应用锥形束CT对种植区牙槽骨质量分类方法的改良研究

目的    应用锥形束CT（cone beam CT，CBCT）测量种植区牙槽骨质量并结合Lekholm和Zarb分类法对骨质量分类方法进行改良，以期为提高牙槽骨质量分类的准确性提供指导。方法    选择2015年10月至2017年10月在呼和浩特市口腔医院种植科进行种植修复的196例患者术前CBCT影像资料，应用 Invivo5诊断设计软件测量306个种植位点的牙槽骨皮质骨厚度和松质骨密度（皮质骨与松质骨的CT值差值），以Lekholm和Zarb分类法为基础结合测量数据对骨质量进行改良后的量化分类。结果    牙槽骨皮质骨厚度为0.18 ~ 2.89 mm，中位数为0.92 mm。皮质骨与松质骨的CT值差值为88.5 ~ 667.8 HU，应用百分位数法找到33.3%和66.6%对应的数值分别为297.8 HU和356.1 HU。依据此数据结合Lekholm和Zarb分类法将196例患者的306个种植位点骨质量分为4类，其中Ⅰ类骨种植位点46个（占15.0%），Ⅱ类骨104个（占34.0%），Ⅲ类骨114个（占37.3%），Ⅳ类骨42个（占13.7%）。结论    结合Lekholm和Zarb分类法，应用CBCT测量种植区牙槽骨质量并进行分类方法的改良，可为临床医生术前评估牙槽骨质量提供一定参考。     

The oncogenic impact of RNF2 on cell proliferation,invasion and migration through EMT on mammary carcinoma

Mammary carcinoma (MC) is one of most common malignancy in women, and ring finger protein 2 (RNF2) possesses various roles in vast human tumors. In MC tissues as well as in cell lines RNF2 exhibited high expression, had significant association with tumor size, lymph node status, TNM stage, patients’ poor survival, and promoted cell proliferation, colony formation, cell migration and invasion of MC cell lines which was mediated by downregulation of E-cadherin protein. These data reveal that RNF2 protein plays a vital role in the development of MC and may be a potential therapy target of MC.     

肝细胞癌TACE术后病灶存活或复发18F-FDGPET/CT和增强CT诊断价值Meta分析

目的采用Meta分析方法评价¹⁸F-脱氧葡萄糖正电子发射计算机体层摄影(¹⁸F-FDG PET/CT)和增强CT(CECT)诊断经导管肝动脉化疗栓塞术(TACE)术后存活或复发病灶的临床价值。方法根据PRISMA报告规范开展Meta分析。检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方和维普数据库中¹⁸F-FDG PET/CT和CECT诊断TACE术后存活或复发病灶的临床研究,时间至2019-04。由2位研究人员独立筛选文献、提取资料,根据诊断准确性研究质量评价工具-2(QUADAS-2)评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析,计算其汇总敏感度(Sen)和特异度(Spe),绘制受试者工作特征曲线(SROC)并计算曲线下面积(AUC)。结果共纳入10篇¹⁸F-FDG PET/CT及13篇CECT诊断TACE术后存活或复发病灶的原始研究,分别包括322例患者的467个病灶和748例患者的943个病灶。Meta分析显示,¹⁸F-FDG PET/CT诊断TACE术后存活或复发病灶的Sen=0.92(95%CI为0.87~0.94)、Spe=0.95(95%CI为0.82~0.99)、AUC=0.97(95%CI为0.93~0.99);CECT诊断TACE术后存活或复发病灶的Sen=0.72(95%CI为0.66~0.78)、Spe=0.99(95%CI为0.93~1.00)、AUC=0.87(95%CI为0.83~0.89)。此外,CECT诊断TACE术后存活或复发Sen(Z=2.34,P=0.02)和AUC(Z=2.21,P=0.03)值低于¹⁸F-FDG PET/CT,差异有统计学意义。结论相比于CECT,¹⁸F-FDG PET/CT对TACE术后存活或复发病灶具有较高诊断效能,可视为TACE术后存活或复发病灶有效的影像学诊断方法。     

Comparison between conventional CT and grayscale inversion CT images in the assessment of the post-operative spinal orthopaedic implants

AimTo compare the accuracy of the inverted greyscale CT versus the conventional CT in the assessment of post-operative spinal orthopaedic implants and osseous fusion.Methods50 patients who had CT as part of their routine spinal implant follow up were evaluated for the presence of fusion, fracture and loosening with conventional CT and with greyscale inverted CT images. 3 independent observers assessed the images 2 months apart. Diagnostic performance (sensitivity and specificity) of the conventional and greyscale inversion images relative to the reference standard were calculated. Agreement with the reference standard was assessed using Cohen's kappa for conventional and greyscale inversion images.ResultsCorrect classifications increased when using the greyscale inverted CT images for each reader compared to conventional CT images (40–46, 39 to 42 and 41 to 44 (out of 50)). Inverted images demonstrated better agreement with the reference standard than conventional grayscale images for assessment of fusion (kappa of 0.588 for inverted CT versus 0.484 for conventional CT) and loosening (kappa 0.386 for inverted versus 0.293 for conventional). Sensitivity was increased for assessment of fusion and loosening. McNemar's test performed for assessment of sensitivity differences showed statistical significance (p = 0.038 for fusion and p = 0.0313 for loosening).ConclusionGreyscale inversion CT is a useful adjunct which has advantages (improved sensitivity and better agreement) over conventional CT imaging in cases of fusion and loosening of metallic implants following spinal instrumentation. We recommend the use of both the greyscale inversion CT images and conventional CT imaging when assessing post-operative spinal orthopaedic implants.     

