Methods to address metal artifacts in post-processed CT images – A do-it-yourself guide for orthopedic surgeons

Computed tomography (CT) scans are often used for postoperative imaging in orthopedics. In the presence of metallic hardware, artifacts are generated, which can hamper visualization of the CT images, and also render the study ineffective for 3-D printing. Various solutions are available to minimize metal artifacts, and radiologists can employ these before or after processing the CT study. However, the orthopedic surgeon may be faced with situations where the metal artifacts were not addressed. To counter such problems, we present three do-it-yourself (DIY) techniques that can be used to manage metal artifacts.     

套索回归模型在中医临床研究数据的统计应用与R语言实践

目的：构建简洁且易于解释的模型,为同类研究提高模型预测的准确率提供参考。方法：从国家自然科学基金项目在研课题(81673904)中选取200例肺纤维化合并心力衰竭患者心力衰竭分级与其可能的相关因素,运用套索回归从患者的“性别”“年龄”“体质量指数”“收缩压”“舒张压”“血清总胆固醇”“空腹血糖”“舌质颜色”“舌苔颜色”“中医体质”等自变量中筛选特征变量,构建回归模型以探讨其与心力衰竭严重程度之间的关系。结果：剔除高维数据中的混杂因素,筛选特征变量,模型中包含6个特征变量,体质量指数=0.006 357 091,收缩压=0.219 695 622,血清总胆固醇=0.229 324 833,舌色红=0.004 216 705,苔色薄白=-0.825 660 057,苔色黄厚=0.356 499 153。肺纤维化合并心力衰竭出现严重心力衰竭的概率为P=-33.632+0.006×BMI+0.220×SBP+0.229×TC+0.004×是否红舌-0.826×是否薄白苔+0.356×是否黄厚苔。结论：得到的模型可用以解释严重心力衰竭发病的相关因素并推广到总体中进行预测。套索回归模型适用于中医临床研究的高维数据分析,可能具有推广价值。     

3种抗肿瘤有毒蒙药的研究进展

随着社会发展和生活水平的提高,恶性肿瘤已经成为影响人类健康的重大疾病之一。有毒蒙药在治疗疾病及救治疑难杂症中具有重要作用。多种有毒蒙药有一定的抗肿瘤作用,且有着良好的治疗效果,但由于其本身的毒性,使其在临床上的应用受到很大的限制。蒙医在实践中不断摸索出有毒蒙药的多种减毒方法,如采用配伍、炮制等减毒手段进行处理,以达到降低毒性、提高疗效的作用。通过对3种代表性有毒蒙药斑蝥Mylabris、草乌Aconiti Kusnezoffii Radix、瑞香狼毒Stellerae Chamaejasmes Radix的抗肿瘤作用、毒性机制及减毒策略进行综述,为其临床用药及新药开发提供依据。     

人工骨和自体骨在复杂跟骨骨折异形钢板内固定术中的病例对照研究

目的 :比较人工骨与自体骨在复杂跟骨骨折异形钢板内固定术中的临床疗效。方法:自2015年4月至2019年4月收治60例复杂跟骨骨折患者行切开复位异形钢板内固定术治疗,按照植骨材料不同分为试验组和对照组,每组30例。试验组男21例,女9例;年龄18～71(36.85±7.42)岁;SandersⅢ型19例,SandersⅣ型11例;采用人工骨植入。对照组男23例,女7例,年龄20～69(37.26±7.38)岁;SandersⅢ型18例,SandersⅣ型12例;采用自体骨植入。比较两组患者手术时间、术中出血量、术后切口干燥时间、愈合时间及并发症情况,比较术前及术后3个月B?hler角及Gissane角变化情况,采用Maryland评分评价患足功能恢复情况。结果:两组患者术后均获得随访,时间3～15(10.15±2.67)个月。试验组手术时间、术中出血量分别为(89.32±12.43) min、(101.64±5.13) ml,对照组分别为(112.45±13.82) min、(119.01±5.26) ml,两组比较差异有统计学意义(P0.05);两组术后切口干燥时间、愈合时间、并发症比较差异无统计学意义(P0.05)。试验组术前、术后3个月B?hler角分别为(14.19±2.47)°、(34.52±4.41)°,对照组分别为(14.08±2.35)°、(33.67±4.36)°;试验组术前及术后3个月Gissane角分别为(90.16±6.43)°、(131.45±9.83)°,对照组分别为(90.11±6.37)°、(130.87±9.24)°;两组术后3个月B?hler角、Gissane角与术前比较差异有统计学意义(P0.05);但两组术后3个月B?hler角、Gissane角比较差异无统计学意义(P0.05)。末次随访时,两组Maryland评分各项目评分、总分及优良率比较差异无统计学意义(P0.05)。结论:在复杂跟骨骨折异形钢板内固定术中,采用人工骨和自体骨在促进骨折恢复方面效果相当,且术后切口干燥时间、愈合时间及并发症发生情况相近,但使用人工骨可减少术中出血量,缩短手术时间。     

