PURPOSE:To study whether the geometric triangle relationship between the Blumensaat line and tibial plateau may be an auxiliary indicator for diagnosing and evaluating anterior cruciate ligament (ACL) injuries to improve the diagnostic accuracy. METHODS:This is a retrospective self-controlled study. Patients with unilateral ACL injuries who were diagnosed by arthroscopy and received ACL reconstruction in Qingdao Municipal Hospital from January 2023 to August 2023 were recruited. Inclusion criteria were patients aged 15 - 60 years with MRI-confirmed unilateral ACL injury without concomitant knee ligament or soft tissue injuries (e.g., collateral ligaments, meniscus, posterior cruciate ligament, or cartilage), arthroscopically verified and reconstructed, having a Kellgren-Lawrence grade of knee osteoarthritis ≤1, and who provided informed consent to participate. Exclusion criteria included patients with MRI images blurry for measurement, a history of ACL reconstructive surgery, or an open ACL injury. Preoperative MRI images of affected knees and healthy knees were collected separately for the ACL injury group and the control group. In these MRI images, the most anterior point, the last point, and the midpoint of the Blumensaat line were defined as point C, point D, and point E, respectively. The turning point of the anterior margin and the posterior margin of the tibial plateau were defined as point A and point B, respectively. The intersection of the DC extension line and the AB line was defined as point C'. Based on these points, ∠DAB, ∠CEB, ∠DC'B, and ∠CDB were established. Analyzed the intraclass correlation coefficients to assess the reproducibility of measurement. Compared the differences between the above-mentioned angles and calculated the area under the receiver operating characteristic curve to evaluate the diagnostic efficacy. RESULTS:Sixty-three patients were evaluated, and 40 of them were included in the study. For ∠CDB, ∠DC'B, ∠CEB, and ∠DAB, the intra-group and inter-group intraclass correlation coefficients were all above 0.80, indicating good reproducibility. Compared to the control group, the ∠CDB, ∠CEB, and ∠DAB of the ACL injury group were decreased significantly (p < 0.001). ∠DAB may be an optimal indicator for diagnosing and evaluating ACL injuries, with an area under the curve of 0.825, a cutoff value of 42.2°, a sensitivity of 0.825, and a specificity of 0.800. CONCLUSION:The geometric triangle relationship between the Blumensaat line and the tibial plateau on MRI images, particularly ∠DAB, may serve as an auxiliary indicator for diagnosing and evaluating ACL injuries, thereby improving diagnostic accuracy.
Objective To investigate the current status of frailty in patients on maintenance hemodialysis(MHD),and explore the correlation of frailty with anxiety and depression.Methods General information,clinical data and blood biochemical data of 101 cases who underwent MHD in Department of Nephrology,Shunde Hospital Affiliated to Jinan University from January 2023 to January 2024 were collected.FRAIL scale was applied to evaluate the frailty of the patients,and they were accordingly classified into frailty group and non-frailty group(including pre-frail and non-frail participants).Anxiety and depression were evaluated by GAD-7 and PHQ-9 scale.Univariate analysis and logistic regression were used to explore the association of frailty with anxiety,depression and other possible influencing factors.Results Among the 101 cases,29 cases(28.71%)were includedin frailty group and 72 cases(71.29%)in non-frailty group.There were 42 patients with depression(41.58%)and 25 with anxiety(24.75%).In the frailty group,the prevalence of depression was 65.52%and that of anxiety 55.17%.There were significant differences in age,grip strength,exercise,stroke and coronary heart disease,anxiety and depression,ferritin and CRP between the two groups(P＜0.01).Multivariate regression analysis showed that depression,anxi-ety,no exercise,stroke and high ferritin concentration were independent risk factors for frailty in MHD patients(P＜0.05).Conclusion In patients on MHD,frailty is closely associated with depression,anxiety,and lack of exercise,and stroke as well as high ferritin concentration are independent risk factors for frailty.
