Quantification of preexisting lung ground glass opacities on CT for predicting checkpoint inhibitor pneumonitis in advanced non-small cell lung cancer patients.

BACKGROUND: Immune checkpoint inhibitors (ICIs) can lead to life-threatening pneumonitis, and pre-existing interstitial lung abnormalities (ILAs) are a risk factor for checkpoint inhibitor pneumonitis (CIP). However, the subjective assessment of ILA and the lack of standardized methods restrict its clinical utility as a predictive factor. This study aims to identify non-small cell lung cancer (NSCLC) patients at high risk of CIP using quantitative imaging. METHODS: This cohort study involved 206 cases in the training set and 111 cases in the validation set. It included locally advanced or metastatic NSCLC patients who underwent ICI therapy. A deep learning algorithm labeled the interstitial lesions and computed their volume. Two predictive models were developed to predict the probability of grade ≥ 2 CIP or severe CIP (grade ≥ 3). Cox proportional hazard models were employed to analyze predictors of progression-free survival (PFS). RESULTS: In a training cohort of 206 patients, 21.4% experienced CIP. Two models were developed to predict the probability of CIP based on different predictors. Model 1 utilized age, histology, and preexisting ground glass opacity (GGO) percentage of the whole lung to predict grade ≥ 2 CIP, while Model 2 used histology and GGO percentage in the right lower lung to predict grade ≥ 3 CIP. These models were validated, and their accuracy was assessed. In another exploratory analysis, the presence of GGOs involving more than one lobe on pretreatment CT scans was identified as a risk factor for progression-free survival. CONCLUSIONS: The assessment of GGO volume and distribution on pre-treatment CT scans could assist in monitoring and manage the risk of CIP in NSCLC patients receiving ICI therapy. CLINICAL RELEVANCE STATEMENT: This study's quantitative imaging and computational analysis can help identify NSCLC patients at high risk of CIP, allowing for better risk management and potentially improved outcomes in those receivingICI treatment.

Comparative study of fault tree analysis and 24Model: taking the cause analysis of the Quanzhou Xinjia Hotel collapse accident as an example.

A comparative study was conducted to compare the accident cause analysis methods of fault tree analysis (FTA) and 24Model. A major accident - the Xinjia Hotel collapse accident - was selected as the research object, the causes of the accident were reanalysed and accident prevention countermeasures were designed based on 24Model and FTA, respectively, and the systematic characteristics of 24Model were summarized. The research shows that both 24Model and FTA can carry out risk assessment, accident cause analysis and preventive countermeasure design based on their own rules. Different from FTA, 24Model has static and dynamic structures of specific forms, the definition of causes and factors in the model is more comprehensive and the analysis method is more hierarchical and normative. 24Model can analyse the deep-level cultural and system causes, but the analysis process does not use quantitative methods, only qualitative methods. 24Model has eight systematic characteristics, such as integrity, hierarchy and dynamics.

Effluent quality prediction of the sewage treatment based on a hybrid neural network model: Comparison and application.

The accurate prediction and assessment of effluent quality in wastewater treatment plants (WWTPs) are paramount for the efficacy of sewage treatment processes. Neural network models have exhibited promise in enhancing prediction accuracy by simulating and analyzing diverse influent parameters. In this study, a back propagation neural network hybrid model based on a tent chaotic map and sparrow search algorithm (Tent_BP_SSA) was developed to predict the effluent quality of sewage treatment processes. The prediction performance of the propose hybrid model was compared with traditional neural network models using five performance indicators (MAE, RMSE, SSE, MAPE and R2). Specifically, in comparison with the prior Tent_BP_SSA, Tent_BP_SSA2 demonstrated notable enhancements, with the R2 increasing from 0.9512 to 0.9672, while MAE, RMSE, SSE, and MAPE decreased by 9.62%, 18.84%, 24.80%, and 47.10%, respectively. These indicators collectively affirm that the utilization of higher-order input parameters ensures improved accuracy of the Tent_BP_SSA2 hybrid model in predicting effluent quality. Moreover, the Tent_BP_SSA2 model exhibited robust prediction ability (R2 of 0.9246) when applied to assess the effluent quality of an actual sewage treatment plant. The incorporation of integrated models comprising the sparrow search optimizing algorithm, tent chaotic mapping, and higher-order magnitude decomposition of input parameters has demonstrated the capacity to enhance the accuracy of effluent quality prediction. This study illuminates novel perspectives on the prediction of effluent quality and the assessment of effluent warnings in WWTPs.

