Objective:To evaluate the effectiveness of deep learning reconstruction (DLR) compared with hybrid iterative reconstruction (Hybrid IR) in improving the image quality in chest low-dose CT (LDCT).Methods:Seventy-seven patients who underwent LDCT scan for physical examination or regular follow-up in Peking Union Medical College Hospital from October 2020 to March 2021 were retrospectively included. The LDCT images were reconstructed with Hybrid IR at standard level (Hybrid IR Stand) and DLR at standard and strong level (DLR Stand and DLR Strong). Regions of interest were placed on pulmonary lobe, aorta, subscapularis muscle and axillary fat to measure the CT value and image noise. The signal to noise ratio (SNR) and contrast to noise ratio (CNR) were calculated. Subjective image quality was evaluated using Likert 5-score method by two experienced radiologists. The number and features of ground-glass nodule (GGN) were also assessed. If the scores of the two radiologists were inconsistent, the score was determined by the third radiologist. The objective and subjective image evaluation were compared using the Kruskal-Wallis test, and the Bonferroni test was used for multiple comparisons within the group.Results:Among Hybrid IR Stand, DLR Stand and DLR Strong images, the CT value of pulmonary lobe, aorta, subscapularis muscle and axillary fat had no significant differences (all P>0.05), but the image noise and SNR of pulmonary lobe, aorta, subscapularis muscle and axillary fat had significant differences(all P<0.05), and the CNR of images had significant difference( P<0.05), too. The CNR of Hybrid IR Stand images, DLR stand images and DLR strong images were 0.71 (0.49, 0.88), 1.06 (0.78, 1.32) and 1.14 (0.84, 1.48), respectively. Compared with Hybrid IR images, DLR images had lower objective and subjective image noise,higher SNR and CNR (all P<0.05). The scores of DLR images were superior to Hybrid IR images in identifying lung fissures, pulmonary vessels, trachea and bronchi, lymph nodes, pleura, pericardium and GGN (all P<0.05). Conclusions:DLR significantly reduced the image noise, and DLR images were superior to Hybrid IR images in identifying GGN in chest LDCT while maintaining superior image quality at relatively low radiation dose levels. Thus DLR images can improve the safety of lung cancer screening and pulmonary nodule follow-up by CT.

Objective:To explore the effect of deep learning reconstruction (DLR) on radiation dosage reduction and image quality of CTPA compared with hybrid iterative reconstruction (HIR).Methods:A total of 100 patients with suspected pulmonary embolism (APE) or indications for CTPA due to other pulmonary artery diseases in Peking Union Medical College Hospital from December 2020 to April 2021 were prospectively enrolled and divided into HIR group and DLR group according to block randomization, with 50 cases in each group. The patient′s gender, age and body mass index (BMI) were recorded. HIR group and DLR group underwent standard deviation (SD)=8.8 and SD=15 CTPA protocols in combination with HIR and DLR algorithm respectively. Other scanning parameters and contrast medium injection plan were the same. The effective dose (ED) and size-specific dose estimate (SSDE) were calculated. Regions of interest (ROIs) were drawn in the lumen of Grade 1-3 pulmonary arteries and bilateral paravertebral muscles. The corresponding CT and SD values were recorded to acquire signal to noise ratio (SNR) and contrast noise ratio (CNR). Based on a double-blind method, two radiologists evaluated the subjective noise, visualization of pulmonary arteries, and diagnostic confidence of the two groups by 5-point Likert scales. The inconsistent results were judged comprehensively by the third radiologist. Independent samples t-test was used to compare the demographic data, radiation dosage and quantitative image quality of the two groups. Mann-Whitney U test was used to compare the subjective noise, visualization of pulmonary arteries and diagnostic confidence between the two groups. Linear weighted Kappa coefficient was calculated to analyze the consistency of the qualitative scores between the two radiologists. Results:There were no significant differences in gender, age and BMI between the two groups ( P>0.05). The CT values of Grade1-3 pulmonary arteries and paravertebral muscle had no significant differences ( P>0.05). Compared with HIR group, the ED and SSDE in DLR group decreased by about 35% to 1.3 mSv and 4.20 mGy respectively, while the SNR (30±5) and CNR (26±5) of CTPA images were higher in DLR group than those in HIR group (23±5 and 20±5, with t=-6.60 and -5.90, respectively, both P<0.001). The subjective noise score was higher in DLR group than that in HIR group ( Z=-7.34, P<0.001). In addition, two radiologists showed excellent interobserver agreement in DLR group (Kappa=0.847, 95%CI 0.553-1.000). No significant differences were found in visualization of pulmonary arteries and diagnostic confidence between the two groups ( P>0.05). Conclusion:DLR further reduced the radiation dosage and improved the image quality of CTPA, with no detriment to diagnostic confidence. Thus DLR is worthy of clinical promotion.

