Lung four dimensional computed tomography (4D-CT) is of great value in tumor target localization and precise cancer radiotherapy. However, it is hard to segment tumors in 4D-CT data manually, since the data may contain a great number of slices with tumor. Meanwhile, auto-segmentation does not certainly guarantee the accuracy due to the complexity of images. Therefore, a new automatic segmentation technique based on Graph Cuts with star shape prior was proposed to increase automation and guarantee the accuracy of segmentation in our laboratory. Firstly, an object seed was selected in the image of initial phase and an initial target block was formed centering the selected seed. Then, the full search block-matching algorithm was adopted to obtain the most similar target block in the next phase and compute the motion field between them, and so on. Afterwards, the center seeds of each phase were obtained according to the motion fields, which would be set to the center point of star shape prior. Finally, tumors could be automatically segmented with Graph Cuts algorithm and star shape prior. Both qualitative and quantitative evaluation results showed that our approach could not only guarantee the accuracy of segmentation but also increase automation, compared with the traditional Graph Cuts algorithm.
ObjectiveTo investigate the effectiveness of posterior minimally invasive approach for internal fixation of displaced scapula fractures. MethodsBetween January 2006 and December 2011,16 patients with scapular fractures underwent surgical fixation by a minimally invasive approach,including 11 cases of displaced glenoid fractures and 5 cases of unstable scapular neck/body fractures.There were 12 males and 4 females,aged 35-69 years (mean,53 years).The causes of injury were traffic accident in 10 cases,falling from height in 4 cases,and tumble in 2 cases.In 11 cases of displaced glenoid fractures,6 were rated as Ideberg type Ⅱ,2 as Ideberg type Ⅲ,1 as Ideberg type IV,and 2 as Ideberg type V,with a fracture displacement of more than 3 mm.In 5 cases of unstable scapular neck/body fractures,there were 3 cases of scapular neck fractures and 2 cases of scapular body fractures,with a fracture end angulation of more than 20°;3 cases had floating shoulder injury.The interval of injury and operation was 4-14 days (mean,6 days). ResultsThe mean operation time was 105.8 minutes;the mean intraoperative blood loss was 105.8 mL,and the mean hospitalization time was 17.6 days.Three patients had inflammation around the surgical incision,which was controlled by change dressing;primary healing of incision was obtained in the others.The patients were followed up 12-36 months (mean,24 months);all fractures healed within 12-19 weeks (mean,15.8 weeks).There was no implant failure or deep infection.Constant shoulder score,disability of the arm,shoulder,and hand (DASH) score,and visual analogue scale (VAS) score at post-operation had a significant improvement when compared with scores at pre-operation (P<0.05),but no significant difference was found between different time points at post-operation (P>0.05).Shoulder joint activities were gradually restored during the follow-up;the shoulder range of motion in elevation,abduction,internal rotation,and external rotation at 12 months after operation and last follow-up were significantly higher than those at 6 months after operation (P<0.05),but difference was not significant between at 12 months and last follow-up (P>0.05). ConclusionPosterior minimally invasive approach for internal fixation has good effectiveness in treating displaced scapula fractures,with the advantages of no need for a large subcutaneous flap and an extensive Judet incision or creation of muscular flaps.
ObjectiveTo study the survival rate and death cause of patients with polymyositis (PM) and dermatomyositis (DM). MethodsBased on the Bohan and Peter diagnosis standard, DM (n=52) and PM (n=98) hospitalized patients between January 1, 2008 and January 1, 2013 were chosen to be followed up to January 2013, or to their death. Sex, age, disease entities, course of the disease, muscle creatine enzyme, interstitial lung disease, connective tissue diseases, lung infection, cardiac involvement, respiratory muscle paralysis, JO-1 antibody, hypoalbuminemia, tumor, and long-term hormone and immune inhibitor treatment were the influencing factors of death. ResultsThirty-eight patients died during the follow-up period, and the 1-, 3- and 5-year survival rate were 87.7%, 74.5% and 55.9% respectively. Cox regression analysis showed that interstitial pneumonia (RR=12.119, P=0.001), heart disease (RR=2.935, P=0.020) and tumor (RR=3.735, P=0.048) were the unfavorable factors of death, while long-term hormones (RR=0.329, P=0.024) and persistent immunosuppressant therapy (RR=0.148, P=0.022) were protective factors. ConclusionThe five-year survival rate of patients with PM/DM is still low, and pulmonary interstitial disease, tumor, cardiac involvement, and pulmonary infection are the major dead causes, while long-team immunosuppression and hormone therapy can decrease the PM/DM mortality.