Modeling and optimizing of an actual municipal sewage plant: A comparison of diverse multi-objective optimization methods.

The activated sludge process of an actual municipal sewage treatment plant was systematically modeled, calibrated, and verified in this study. Identified multi-objective optimization (MOO) methods were employed to optimize the process parameters of the validated model, and the optimal MOO algorithm was obtained by comparing Pareto solution sets. The optimization model consisted of three key evaluation indicators (objective functions), which are the average effluent quality (AEQ), overall cost index (OCI), and total volume (TV) of the biochemical tank, along with 12 more process parameters (decision variables). Three optimization algorithms, i.e., adaptive non-dominated sorting genetic algorithm III (ANSGA-III), non-dominated sorting genetic algorithm II (NSGA-II), and particle swarm algorithm (PSO), were adopted using MATLAB. The comparison of these algorithms demonstrated that the ANSGA-III algorithm had better Pareto solution sets under the triple objective optimization, and the effluent quality of COD, TN, NH4+-N, and TP after optimization decreased by 2.22, 0.47, 0.13, and 0.02 mg/L, respectively. Additionally, the simulated AEQ was reduced by 13% compared to the original effluent, and the OCI and TV decreased from 21,023 kWh d-1 and 17,065 m3 to 20,226 kWh d-1 and 16,530 m3, respectively. The reported ANSGA-III algorithm and the proposed multi-objective method have a promising ability for energy conservation, emission reduction, and upgrading of municipal sewage treatment plants.

MRI radiomics-based nomogram for individualised prediction of synchronous distant metastasis in patients with clear cell renal cell carcinoma.

OBJECTIVE: To evaluate the performance of a multiparametric MRI radiomics-based nomogram for the individualised prediction of synchronous distant metastasis (SDM) in patients with clear cell renal cell carcinoma (ccRCC). METHODS: Two-hundred and one patients (training cohort: n = 126; internal validation cohort: n = 39; external validation cohort: n = 36) with ccRCC were retrospectively enrolled between January 2013 and June 2019. In the training cohort, the optimal MRI radiomics features were selected and combined to calculate the radiomics score (Rad-score). Incorporating Rad-score and SDM-related clinicoradiologic characteristics, the radiomics-based nomogram was established by multivariable logistic regression analysis, then the performance of the nomogram (discrimination and clinical usefulness) was evaluated and validated subsequently. Moreover, the prediction efficacy for SDM in ccRCC subgroups of different sizes was also assessed. RESULTS: Incorporating Rad-score derived from 9 optimal MR radiomics features (age, pseudocapsule and regional lymph node), the radiomics-based nomogram was capable of predicting SDM in the training cohort (area under the ROC curve (AUC) = 0.914) and validated in both the internal and external cohorts (AUC = 0.854 and 0.816, respectively) and also showed a convincing predictive power in ccRCC subgroups of different sizes (≤ 4 cm, AUC = 0.875; 4-7 cm, AUC = 0.891; 7-10 cm, 0.908; > 10 cm, AUC = 0.881). Decision curve analysis indicated that the radiomics-based nomogram is of clinical usefulness. CONCLUSIONS: The multiparametric MRI radiomics-based nomogram could achieve precise individualised prediction of SDM in patients with ccRCC, potentially improving the management of ccRCC. KEY POINTS: • Radiomics features derived from multiparametric magnetic resonance images showed relevant association with synchronous distant metastasis in clear cell renal cell carcinoma. • MRI radiomics-based nomogram may serve as a potential tool for the risk prediction of synchronous distant metastasis in clear cell renal cell carcinoma.