Objective:To investigate the feasibility of chest ultra-low dose CT (ULDCT) using deep learning reconstruction (DLR) for lung cancer screening, and to compare its image quality and nodule detection rate with ULDCT iterative reconstruction (Hybrid IR) and conventional dose CT (RDCT) Hybrid IR.Methods:The patients who underwent chest CT examination for pulmonary nodules in Peking Union Medical College Hospital from October 2020 to March 2021 were prospectively included and underwent chest RDCT (120 kVp, automatic tube current), followed by ULDCT (100 kVp, 20 mA). The RDCT images were reconstructed with Hybrid IR (adaptive iterative dose reduction 3D,AIDR 3D), and ULDCT was reconstructed with AIDR3D and DLR. Radiation dose parameters and nodule numbers were recorded. Image quality was assessed using objective noise, signal-to-noise ratio (SNR) of the main trachea and left upper lobe, subjective image scores of the lung and nodules. Subjective scores were scored by 2 experienced radiologists on a Likert 5-point scale. The difference of radiation dose was compared with paired t-test between ULDCT and RDCT.The differences of quantitative indexes, objective image noise and subjective scores of the three reconstruction methods were compared with one-way analysis of variance or Friedman test. Results:Forty-five patients were enrolled, including 17 males and 28 females, aged from 32 to 74 (55±11) years. The radiation dose of ULDCT was (0.17±0.01) mSv, which was significantly lower than that of RDCT [(1.35±0.41) mSv, t=15.46, P<0.001]. There were significant differences in the image noise and SNR in the trachea and lung parenchyma and in the CT value of the trachea among ULDCT-AICE, ULDCT-AIDR 3D and RDCT-AIDR 3D images ( P<0.05). Image noise in the trachea and lung parenchyma and CT value in the trachea of ULDCT-AICE were significantly lower than those of ULDCT-AIDR 3D ( P<0.05) and comparable to RDCT-AIDR 3D ( P>0.05). There were significant differences in subjective image scores of the lung and nodules among ULDCT-AICE, ULDCT-AIDR 3D and RDCT-AIDR 3D images (χ2=50.57,117.20, P<0.001). Subjective image scores of the lung and nodules for ULDCT-AICE were significantly higher than those of ULDCT-AIDR 3D ( P<0.05), and non-inferior to RDCT-ADIR 3D ( P>0.05). All 72 clinically significant nodules detected on RDCT-ADIR 3D were also noted on ULDCT-AICE and ULDCT-AIDR 3D images. Conclusions:Chest ULDCT using DLR can significantly reduce the radiation dose, and compared with Hybrid IR, it can effectively reduce the image noise and improve SNR, and display the pulmonary nodules well. The image quality and nodule detection are not inferior to RDCT Hybrid IR routinely used in clinical practice.

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods: We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results: A total of 451 patients were included in three randomized and two nonrandomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.

ObjectiveTaking Chuanxiong Chatiaosan prescription as the carrier， by comparing the differences of volatile components in Chuanxiong Rhizoma with single decoction pieces and compatible prescription of different decoction pieces， the differences of material basic connotation of different formulations of Chuanxiong Chatiaosan were revealed from the aspects of processing （raw and wine-processed products）， compound compatibility and dosage form （powder and decoction）. MethodThe volatile oil was extracted from different decoction pieces of Chuanxiong Rhizoma， Chuanxiong Chatiaosan and its decoction with different decoction pieces of Chuanxiong Rhizoma by steam distillation， the main components and their relative contents were identified by gas chromatography-mass spectrometry （GC-MS）. ResultA total of 25 volatile components were identified from different processed products of Chuanxiong Rhizoma， including 11 monoterpenoids， 4 phenols， 3 sesquiterpenoids， 3 phthalides， 2 ketones and 2 olefins， the contents of α-pinene， β-pinene， 3-butylphthalide and others increased after the raw products was processed with wine. A total of 85 constituents were identified from Chuanxiong Chatiaosan with different decoction pieces， including 31 monoterpenoids， 23 sesquiterpenoids， 5 alcohols， 5 aldehydes， 4 phenols， 4 phthalides， 3 ethers， 3 ketones， 1 olefin， 1 organic acid， 2 esters and 3 other compounds. A total of 22 components， including 9 sesquiterpenoids， 3 phthalides， 2 phenols， 6 monoterpenoids， 1 aldehyde and 1 alkane， were identified from the decoction of Chuanxiong Chatiaosan with different processed products. ConclusionThere was no significant difference in the composition between raw products and wine-processed products of Chuanxiong Rhizoma either in single decoction pieces or in compatibility prescription， but the relative content changed to some extent， and the wine-processed products was the most obvious. There was a great difference in the composition of volatile components between the Chuanxiong Chatiaosan and its decoction. The volatile components， such as isopulegol， isocalamendiol and safrole， were not found in the decoction. Components in Chuanxiong Rhizoma processed with wine will change with the addition of yellow rice wine， and volatile components can reflect the difference between decoction pieces and prescriptions of the wine-processed products.