A comprehensive 3D CT based classification of intertrochanteric fracture

IntroductionDespite advancements in surgical techniques complications like implant failure is very common after the fixation of intertrochanteric fractures. Classifying these complex fractures based on plain radiographs underestimates the complexity of these fractures which in turn leads to complications. We propose a comprehensive classification of the intertrochanteric fractures based on 3D Non Contrast Computed Tomography (3D NCCT) scan.Material and methodsA total of 102 patients (51 males and 51 females) with intertrochanteric fractures were included in this study conducted over a time period of 22 months in a Tertiary care center in North India. NCCT proximal femur of the intertrochanteric fracture patients was done to formulate a new CT classification system and classify all fractures. Intra and inter-observer reliability was tested using kappa variance.ResultsNew classification system was proposed which included 3 main and a total of 6 groups. All the fractures were classifiable into the new system. Kappa variance of the study showed a good intra and interobserver reliability (0.95 and 0.90) proving clinical agreement of the classification.ConclusionThis new 3D-CT based classification has the advantages of being easy, comprehensible with high intra and inter-observer reliability. This 3DCT based classification can prove to be useful to detect occult intertrochanteric fractures undetectable in plain radiographs as well as choosing the optimum treatment plan.     

Derivation of internal dose-based thresholds of toxicological concern for occupational inhalation exposure to systemically acting organic chemicals

This study aimed at deriving occupational thresholds of toxicological concern for inhalation exposure to systemically-acting organic chemicals using predicted internal doses. The latter were also used to evaluate the quantitative relationship between occupational exposure limit and internal dose. Three internal dose measures were identified for investigation: (i) the daily area under the venous blood concentration vs. time curve, (ii) the daily rate of the amount of parent chemical metabolized, and (iii) the maximum venous blood concentration at the end of an 8-hr work shift. A dataset of 276 organic chemicals with 8-hr threshold limit values-time-weighted average was compiled along with their molecular structure and Cramer classes (Class I: low toxicity, Class II: intermediate toxicity, Class III: suggestive of significant toxicity). Using a human physiologically-based pharmacokinetic model, the three identified dose metrics were predicted for an 8-hr occupational inhalation exposure to the threshold limit value for each chemical. Distributional analyses of the predicted dose metrics were performed to identify the percentile values corresponding to the occupational thresholds of toxicological concern. Also, simple linear regression analyses were performed to evaluate the relationship between the 8-hr threshold limit value and each of the predicted dose metrics, respectively. No threshold of toxicological concern could be derived for class II due to few chemicals. Based on the daily rate of the amount of parent chemical metabolized, the proposed internal dose-based occupational thresholds of toxicological concern were 5.61?×?10^?2 and 9?×?10^?4 mmol/d at the 10th percentile level for classes I and III, respectively, while they were 4.55?×?10^?1 and 8.5?×?10^?3 mmol/d at the 25th percentile level. Even though high and significant correlations were observed between the 8-hr threshold limit values and the predicted dose metrics, the one with the rate of the amount of chemical metabolized was remarkable regardless of the Cramer class (r² = 0.81; n = 276). The proposed internal dose-based occupational thresholds of toxicological concern are potentially useful for screening-level assessments as well as prioritization within an integrated occupational risk assessment framework.     

磁共振结合高分辨率CT在中耳乳突炎患者术前评估中的临床应用

目的探讨磁共振结合高分辨率CT在中耳乳突炎患者术前评估中的临床应用。方法选取我院2018年11月~2020年12月接收患有中耳乳突炎的患者40例为研究对象,所有患者均采用磁共振以及高分辨率CT进行诊断检查,比较两组患者诊断后手术特征显示度。结果诊断后,磁共振联合高分辨率CT检查图像显示度高于单独使用磁共振或高分辨率CT诊断(P<0.05)。结论使用磁共振结合高分辨率CT对中耳乳突炎患者进行术前评估,显示度较高,提高诊断准确度,值得推广。     

基于肿瘤影像学异质性分析CT在诊断十二指肠恶性肿瘤的价值

目的 探讨十二指肠肿瘤血流量存在的异质性及容积灌注CT成像对降低肿瘤异质性的影响。方法 纳入我院2013年1月至2014年11月十二指肠结节病例的132例,其中腺癌48例,间质瘤52例,淋巴瘤32例。所有的病例均行单层面灌注CT和容积灌注CT成像扫描,比较两者对十二指肠恶性肿瘤的诊断效能,采用变异系数评价两者在影像学异质性的差异,评价肿瘤影像学异质性对十二指肠恶性肿瘤的影响。结果 容积灌注CT成像与单层面灌注CT诊断恶性结节的效能其敏感性、特异性、准确性、阴性预测值、阳性预测值比较均无明显差别(P0.05);中高分化组及低分化组两个亚组的容积灌注CT成像的变异系数也均小于单层面灌注CT的变异系数,组间相比具有统计学差异(P0.05);血流量差异性的大小相比具有统计学差异(P0.05)。结论 容积灌注CT成像与单层面灌注CT检查在诊断效能上无明显差异,稳定性好,肿瘤影像学异质性对评价十二指肠肿瘤血流量有着一定影响,容积灌注CT成像能够降低肿瘤异质性的影响。