Based on the guidelines of the diagnostic test systematic review, this study elaborated the statistical processing of the pooling of data detailed in the systematic review of diagnostic test, discussed the methods for identification and handling of the heterogeneity, evaluated the advantages and disadvantages of the index of the accuracy in diagnostic tests, and proposed the identification method of the publication bias. It also took the data from the published article entitled “Diagnostic Value of ProGRP and NSE for Small Cell Lung Cancer: A Meta-Analysis” as an example for analysis and illustration, which presented clearly the data processing and interpretation of the systematic review of diagnostic test, in order to provide references for clinical researchers to study and conduct the systematic review of diagnostic test.
Objective To explore the correlation between liver volume variation of posthepatitic cirrhosis patients and the severity of the disease. Methods One hundred and eleven patients with normal livers and 74 posthepatitic cirrhosis patients underwent volume CT scan. The relation between normal liver volume and body height, body weight and body surface area was studied by linear regression and correlation method, the standard liver volume equation was deduced. The change ratio of liver volume in cirrhotic patients was calculated and compared with Child classification. Results The mean normal liver volume of Chinese adults was （1 225.15±216.23） cm3, there was a positive correlation between liver volume and body height, body weight 〔liver volume (cm3)=12.712×body weight (kg)+450.44〕 and body surface area 〔liver volume (cm3)=876.02×body surface area (m2)-297.17〕. The mean liver volume of Child A, B and C patients were （1 077.77±347.01） cm3, (1 016.35±348.60) cm3 and (805.73±208.85) cm3 respectively. The liver volume and liver volume index was significantly smaller in Child C patients than those in Child A and B patients (P＜0.05); while liver volume change ratio was higher in Child C patients (P＜0.05). Conclusion Liver volume variation of cirrhotic patients can be quantitatively assessed by 16 slices helical CT volume measurement and standard liver volume equation. The change of the liver volume is correlated with the severity of liver cirrhosis.
Objective To study the value of the clinical application of stereography and measurement of liver volume in cirrhotic patients with portal hypertension. Methods By use of the personal computer and the software of threedimensional reconstruction and measurement system of liver faultage photograph, the liver volume in vivo was successfully measured and the threedimensional image of the liver rebuilt in 46 posthepatitic cirrhotics who were selected for orthotopic liver transplantation and in 30 noncirrhotic controls, and comparison with the reference volume of recipient liver was obtained by means of water deplacement after transplantation. Results The liver volume of cirrhotic patients with portal hypertension measured by software and water deplacement was (983.33±206.11) cm3, and (904.93±209.56) cm3 respectively. Comparison by means of linear regression analysis between volume measurement on threedimensional reconstruction software and reference volume showed a nearly ideal correlation coefficient(r=0.969,P＜0.01), the average error was 8.66%.The average of liver volume in controls was (1287.00±96.18) cm3, and was positively correlated to the height，weight and body surface area (r=0.845,0.833,0.932 respectively,P＜0.01)，and was different from that of cirrhotics. Liver volume of cirrhoitic patients with portal hypertension was related to their ChildPugh classification. The liver volume of patients in Child C group was significantly smaller than that of patients of Child B group, and was significantly correlated with Alb （r=0.496, P＜0.01） and TBIL（r=-0.493, P＜0.01）,PT(r=-0.517, P＜0.01), but was not significantly correlated with ALT（r=0.206，Pgt;0.05）,portal pressure（r=-0.093，P=0.539） and portosystemic shunt index (r=0.044，P=0.769). Conclusion The volume measurement of the liver by the threedimensional software is relatively accurate. Liver volume of cirrhotic patients with portal hypertension was significantly related to their liver function,and can reflect the liver reserve function.