Objective:To investigate the efficacy of internal fixation of Pipkin types I and II femoral head fractures through the modified Smith-Petersen (S-P) approach.Methods:A retrospective case control study was conducted to analyze the clinical data of 33 patients with Pipkin types I and II femoral head fractures admitted to Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from June 2015 to September 2019. There were 22 males and 11 females, aged 20-40 years (mean, 29.5 years). There were 15 patients with Pipkin type I fractures and 18 with Pipkin type II fractures. A total of 22 patients were treated using the modified S-P approach via the sartorius and tensor fascia lata space (modified S-P group) and 11 patients were treated using the modified K-L approach via the posterior superior iliac spine and gluteus maximus (modified K-L group). The operation duration, intraoperative blood loss, postoperative drainage volume, length of hospital stay, numeric rating scales (NRS) for pain assessment at postoperative 15 days, bone healing time, Harris hip joint score at postoperative one month, and complication rate were compared between the two groups.Results:All patients were followed up for 1-24 months (mean, 6.5 months). The operation duration, blood loss, drainage rate and length of hospital stay in modified S-P group were better than those in modified K-L group [(71.7±7.3)minutes vs. (112.1±6.7)minutes, (55.9±6.2)ml vs. (99.4±8.7)ml, (91.2±5.9)ml vs. (121.3±7.0)ml, (6.0±1.5)days vs. (10.5±1.6)days] ( P<0.01). There were no significant differences between two groups in terms of NRS, bone healing time and Harris score ( P>0.05). The incidence of complications was similar between the two groups, including femoral head ischemia necrosis, traumatic arthritis, and heterogenous ossification ( P>0.05). Conclusion:For Pipkin types I and II femoral head fractures, the modified modified S-P approach is superior to modified K-L approach in aspects of operative time, intraoperative blood loss, postoperative drainage and length of hospital stay.

Objective: To develop medical emergency support information system for large-scale social activities based on 5G communication technology to improve efficiency of emergency medical services. Methods: The project was completed in Hangzhou, China, from March 2016 to September 2019. Based on the medical service of large social activities, five information terminals are constructed, including on-site mobile terminal, on-board first aid terminal, expert remote consultation terminal, hospital terminal, and command dispatch center. The system can realize the real-time communication of medical information, patient's vital signs, audio, picture and video information, and can also make intelligent scheduling decisions for patients. Results: 5G Emergency Medical information System for Large-scale Social Activities has been completed, which consists of three parts: command and control platform, on-site rescue platform, and evacuation support platform. The command and monitoring platform displays the information of on-site medical teams, ambulances, hospitals and experts through web pages, and realizes multi-party video communication at any time, as well as text, voice and image information of patients' current condition, so as to realize command, dispatch and display statistical summary information. On-site rescue terminal includes patient information input, video signal acquisition and physiological information acquisition equipment. It realizes multiple methods of patient information input, vital signs and physiological information acquisition, multi-angle video acquisition and transmission to the command center. The evacuation support platform includes vehicle emergency terminal, remote expert consultation terminal, hospital terminal and UAV system. Vehicle terminal can scan and transfer with on-site ambulance team, record physiological information during transit, and also acquire and transmit monitor, electrocardiogram and ultrasound information. Hospital terminals can obtain patient information at the first time and prepare for first-aid in hospital. The remote expert terminal can be dispatched by the command center and the hospital terminal, and can join the remote consultation at any time. Unmanned aerial vehicle (UAV) system can transfer medical material between any locations. Conclusions This system can guarantee the patients to be transported from the scene to the ambulance and finally to the hospital during the large-scale social activities. In the whole process, the information transmission and dispatching decision-making are initially realized, and the statistical report forms can be made. However, to fully exert its advantages, it still needs the support of the complete 5G network and continuous optimization in real scenarios.