补肾活血汤联合手法复位小夹板固定治疗老年肱骨近端骨折患者的临床效果

目的:探讨补肾活血汤联合手法复位小夹板固定治疗老年肱骨近端骨折患者的疗效及对肢体功能的影响。方法:选择2018年5月—2020年1月我院收治的老年肱骨近端骨折患者84例,随机分为对照组和观察组,各42例。对照组采用手法复位小夹板固定治疗,观察组在对照组基础上联合补肾活血汤治疗,治疗4周后对患者效果进行评估,比较两组骨折愈合效果、肢体功能、骨折愈合时间、视觉模拟疼痛(VAS)评分、肩关节评分系统Constant-Murley(C-M)评分及治疗预后。结果:治疗4周后,观察组的优良率为92.86%,高于对照组71.43%;观察组的旋前度(88.68±7.56)°、背伸度(89.41±2.43)°、桡偏角度(15.39±2.15)°、掌屈度(42.35±4.61)°及旋后度(80.45±5.98)°均大于对照组[旋前度(81.32±6.42)°、背伸度(68.98±2.35)°、桡偏角度(12.19±2.05)°、掌屈度(45.72±5.32)°及旋后度(84.36±6.01)°],差异有统计学意义(P<0.05);观察组治疗2周、4周后的VAS评分分别为(3.11±0.38)分、(1.09±0.21)分,骨折愈合时间为(6.49±0.63)周,均低(短)于对照组2周、4周的VAS评分[(4.59±0.43)分、(3.21±0.33)分]及骨折愈合时间[(9.64±0.81)],差异有统计学意义(P<0.05);观察组治疗4周后的畸形愈合、骨折不愈、股骨头坏死、感染及跛行发生率均低于对照组(P<0.05)。结论:补肾活血汤联合手法复位小夹板固定用于老年肱骨近端骨折患者中能提高骨折愈合率,改善患者肢体功能,缩短骨折愈合时间,减轻患者疼痛,改善预后,值得推广应用。     

Short-term multiorgan metabolic benefits of rapid weight loss after sleeve gastrectomy in severely obese patients

BackgroundSleeve gastrectomy (SG) has become the most prevalent bariatric-metabolic surgical approach in the United States. Its popularity among surgeons and patients is mainly due to a better safety profile and less overall morbidity, with broad benefits from a systemic and metabolic perspective.ObjectiveComprehensively describe the short-term multiorgan metabolic effects of rapid weight loss after SG.SettingAcademic hospital, United States.MethodsWe retrospectively reviewed the charts of patients that underwent SG at our institution between 2012 and 2016. We analyzed the required variables to calculate multiple risk scores, such as cardiovascular, hypertension, and diabetes risk scores. Furthermore, the renal and hepatic functions and the metabolic and hematologic profiles were assessed at 12 months of follow-up.ResultsA total of 1002 patients were included in the analysis. The percentage of excess body mass index loss was, on average, 65% at 12 months of follow-up. We observed a positive cardio-renal-hepatic improvement, demonstrated by a substantial reduction of the 10-year cardiovascular risk. We noticed an improvement of renal function, which was more significant in chronic kidney disease (stage ≥2), and a significant improvement on liver function tests (measured by decreased aspartate aminotransferase and alanine transaminase) at 12 months of follow-up. Our data also show a positive impact on decreasing the risk of developing hypertension and type 2 diabetes. There was a positive impact on the lipid profile, with the exception of low-density lipoprotein.ConclusionThere are significant short-term benefits on multiorgan metabolic parameters after rapid weight loss in severely obese patients undergoing sleeve gastrectomy.     

Pediatric Hand Injuries Requiring Closed Reduction at a Tertiary Pediatric Care Center

Background: Hand fractures and dislocations are common injuries in the pediatric population. This study aims to characterize the pediatric hand injuries that required closed reduction and identify those that required multiple reduction attempts. Methods: A retrospective cohort study was carried out in patients younger than 18 years of age with hand fractures or dislocations who underwent closed reduction in the emergency department (ED). Patients who ultimately required surgical reduction and fixation were not included. Results: Of the 310 hand injuries identified, 148 (114 fractures and 34 dislocations) underwent closed reduction in the ED; 7.4% of those required repeat reduction. Hand injuries that most often required repeat reduction included metacarpophalangeal joint dislocations (20.0%) and proximal phalanx neck (16.7%), metacarpal shaft (15.4%), metacarpal neck (6.2%), and proximal phalanx base (5.6%) fractures. No modifiable risk factors predicting the need for repeat reduction were identified. Conclusions: Some pediatric hand injuries are more likely to require repeat closed reduction by a hand surgeon. This retrospective study is the first step toward quality improvement as it provides opportunities for further research into the factors contributing to reductions that are unsuccessful at the first attempt. Identification of these factors and implementation of quality improvement measures are necessary to ensure the effective treatment of all pediatric hand injuries.     

跟骨骨折内骨缺损的三维重建与参数测量

目的 应用跟骨骨折CT影像资料建立跟骨内部骨缺损的数字化模型,并进行相关参数的测量,为术中是否需要植骨提供参考。方法 回顾性分析2013年至2019年于我院进行检查的62例（66足）跟骨骨折病人的CT影像资料,其中男54例,女8例,年龄为（49.0±12.7）岁（27~79岁）。应用Mimics软件进行三维重建、虚拟复位,还原跟骨外形,分离内部骨缺损,测量骨缺损的形态学参数,进而分析不同Sanders分型间骨缺损的差异。结果 本组病人跟骨骨折复位后,内部骨缺损体积为（2 419.69±1 371.26） mm3,高度为（17.52±7.53） mm,宽度为（18.56±6.12） mm,长度为（22.33±8.91） mm。左右侧比较,各测量参数之间的差异均无统计学意义（P均＞0.05）。不同Sanders分型间骨缺损测量值差异较大,Ⅲ型骨折和Ⅳ型骨折的体积、高度、宽度、长度均大于Ⅱ型骨折（P均＜0.05）;而Ⅲ型骨折和Ⅳ型骨折之间,各测量参数的差异均无统计学意义（P均＞0.05）。不同Sanders分型亚型间骨缺损差异不大,ⅡA型与ⅡB型仅在长度方面存在差异（P＜0.05）,Ⅲ型各亚型间骨缺损基本接近。结论 跟骨骨折复位后的骨缺损在不同Sanders分型间存在差异,而在各亚型之间,骨缺损大小接近,可以为术中是否需要植骨提供参考。