ObjectiveTo three-dimensionally calculate the craniofacial parameters of midface of patients with Treacher Collins syndrome (TCS) in China, in order to understand the changes in the spatial position relationship between the various anatomical structures of the midface.MethodsCT imaging data of TCS patients and age- and gender-matched normal populations between January 2013 and July 2020 was retrospectively analyzed. A total of 33 cases met the selection criteria for inclusion in the study, including 14 cases in the TCS group and 19 cases in the control group. ProPlan CMF 3.0 software was used to perform three-dimensional digital reconstruction of the craniofacial bone, measure the anatomical parameters of the midface, and analyze its morphological structure; at the same time perform three-dimensional digital reconstruction of the upper airway for morphological analysis (measure upper airway volume).ResultsCT images analysis revealed that all 14 patients with TCS presented the typical features with downward slanting of the palpebral fissures and different degrees of zygomatico-orbital complex dysplasia. Cephalometric and morphological analysis of the midface revealed that, multiple transverse diameters of the midface of TCS patients were significantly decreased when compared with the control group (P<0.05), such as the width of the maxillary base, the length of the maxillary complex, and some distances related to the nasal morphology; but the distance between bilateral orbitales increased in TCS group (P<0.05). Several anteroposterior distances in TCS group were decreased significantly when compared to control group and the distance between the skull base point and the posterior nasal spine was the most shortened (P<0.05). But there was no significant difference of the distance between nasion and anterior nasal spine, which represented anterior midface height, between groups (P>0.05). The skull base angle and SNB angle (the angle between the sella point-nose root point-inferior alveolar seat point) of the TCS group both decreased when compared with the control group (P<0.05), but there was no significant difference in SNA angle (the angle between the sella point-nose root point-upper alveolar seat point) between the two groups (P>0.05). The total volume of the upper airway was (24 621.07±8 476.63) mm3 in the TCS group, which was significantly lower than that of the control group [(32 864.21±13 148.74) mm3] (t=2.185, P=0.037).ConclusionThe transverse distances, anteroposterior distances, and multiple craniofacial angles measurement of TCS patients were significantly decreased when compared to the control group, presented with different degrees of zygomatico-orbital complex dysplasia, nasal and maxillary dysplasia, but there was no obvious restriction in face height development. Reduced internal diameters of the upper airway maybe responsible for the decreased upper airway volume of patients with TCS.
In order to conduct surface monitoring of the three-dimensional spine morphology of the human body in daily life, a spine morphology measuring method using "single camera, multi-view" to construct stereo vision is proposed. The images of the back of the human body with landmarks of spinous process are captured from multiple angles by moving a single camera, and based on the "Zhang Zhengyou calibration method" and the triangulation principle of binocular stereo vision, the spatial conversion matrices corresponding to each other between all images and the 3D coordinates of the landmarks are calculated. Then the spine evaluation angle used to evaluate the spine morphology is further calculated. The tests’ results showed that the spine evaluation angle error of this method is within ±3°, and the correlation between the results and the X-ray film Cobb angles is 0.871. The visual detection algorithm used in this paper is non-radioactive, and because only one camera is used in the measurement process and there is no need to pre-set the camera's shooting pose, the operation is simple. The research results of this article can be used in a mobile phone-based intelligent detection system, which will be suitable for the group survey of scoliosis in communities, schools, families and other occasions, as well as for the long-term follow-up of confirmed patients. This will provide a reference for doctors to diagnose the condition, predict the development trend of the condition, and formulate treatment plans.