Prediction of microvascular invasion of hepatocellular carcinoma with preoperative diffusion-weighted imaging: A comparison of mean and minimum apparent diffusion coefficient values.

The aim of the study was to investigate the value of preoperative diffusion-weighted imaging (DWI) in predicting microvascular invasion (MVI) of hepatocellular carcinoma (HCC), using and comparing mean and minimum apparent diffusion coefficient (ADC) values.Preoperative MR images of 318 patients with HCC confirmed by surgical pathology were retrospectively analyzed. All patients underwent preoperative DWI on a 1.5 Tesla MRI scanner. The mean and minimum ADC values of the tumors were measured. Interobserver agreements were assessed by the intraclass correlation coefficient (ICC). The ADC values were compared in HCCs between with and without MVI. ROC curves of ADC values were obtained and then compared in distinguishing HCCs with MVI from those without MVI.There were 211 HCCs with MVI and 107 HCCs without MVI. ICC for the measurements of the mean and minimum ADC values between both observers was 0.88 (95% CI 0.85 - 0.90) and 0.88 (95% CI 0.85 - 0.90), respectively. The mean and minimum ADC values of HCCs with MVI were lower than those of HCCs without MVI (P = .00, .00, respectively). With a cut-off value of 0.98 × 10 mm/s, the minimum ADC (MinADC) showed a sensitivity of 62.56% and a specificity of 65.42% in predicting MVI, whereas the mean ADC provided a sensitivity of 79.15% and a specificity of 50.47% with a cut-off value of 1.19 × 10 mm/s. No significant difference existed between MinADC and mean ADC for their diagnostic performances in the prediction of MVI (P = .48).DWI could preoperatively provide quantitative parameters for predicting MVI of HCC.

Integrated analysis of genome­wide gene expression and DNA methylation microarray of diffuse large B­cell lymphoma with TET mutations.

Diffuse large B-cell lymphoma (DLBCL), the most frequently occurring type of lymphoid malignancy, has been demonstrated to be associated with mutations of Ten­Eleven Translocation (TET). In order to explore the association between DLBCL and TET mutations, the present study analyzed the gene expression and methylation profiles in human DLBCL biopsy tissues with wildtype and mutated TET2. The microarray dataset GSE37365, containing two subseries: the genome­wide gene expression dataset GSE37362 and the DNA methylation microarray dataset GSE37363, was downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified using the limma package of R. Furthermore, differentially methylated sites and differentially methylated regions were identified. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed via GO stats and GSEABase packages respectively. Finally, the Pathview package was used to construct the network of enriched pathways. A total of 198 DEGs (106 up­ and 92 downregulated) were obtained. A total of 602 shared differentially methylated genes (DMGs) were identified according to differentially methylated levels. A total of 12 overlapping genes were identified in DEGs and DMGs. It was observed that 9 of the 12 overlapped genes were downregulated and hypermethylated, with 24 GO terms and one KEGG pathway significantly enriched. The results of the present study demonstrated that the genes cryptochrome circadian clock 1, zinc finger protein (ZNF) interacting with K protein 1, ZNF134, ZNF256 and ZNF615, which were hypermethylated and downregulated in DLBCL patients with TET2 mutations, were the key genes in the association between DLBCL and TET mutations. These genes may act as potential biomarkers for the diagnosis of DLBCL in the future.

Identification of targets of miRNA-221 and miRNA-222 in fulvestrant-resistant breast cancer.

