Objective: To evaluate the clinical efficacy of costal cartilage septal-columellar composite grafts in refining nasal tip aesthetics for secondary unilateral cleft lip nasal deformities, and to provide a reference for clinical treatment. Methods: This study has been approved by the institutional medical ethics committee and informed consent was obtained from the patients. A total of 31 patients underwent surgery with a costal cartilage strut-septum complex stent graft. The follow-up period was a minimum of 6 months. Anteroposterior, lateral, and supine photos of the patient were taken before and after the operation. The following measurements were obtained: nasal tip projection (NTP), nasofrontal angle (NFA), nasolabial angle (NLA), nasal tip alar angle (NAA), and nasal tip tangent angle (NTA). Nostril-related indices [nostril area (S), nostril height (h1), nostril width (w), and nasal sill height (h2)]) were measured before and after surgery, and cleft/non-cleft side ratios were calculated. Satisfaction with nasal tip aesthetics was investigated using the visual analogue scale (VAS). All measurements were made using preoperative photographs and the most recent follow-up photographs of the patients. Results The follow-up period ranged from 6 to 49 months, with an average of 28 months. All patients underwent healing Results: The follow-up period ranged from 6 to 49 months, with an average of 28 months. All patients underwent healing by first intention. Compared with preoperative measurements, postoperative NTP (preoperative 0.48 vs. postoperative 0.55), NLA (preoperative 83.98° vs. postoperative 100.80°), and NAA (preoperative 160.30° vs. postoperative 168.40°) were significantly increased (P < 0.05). NFA (preoperative 139.20° vs. postoperative 133.50°, P < 0.05) and NTA (preoperative 43.76° vs. postoperative 35.80°, P = 0.062) were decreased. On the cleft versus non-cleft sides, the ratios of S (preoperative 1.10 vs. postoperative 0.94, P < 0.05), w (preoperative 1.10 vs. postoperative 1.02, P = 0.194), h1 (preoperative 0.71 vs. postoperative 0.90, P < 0.05), and h2 (preoperative 0.53 vs. postoperative 0.79, P = 0.065) were all near 1. Satisfaction with postoperative results was fairly high. Conclusion The costal cartilage strut-septum complex stent can effectively correct the deflection and collapse of the nasal tip in patients with unilateral cleft lip nose deformity. The postoperative long-term effect is relatively stable.

Objective The study aims to investigate the effects of different adaptive statistical iterative reconstruction-V（ ASiR-V） and convolution kernel parameters on stability of CT auto-segmentation which is based on deep learning. Method Twenty patients who have received pelvic radiotherapy were selected and different reconstruction parameters were used to establish CT images dataset. Then structures including three soft tissue organs (bladder, bowelbag, small intestine) and five bone organs (left and right femoral head, left and right femur, pelvic) were segmented automatically by deep learning neural network. Performance was evaluated by dice similarity coefficient（ DSC） and Hausdorff distance, using filter back projection(FBP) as the reference. Results Auto-segmentation of deep learning is greatly affected by ASIR-V, but less affected by convolution kernel, especially in soft tissues. Conclusion The stability of auto-segmentation is affected by parameter selection of reconstruction algorithm. In practical application, it is necessary to find a balance between image quality and segmentation quality, or improve segmentation network to enhance the stability of auto-segmentation.
Algorithms ; Humans ; Image Processing, Computer-Assisted ; Neural Networks, Computer ; Radiation Dosage ; Tomography, X-Ray Computed

OBJECTIVE: To explore the feasibility of using the bidirectional local distance based medical similarity index (MSI) to evaluate automatic segmentation on medical images. METHODS: Taking the intermediate risk clinical target volume for nasopharyngeal carcinoma manually segmented by an experience radiation oncologist as region of interest, using Atlas-based and deep-learning-based methods to obtain automatic segmentation respectively, and calculated multiple MSI and Dice similarity coefficient (DSC) between manual segmentation and automatic segmentation. Then the difference between MSI and DSC was comparatively analyzed. RESULTS: DSC values for Atlas-based and deep-learning-based automatic segmentation were 0.73 and 0.84 respectively. MSI values for them varied between 0.29~0.78 and 0.44~0.91 under different inside-outside-level. CONCLUSIONS It is feasible to use MSI to evaluate the results of automatic segmentation. By setting the penalty coefficient, it can reflect phenomena such as under-delineation and over-delineation, and improve the sensitivity of medical image contour similarity evaluation.
Feasibility Studies ; Radiotherapy Planning, Computer-Assisted