ObjectiveTo explore the effect of false acetabulum on the development and anatomical morphology of proximal femur in Crowe type Ⅳ developmental dysplasia of the hip (DDH), providing a theoretical basis for the development of femoral reconstruction strategy and prosthesis selection for total hip arthroplasty. Methods The medical records of 47 patients (54 hips) with Crowe type Ⅳ DDH between February 2008 and March 2020 were retrospectively analyzed, of which 21 patients (26 hips) were Crowe type Ⅳa (type Ⅳa group) and 26 patients (28 hips) were Crowe type Ⅳb (type Ⅳb group). There was no significant difference in general data such as gender, age, height, weight, body mass index, and side between the two groups (P>0.05), which were comparable. The height of femoral head dislocation, the height of pelvis, and the proportion of dislocation were measured based on preoperative anteroposterior pelvic X-ray film. Based on the preoperative femoral CT scan data, the anatomical parameters of the femur and femoral medullary cavity were measured after three-dimensional reconstruction using Mimics19.0 software to calculate the canal fare index; and the femoral medullary cavity parameters were matched with the modular S-ROM prosthesis parameters. ResultsThe results of X-ray film measurement showed that the height of femoral head dislocation and the proportion of dislocation in type Ⅳa group were significantly higher than those in type Ⅳb group (P<0.05). There was no significant difference in the height of pelvis between the two groups (P>0.05). The results of CT three-dimensional reconstruction measurements showed that compared with the type Ⅳb group, the type Ⅳa group had less isthmus height, smaller femoral head, shorter femoral neck, narrower neck-shaft angle, increased anteversion angle, and higher greater trochanter, and the differences were significant (P<0.05). There was no significant difference in the height of femoral head, femoral offset, and height difference between greater trochanter and femoral head between the two groups (P>0.05). There was no significant difference in the mediolateral width (ML), anteroposterior width (AP), and diameter of the isthmus (Ci level) and the AP of the medullary cavity in the plane 40 mm distal to the most prominent point on the medial side of the lesser trochanter (C–40 level) (P>0.05), and the size of medullary cavity was significantly smaller in type Ⅳa group than in type Ⅳb group at the other levels (P<0.05). Compared with the type Ⅳb group, the difference between the outer diameter of the prosthetic sleeve and the diameter of the medullary cavity fitting circle in the plane where the center of femoral head rotation was located from the medial most prominent point of the lesser trochanter (C0 level) in type Ⅳa group was smaller, and the proportion of negative values was greater (P<0.05). The difference between the longest diameter of the prosthetic sleeve triangle and the ML of the medullary cavity in the plane 10 mm proximal to the most prominent point on the medial side of the lesser trochanter (C+10 level) in type Ⅳa group was smaller, and the proportion of negative values was greater (P<0.05). ConclusionFalse acetabulum has a significant impact on the morphology of the proximal femur and medullary cavity in patients with Crowe type Ⅳ DDH, and the application of three-dimensional reconstruction technique can accurately evaluate the femoral morphology and guide the selection of femoral prosthesis.
In order to investigate the histological and stereological change of the rapidly expanded skin tube, 15 Japanese Long Ear Rabbits were divided into 3 groups: (1) Rapid expansion group, injecting once a day for 7 days; (2) Routine expansion group, injecting every 3 days for 21 days and (3) Control group, no expander implanted. The results showed that: in the rapid expansion group, the thickness of the epidermis and dermis were both increased, fibroblast proliferation was active, a large amount of new capillaries was observed, the collagen fiber was in loose type, and the mitochondria and rough endoplasmic net of epithelial cell were increased. In the routine expansion group, similar changes were observed. The vascular density and volume fraction were significantly higher in rapid expansion group than those in the control group (P lt; 0.05). It was concluded that the rapid expansion of skin tube was feasible.
ObjectiveTo assess outcomes of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation.MethodsA total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed. There were 83 males and 46 females with an average age of 72.26±8.97 years. The patients were divided into a pure native aortic valve regurgitation group (17 patients) and an aortic valve stenosis group (112 patients).ResultsThe incidence of valve in valve was higher in the pure native aortic valve regurgitation group (47.0% vs. 16.1%, P<0.01). There was no statistical difference between the two groups in conversion to surgery, intraoperative use of extracorporeal circulation, intraoperative left ventricular rupture, postoperative use of extracorporeal membrane oxygenation (ECMO), peripheral vascular complications, disabled stroke, death, or pacemaker implantation. There was no statistical difference in the diameter of annulus (25.75±2.21 mm vs. 24.70±2.90 mm, P=0.068) or diameter of outflow tract (25.82±3.75 mm vs. 25.37±3.92 mm, P=0.514) between the pure native aortic valve regurgitation group and the aortic valve stenosis group.ConclusionTransfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation. The diameter of annulus plane, the diameter of outflow tract and the shape of outflow tract should be evaluated.