The present study aimed to identify the differentially expressed genes (DEGs) regulated by microRNA (miRNA)-221 and miRNA-222 that are associated with the resistance of breast cancer to fulvestrant. The GSE19777 transcription profile was downloaded from the Gene Expression Omnibus database, and includes data from three samples of antisense miRNA-221-transfected fulvestrant-resistant MCF7-FR breast cancer cells, three samples of antisense miRNA-222-transfected fulvestrant-resistant MCF7-FR cells and three samples of control inhibitor (green fluorescent protein)-treated fulvestrant-resistant MCF7-FR cells. The linear models for microarray data package in R/Bioconductor was employed to screen for DEGs in the miRNA-transfected cells, and the pheatmap package in R was used to perform two-way clustering. Pathway enrichment was conducted using the Gene Set Enrichment Analysis tool. Furthermore, a miRNA-messenger (m) RNA regulatory network depicting interactions between miRNA-targeted upregulated DEGs was constructed and visualized using Cytoscape. In total, 492 and 404 DEGs were identified for the antisense miRNA-221-transfected MCF7-FR cells and the antisense miRNA-222-transfected MCF7-FR cells, respectively. Genes of the pentose phosphate pathway (PPP) were significantly enriched in the antisense miRNA-221-transfected MCF7-FR cells. In addition, components of the Wnt signaling pathway and cell adhesion molecules (CAMs) were significantly enriched in the antisense miRNA-222-transfected MCF7-FR cells. In the miRNA-mRNA regulatory network, miRNA-222 was demonstrated to target protocadherin 10 (PCDH10). The results of the present study suggested that the PPP and Wnt signaling pathways, as well as CAMs and PCDH10, may be associated with the resistance of breast cancer to fulvestrant.

Lesion Size and Iodine Quantification to Distinguish Low-Grade From High-Grade Clear Cell Renal Cell Carcinoma Using Dual-Energy Spectral Computed Tomography.

OBJECTIVE: The aim of this study was to assess the utility of lesion size and iodine quantification using dual-energy spectral computed tomography to distinguish between low-grade and high-grade clear cell renal cell carcinomas (ccRCCs). METHODS: Spectral parameters of 75 patients with pathologically proven ccRCCs who underwent preoperative dual-energy spectral computed tomography examinations were divided into low-grade and high-grade groups. Independent sample t test, receiver operating characteristic curve analysis, and Spearman rank correlation were analyzed. RESULTS: The lesion size was significantly smaller, and spectral parameters were significantly higher in the low-grade ccRCC. The significant correlation (r = -0.412, P < 0.001) by the Spearman rank correlation was between the normalized iodine concentration and lesion size. The receiver operating characteristic analysis demonstrated that 0.710 was the optimal cutoff value, which yielded the following: sensitivity, 97.6%; specificity, 97.1%; positive predictive value, 97.6%; negative predictive value, 97.1%; and accuracy, 97.3%. CONCLUSIONS: Iodine quantification can play an important role in distinguishing low-grade from high-grade ccRCC.

Usefulness of the neutrophil-to-lymphocyte ratio in predicting lymph node metastasis in patients with non-small cell lung cancer.

Preoperative neutrophil-to-lymphocyte ratio (NLR) is a new hotspot for its prognostic significance in many types of cancers. In this study, a novel diagnosing model-the combination of enhanced contrast computed tomography (ECCT) and NLR (COCT-NLR) was constructed to detect the lymph nodal involvement in patients with non-small cell lung cancer (NSCLC). The clinicopathological parameters and thoracic ECCT images of 353 NSCLC patients were retrospectively reviewed. The COCT-NLR model was constructed and evaluated in detecting regional lymph nodal metastasis in patients with NSCLC. Univariate and multivariate analyses of clinicopathological parameters revealed that NLR value was independently associated with regional nodal involvement rate in patients with NSCLC (odds ratio (OR) = 4.770; 95 % confidence interval (CI), 2.487-9.146; P < 0.001). Compared with ECCT and NLR, the COCT-NLR model showed the highest efficacy in predicting nodal involvement. The sensitivity and specificity of COCT-NLR were 70.59 and 74.89 %, respectively. The COCT-NLR model is a valuable tool in detecting regional lymph node metastasis in patients with NSCLC.

[CT differential diagnosis of cystic nephroma and multilocular cystic renal cell carcinoma].

