BACKGROUND: The knee joint anatomical structure is susceptible to external forces, which can lead to functional break down, profoundly affecting the quality of life and daily functioning of individuals. OBJECTIVE: To investigate the effects of continuous nursing intervention on walking function, quality of life, and treatment satisfaction in patients undergoing unicondylar knee replacement. METHODS: This prospective study included 90 patients who underwent unicondylar knee arthroplasty due to unicondylar osteoarthritis. Participants were divided into two groups based on their nursing methods: the control group (n= 45) and the observation group (n= 45). RESULTS: Three months post-intervention, the observation group demonstrated significant improvements in knee joint range of motion, Hospital for Special Surgery Knee Score score, and Lysholm knee joint score compared to the control group (P< 0.05). The observation group also had a shorter completion time for the Timed Up and Go test and significantly higher SF-36 scores (P< 0.05 for both). Additionally, Knee Injury and Osteoarthritis Outcome Score scores in the observation group were significantly higher after three months of intervention (P< 0.05). And the observation group reported higher satisfaction rates and lower dissatisfaction rates compared to the control group (P< 0.05). CONCLUSION: Early postoperative rehabilitation guidance, regular reviews, and rehabilitation exercise guidance result in better rehabilitation outcomes, enhanced knee joint function, improved walking ability, and overall quality of life for patients undergoing unicondylar knee replacement.

The imaging signs which can accurately predict survival prognosis after standard treatment of high-grade glioma (HGG) are highly desirable. This study aims to explore the role of new enhancement beyond radiation field (NERF) in the survival prediction in patients with post-treatment HGG. The present study included 142 pathologically confirmed HGG patients who had received standard treatment. NERF, as well as other conventional MR findings and clinical variables, were included in univariate and multivariate analyses for evaluating their impactions on progression-free survival (PFS) and overall survival (OS). Univariate analysis showed that histological grade (p=0.008) and NERF (p=0.001) were the prognostic variables for poor PFS, whereas histological grade (p=0.017), NERF (p=0.001), and new subventricular zone enhancement (nSVZE) (p=0.001) were prognostic variables for poor OS. The multivariate analysis showed that NERF (HR 3.93; 95% CI 1.93–8.01; p=0.001) and nSVZE (HR 3.92; 95% CI 1.95–7.89; p=0.001) were the prognostic variables for poor OS. However, only nSVZE was (HR 3.29; 95% CI 2.04–5.28; p=0.001) the prognostic variable for poor PFS. When combining the NERF with the clinical and other MR variables, the highest AUC (0.924) and specificity (0.899) for predicting poor OS were achieved. The location of new developed enhancements relevant to high dose radiation field appears to be the main determinant of their prognostic value. Our results suggest that the new enhancement beyond radiation field can improve the survival prediction in patients with HGG after standard treatment.

目的 分析颅内高级别胶质瘤(HGG) MRI复发模式及其对患者生存影响,探讨此种模式对预后的影响.方法 回顾性分析经病理学证实及标准治疗的63例HGG(Ⅲ级29例,Ⅳ级34例),纵向MRI随访至少＞12个月,4例手术病理证实为复发.比较局部复发组和非局部复发组MRI征象差异,并评估其对生存的影响.局部复发定义为复发病灶位于残腔内或者距残腔20 mm以内.结果 中位随访时间为450天.局部复发41例(65.1％),非局部复发22例(34.9％).63例中位无进展生存期(PFS)为300天,中位总生存期(OS)为600天.局部复发患者的中位PFS为210天,非局部复发患者为330天(P =0.769),中位OS分别为540天、390天(P ＜0.001).早期(初次手术后2年内)和非早期(初次手术后2年以上)复发、快速(≤6个月)和缓慢(＞6个月)影像学进展与复发模式明显相关(P =0.018、P=0.017).Cox比例风险模型得出复发模式(HR:2.604)、复发早晚(HR:0.004)、影像学进展快慢(HR:0.330)、胶质瘤级别(HR:2.998)是影响OS的因素,强化模式(HR:0.122)、复发早晚(HR:0.022)是影响PFS的因素.结论 HGG复发以局部多见;局部复发者OS较长、但PFS较短;局部复发与早期复发、MRI影像快速进展相关.复发早、MRI影像进展快对OS有显著的负面影响.

目的:探讨异柠檬酸脱氢酶(IDH)突变表型与高级别胶质瘤(HGG)治疗后MRI表现及患者生存预后的相关性.方法:回顾性分析经手术病理证实的70例HGG患者的临床及术后MRI资料.其中,IDH突变型26例,IDH野生型44例.临床资料主要包括年龄、性别、肿瘤的组织病理学分级和部位.MRI扫描序列包括平扫T1 WI、T2 WI、T2-FLAIR和对比增强T1 WI,检查时间点包括术后72 h内、放疗前、放疗结束和术后6个月.分析术后6个月时的MRI资料,主要包括T2-FLAIR序列上高信号范围、残腔壁强化类型、远处新增强化灶(nDE)、新增室管膜下强化灶(nSVZE)及有无扩散受限灶;随后视有无新增强化灶和T2-FLAIR序列高信号灶而每隔1～3个月复查1次.70例HGG患者的术后随访时间为16～23个月(中位数为19个月).计算无进展生存期(PFS)和总生存期(OS)来评估患者的预后情况.统计学方法包括单因素和多因素方差分析、受试者工作特征曲线(ROC).结果:IDH野生型组的无进展生存期(PFS)及总生存期(OS)明显低于IDH突变型组(PFS中位数:10.0 vs.17.0个月;OS中位数:13.0 vs.22.5个月).IDH野生型组的nDE和nSVZE出现率均高于突变组(nDE:43.2％vs.23.1％;nSVZE:52.3％vs.26.9％),差异均有统计学意义(P=0.010、0.038);而两组间年龄、性别、病理级别、病变部位、残腔壁强化类型、T2-FLAIR序列上高信号灶及扩散受限灶出现率的差异均无统计学意义(P值均>0.05).70例中34例行DWI检查:IDH野生型中表现为扩散受限者(16/23,69.6％)多于突变型(5/11,45.5％),但差异无统计学意义(P=0.262).IDH基因表型联合年龄、组织病理学分级、nDE、nSVZE评估预后不良的ROC曲线下面积(AUC)为0.922,诊断效能优于其它单个因素及术后MRI形态学+临床因素的联合模型(ACU为0.583～0.885).结论:相对于IDH突变型,IDH野生型HGG在治疗后远处新增强化灶和新增室管膜下强化灶的出现率更高且预后不佳,结合IDH突变状态可改善MRI征象对HGG治疗后生存情况的评估效能.