【Abstract】 Objective To explore the methods and appl ication value of surface shaded display (SSD) and multiplanarreconstruction (MPR) in the evaluation of acetabular morphology in patients with developmental dysplasia of the hip (DDH) before total hip arthroplasty (THA). Methods From October 2003 to November 2006, 17 patients (3 males and 14 females, aging from 35 years to 61 years) with osteoarthritis secondary to DDH were scanned with spiral CT preoperatively. According to the Crowe standard, 19 dysplasia hips were classified as type I in 4 hips, type II in 9 hips, type III in 6 hips. The obtained hip CT data were developed with SSD and MPR to observe spational position and bone stock of the acetabula. Results The dislocated extent was 25%-89% in these dysplasia hips according to the Crowe method and their sharp angles all exceeded 45°. Bone defect occurred to each of the acetabula, among which it was located in anterosuperior acetabulum in 5 hips, in superolateral acetabulum in 11 hips and in posterosuperior acetabulum in 3 hips. The hip images made with MPR showed that the minimum thickness of the medial wall of acetabula ranged from 2.0 mm to 10.9 mm. Among 15 unilateral dysplasia patients, the opening difference anddepth difference between the dysplasia acetabulum and the contralateral one ranged from 2.7 mm to 19.1 mm and from 2.3 mm to 13.1 mm, respectively. Conclusion SSD and MPR of spiral CT are effective methods in evaluating acetabular morphology preoperation and contribute to intraoperative acetabular reconstruction in patients with DDH performed THA.
ObjectiveTo explore the clinical diagnosis and treatment of Talaromyces marneffei (TM) infection by bone marrow examination, and to clarify the important role and significance of bone marrow smear and pathogenic examination.MethodsRetrospective analysis was conducted on a case of disseminated TM infection that was clearly diagnosed through bone marrow related examination. Literature review of TM infection was conducted by retrieving relevant case reports at home and abroad from 1990 to 2018.ResultsThe patient was a 23-year-old man with recurrent cough and onset of fever, superficial lymph node enlargement in multiple parts of the body, no abnormal chest CT sign, and poor efficacy in anti-infection treatment. The patient developed progressive abdominal pain, accompanied by systemic papulosis, decreased consciousness, and progressive decline of blood cells. The patient underwent bone marrow puncture surgery in our hospital, and developed circulatory and respiratory failure half an hour after surgery. TM was confirmed bybone marrow smear and pathogenic culture. In the literature review, 2 855 cases of TM infection were retrieved, among which the majority of cases were confirmed through blood and bone marrow related examination. The positive rate of bone marrow culture was significantly higher than that of blood culture (72.4% and 66.8%, respectively, P=0.007). Compared with bone marrow culture, the misdiagnosis and missed diagnosis rate of bone marrow smear microscopy was 27.6%. Patients diagnosed with TM infection by bone marrow examination had the highest HIV positive rate (95.7%).ConclusionsThe examination of bone marrow cells and the culture are of great clinical significance for the diagnosis of TM infection. TM infection should be identified in patients suspected of HIV positive with fever, lymph node enlargement and abnormal blood routine.
ObjectiveTo investigate the morphology of coronal femoral intertrochanteric fracture and its effect on reduction and internal fixation.MethodsThe clinical and imaging data of 46 patients with femoral intertrochanteric fracture who met the selection criteria between August 2017 and October 2018 were reviewed. There were 15 males and 31 females; the age ranged from 62 to 91 years, with an average of 72.8 years. The causes of injury included walking falls in 35 cases, falling out of bed in 4 cases, and traffic accidents in 7 cases. The AO/Orthopaedic Trauma Association classification was type 31-A1 in 11 cases and type 31-A2 in 35 cases. All patients underwent closed reduction and internal fixation with intramedullary nails. During the operation, fracture reduction and fixation were performed according to the preoperative evaluation results. According to the patients’ preoperative X-ray film and CT three-dimensional reconstruction images, the direction of the coronal fracture line of the femoral intertrochanter and the morphological characteristics of the fracture block were observed; and the coronal fracture discrimination analysis was carried out for the fractures of different AO/OTA types. The percentages of coronal femoral intertrochanteric fractures diagnosed by preoperative X-ray film and CT three-dimensional reconstruction were calculated and statistically analyzed. The fracture reduction, the position of internal fixation [measurement of tip-apex distance (TAD)]. and the reliability of internal fixation were observed after operation.ResultsX-ray film was not easy to identify coronary fracture, and the coronal fracture line and the shape of the fracture piece weree clearly visible in CT three-dimensional reconstruction images. The morphological characteristics of the coronary fracture block: in AO/OTA 31-A1 type, the fracture line extended