ObjectiveTo systematically review the clinical value of the contrast-enhanced ultrasonic in the diagnosis of breast tumors. MethodsWe electronically and comprehensively searched the databases including The Cochrane Library (Issue 2, 2013), PubMed, CNKI, WanFang Data, Chaoxing medalink, VIP, and CBM for clinical research reports of diagnosing breast cancer with Contrast-enhance ultrasonic (all from foundation to May 2013). Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies according to the QUADAS items. The Meta-DiSc software (version 1.4) was used to conduct pooling on sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. Heterogeneity test was performed and the summary receiver operating characteristic (SROC) curve was drawn for area under the curve (AUC). ResultsA total of 19 studies involving 1 161 participants were included. The results of meta-analysis showed that, specificity, the pooled sensitivity, positive likelihood ratio, negative likelihood ratio and DOR were 0.79 (95%CI 0.75 to 0.82), 0.86 (95%CI 0.83 to 0.89), 3.92 (95%CI 2.77 to 6.56), 0.18 (95%CI 0.13 to 0.26), and 25.86 (95%CI 13.77 to 48.55), respectively. The AUC of the SROC curve was 0.917 0. ConclusionThe current evidence shows that contrast-enhanced ultrasonic has high sensitivity and specificity in the diagnosis of preoperative benign and malignant breast mass, which indicates that it could be used as a good method to diagnosing breast tumors.
ObjectiveTo investigate the application value of totally laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS) using the anterior approach technique for hepatocellular carcinoma (HCC) with hepatitis B cirrhosis. MethodsIn September, 2014, a patient suffered cirrhotic hepatocellular carcinoma in the right liver scheduled for two-stage liver resection, in whom the future liver remnant (FLR) was considered too small (FLR/standard liver volume:29.1%, FLR/body wight:0.49%). In the first stage, using totally laparoscopic technique, a tourniquet was placed around the parenchymal transection line on the Cantlie's line via an anterior approach through retrohepatic tunnel for staged right hepatectomy, and the right portal vein was ligated. In the second stage, totally laparoscopic right hemihepatectomy was carried out on 10 days after the first-stage operation that achieved sufficient hypertrophy of the FLR. ResultsThe FLR on postoperative day 4 of the first stage increased from 301.48 to 496.45 mL (FLR/standard liver volume:47.9%, FLR/body wight:0.81%), with a 64.67% hypertrophy. And the FLR on postoperative day 8 of the first stage increased to 510.96 mL (FLR/standard liver volume:49.3%, FLR/body wight:0.84%), with a 69.48% hypertrophy. The remnant liver volume on postoperative day 5 of the second stage increased to 704.53 mL. The duration of the first stage was 180 min, intraoperative blood loss was 50 mL, and patient did not received a blood transfusion. The duration of the second stage was 220 min, intraoperative blood loss was 400 mL, and patient did not required a blood transfusion. No serious complications happened. The patient was discharged on 7 days after the second stage. ConclusionsAs a effective, safe, simple, and "non-touch" technique which provided a less aggressive modification of the ALPPS procedureto achieve oncological efficacy, the totally laparoscopic ALTPS using the anterior approach technique also could achieve sufficient hypertrophy of the FLR in several days. A proper expansion of the indications for the procedure is safe and feasible in HCC patients with cirrhosis.