乳腺癌是女性最常见的肿瘤相关死亡原因之一,占女性恶性肿瘤发病率的第1位,其发病率逐年上升、逐渐年轻化.淋巴结(LN)转移是评估乳腺癌患者复发和生存率最重要的预测指标,准确评估腋窝淋巴结是否受累是乳腺癌分期的重要组成部分.前哨淋巴结活检术(SLNB)和腋窝淋巴结清扫术(ALND)均是有创检查,存在并发症风险及穿刺假阴性率较高,因此无创性影像学检查方法预测腋窝淋巴结转移成为近年的研究热点.多模态磁共振较其他成像方式预测乳腺癌淋巴转移更具优势,如无辐射、软组织分辨率更高、可进行多参数及多序列成像,应用于鉴别良恶性乳腺病变、评估乳腺癌患者预后、预测淋巴结转移状态、评估新辅助化疗的疗效等.本文就多模态磁共振中各指数模型及峰度扩散成像预测乳腺癌腋窝淋巴结转移的研究进展进行综述.
目的 分析基于从头训练模式深度学习-卷积神经网络模型[the deep learning convolutional neural network model trained from scratch,DL-CNN(fs)]的人工智能算法评估急性肺动脉血栓栓塞(acute pulmonary thromboembolism,APE)的价值.方法 回顾性纳入214例可疑APE行CT肺动脉造影(CTPA)的住院患者,包括急性肺动脉血栓栓塞137例,阴性77例.放射科医师根据CTPA图像判断有无APE,并计算Qanadli评分、Mastora评分和其他CTPA参数.采用DL-CNN(fs)训练网络模型自动检测栓子的分布及容积.评估DL-CNN(fs)模型测量血栓分布的价值,计算血栓负荷与Qanadli评分、Mastora评分和其他CTPA参数的相关性.结果 DL-CNN(fs)测算的中心肺动脉栓子敏感度、特异度、感兴趣区曲线下面积(AUC)分别为100%、16.8%、0.584(95%CI,0.508～0.661);DL-CNN(fs)测算的外周肺动脉栓子敏感度、特异度、AUC均较高(R1-R9,60.8%～95.2%,67.9%～87.1%,0.740～0.844;L1-L10,64.6%～93.4%,62.7%～83.1%,0.732～0.791).DL-CNN(fs)测算的栓子体积与Qanadli score肺栓塞指数显著正相关(r = 0.867,P<0.001),与Mastora score肺栓塞指数显著正相关(r = 0.854,P<0.001),与右心室及左心室最大横径比、右心室及左心室最大面积比呈正相关(r = 0.549,0.559,P<0.01).结论 DL-CNN(fs)模型检测外周肺动脉栓子具有较高的价值,对中心肺动脉栓子诊断特异度有待进一步提高.DL-CNN(fs)模型自动提供APE患者的栓子体积,可以一定程度反映栓塞程度及右心功能,能够辅助医生对于APE患者血栓负荷及危险分层的快速评估.
目的 研究乳腺癌患者应用保留乳头乳晕的乳腺癌根治术后采用不同重建术的临床疗效及影响因素.方法 回顾性分析2010年3月至2022年3月上海交通大学乳腺癌数据库中进行保留乳头乳晕的乳房重建手术的患者1408例,根据重建手术方法将其分为一步法组(n = 876)和二步法组(n = 532),比较两组患者乳房外观美容效果、满意度、并发症、术后复发率及生存质量;再根据患者复发情况将其分为复发组(n = 162)和非复发组(n = 1246),多因素logistic回归分析患者术后复发的危险因素.结果 一步法组患者乳房外观优良率和术后满意度明显高于二步法组(P<0.05);两组患者的并发症发生率、局部复发率差异无统计学意义(P>0.05);术后六个月后两组患者的各项生命质量测定量表(FACT-B)评分均高于术前,并且一步法组患者的FACT-B评分均高于二步法组(P<0.05);复发组患者中年龄>35岁、浸润性非特殊型癌、未行内分泌治疗、未行放疗辅助治疗的比例明显高于非复发组(P<0.05);多因素logistic回归分析显示,年龄>35岁、浸润性非特殊型癌、未行放疗辅助治疗是影响患者术后复发的独立危险因素(P<0.05).结论 一步法重建术对乳腺癌根治术患者具有较高应用价值,值得临床广泛推广;年龄＞35岁、浸润性非特殊型癌、未行放疗辅助治疗是影响保留乳头乳晕的乳腺癌根治术患者复发的独立危险因素.