obliquely backward from the anterior tip of the large rotor, above the small rotor with or without small rotor fracture; in AO/OTA 31-A2 type, fracture line extended obliquely backward from the anterior tip of the large rotor to below the small rotor. Thirteen cases (28.3%) of coronal fractures were found on preoperative X-ray films, and 35 cases (76.1%) were found by CT three-dimensional reconstruction, showing significant difference (χ2=21.083, P=0.000). In AO/OTA 31-A1 type patients, the proportion of coronal fractures found by X-ray film and CT three-dimensional reconstruction was 18.2% (2/11) and 54.5% (6/11), respectively, and that in AO/OTA 31-A2 type patients was 31.4% (11/35) and 82.9% (29/35), respectively, showing significant differences (χ2=3.143, P=0.000; χ2=20.902, P=0.000). Among the 35 patients with coronal fractures, 6 cases (17.1%) of AO/OTA 31-A1 type, 29 cases (82.9%) of AO/OTA 31-A2 type. The operation time of the patient was 80-112 minutes, with an average of 95 minutes; the intraoperative blood loss was 180-450 mL, with an average of 360 mL. There was no complication such as infection, falling pneumonia, and deep vein thrombosis of the lower extremities. At 3 days after operation, the internal fixators were all in the proper position. The TAD was 0.9-1.8 cm, with an average of 1.4 cm. All patients were followed up 14-18 months, with an average of 16 months. All the fractures healed osseously, and there was no complication such as nonunion and loosening of internal fixation.ConclusionCT three-dimensional reconstruction can better identify coronal femoral intertrochanteric fractures than X-ray films, and accurately recognize and analyze the incidence and morphological characteristics of coronal fractures, which can help formulate more effective surgical strategies to promote patient recovery.
ST segment morphology is closely related to cardiovascular disease. It is used not only for characterizing different diseases, but also for predicting the severity of the disease. However, the short duration, low energy, variable morphology and interference from various noises make ST segment morphology classification a difficult task. In this paper, we address the problems of single feature extraction and low classification accuracy of ST segment morphology classification, and use the gradient of ST surface to improve the accuracy of ST segment morphology multi-classification. In this paper, we identify five ST segment morphologies: normal, upward-sloping elevation, arch-back elevation, horizontal depression, and arch-back depression. Firstly, we select an ST segment candidate segment according to the QRS wave group location and medical statistical law. Secondly, we extract ST segment area, mean value, difference with reference baseline, slope, and mean squared error features. In addition, the ST segment is converted into a surface, the gradient features of the ST surface are extracted, and the morphological features are formed into a feature vector. Finally, the support vector machine is used to classify the ST segment, and then the ST segment morphology is multi-classified. The MIT-Beth Israel Hospital Database (MITDB) and the European ST-T database (EDB) were used as data sources to validate the algorithm in this paper, and the results showed that the algorithm in this paper achieved an average recognition rate of 97.79% and 95.60%, respectively, in the process of ST segment recognition. Based on the results of this paper, it is expected that this method can be introduced in the clinical setting in the future to provide morphological guidance for the diagnosis of cardiovascular diseases in the clinic and improve the diagnostic efficiency.
Femtosecond laser small incision lenticule extraction (SMILE) with different residual stromal thicknesses (RST) is set to investigate its effect on corneal biomechanical properties of rabbits in vivo. In this study, 24 healthy adult Japanese rabbits were randomly divided into group A and B. The RST of group A was set 30% of the corneal central thickness (CCT), and the RST of group B was 50% of the CCT. The thickness of the corneal cap in both groups was set one third of CCT. Corneal visualization Scheimpflug technology (Corvis ST) and Pentacam three-dimensional anterior segment analyzer were used to determine corneal biomechanical and morphological parameters before surgery, and 1 week, 1 month and 3 months after surgery. Pearson correlation analysis was used to analyze factors affecting corneal biomechanical parameters after SMILE. The results showed that the corneal stiffness of group A was significantly higher than that of group B at 1 week and 1 month after surgery, and most biomechanical parameters returned to preoperative levels at 3 months postoperatively. The results of correlation analysis showed that postoperative CCT and RST were the main factors affecting corneal biomechanical parameters after SMILE. There was no significant difference in corneal posterior surface height (PE) between 3 months after surgery and before surgery in both two groups. It indicates that although the ability to resist deformation of cornea decreases in SMILE with thicker corneal cap and less RST, there is no tendency to keratoconus, which may be related to the preservation of more anterior stromal layer.