ObjectiveTo analyze the causes of meniscal root tears (MRTs), and to review the progress in its diagnosis and therapy. MethodsThe published literature about MRTs was extensively reviewed and summarized. ResultsMRTs can be divided into acute traumatic injuries and chronic degenerative injuries; MRI examination is an effective way to diagnose according to meniscal extrusion, ghost sign, and meniscal root linear defects. Conservative treatments are mainly performed for chronic MRTs; partial meniscectomy can obtain predictable improvement in symptoms. Acute MRTs can be treated by arthroscopic meniscus repair and reconstruction which can effectively restore meniscal root anatomy and function, and knee joint degeneration can be postponed. ConclusionMRTs diagnosis relies on MRI, appropriate treatment plan should be made based on the specific circumstances of the patient after accurate diagnosis. Usually the satisfied short-term clinical results can be obtained, while the long-term results need more clinical evaluation.
ObjectiveTo establish the system of isolation, cultivation, and identification of the neural stem cells (NSCs) from subventricular zone (SVZ) of neonatal mice so as to seek for the appropriate seed cells for potential therapeutic interventions of neurological disorders. MethodsNSCs were isolated enzymatically and mechanically from SVZ of neonatal mice and cultured. The cellular morphology was observed by inverted microscopy. Immunocytochemical stainings of anti-Nestin and anti-SOX-2 were used to identify NSCs of passage 3. To study the differentiation of NSCs, NSCs were plated into 24-wells in the medium supplemented without epidermal growth factor (EGF) and basic fibroblastic growth factor (bFGF) for 3 or 7 days. To compare the differentiation and proliferation potential of NSCs with different cultivation time, the BrdU pulse-labeling method and MTT test were used. To identify neurons and astrocytes, the anti-β-tubulin Ⅲ (Tuj-1) and anti-glial fibrillary acidic protein (GFAP) staining were used. ResultsThe cells of the SVZ can be isolated and cultured in vitro, and these cells began to form neurospheres after cultured for 3 days at primary passage. While cultured for 7 days, these cells formed more neurospheres, and the volume of the neurospheres became bigger than neurospheres cultured for 3 days. In addition, after cultured for 7 days, the phenomena of fusion of neurospheres and adherent differentiation of neurospheres were observed under inverted microscope. These cells were provided with the typical phenotype of NSCs. The immunofluorescence staining results revealed that these cells showed positive immunoreactivity to Nestin and SOX-2. During the 4 hours BrdU pulse, the number of proliferated NSCs cultured for 3 days (75.817±2.961) was significantly higher than that of NSCs cultured for 7 days (56.600±4.881) (t=3.366, P=0.028). The results of MTT assay revealed that the absorbance (A) value of NSCs cultured for 3 days (0.478±0.025) was significantly higher than that of NSCs which were cultured for 7 days (0.366±0.032)(t=2.752, P=0.011). After cultivated without EGF and bFGF, the percentage of Tuj-1 and GFAP positive cells in NSCs was 23.1%±3.7% and 23.7%±3.8% for 3 days and was 40.1%±3.6% and 37.1%±4.5% for 7 days, respectively, all showing significant differences (t=3.285, P=0.030; t=3.930, P=0.017). ConclusionThe NSCs from SVZ of neonatal mice have potentials of self-renewal and multipotential differentiation in vitro. With different cultivation time, the potentials of proliferation and differentiation of NSCs are different.
Objective To analyze clinical outcome of the technique of comprehensive aortic root and valve reconstruction (CARVAR) applying in aortic valve and root disease. Methods We retrospectively analyzed the clinical data of 106 patients with aortic valve and root disease underwent CARVAR technique in our hospital from July 2012 to July 2015. There were 72 males and 34 females at the average age of 57.3 (11-67) years. We operated the CARVAR technique and analyzed the early and midterm clinical outcomes. Results There was no mortality and low cardiac output syndrome postoperatively. But there were 2 cases of renal insufficiency or failure and 1 case of infective endocarditis. The average ejection fraction was 54%. The mean area of aortic valve orifice was 2.2±0.8 cm2. The aortic valve pressure gradient was 11.2±2.3 mm Hg. There were 2 cases of mild aortic valve regurgitation. The result of operation was satisfying with a stable hemodynamics and few complications. The follow-up after surgery showed that there was no obvious abnormity in aortic valve and root. Conclusion Using CARVAR technique to cure aortic valve and root disease is an effective treatment and it can achieve satisfactory early and midterm clinical outcomes.
