Advancements in Uric Acid Stone Detection: Integrating Deep Learning with CT Imaging and Clinical Assessments in the Upper Urinary Tract.

INTRODUCTION: Among upper urinary tract stones, a significant proportion comprises uric acid stones. The aim of this study was to use machine learning techniques to analyze CT scans and blood and urine test data, with the aim of establishing multiple predictive models that can accurately identify uric acid stones. METHODS: We divided 276 patients with upper urinary tract stones into two groups: 48 with uric acid stones and 228 with other types, identified using Fourier-transform infrared spectroscopy. To distinguish the stone types, we created three types of deep learning models and extensively compared their classification performance. RESULTS: Among the three major types of models, considering accuracy, sensitivity, and recall, CLNC-LR, IMG-support vector machine (SVM), and FUS-SVM perform the best. The accuracy and F1 score for the three models were as follows: CLNC-LR (82.14%, 0.7813), IMG-SVM (89.29%, 0.89), and FUS-SVM (29.29%, 0.8818). The area under the curves for classes CLNC-LR, IMG-SVM, and FUS-SVM were 0.97, 0.96, and 0.99, respectively. CONCLUSION: This study shows the feasibility of utilizing deep learning to assess whether urinary tract stones are uric acid stones through CT scans, blood, and urine tests. It can serve as a supplementary tool for traditional stone composition analysis, offering decision support for urologists and enhancing the effectiveness of diagnosis and treatment.

Clinical evaluation of S1 alar screws application in short-segment lumbosacral fixation and fusion for spine infection with severe S1 vertebral body loss.

BACKGROUND: The one-stage posterior approach for treating spinal infection has recently been generally accepted. However, severe vertebral body loss caused by infection remains a major challenge in posterior surgery. This study was conducted to evaluate the clinical application and outcomes of S1 alar screws used in the one-stage posterior surgery of short-segment lumbosacral fixation and fusion after debridement for infection with severe S1 vertebral body loss. METHODS: The clinical features and treatment outcomes of 7 patients with spinal infections from August 2016 to August 2021 who were treated with one-stage posterior surgery using S1 alar screws were retrospectively analyzed. The clinical data, including patient data, visual analogue scale (VAS), Oswestry Disability Index (ODI), fusion time and complications of the patients, were recorded. RESULTS: All 7 patients were followed up for an average duration of 14.57 months (range, 12-18 months). The VAS score decreased significantly from 7.3 preoperatively (range, 6-8) to 2.6 postoperatively (range, 2-3). The ODI score demonstrated a steady and gradual increase from 73.8 preoperatively (range, 68-75) to 33.6 postoperatively (range, 30-37). Bony fusion time was observed approximately 6.8 months after surgery. Two patients in our study experienced the postoperative local pain, which could be relieved by analgesics and disappeared 3 months after the operation. There were no complications of intraoperative fracture, posterior wound infection or neurovascular injury. CONCLUSIONS: S1 alar screws are suitable for use in the operation and could be an alternative option to S1 pedicle screws for short-segment lumbosacral fixation and fusion with severe S1 vertebral body loss caused by spinal infection, which could provide satisfactory clinical outcomes.

Analysis of Staged Treatment for Gustilo Anderson IIIB/C Open Tibial Fractures.

BACKGROUND: Gustilo Anderson III B/C open tibial fractures are more difficult to manage than I, II, and III A fractures. These open tibial fractures are often associated with wound infection, soft tissue necrosis, bone nonunion, osteomyelitis or amputation. Staged treatment for this severe trauma is very necessary. MATERIALS AND METHODS: 25 cases of Gustilo Anderson IIIB/C open tibial fractures with serious soft-tissue defects treated between January 2010 and January 2015 were included in this study. The treatment was administered in three stages. The first stage included emergency debridement, external fixation, repair of damaged main blood vessels and nerves, covering of the wound, and infection control. The second stage involved skin flap or skin graft placement to repair wounds. The third stage involved replacement of the external fixator with an internal fixator and the placement of bone grafts. RESULTS: All the skin flaps or skin grafts survived, and a small necrotic area in the distal flap was observed in only two cases (which resolved spontaneously after the dressing was changed). Bone union occurred at the predicted time in 23 cases, while it was delayed in 2 cases. The rate of excellent and good was 88%. CONCLUSION: Staged treatment was safe and effective for Gustilo Anderson IIIB/C tibial fractures. The timing for the placement of internal and external fixators and choosing the appropriate skin flap repair technique are important.

Posteromedial approach in treatment of talar posterior process fractures.

To evaluate the surgical outcomes of talar, posterior process displaced fractures with posteromedial approach. From January 2008 to December 2010, 18 patients with displaced fracture of talar posterior process were treated in our department. Open reduction and screw fixation through posteromedial approach was performed after soft tissue swelling were subsided. The results were evaluated with Visual Analog Scale Pain Score (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores. The average follow-up period was 16.8 months. There was no wound infection or nerve injury. There was no screw loosening, implant breakage, nonunion, or malunion. The average AOFAS score was 83.1, and the VAS score was 1.4. Two patients developed posttraumatic subtalar joint arthritis 1 year after operation, and one of them had subtalar arthrodesis performed due to pain and walking disability. Posteromedial approach can provide a good surgical exposure to the posterior portion of the talus without compromising the surrounding neurovascular structures. Small fragment screws can provide stable fixation and early mobilization of the ankle and subtalar joint. Open reduction and internal fixation via posteromedial approach is an effective and reliable method for the treatment to displaced fractures of the posterior process of the talus.