OBJECTIVE: To study the CT findings of cystic nephroma (CN) and multilocular cystic renal cell carcinoma (MCRCC) and to improve the accuracy of preoperative diagnosis of these two diseases. METHODS: The CT findings of nine CN cases and 19 MCRCC cases confirmed by pathology were blindly reviewed and compared with their pathological results. Fisher's exact test and independent-samples T test were applied to statistically analyze some of the CT features of the CN and MCRCC lesions. RESULTS: The thickness of cystic walls and partitions in the nine CN cases ranged from 0.5 to 5 mm. Cystic walls and partitions were slightly thicker in some parts without visible mural nodules. Varying amounts of solid tissue could be found in all the 19 MCRCC tumors, and the cystic walls and partitions were found partially thickened ranging from 3 mm to 13 mm. Eight cases were with mural nodules (nodule diameter: 4.5-16 mm). Nine cases of CN tumors were lobulated and 7 protruded into the renal sinus. Three out of the 19 MCRCC presented shallow lobulation, and 7 tumors protruded into the renal sinus. The CT contrast-enhancement scanning displayed moderate delayed enhancement in the cystic walls and partitions in 8 cases. The enhanced scanning revealed that all the nine cases showed enhancement of the cystic walls and partitions, while 8 cases of them had mild to moderate delayed enhancement. The cystic walls, partitions and nodules were enhanced in 19 MRCC cases, among them 17 cases displayed obvious enhancement in the cortical phase. Among the differences of CT findings between MC and MRCC, the shallow lobulation, protruding into the renal sinus, mural nodules, cystic wall and partition thickness, and net growth in the cortical and nephrographic phase were statistically significantly different (P<0.05 for all). CONCLUSIONS: CT scan can provide significant evidence for CN and MCRCC diagnosis. CN cases usually present relatively thin and even cystic walls and partitions without mural nodules and with shallow lobulation and protruding into the renal sinus. The enhancement is mild to moderate, dynamic and delayed, while the opposite CT findings may indicate a higher possibility of MCRCC.

Molecular characterization and expression patterns of myogenin in compensatory growth of Megalobrama amblycephala.

Myogenin (myog) is a muscle-specific basic helix-loop-helix (bHLH) transcription factor that plays an essential role in regulating skeletal muscle development and growth. To investigate molecular characterization of myog and the effect of starvation/refeeding on the gene expression, we isolated the myog cDNA sequence and analyzed the expression patterns using quantitative real-time polymerase chain reaction in Megalobrama amblycephala. Sequence analysis indicated that M. amblycephala myog shared an analogous structure with the highly conserved His/Cys-rich, bHLH and C-terminal helix III domains with other vertebrates. Sequence alignment and phylogenetic tree showed that M. amblycephala myog had the highest identity with the homologues of Ctenopharyngodon idella and Cyprinus carpio. Spatio-temporal expression patterns revealed that myog mRNA levels at the segmentation period and 12 h post-hatching (hph) were significantly higher than at other development stages (P<0.05). Furthermore, the highest myog expression level was predominantly observed in white muscle compared with the other types of muscle. Fish body weight continuously decreased during 21-day starvation and then significantly increased after 7days of refeeding and reached the similar level to the control at 21days of refeeding, indicating that the pattern of complete compensatory growth possibly occurred in M. amblycephala; meanwhile, the relative somatic growth rate after refeeding was also dramatically higher than the control group. In addition, the myog expression decreased during 21days of starvation and then exhibited a strong rebound effect after 7days of refeeding and subsequently declined gradually to the control level by 21days of refeeding.

Correlation between CT perfusion parameters and microvessel density and vascular endothelial growth factor in adrenal tumors.