ObjectiveTo systematically review the complications and quality of life (QoL) in patients with esophageal cancer after esophagectomy using gastric tube. MethodsRandomized controlled trials (RCTs) about the postoperative complications and QoL of patients using gastric tube and the whole stomach reconstruction were electronically searched in PubMed, EMbase, The Cochrane Library, Web of Knowledge, CBM, CNKI, VIP and WanFang Data from inception to September 30th, 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 10 RCTs involving 1 085 patients were included. The results of meta-analysis showed that, in terms of postoperative complications, the incidences of reflux esophagitis (OR=0.19, 95%CI 0.12 to 0.32, P < 0.000 01) and intrathoracic stomach syndrome (OR=0.11, 95%CI 0.04 to 0.32, P < 0.000 1) with gastric tube were significantly lower than those of the whole stomach; in terms of QoL, the scores of QoL in the 6th month (MD=18.71, 95%CI 7.72 to 29.71, P=0.000 9) and in the 12th month (MD=22.95, 95%CI 8.21 to 37.69, P=0.002) with gastric tube were significantly higher than those of the whole stomach. In terms of satisfaction degree of QoL, the satisfaction degree of QoL in the 6th month (OR=1.78, 95%CI 1.10 to 2.88, P=0.02) and the 12th month (OR=2.73, 95%CI 1.67 to 4.47, P < 0.000 1) with gastric tube were both significantly higher than those of the whole stomach. ConclusionCompared with the whole stomach reconstruction, the method of gastric tube reconstruction has beneficial effects in reducing the incidences of postoperative complications (such as reflux esophagitis, intrathoracic stomach syndrome) and improves patients' QoL. But there are many uncertain factors about postoperative anastomotic complication and its influence on patients' long-term QoL remains uncertain. Thus, further studies should be conducted.
ObjectiveTo systematically evaluate the effects of closed drainage and simply closed drainage combined with pleurodesis in the treatment spontaneous pneumothorax. MethodsWe searched PubMed, Web of Science, The Cochrane Library, CBM, WanFang Data and CNKI from their inception to December 2nd, 2014, to collect randomized controlled trials (RCTs) of simple closed drainage versus closed drainage combined with pleurodesis in the treatment of spontaneous pneumothorax. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 5 RCTs including 499 patients were included. The results of meta-analysis showed that:Compared with the simple closed drainage, the closed drainage combined with pleurodesis was superior in the effective rate of recurrence spontaneous pneumothorax (OR=6.85, 95%CI 3.26 to 14.39, P<0.000 01) and the recurrence rate of primary spontaneous pneumothorax (OR=0.32, 95%CI 0.18 to 0.57, P<0.001). But there were no statistical differences in both groups in the effective rate of primary spontaneous pneumothorax (OR=1.49, 95%CI 0.71 to 3.14, P=0.29), the hospital stays of primary spontaneous pneumothorax (SMD=0.08, 95%CI -0.16 to 0.31, P=0.52), the hospital stays of recurrence spontaneous pneumothorax (SMD=-1.67, 95%CI -3.96 to 0.61, P=0.15), and the duration of drainage of primary spontaneous pneumothorax (SMD=-0.11, 95%CI 0.79 to 0.58, P=0.76). ConclusionCurrent evidence suggests that closed drainage combined with pleurodesis could improve the effective rate of recurrence spontaneous pneumothorax and decrease the recurrence rate of primary spontaneous pneumothorax. Due to limited quantity and quality of included studies, the above conclusion should be validated by more high quality studies.