Sex-specific bone and muscular morphological features in ischiofemoral impingement: A three-dimensional study.

The study aimed to investigate how hip bone and muscular morphology features differ between ischiofemoral impingement (IFI) patients and healthy subjects among males and females. Three-dimensional models were reconstructed based on magnetic resonance imaging images from IFI patients and healthy subjects of different sexes. Bone morphological parameters and the cross-sectional area of the hip abductors were measured. The diameter and angle of the pelvis were compared between patients and healthy subjects. Bone parameters of the hip and cross-sectional area of the hip abductors were compared between affected and healthy hips. The comparison results of some parameters were significant for females but not males. For females, the comparison results of pelvis parameters showed that the anteroposterior diameter of the pelvic inlet (p = 0.001) and intertuberous distance (p < 0.001) were both larger in IFI patients than in healthy subjects. Additionally, the comparison results of hip parameters showed that the neck shaft angle (p < 0.001) and the cross-sectional area of the gluteus medius (p < 0.001) and gluteus minimus (p = 0.005) were smaller, while the cross-sectional area of the tensor fasciae latae (p < 0.001) was significantly larger in affected hips. Morphological changes in IFI patients demonstrated sexual dimorphism, including bone and muscular morphology. Differences in the anteroposterior diameter of the pelvic inlet, intertuberous distance, neck shaft angle, gluteus medius, and gluteus minimus may explain why females are more susceptible to IFI.

Spatial organization and crosstalk of vimentin and actin stress fibers regulate the osteogenic differentiation of human adipose-derived stem cells.

Human adipose-derived stem cells (hASCs) are ideal seed cells for tissue engineering due to their multidirectional differentiation potential. Microfilaments, microtubules, and intermediate filaments are responsible for supporting the intracellular space. Vimentin, a type III intermediate filament protein that is specifically expressed in cells of mesenchymal origin, can function as a scaffold and endow cells with tension and shear stress resistance. Actin stress fibers (ASF) act as an important physical device in stress signal transduction, providing stiffness for cells, and promoting osteogenesis. Through direct physical contact, cross-linkers, and spatial interactions, vimentin and actin networks exist as intersecting entities. Spatial interactions occur in the overlapping area of cytoskeleton subsystems, which could affect cell morphology, cell mechanics, and cell fate. However, how does the spatial organization between the cytoskeletal subsystems changed during osteogenesis, especially between vimentin and ASF, is still not understood, and its mechanism effect on cell fate remains unclear. In our study, WB experiment was used to detect the expression changes in Vimentin, ASF, and other proteins. Cells were reconstructed by three-dimensional scanning with fluorescence microscope, and the spatial thickness of vimentin and ASF cytoskeletons and the thickness of the overlapping area between them were calculated, respectively, so as to observe the spatial reorganization of vimentin and ASF in cells. Cytochalasin D (an inhibitor of actin polymerization) and vimentin upregulated/downregulated cells were used to verify the change in the spatial organization between vimentin and ASF and its influence on osteogenesis. Then, heat shock protein 27 (HSP27) was downregulated to illuminate the regulatory mechanisms of spatial organization between vimentin and ASF during osteogenesis. The amounts and the spatial positions of vimentin and actin stress fiber exhibited opposite trends during osteogenesis. Through controlling the anchor sites on the nucleus, intermediate filaments vimentin can reduce the spatial proportion of actin stress fibers, which can be regulated by HSP27. In addition, depolymerization of actin stress fibers lead to lower osteogenic differentiation ability, resulting in osteogenesis and lipogenesis existed simultaneously, that can be resisted by vimentin. Our data indicate that the spatial reorganization of vimentin and actin stress fibers is a key factor in the regulation of the differentiation state of hASCs. And their spatial overlapping area is detrimental to hASCs osteogenesis, providing a new perspective for further exploring the mechanism underlying hASCs osteogenesis.

Quantitative MR evaluation of the infrapatellar fat pad for knee osteoarthritis: using proton density fat fraction and T2* relaxation based on DIXON.

