O ultrassom substituirá o estetoscópio?: relato de caso sobre ventilação monopulmonar neonatal

Background and objectivesOne‐lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position.Case reportWe present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound.ConclusionUS is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion.     

Family history and its association to curve size and treatment in 1,463 patients with idiopathic scoliosis

Purpose

To study family history in relation to curve severity, gender, age at diagnosis and treatment in idiopathic scoliosis.

Methods

A self-assessment questionnaire on family history of scoliosis was administered to 1,463 untreated, brace or surgically treated idiopathic scoliosis patients.

Results

Out of the 1,463 patients, 51 % had one or more relatives with scoliosis. There was no significant difference between females and males, nor between juvenile and adolescent study participants in this respect (p = 0.939 and 0.110, respectively). There was a significant difference in maximum curve size between patients with one or more relatives with scoliosis (median 35°, interquartile range 25) and patients without any relative with scoliosis (median 32°, interquartile range 23) (p = 0.022). When stratifying patients according to treatment (observation, brace treatment or surgery), we found that it was more common to have a relative with scoliosis among the treated patients (p = 0.011). The OR for being treated was 1.32 (95 % CI 1.06–1.64) when the patient had a relative with scoliosis, compared to not having.

Conclusions

Larger curve sizes were found in patients with a family history of scoliosis than in the ones without. No relation between family history and gender or between family history and age at onset of idiopathic scoliosis was found. Although the presence of a family history of scoliosis may not be a strong prognostic risk factor, it indicates that these patients are at higher risk of developing a more severe curve.     

Radiomics for classification of bone mineral loss: A machine learning study

PurposeThe purpose of this study was to develop predictive models to classify osteoporosis, osteopenia and normal patients using radiomics and machine learning approaches.Materials and methodsA total of 147 patients were included in this retrospective single-center study. There were 12 men and 135 women with a mean age of 56.88 ± 10.6 (SD) years (range: 28–87 years). For each patient, seven regions including four lumbar and three femoral including trochanteric, intertrochanteric and neck were segmented on bone mineral densitometry images and 54 texture features were extracted from the regions. The performance of four feature selection methods, including classifier attribute evaluation (CLAE), one rule attribute evaluation (ORAE), gain ratio attribute evaluation (GRAE) and principal components analysis (PRCA) along with four classification methods, including random forest (RF), random committee (RC), K-nearest neighbor (KN) and logit-boost (LB) were evaluated. Four classification categories, including osteopenia vs. normal, osteoporosis vs. normal, osteopenia vs. osteoporosis and osteoporosis + osteopenia vs. osteoporosis were examined for the defined seven regions. The classification model performances were evaluated using the area under the receiver operator characteristic curve (AUC).ResultsThe AUC values ranged from 0.50 to 0.78. The combination of methods RF + CLAE, RF + ORAE and RC + ORAE yielded highest performance (AUC = 0.78) in discriminating between osteoporosis and normal state in the trochanteric region. The combinations of RF + PRCA and LB + PRCA had the highest performance (AUC = 0.76) in discriminating between osteoporosis and normal state in the neck region.ConclusionThe machine learning radiomic approach can be considered as a new method for bone mineral deficiency disease classification using bone mineral densitometry image features.     

胸腹腔镜联合食管癌根治术学习曲线分析

目的 探讨胸腹腔镜联合食管癌根治术的学习曲线.方法 回顾性分析2010年4月至2011年12月由同一治疗组医师完成的144例胸腹腔镜联合食管癌根治术.按照手术日期先后顺序分为A、B、C、D4组,每组36例.比较各组患者的手术时间,术中出血量,淋巴结清扫个数,中转开放手术率,并发症率,住院时间及手术频度,分析不同阶段的手术效果.结果 4组患者在年龄、性别、肿瘤侵犯深度,肿瘤位置,中转开放手术率,并发症发生率及手术后住院时间等方面差异均无统计学意义(P＞0.05).A组手术时间为(339.1 ± 56.5)min,显著长于B组(240.7±58.2)min、C组(255.4±45.7) min和D组(269.9 ±45.4) min,P＜0.05.A组的术中失血量为(218.6±142.9)min,显著多于B组(106.4±76.0)min、C组(75.5 ±48.7) min和D组(100.5±91.9) min,P＜0.05.B、C、D三组间差异无统计学意义(P＞0.05).A组清扫淋巴结的个数为(10.6±5.6)个,显著少于B组(15.6±7.7)个、C组(18.3±6.9)个和D组(18.4±8.7)个,(P＜0.05).B、C、D三组间差异无统计学意义(P＞0.05).手术频度由A组的3.9例/月上升到B组的14.4例/月、C组的11.1例/月、D组的10.6例/月,并趋于稳定.结论 胸腹腔镜联合食管癌根治术学习曲线大约为36例.     

“一勾到底法”在腹腔镜胆囊切除术中预防并发症的应用体会(附173771例报告)

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中应用电剥离钩"一勾到底法"的应用价值。方法:回顾分析1992年2月至2012年2月为173 771例患者行LC的临床资料,其中133 606例术中采用以电剥离钩为主的"一勾到底法"(观察组),应用"勾、打、压、推、撕、割、挑"操作技巧。同期为40 165例患者行常规LC(对照组),观察"一勾到底法"在减少手术并发症、缩短手术时间等方面的效果。结果:观察组36例(0.0269%)发生手术并发症,175例(0.131%)中转开腹,无一例死亡;胆囊分离切除时间一般为5 min,术后住院3～5 d。对照组60例(0.149%)发生并发症,431例(1.073%)中转开腹,3例死亡。两组患者并发症发生率、中转开腹率差异有统计学意义(P<0.01)。结论:LC术中应用"一勾到底法"可明显减少手术并发症,缩短手术时间、麻醉时间,减少出血量,减轻患者痛苦,术后康复快,在胆囊切除与胆道外科领域充分发挥了微创手术的优势,值得推广。     

Principal component analysis of coagulation assays in severely injured children

Background

Trauma-induced coagulopathy is common and associated with poor outcome in injured children. Our aim is to identify patterns of coagulation dysregulation after injury and associate these phenotypes with relevant clinical outcomes.