Objective To investigate the use of intraoperative transit time flow measurement （TTFM） to accuratelyevaluate graft patency during sequential coronary artery bypass grafting （CABG）. Methods Clinical data of 131 patientsundergoing sequential off-pump coronary artery bypass grafting （OPCAB） with the great saphenous vein （with or without internal mammary artery） as graft vessels in Beijing Anzhen Hospital from April 2012 to January 2013 were retrospectivelyanalyzed. There were 92 male and 39 female patients with their age of 61.35±8.24 years. During the operation，2 methods were used to measure mean blood flow volume，pulsatility index （PI） and diastolic filling （DF） of the graft vessels. For thenon-blocking method，blood flow in graft vessels was maintained，and TTFM was applied 2 cm proximal to the anastomoticsite in graft vessels to record above parameters. For the blocking method，blood flow in graft vessels was temporally blockedby clipping distal graft vessels with an atraumatic bulldog clamp，and TTFM was applied 2 cm proximal to the anastomotic site in graft vessels to record above parameters. Results Blood flow volumes of the diagonal branch （27.43±15.22 ml/minvs. 59.28±30.13 ml/min），obtuse marginal branch （26.14±19.74 ml/min vs. 47.19±24.27 ml/min） and posterior left ventr-icular branch （19.16±8.92 ml/min vs. 38.83±20.11 ml/min） measured by the blocking method were significantly smallerthan those measured by the non-blocking method （P＜0.05） . PI values of the diagonal branch （2.93±1.30 vs. 2.31±0.91），obtuse marginal branch （2.62±1.17 vs. 2.01±0.87） and posterior left ventricular branch （2.33±0.92 vs. 1.80±0.73） meas-ured by the blocking method were significantly higher than those measured by the non-blocking method （P＜0.05）. There was no statistical difference in DF values measured by 2 methods at respective anastomotic sites，and all DF values were higher than 50%. Non-blocking method identified 1 anastomotic site and blocking method identified 3 anastomotic sites that were not patent，and these anastomotic sites became patent after graft reconstruction. Conclusion Blood flow velocity of sequential grafts is higher than that of single grafts，indicating that sequential grafts have the advantages of high blood flow volume and low risk of thrombosis. Blocking method can more accurately evaluate graft patency at the anastomotic sites and sensitively identify graft vessels that are not patent，which is helpful for anastomotic site reconstruction in time and enhancement of successful rate of CABG.
Objective To study the relation between competitive flow and graft flow in coronary artery bypass grafting. Methods Twelve adult healthy dogs （weighing 27. 62 ± 1. 63 kg） were anesthetized and received offpump coronary artery bypass grafting. During operation, flow meter was used to measure the degree of stenosis, and according to which four groups were classified. They were： non-stenosis group, 33% stenosis group, 50% stenosis group and 75 % stenosis group. Hemodynamic parameters including flow volume of graft, pulsatility indes （PI）, heart rate（HR） and mean arterial pressure（MAP） were recorded with or without competitive flow. Results When there was a competitive flow, the flow volume of graft in all four groups was less than the flow volume of graft which has not been affected by competitive flow. PI of non-stenosis group and 33% stenosis group was lower than normal PI. 50% stenosis group PI decreased from 8. 36±3. 52 to 3. 02±0. 94; 75% stenosis group PI was more than 5. Conclusion Competitive flow will restrain the graft flow. The position of graft anastomosis may be affected graft＇s patency.
Objective To analyze the mean flow in left internal m am mary artery ( L IMA) graft and the influencing factors in off- pump coronary artery bypass grafting ( OPCAB) in the Chinese. Methods One hundred and eighty patients with OPCAB were studied.Transit- tim e flowmeter( TTFM) was utilized to measure and record the L IMA’s blood flow wave,pulsatility index( PI) ,value of mean flow,systolic and diastolic peak flow,vascular resistance,insufficiency ratio and mean blood pressure and to analyze the relationship between mean flow of LIMA and other factors. Results Total mean flow calculated from that of all patients was2 8.19± 2 .89ml/ min( 6 - 178 ml/ m in) .Majority m ean value ( 6 4 .4 % ) was in the range of 10 - 30 ml/ min.Statistics showed that mean flow was significantly related to systolic and diastolic peak flow and vascular resistance rather than the other factors( r=0 .75 , 0 .94 ,- 0 .95 ) . Conclusions For the Chinese,over 10 ml/ min mean flow of L IMA graftis acceptable and ov...更多er 2 2 ml/ min is satisfactory.The diastolic peak flow and vascular resistance are two most important factors in influencing mean flow.
Objective To investigate and analyze the three-dimensional anatomic structure of glenoid bone in some Chinese people so as to provide the accurate anatomic data to design the new prosthesis of glenoid bone for Chinese people. Methods A total of 90 volunteers with two healthy shoulders (52 males and 38 females, aging 19-60 years with an average of 39.6 years) were selected. Five parameters were measured by use of three-dimensional computed tomography, volumerendering technique (VRT) and multiplanar reformation (MPR), including the maximum antero-posterior width (MAPW),antero-posterior radius of curvature (APROC), maximum supero-inferior height (MSIH), supero-inferior radius of curvature(SIROC) and version angle (VA) of glenoid. All parameters were measured two times, and the average values were analysed by SPSS13.0. The level of significance was set at P lt; 0.05. Results The average MAPW was (2.51 ± 0.32) cm, the average APROC was (5.50 ± 1.21) cm, the average MSIH was (3.45 ± 0.29) cm, the average SIROC was (3.98 ± 0.55) cm, and the average VA was (— 0.03 ± 4.66)°. There were no significant differences (P gt; 0.05) in MAPW, APROC, MSIH, SIROC and VA between two sides. There were significant differences (P lt; 0.05) in MAPW, MSIH, SIROC and VA, and no significant difference (P gt; 0.05) in APROC between female and male. MAPW was correlated with APROC, MAPW was correlated with MSIH, APROC was correlated with SIROC, and the correlation coefficient was 0.298, 0.495 and 0.262, respectively. Conclusion There are no significant differences in MAPW, APROC, MSIH, SIROC and VA of glenoid between two sides. There are sexual significant differences in MAPW, MSIH, SIROC and VA. The data and its statistical results may serve as guidel ines for the design of the glenoid component.