We evaluated the correlation between computed tomography (CT) perfusion parameters and markers of angiogenesis in adrenal adenomas and non-adenomas to determine if perfusion CT can be used to distinguish between them. Thirty-four patients with pathologically-confirmed adrenal tumors (17 adenomas, 17 non-adenomas) received CT perfusion imaging before surgery. CT perfusion parameters (blood flow [BF], blood volume [BV], mean transit time [MTT], and permeability surface area product [PS]) were calculated. Tumor tissue sections were examined with immunohistochemical methods for vascular endothelial growth factor (VEGF) expression and microvessel density (MVD). The mean age of the 34 patients was 43 years. The median BV was significantly higher in adenomas than in non-adenomas [12.3 ml/100 g, inter-quartile range (IQR): 10.4 to 16.5 ml/100 g vs. 8.8 ml/100 g, IQR: 3.3 to 9.4 ml/100 g, p=0.001]. Differences in BF, MTT, and PS parameter values between adenomas and non-adenomas were not significant (p>0.05). The mean MVD was significantly higher in adenomas compared to non-adenomas (98.5 ± 28.5 vs. 53.5 ± 27.0, p<0.0001). Adenomas also expressed significantly higher median VEGF than non-adenomas (65%, IQR: 50 to 79% vs. 45%, IQR: 35 to 67%, p=0.02). A moderately strong correlation between BF and VEGF (r=0.53, p=0.03) and between BV and MVD among adenomas (r=0.57, p=0.02) exist. Morphology, MVD, and VEGF expression in adenomas differ significantly from non-adenomas. Of the CT perfusion parameters examined, both BF and BV correlate with MVD, but only BF correlates with VEGF, and only in adenomas. The significant difference in BV suggests that BV may be used to differentiate adenomas from non-adenomas. However, the small difference in BV shows that it may only be possible to use BV to identify adenomas vs. non-adenomas at extreme BV values.

Treatment of thumb soft-tissue defects using a bipedicle island flap of the index finger: anatomical basis and clinical application.

PURPOSE: Reconstruction of the thumb with exposure of bone and tendon is challenging. We designed a bipedicle island flap from the dorsum of the index finger to repair thumb defects. One pedicle includes the radial proper palmar digital artery (PDA) of the index finger, another pedicle includes the first dorsal metacarpal artery (FDMA). The aim of the study was to investigate the anatomical basis and clinical application of this flap. METHODS: Eleven fresh cadaver hands were dissected, the FDMA and the radial proper PDA were exposed. Their origin, distribution and diameter in different locations, especially in the dorsum of the proximal phalanx of the index finger, were examined. Ten patients (11 hands) underwent thumb reconstruction using this flap. During follow-up, the flap survival and hand function were evaluated. RESULTS: The origin of the FDMA in three cadaver hands was abnormal. The FDMA was mainly distributed in the proximal area of the dorsum of the proximal phalanx. The radial proper PDA of the index finger formed one constant dorsal branch, mainly distributing in the middle and distal area of the dorsum of the proximal phalanx. All flaps survived. At follow-up, the span of the first web and the range of motion of the thumbs and index fingers reached more than 94 % of the contralateral finger. All patients were satisfied with the hand function according to the Michigan Hand Outcomes Questionnaire (MHQ). CONCLUSIONS: The bipedicle island flap has two arterial systems to provide sufficient blood supply. This technique provides another option for thumb reconstruction when a large supercharged FDMA island flap needs to be designed, or when there is an additional injury to the radial side of the dorsum of the hand or if there are anatomical variations of the FDMA, or if damage to the FDMA occurs during surgery.

Clinical results of treatment using a clavicular hook plate versus a T-plate in neer type II distal clavicle fractures.

AO clavicular hook plate fixation provides more rigid fixation and good bony union rates for Neer type II distal clavicular fractures. However, the hook may cause rotator cuff tears and subacromial impingement, which adversely affect the clinical results. T-plate fixation is another surgical method of treatment for unstable clavicle fractures, and its clinical efficacy has been demonstrated. The purpose of this study was to compare the clinical outcomes of AO clavicular hook plate and T-plate fixation for Neer type II distal clavicular fractures. Forty-two patients with Neer type II fractures were divided into 2 groups. The hook plate group comprised 23 patients who underwent hook plate fixation, and the T-plate group comprised 19 patients who underwent distal radius volar locking T-plate fixation. Hook plates were removed 3 to 14 months postoperatively in 15 patients because of shoulder function limitations. All patients were evaluated postoperatively for shoulder pain, activities of daily living, range of motion, strength, and satisfaction according to the University of California, Los Angeles (UCLA) Shoulder rating scale. All fractures in the 2 groups achieved stable fixation and bony union. Both groups yielded similar outcomes with regard to shoulder strength and patient satisfaction (P=.207 and P=.398, respectively). Significant differences existed between the 2 groups in the mean scores of shoulder pain, activities of daily living, range of motion, and total UCLA score (P=.001, P=.011, P=.038, and P=.001, respectively). More patients (74%) in the hook plate group had mild to severe shoulder pain than in the T-plate group (16%). However, shoulder pain was relieved and function improved significantly after removal of the hook plate (P=.001).