Objective:To synthesize 177Lu-prostate-specific membrane antigen (PSMA)-617 with domestic 177Lu (made in China), and explore its optimal labeling condition, biodistribution, stability, and safety. Methods:177Lu-PSMA-617 was prepared with domestic 177Lu by a manual method. The optimal labeling condition, radiochemical purity, stability ( in vivo and in vitro), lipid-water partition coefficient, and plasma protein binding rate were determined. The uptake rate of 177Lu-PSMA-617 was evaluated by using 22RV1 cells. Biodistribution and SPECT/CT imaging were performed on normal mice with imported 177Lu-PSMA-617 as control group. The blood routine test was performed to evaluate the safety. Results:The best labeling result of domestic 177Lu-PSMA-617 can be obtained under the following conditions: pH=4.5, 100 ℃ for 30 min. And the radiochemical purity was ≥99%. The product was stable in vivo and in vitro, with the radiochemical purity >95% in 72 h. The plasma protein binding rate was (35.3±5.3)%, the lipid-water partition coefficient was -2.27±0.06, and the specific uptake rate of domestic 177Lu-PSMA-617 by 22RV1 cells reached the highest in 1 h ((7.58±0.84)%), which was slightly lower than the imported 177Lu-PSMA-617 ((7.86±0.96)%), but there was no significant difference between them ( t=-0.439, P>0.05). The distribution and SPECT/CT imaging of normal mice showed that domestic and imported 177Lu-PSMA-617 in blood were cleared quite fast, and both of them were excreted mainly through the kidneys. No obvious adverse reactions were found in the toxicity test of domestic and imported 177Lu-PSMA-617. There was no obvious abnormality in blood routine and liver and kidney metabolism. Conclusion:The domestic 177Lu-PSMA-617 has many advantages, such as qualified quality control, good biological properties and safety, which support its potential application value in diagnosis of prostatic neoplasms.

ObjectiveTo understand the status of stigma and subjective well-being of patients with mental disorders and co-resident family members， to analyze the correlation between them， and to compare the impact of stigma upon the subjective well-being of patients and family members of the same household. MethodsPatients with mental disorders （n=154） and their families （n=154） who visited the outpatient department of a tertiary psychiatric hospital in Chengdu from October to November 2019 were selected， and four instruments were used for collecting the data， including self-designed demographic information questionnaire， self-designed disease-related information questionnaire， brief version of Internalized Stigma of Mental Illness Scale （ISMI-10） and Index of Well-Being Scale （IWB）. ResultsA total of 118 （76.62%） patients with mental disorders and 151 （98.05%） family members experienced stigma. The total score and each factors score in ISMI-10 of family members were higher than those of patients （P<0.01）， and the total score and each dimension score in IWB were lower than those of patients （P<0.01）. Pearson correlation analysis showed that ISMI-10 total score of patients and family members was negatively correlated with IWB total score （r=-0.600，-0.202， P<0.05 or 0.01）. After controlling demographic and disease-related variables， multiple linear regression analysis showed that the regression model of mental disorder patients achieved good fit effect （adjusted R²=0.457）， with statistical significance （F=26.746， P<0.01）， while the regression model of co-living family members was lack of fit （adjusted R²=0.035）. After controlling for family demographic variables， the model was at the statistical level （F=3.769， P<0.01）. ConclusionMental disorder patients have low illness stigma and high subjective well-being， whereas the opposite is true for family members. Moreover， there is a negative relationship between stigma and subjective well-being for both patients and family members， stigma is a significant factor affecting subjective well-being for people with mental disorders.