Objective To summarize our clinical experience of cryoablation for renal cancer and to analyze the therapeutic indication,security,selection of cryoablation and outcomes.Methods Sixty-four patients suffered with T1a renal cell carcinoma were enrolled in this study from March 2012 to March 2018.Among them,5 cases were senile patients (≥ 80 years),5 cases complicated with other cancers,3 cases complicated with renal insufficiency,4 cases complicated with decompensated cirrhosis,3 cases with bilateral renal cancer,4 cases with solitary kidney cancer and 39 cases with some other complications.The preoperative serum creatinine level was(80.5 ± 38.2)μmol/L.The patients underwent laparoscopic singlesite (LESS) renal cryoablation,conventional laparoscopic renal cryoablation,or percutaneous image-guided cryoablation according to individual situation.Contrast-enhanced CT scan or MRI were used during the procedures and follow-up was performed.Results All operations were completed successfully and technical success was achieved as well in all cases.Blood transfusion was necessary for 2 cases because of hemorrhage.The mean diameter of the mass was (2.6 ± 0.90) cm,the median volume of blood loss was 50ml(10-110 ml),and the mean operation time was(96.0 ± 24.5) min.The median inpatient hospital stay was 3 d (1-6 d).In one case,digital subtraction angiography (DSA) embolization was performed due to hemorrhage after surgery.None of the other cases had intraoperative or postoperative complications.The serum creatinine level after surgery was not significantly decreased [postoperative (83.8 ±42.1) μmol/L,P =0.64].The contrast-enhanced CT or MRI of the kidneys one week postoperatively showed uniform low density in all lesion areas,which represented complete ablation and regression of the tumor.All cases were followed up regularly.One case showed relapse at the 6 th month follow-up and underwent cryoablation again.Another case,who was not regularly followed up,relapsed at 69th month after surgery.No relapse was observed in the other cases during the follow-up.Conclusions Renal cancer cryoablation is a safe,feasible and efficacious therapy for the patients who suffered from unresectable T1a renal cell carcinoma because of high surgical risk or multifocal lesions.

Objective To evaluate the clinical efficacy and complications of lattice carbon dioxide laser in the treatment of female mild to moderate stress incontinence.Methods 30 cases of mild to moderate stress urinary incontinence in our hospital from August to October 2017 were reviewed.The average age was (46.5 ±3.5) years old,all married and has been bred,12 patients with mild stress incontinence and 18 patients with moderate stress urinary incontinence.Preoperative preparation including:1h urine cushion test measured leakage of urine,urine flow rate,residual urine,the international consultation on incontinence questionnaire (ICI-Q-SF) score,urine routine examination.Preoperative urine flow rate (31.87 ± 2.42) ml/s,preoperative (1 h) pad test (8.19 ± 2.42) ml,preoperative ICI-Q-SF score (4-8).The power was 12.5 mJ,the efficacy was 25％,and the single treatment was chosen.Urine flow rate,1 h urine pad test,residual urine test,ICI-Q-SF score,and subjective satisfaction were recorded at 1,3,6 months after operation.Results All 30 patients in this group were followed up for more than 6 months.The pad test was (2.14 ± 0.36) ml,(1.02 ± 0.54) ml,(0.80 ± 0.41) ml at 1,3 and 6 months postoperatively,which were significantly different from preoperative pad test (P ＜ 0.01,).The urine flow rate at 1,3,6 months after operation was (30.53 ± 3.15) ml/s,(32.19 ± 2.72) ml/s,(31.23 ± 5.76) ml/s,respectively,and there was no significant difference between the 3 groups (P ＞ 0.05).There was no significant difference between preoperative and postoperative urine flow rate (P ＞ 0.05).The ICI-Q-SF at 1,3,6 months after operation were 3 (1-4),3 (0-4),3 (0-4),which were significantly different from preoperative ICI-Q-SF.Among the 30 patients,3 cases had frequent urination after operation,1 case had frequent urination before operation,and became more severe after operation.The residual urine of 30 patients was negative after operation.All patients had no dysuria and no vaginal bleeding.No signs of urinary incontinence were observed after 6 months follow-up.Conclusions For patients with mild stress urinary incontinence,there is no obvious serious complication in the short term after the laser treatment of dot matrix carbon dioxide laser.The clinical treatment is safe and the leakage of urine can be improved.

Objective To investigate the causes and managements of postoperative complications of proximal femoral nail anti-rotation(PFNA)in treating intertrochanteric fractures. Methods A total of 155 patients with intertrochanteric fractures were treated with PFNA from January 2011 to December 2017.Causes and managements of postoperative complications were analyzed and discussed. Results At an average follow-up of 48 months(range ,12~72 months) ,the rate of good postoperative recovery in hip function was 96.0% . Among 155 patients ,the internal fixation-associated postoperative complications occurred in 15(9.7% )patients.Details were as follows :7 cases had spiral blade breakage into the femoral head or inwardly ,in whom 5 cases received artificial joint replacement whereafter.5 cases had coxa vara ,mainly in patients with obvious posterior fracture of the femoral intertrochanter with obviously bone fragments.3 cases had delayed fracture healing due to the fracture damaging calcar femorale ,or extensive soft tissue dissection during the operation on small trochanter. The Harris function score was 82 points. Conclusions The location of the PFNA spiral blade ,as an important factor ,is correlated with postoperative complications ,while severe osteoporosis ,unstable fractures ,and poor fracture reduction increase the incidence of surgical complications.