y 1 798 patients with Coronary atherosclerotic heart disease who received percutaneous coronary interventions were divided to two groups:Talcom?group (n=1 104) and Plavix?group (n=694). 300 mg clopidogrel was administrated oral y before percutaneous coronary intervention fol owed by 75 mg/d clopidogrel sequential y for 1 year. Al the patients were fol owed for 3-28 months to observe the incidence rate of stent thrombosis at acute, subacute, late, and very late stage, major adverse cardiac events of combination end point (including myocardial infarction, cardiac death, and stroke), and correlated adverse reactions, such as bleeding.
RESULTS AND CONCLUSION:There were no significant differences in the incidence of stent thrombosis, target vessel revascularization, cardiac death, bleeding, major bleeding and major adverse cardiac events of combination end point between Talcom?group and Plavix?group. In addition, event-free survival also showed no difference between the two groups. After treatment, white blood cellcount, erythrocyte count, hemoglobin, hematocrit, platelet count were significantly decreased in both the two groups (P<0.05). Hemoglobin level in the Talcom?group was fewer than that in the Plavix?group (P<0.05). The results suggest that effects and safety of Talcom?are similar to those of Plavix?for percutaneous coronary interventions.

Objective To evaluate the clinical applications of helical CT scans in the ureteral diseases.Methods The precontrast and four-phase postcontrast helical CT scans were performed in 110 patients with ureteral diseases confirmed by clinic and pathology, and the multiplanar reformation (MPR) and three-dimensional reconstruction (3D) images were generated from the volumetric data.The ability of helical CT in detecting and diagnosing the ureteral diseases was investigated.The results were then compared with the findings of the other imaging techniques and surgery.Results Combined with axial and MPR images, the location, size, morphology, extension, and the urinary obstruction of the ureteral diseases could be clearly demonstrated in 97.3% cases, and the curved MPR was useful in directly detecting the lesions.The findings of ureteral lesion on helical CT images corresponded well with that of surgery in 81 cases. 3D reconstruction could produce a three-dimensional image that mimics conventional urography, and was useful in displaying the ureteral lesions from multiple views.Helical CT could compensate for some disadvantages of the other imaging techniques.Conclusion Helical CT, with large scanning area and high resolution, can provide comprehensive information about the ureteral diseases, and the curve MPR has the highest value.

Objective To evaluate the clinical applications and limitations of helical CT virtual cystoscopy (CTVC).Methods CTVC was performed in 36 patients suspected bladder diseases, all cases were confirmed by conventional cystoscopy and pathology. CTVC images were generated from the volumetric data of the excretory phase using helical CT. The results were then compared with the findings of axial images and conventional cystoscopy in a double-blinded manner. Results CTVC could clearly display the normal anatomic structures of bladder, 11 ureteric orifices were visualized at CTVC in 7 of 8 normal bladders. The location, size, numbers, configuration and extension of lesions showed on CTVC were corresponded well with that of conventional cystoscopy. The sensitivity to vesical carcinoma was 94.7%,2 tumors smaller than 5 mm depicted on CTVC images were not seen on the axial images, whereas areas of wall thickening and extravesical invasions were more readily appreciated on axial and MPR images. There was 1 false lesions detected on CTVC images. Conclusion CTVC has proved to be a noninvasive and reliable technique in the detection and diagnosis of bladder lesions, but the optimal evaluation requires adequate bladder filling with contrast medium, and should combine with the interpretation of axial and MPR images.

Objective　To evaluate the clinical application of helical CT multiplanar reformation (MPR), three-dimensional reconstruction (3D) and virtual laryngoscopy (CTVL) in laryngeal and hypopharyngeal carcinoma. Methods　Axial helical CT scans were performed in 22 patients with laryngeal or hypopharyngeal carcinoma, along with MPR, 3D and CTVL. These results were compared with the findings of fiber optic laryngoscopy and surgery. Results　Combining axial and MPR images, both the accuracy in preoperative tumor staging and the diagnosis of metastatic lymph nodes were 95%. MPR demonstrated more information about the extent of tumor than axial images in 23% cases; 3D image displayed clearly the extension of tumor, the vessels and airway from multiple views. The location, size and extent of tumors found in cranio-caudal CTVL corresponded well with that of laryngoscopy, and CTVL demonstrated the relationship between the tumor and vocal cords and anterior commissure by caudo-cranial approach, which was inaccessible to fiber optic laryngoscopy in 3 cases. Conclusions　Axial images of helical CT clearly demonstrate the location, size and extent of laryngeal and hypopharyngeal carcinoma, while MPR and 3D images are useful in displaying the three-dimensional images and anatomical relation of the tumor. CTVL can clearly display the mucosal surface structures of the larynx and hypopharynx and is a good complementary method of laryngoscopy.