异柠檬酸脱氢酶(IDH)不仅与高级别脑胶质瘤(HGG)的发生关系密切,对于其预后判断也具有重要作用.MR常规成像、功能成像及影像组学已越来越多地用于HGG的研究且证实多种MR征象与IDH基因表型有较好的相关性,但不同IDH基因表型的HGG的影像征象也有很大差异,据此可以对HGG进行IDH表型预测及预后评估.就不同IDH表型及影像特点与HGG病人预后关系的MRI研究进展进行综述.

患者 男,31岁.5天前无明显诱因出现头痛、头晕,间断发作,可自行缓解,伴行走不稳,无恶心呕吐、发热、抽搐. CT:右侧桥小脑角区可见一团块状肿物,大小3.6cm×3.3 cm,呈低及等混杂密度(图1),以低密度为主,CT值10～32 HU,病变前缘可见斑点状钙化,CT值217 HU,第四脑室及右侧桥小脑角池受压变窄.

病例资料 患者,女,25岁.发现右臀部肿物4个月.查体:右臀部距肛门约5 cm处触及一质韧肿物,无压痛及波动感;肛门指诊无异常;无其他异常体征.实验室检查:血小板增高(380×109/L).尿、便、胸片检查无明显异常.超声显示右臀下部不均匀团块状回声,疑似盆底疝.CT平扫:盆腔一巨大不均匀稍低密度肿物,CT值35 HU(图1),边界尚清,向下延伸至右侧臀部皮下,大小15.3cm×19.2cm×8.6cm,子宫受压向左上方移位,膀胱向前下方移位,直肠向左移位.MRI平扫:肿物呈T1WI低信号(图2),T2 WI呈不均匀高/低信号(图3),矢状面T2WI显示头端与骶骨相邻,尾端达臀部肌肉(图4),DWI为不均匀高低信号(图5).横轴面增强T1WI示平扫T1低信号、T2稍低信号区域强化(图6),肿物呈分层状强化(图7),MRI时间-信号曲线(time-to-intensity curve,TIC)呈缓升型(图8).

患者 女,3岁.发作性右侧肢体抽搐8月余.患者8个月前摔倒,左前额磕碰在电动车踏板,伤后诉肢体无力,不能行走,20 min后呕吐一次,为非喷射样呕吐,呕吐物为胃内容物,呕吐后不久出现右上肢及右下肢抽搐,家属诉其抽搐时意识清楚,抽搐持续10 min,自行缓解.15天前再次发生右侧肢体抽搐,持续10 min,期间意识清楚,无恶心呕吐,无口吐白沫,患者自发病以来精神较差,饮食及睡眠差,二便正常,体重稍减轻.常规实验室检查及胸片无异常.

患者 女,50岁.发现“子宫黏膜下肌瘤”4年,阴道流液2个月,下腹痛7天.精神、饮食及睡眠可,二便正常.专科体检:阴道通畅,黏膜无充血,官颈光滑,无举痛、摇摆痛.子宫体前位,增大如孕3个月大小,质硬,活动可,轻压痛,双附件区未及异常.实验室检查:尿常规示白细胞计数(354.6/μL)、红细胞计数(4674.5/μL)明显升高.胸片无明显异常.超声:子宫外形不规则,宫壁有数个低回声团,宫体中央及上部颈管内探及大小约9.6 cm×7.4 cm ×6.9 cm低回声区,双侧附件(-).

To explore the value of unmeasurable enhancement pattern of residual cavity in predicting survival at early stage after gross-total resection in high-grade glioma (HGG) patients.

患者 女,6个月.5天前抽搐,双手掌伸直,双眼发直,口唇发紫,持续约10 s后缓解,随后上述症状频繁发作,每天发作3～5次.双侧Babinski征阴性,双侧Chaddock征阴性,Kernig征阴性. 影像学检查.CT平扫:病变囊性部分为低密度,实性部分为等密度(图1).MRI平扫:右侧额顶颞岛叶-基底节区囊实性肿物,大小5.2cm×9.5 cm×7.5 cm;囊性部分呈长T1、长T2、低FLAIR信号,内见多个分隔;实性部分呈等T1、等T2、等FLAIR信号;中线结构左移约1 cm,脑干受压左移变形,右侧侧脑室变窄(图2～4).扩散加权成像(DWI):病变区实性部分呈不均匀等/稍低信号,指数化表观扩散系数(eADC)呈低信号(图5).增强扫描病变实性部分明显强化,主要见于其前外侧近脑膜处,大小6.0 cm ×4.0 cm,与脑膜呈宽基底相连;囊性区分隔及囊壁轻度强化(图6).