[Treatment of fresh tossy type III acromioclavicular joint dislocations and neer type II distal clavicle fractures with clavicular hook plate].

OBJECTIVE: To investigate the clinical efficacy, complications and necessity of removing internal fixation in treatment of fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal clavicle fractures with clavicular hook plate. METHODS: From June 2005 to June 2008, 24 patients with fresh Tossy type III acromioclavicular joint dislocations and 20 patients with fresh Neer type II distal clavicle fractures were treated. There were 32 males and 12 females with an age range of 18-66 years (38.5 years on average), involving 18 left shoulders and 26 right shoulders. The injury was caused by traffic accident in 31 cases and by falling in 13 cases. The mean time from injury to operation was 4 days (range, 2-8 days). All patients were treated by reduction with clavicular hook plate fixation. The coracoclavicular ligaments were not sutured. The shoulder functions were evaluated according to University of California-Los Angeles (UCLA) score system and analysed before and after removing internal fixation. RESULTS: Wound infection occurred in 2 cases 1 week after operation and healed after symptomatic management, the other incisions healed by first intention. One case accepted hook plate fixation again because of loosening hooking-up 1 week after operation. One case accepted hook plate removal and Kirschner wire fixation because of severe shoulder's pain on the postoperative third day. Thirty-eight patients were followed up for 8-32 months (18 months on average), there was no plate breakage. Clavicle fractures got bony union after 3-6 months (4.2 months on average). At last follow-up (before plate removal), according to UCLA shoulder function score system, the results were excellent in 11 cases, good in 22 cases, and fair in 5 cases; the excellent and good rate was 86.8%. Because of shoulder's pain, plates were removed in 20 patients 3-16 months (10 months on average) after operation. The cases were followed up 3-8 months (5 months on average) after removing plate. No dislocation and fracture occurred again. There was statistically significant difference (P < 0.01) in the functional scores of shoulder between before (30.55 +/- 4.00) and after removing internal fixation (33.85 +/- 1.95). CONCLUSION: Clavicular hook plate fixation is an effective treatment for fresh Tossy type III acromioclavicular joint dislocations and Neer type II distal clavicle fractures. Normative operating, correct plate moulding, functional rehabilitation after operation are key factors in preventing complications and reaching good clinical efficacy. For the patients with postoperative symptoms, the plate should be removed to improve the shoulder's function.

[Treatment of conmminuted patellar fractures with internal Ni-Ti patellar concentrator and tension bind wire fixation].

OBJECTIVE: To study the clinical efficacy of the treatment of comminuted patellar fractures with internal NiTi-Patellar concentrator and tension bind wire fixation. METHODS: From March 2004 to June 2007, 38 cases of fresh comminuted patellar fractures were treated with internal NiTi-Patellar concentrator and tension bind wire fixation. There were 25 males and 13 females,ranging from 21 to 64 years (mean 42.5 years). All were comminuted fractures with displacement, 16 cases were 3 fragments, 14 cases were 4 fragments, 8 cases were 5 fragments. There were other fractures in 8 cases. During followed-up, knee function and complications were evaluated. RESULTS: All patients were followed up for 8 to 24 months (mean 15 months) and obtained complete bone union. No case of implant was loosening and fragment displacement, traumatic arthritis occured in 2 cases. Under Lysholm & Gillquist score, the results were excellent in 17 cases, good in 19, fair in 2. CONCLUSION: Internal Ni-Ti-Patellar concentrator and tension bind wire fixation is one of the ideal methods for the treatment of comminuted patellar fracture, which could provide satisfied reduction, reliable fixation and good functional recovery.