To study project of simpl icity and util ity for screw-plate system by pedicle of atlanto-axis mani pulatively hand by X-ray film and CT to prove the one success rate of putting screws. Methods Formulate personal program was used in operation by image save transmission of X-ray film and CT during January 2002 and September 2006 in 31 patients. There were 18 males and 13 femals, aged from 23 to 61 years old with an average age of 43.5 years. Putting screw points bypedicle of atlas were measured: left (19.93 ± 1.32) mm, right (19.16 ± 1.30) mm; putting screw obl iquity angle to inside by pedicle of atlas: left (23.72 ± 2.09)°, right (23.35 ± 1.91)°; putting screw obl iquity angle to side of head by pedicle of atlas: (9.00 ± 1.20)°. Screw points by pedicle of axis: left (13.14 ± 0.82) mm right (13.85 ± 0.79) mm; putting screw obl iquity angle to inside by pedicle of axis: left (24.52 ± 1.26)°, right (20.42 ± 1.42)°; putting screw obl iquity angle to side of head by pedicle of axis: (25.00 ± 3.00)°. The domestic location toward speculum was employed in operation and putting screw points and angles were formulated by X-CT program. The pedicle screws of suitable diameter and length were of exception and screws into pedicle of atlanto-axis were put by hand. Results Pain of the greater occipital nerve occurred in 2 patients after operation and was fully recovered by treatment 1 month after operation. The lateral cortical bone of pedicle was cut by 2 screws, but the spinal cord and vertebral artery were fine. The atlas and the fracture of odontoid process of axis were completely replaced in X-ray films of all patients 1 day after operation.The position relation of lag screw and vertebral artery or spinal cord was very good in CT sheets. All cases were followed up with an average of 10.5 months during 9 months to 5 years and 4 months, and obtained atlantoaxial arthrodesis. The breakage of screw and plate was not found in all cases. According to JOA score standard, 16 cases were excellent, 12 were good, 2 were fair, 1 was poor, and the excellent and good rate was 90.32% . Conclusion The personal design and cl inical appl ication of X-ray films and CT sheets are of great significance to screw-plate system by pedicle of atlanto-axis because of simpl ification of designs and methods and better personal ity.
To assess the rel iabil ity of diabetic cutaneous ulcer surface area (DCUSA) measurement usingdigital planimetry method (A) and transparency tracing method (B). Methods Images of diabetic cutaneous ulcers from35 inpatients with diabetic skin ulcers from September 2005 to April 2007 were taken by a digital camera once a week or twice a week over a period of 12 weeks, resulting in 305 photographs; the ulcers were traced on a grid with acetate wound tracings, simultaneously. A total of 305 pairs of DCUSA which were calculated respectively throughout digital camera combined with Image J medical imaging software and transparency tracing with grid sheet by two independent observers sequentially were obtained. The intraclass correlation coefficients (ICCs, one-way random effect model) was used as an indicator of chancecorrected agreement to estimate the relative rel iabil ity for the interobserver data. Multiple l inear regression analysis was also used to measure the relationship of these two methods. Results DCUSA obtained from method A and obtained from method B was (4.84 ± 7.73) cm2 and (5.03 ± 7.89) cm2, respectively; no significant difference was found (P gt; 0.05). ICCs was high (ICCs=0.949 for method B and 0.965 for method A), indicating that the relative rel iabil ity for the interobserver was excellent. The method A were highly correlated with measurements obtained from method B (r = 0.957, P lt; 0.05). Conclusion The digital planimetry method described in this study represents a simple, practical, without any wound damage and contamination, and inexpensive technique to accurately evaluate the areas of diabetic cutaneous ulcers. The photographic technique combined with Image J medical imaging software should be considered for wound measurement.
The experiment performed on domestic pig, was designed to investigate the architecture of the stretching skin and the effect of tension traction on the wound closure. An 7 cm x 3.5 cm was drawn at a standard position. Drawing horizontal and vertical lines on the traction area, points of 1 cm apart were tattooed on the lines. A traction force measuring device was used to draw the wound edges together. Measurements of the distances between the points were made. An 7 cm x 10 cm wound was made on identical sites of each hind leg. In the experiment the traction tension was applied on the edges of wound immediately after the wound debridement. The results showed the stretched distance in the two areas was 5-7 times the width of the wound. The gain of skin from traction was 61-89 percent in the width of the wound. The wounds from traction five days could be closed 5 days after traction. It was concluded that the skin which could be used for traction was abundant. Wound closure with the skin traction technique had many advantages, such as rapid decreasing the size of wound and early closing of wound.