Radiomics model based on preoperative gadoxetic acid-enhanced MRI for predicting liver failure

BACKGROUND Postoperative liver failure is the most severe complication in cirrhotic patients with hepatocellular carcinoma(HCC) after major hepatectomy. Current available clinical indexes predicting postoperative residual liver function are not sufficiently accurate.AIM To determine a radiomics model based on preoperative gadoxetic acid-enhanced magnetic resonance imaging for predicting liver failure in cirrhotic patients with HCC after major hepatectomy.METHODS For this retrospective study, a radiomics-based model was developed based on preoperative hepatobiliary phase gadoxetic acid-enhanced magnetic resonance images in 101 patients with HCC between June 2012 and June 2018. Sixty-one radiomic features were extracted from hepatobiliary phase images and selected by the least absolute shrinkage and selection operator method to construct a radiomics signature. A clinical prediction model, and radiomics-based model incorporating significant clinical indexes and radiomics signature were built using multivariable logistic regression analysis. The integrated radiomics-based model was presented as a radiomics nomogram. The performances of clinical prediction model, radiomics signature, and radiomics-based model for predicting post-operative liver failure were determined using receiver operating characteristics curve, calibration curve, and decision curve analyses.RESULTS Five radiomics features from hepatobiliary phase images were selected to construct the radiomics signature. The clinical prediction model, radiomics signature, and radiomics-based model incorporating indocyanine green clearance rate at 15 min and radiomics signature showed favorable performance for predicting postoperative liver failure(area under the curve: 0.809-0.894). The radiomics-based model achieved the highest performance for predicting liver failure(area under the curve: 0.894; 95%CI: 0.823-0.964). The integrated discrimination improvement analysis showed a significant improvement in the accuracy of liver failure prediction when radiomics signature was added to the clinical prediction model(integrated discrimination improvement = 0.117, P =0.002). The calibration curve and an insignificant Hosmer-Lemeshow test statistic(P = 0.841) demonstrated good calibration of the radiomics-based model. The decision curve analysis showed that patients would benefit more from a radiomics-based prediction model than from a clinical prediction model and radiomics signature alone.CONCLUSION A radiomics-based model of preoperative gadoxetic acid–enhanced MRI can be used to predict liver failure in cirrhotic patients with HCC after major hepatectomy.     

Treatment of An Acute Severe Cadmium Poisoning Patient Combined with Multiple Organ Dysfunction Syndromes by Integrated Chinese and Western Medicines: A Case Report

正Cadmium(Cd), a toxic heavy metal commonly found in the environment, can cause toxic reactions at a dose of 30 mg. Cd is absorbed into the body mainly through the respiratory tract, digestive tract,     

Effects of exogenous factors on spatial accuracy in neurosurgery

The study aimed to assess the effect of exogenous factors such as surgeon posture, surgical instrument length, fatigue after a night shift, exercise and caffeine consumption on the spatial accuracy of neurosurgical manipulations. For the evaluation and simulation of neurosurgical manipulations, a testing device developed by the authors was used. The experimental results were compared using nonparametric analysis (Wilcoxon test) and multivariate analysis, which was performed using mixed models. The results were considered statistically significant at p < 0.05. The study included 11 first-year neurosurgery residents who met the inclusion criteria. Hand support in the sitting position (Wilcoxon test p value = 0.0033), caffeine consumption (p = 0.0058) and the length of the microsurgical instrument (p = 0.0032) had statistically significant influences on the spatial accuracy of surgical manipulations (univariate analysis). The spatial accuracy did not significantly depend on the type of standing position (Wilcoxon test p value = 0.2860), whether the surgeon was standing/sitting (p = 0.1029), fatigue following a night shift (p = 0.3281), or physical exertion prior to surgery (p = 0.2845).When conducting the multivariate analysis, the spatial accuracy significantly depended on the test subject (p < 0.0001), the use of support during the test (p = 0.0001), and the length of the microsurgical instrument (p = 0.0397). To increase the spatial accuracy of microsurgical manipulations, hand support and shorter tools should be used. Caffeine consumption in high doses should also be avoided prior to surgery.     

急诊抗菌药物的使用调查与分析

目的考察了解急诊抗菌药物的使用情况。方法随机抽取2008年7—12月的急诊处方2700张，对其中抗菌药物的应用情况进行统计分析。结果急诊抗菌药物使用率49．1％，药物应用形式以单用为主（占66．3％）；给药途径以口服和静脉注射为主。不合理用药处方占抗菌药物处方的10．8％，分别在选药方案、给药方案、溶媒使用、联合应用等方面存在问题。结论我院急诊抗菌药物的应用基本合理，但仍存在一定问题，需进一步加强管理。     

针药并用治疗男性不育297例疗效分析

本文采用针刺加鹿茸精注射液穴位注射及中药治疗男性不育297例,痊愈142例,占47.8％,显效81例,占27.3％,有效53例,占17.8％,无效21例,占7.1％,三者联合运用效果较满意。     

肘关节后脱位并尺骨冠状突骨折9例临床疗效分析

目的 探讨肘关节后脱位并尺骨冠状突骨折的治疗方法。方法 总结2000年3月～2003年5月9例肘关节后脱位合并尺骨冠状突骨折患者的治疗经验，根据骨折类型分别采用内外侧入路对8例患者进行手术治疗，术后配合早期功能锻炼。结果 所有患者随访8～24个月，根据HSS评分标准，优5例（55.6%)，良2例（22.2%)，一般2例（22.2%)，优良率77.8%，无严重肘关节并发症发生。结论 选择恰当的手术入路和早期功能锻炼是提高该类骨折效果的关键。     

应用张力带固定法治疗锁骨远端骨折

目的：评价张力带固定法治疗锁骨远端骨折的临床效果。方法：对20例锁骨远端骨折行切开复位后张力带固定法治疗。术后随诊分析。结果：所有骨折均在半年内愈合。患侧肩关节功能恢复良好。无一例出现伤口感染。结论：张力带固定治疗锁骨远端骨折是一种简单可靠的手术方法。     

Anaesthesia for abdominal vascular surgery

Abdominal vascular surgery is required for aneurysmal and symptomatic occlusive disease of the aorta. Abdominal aortic aneurysms account for more than 8,500 deaths per year in England and Wales. Most deaths occur as a result of rupture of the abdominal aortic aneurysm, which has an overall mortality of 80%. These deaths are potentially preventable because elective repair of the abdominal aorta can be performed with an operative mortality of less than 7%. This article reviews the current indications and anaesthetic practices for open and endovascular abdominal aortic aneurysm repair.     

应用新型球囊Hyperglide或Hyperform辅助弹簧圈技术栓塞治疗颅内宽颈动脉瘤(附22例分析)

目的探讨采用新型MTI球囊重塑技术栓塞治疗颅内宽颈动脉瘤的可行性及有效性。方法总结22例26个宽颈动脉瘤的栓塞治疗经验。均采用新型球囊Hyperglide或Hyperform置于载瘤动脉处,同时将微导管置于动脉瘤内,充盈球囊以封闭瘤颈口后将合适的弹簧圈推送进入动脉瘤内,重复进行充盈球囊和填塞过程,直至动脉瘤致密填塞。结果19例23个动脉瘤成功填塞;1例前交通动脉瘤因血管迂曲致球囊不能到位而改用其他技术栓塞;另1例前交通动脉瘤因球囊选择不当,瘤颈封堵不完全,导致部分弹簧圈移位进入载瘤动脉;1例动脉瘤术中破裂出血,病人死亡。结论新型球囊重塑技术有助于达到宽颈动脉瘤致密、有效的栓塞。