Portal Setup: the Key Point in the Learning Curve for Hip Arthroscopy Technique

ObjectiveTo analyze the learning curve experience of hip arthroscopy based on patient demographics, surgical time, portal setup time, and postoperative complications and to find the key point in the learning curve.MethodsFrom May 2016 to February 2019, a prospective study on the learning curve experience of hip arthroscopy was performed in our hospital. We evaluated the first 50 consecutive hip arthroscopy procedures performed by a single surgeon. There were nine females and 41 males with a mean age of 30.8 years. We divide the patients into early group and late group according to the date of their operation, with each group including 25 patients. Data on patient demographics, types of procedure, surgical time, portal setup time, and postoperative complications were collected. Functional scores were assessed with the modified Harris Hip Score (mHHS).ResultsPatients were followed up for 16.4 months on average (range, 13–27 months). The early group of patients had a mean age of 35.2 years and the late group a mean age of 26.5 years. The most common procedures performed for the early group were debridement (17 patients, 68%), and in the late group, most patients underwent labral repair (18 patients, 72%). Mean total surgical time was 168 min for the early group and 143 min for the late group, and there was no statistically significant difference between two groups. The portal setup time in the early group and late group was 40.2 ± 12.4 min and 18.5 ± 6.2 min, respectively (P < 0.001), and the portal setup time was significantly longer in the early group. Further analysis of the learning curve of portal setup showed that the average portal setup time was not statistically significant changed after 30 cases. There were six complications including iatrogenic cartilage injury and iatrogenic labrum injury in the early group and five complications including perineal crush injury and nerve stretch injury in the late group. The functional score of patients in the late group was significantly higher than that in the early group during follow‐up.ConclusionThe steep learning curve of hip arthroscopy is mainly caused by the challenge of portal setup and portalrelated complications were more common in the early group than in the late group. Surgical time is not an effective indicator for evaluating progress on the learning curve of hip arthroscopy.     

Spinal decompensation in degenerative lumbar scoliosis

Due to the aging population, degenerative scoliosis is a growing clinical problem. It is associated with back pain and radicular symptoms. The pathogenesis of degenerative scoliosis lies in degenerative changes of the spinal structures, such as the intervertebral disc, the facet joints and the vertebrae itself. Possibly muscle weakness also plays a role. However, it is not clear what exactly causes the decompensation to occur and what determines the direction of the curve. It is known that in the normal spine a pre-existing rotation exists at the thoracic level, but not at the lumbar level. In this retrospective study we have investigated if a predominant curve pattern can be found in degenerative scoliosis and whether symptoms are predominantly present at one side relative to the curve direction. The lumbar curves of 88 patients with degenerative scoliosis were analyzed and symptoms were recorded. It was found that curve direction depended significantly on the apical level of the curve. The majority of curves with an apex above L2 were convex to the right, whereas curves with an apex below L2 were more frequently convex to the left. This would indicate that also in degenerative scoliosis the innate curvature and rotational pattern of the spine plays a role in the direction of the curve. Unilateral symptoms were not coupled to the curve direction. It is believed that the symptoms are related to local and more specific degenerative changes besides the scoliotic curve itself.     

Quantification of coronary arterial stenoses in CTA using fuzzy distance transform

Quantification of coronary arterial stenoses is useful for the diagnosis of several coronary heart diseases. Being noninvasive, economical and informative, computed tomographic angiography (CTA) has become a common modality for monitoring disease status and treatment effects. Here, we present a new method for detecting and quantifying coronary arterial stenosis in CTA using fuzzy distance transform (FDT) approach and a new coherence analysis of observed data for computing expected local diameter. FDT allows computing local depth at each image point in the presence of partial voluming and thus, eliminates the need for binarization, commonly, associated with inclusion of additional errors. In the current method, coronary arterial stenoses are detected and their severities are quantified by analyzing FDT values along the medial axis of an arterial tree obtained by its skeletonization. A new skeletal pruning algorithm has been developed toward improving the quality of medial axes and thereby, enhancing the accuracy of stenosis detection and quantification. Further, we have developed a new method to estimate “expected diameter” along a given arterial branch using a new coherence analysis of observed diameter values along the branch. The overall method is completed in the following steps - (1) fuzzy segmentation of coronary artery in CTA, (2) FDT computation of coronary arteries, (3) medial axis computation, (4) estimation of observed and expected diameters along arteries and (5) detection of stenoses and quantification of arterial blockage. The performance of this method has been quantitatively evaluated on a realistic coronary artery phantom dataset with randomly simulated stenoses and the results have been compared with a binary distance transform based and a conventional binary algorithm. The method has also been applied on a clinical CTA dataset from thirteen heart patients and the results have been compared with an expert's quantitative assessment of stenoses. Results of the phantom experiment indicate that the new method (error: 0.53%) is significantly more accurate as compared to both binary distance transform based (error 2.11%) and conventional binary (error 3.71%) methods. Also, the results of the clinical study indicate that the new FDT-based method (kappa coefficient = 87.9%) is highly in agreement with the expert's assessments and, in this respect, outperforms the other two methods (kappa coefficients = 75.2% and 69.5%).