Compared with the previous automatic segmentation neural network for the target area which considered the target area as an independent area, a stacked neural network which uses the position and shape information of the organs around the target area to regulate the shape and position of the target area through the superposition of multiple networks and fusion of spatial position information to improve the segmentation accuracy on medical images was proposed in this paper. Taking the Graves' ophthalmopathy disease as an example, the left and right radiotherapy target areas were segmented by the stacked neural network based on the fully convolutional neural network. The volume Dice similarity coefficient (DSC) and bidirectional Hausdorff distance (HD) were calculated based on the target area manually drawn by the doctor. Compared with the full convolutional neural network, the stacked neural network segmentation results can increase the volume DSC on the left and right sides by 1.7% and 3.4% respectively, while the two-way HD on the left and right sides decrease by 0.6. The results show that the stacked neural network improves the degree of coincidence between the automatic segmentation result and the doctor's delineation of the target area, while reducing the segmentation error of small areas. The stacked neural network can effectively improve the accuracy of the automatic delineation of the radiotherapy target area of Graves' ophthalmopathy.
Algorithms ; Image Processing, Computer-Assisted ; Neural Networks, Computer ; Tomography, X-Ray Computed

The development of medical image segmentation technology has been briefly reviewed. The applications of auto-segmentation of organs at risk and target volumes based on Atlas and deep learning in the field of radiotherapy have been introduced in detail, respectively. Then the development direction and product model for general automatic sketching tools or systems based on solid clinical data are discussed.
Image Processing, Computer-Assisted ; Radiotherapy/trends* ; Radiotherapy Planning, Computer-Assisted ; Technology ; Tomography, X-Ray Computed

Objective:To explore the reasons why patients with severe mental disorders and their family members refuse to participate in the community management and treatment service network.Methods:Totally 12 patients with severe mental disorders hospitalized and 7 family members in a ClassⅢ Grade A psychiatric hospital in Chengdu between January and May 2018 received semi-structural interviews using descriptive qualitative research methods. The content analysis and Nvivo 10.0 were used to organize and analyze the interview materials.Results:The five themes that affected refusal of patients with severe mental disorders and their family members to participate in the community management and treatment network were: poor perception of the patients, which covered the sub-themes of insufficient awareness of severe mental disorders and incorrect understanding of the community management and treatment service network; negative emotions of the patients and their family members, including the sub-themes of severe feelings of stigma and lack of trust; the patients and their family members actual needs were not met; the introverted personality traits of the patients; the decision-making game between the patients and the main caregiver of the family.Conclusions:Strengthening publicity, fully protecting the privacy of the patients, eliminating doubts, building a professional psychiatric prevention team, providing a diverse community management and treatment service network, and grasping the relevant drivers for the patient's refusal to participate in the community management and treatment service network can help enhance the enthusiasm of patients with severe mental disorders and their family members to participate in the community management and treatment service network.

Objective This article reported a patient with severe bilateral nostril stenosis secondary to bilateral cleft lip nasal deformity correction surgery.Methods The surgical procedure included columellar flap and local soft tissue flap was transferred to nasal inside,columellar was narrowed,reconstruction of nasal dome,increased nostrils height and nasal vestibular mucosa area.Results Effective improvement of nasal profile and reduction of ventilation features obstacles was observed.Nasal retainer was used for half a year postoperatively.After two years' follow-up,it showed good results.Conclusions This article is to introduce the therapeutic process and detailed literature review of clinical study of nostril stenosis abnormalities.

Objective To assess the effectiveness of the Mulliken's method in bilateral complete cleft lip patients with 3dMD system and anthropometric landmarks.Methods Thirty-one infants with bilateral complete cleft lip received treatment in Hospital of Stomatology,Wuhan University between January 2014 and December 2016.Patients underwent primary cheiloplasty and nasoplasty by the same senior surgeon.Periodic review was taken to measure and record the 7 items in the nasolabial area with three-dimensional (3D) images.Results The labial and nasal deformities were restored after primary surgery.The upper lip and nose were corrected and obtained the symmetric shape.The columella was elongated to acquire favorable nasal tip.The arc of nasal fornix was upward.The ridge of the white lipwas continuous and integrated with full vermilion tubercle.Total length of upper lip (Sn-Sto),thickness of the vermilion tubercle (Ls-Sto),protrusion of the nasal tip (Nh) and columellar height (Ch) were markedly improved and there were no significant difference between the observation group and the control group.The significant differences between two groups occurred in values of the nostril width (Nw),which was greater than control group and white lip height (Sn-Ls) and lower than that of control group.Conclusions Mulliken's method during the primary cheiloplasty of the bilateral complete cleft lip shows better results in correction the nasal deformity and the ideal effects are achieved during follow-up.