OBJECTIVES: To investigate the efficacy of fat fraction (FF) and T2* relaxation based on DIXON in the assessment of infrapatellar fat pad (IFP) for knee osteoarthritis (KOA) progression in older adults. METHODS: Ninety volunteers (age range 51-70 years, 65 females) were enrolled in this study. Participants were grouped based on the Kellgren-Lawrence grading (KLG). The FF and T2* values were measured based on the 3D-modified DXION technique. Cartilage defects, bone marrow lesions, and synovitis were assessed based on a modified version of whole-organ magnetic resonance imaging score (WORMS). Knee pain was assessed by self-administered Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire. The differences of FF and T2* measurement and the correlation with WORMS and WOMAC assessments were analyzed. Diagnostic efficiency was analyzed by using receiver operating characteristic (ROC) curves. RESULTS: A total of 60 knees were finally included (n = 20 in each group). The values were 82.6 ± 3.7%, 74.7 ± 5.4%, and 60.5 ± 14.1% for FF is the no OA, mild OA, and advanced OA groups, and were 50.7 ± 6.6 ms, 44.1 ± 6.6 ms, and 39.1 ± 4.2 ms for T2*, respectively (all p values < 0.001). The WORMS assessment and WOMAC pain assessment showed negative correlation with FF and T2* values. The ROC showed the area under the curve (AUC), sensitivity, and specificity for diagnosing OA were 0.93, 77.5%, and 100% using FF, and were 0.86, 75.0%, and 90.0% using T2*, respectively. CONCLUSIONS: FF and T2* alternations in IFP are associated with knee structural abnormalities and clinical symptoms cross-sectionally and may have the potential to predict the severity of KOA. KEY POINTS: • Fat fraction (FF) and T2* relaxation based on DIXON imaging are novel methods to quantitatively assess the infrapatellar fat pad for knee osteoarthritis (KOA) progression in older adults. • The alterations of FF and T2* using mDIXON technique in IFP were associated with knee structural abnormalities and clinical symptoms. • FF and T2* alternations in IFP can serve as the new imaging biomarkers for fast, simple, and noninvasive assessment in KOA.

Intestinal epithelial cells related lncRNA and mRNA expression profiles in dextran sulphate sodium-induced colitis.

Intestinal epithelial barrier damage caused by intestinal epithelial cells (IECs) dysfunction plays a crucial role in the pathogenesis and development of inflammatory bowel disease (IBD). Recently, some studies have suggested the emerging role of long non-coding RNAs (lncRNAs) in IBD. The aim of this study was to reveal lncRNAs and mRNA expression profiles in IECs from a mouse model of colitis and to expand our understanding in the intestinal epithelial barrier regulation. IECs from the colons of wild-type mice and dextran sulphate sodium (DSS)-induced mice were isolated for high-throughput RNA-sequencing. A total of 254 up-regulated and 1013 down-regulated mRNAs and 542 up-regulated and 766 down-regulated lncRNAs were detected in the DSS group compared with the Control group. Four mRNAs and six lncRNAs were validated by real-time quantitative PCR. Function analysis showed that dysregulated mRNAs participated in TLR7 signalling pathway, IL-1 receptor activity, BMP receptor binding and IL-17 signalling pathway. Furthermore, the possibility of indirect interactions between differentially expressed mRNAs and lncRNAs was illustrated by the competing endogenous RNA (ceRNA) network. LncRNA ENSMUST00000128026 was predicted to bind to mmu-miR-6899-3p, regulating Dnmbp expression. LncRNA NONMMUT143162.1 was predicted to competitively bind to mmu-miR-6899-3p, regulating Tnip3 expression. Finally, the protein-protein interaction (PPI) network analysis was constructed with 311 nodes and 563 edges. And the highest connectivity degrees were Mmp9, Fpr2 and Ccl3. These results provide novel insights into the functions of lncRNAs and mRNAs involved in the regulation of the intestinal epithelial barrier.

Bioinformatics analysis of the biological changes involved in the osteogenic differentiation of human mesenchymal stem cells.

The mechanisms underlying the osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs) remain unclear. In the present study, we aimed to identify the key biological processes during osteogenic differentiation. To this end, we downloaded three microarray data sets from the Gene Expression Omnibus (GEO) database: GSE12266, GSE18043 and GSE37558. Differentially expressed genes (DEGs) were screened using the limma package, and enrichment analysis was performed. Protein-protein interaction network (PPI) analysis and visualization analysis were performed with STRING and Cytoscape. A total of 240 DEGs were identified, including 147 up-regulated genes and 93 down-regulated genes. Functional enrichment and pathways of the present DEGs include extracellular matrix organization, ossification, cell division, spindle and microtubule. Functional enrichment analysis of 10 hub genes showed that these genes are mainly enriched in microtubule-related biological changes, that is sister chromatid segregation, microtubule cytoskeleton organization involved in mitosis, and spindle microtubule. Moreover, immunofluorescence and Western blotting revealed dramatic quantitative and morphological changes in the microtubules during the osteogenic differentiation of human adipose-derived stem cells. In summary, the present results provide novel insights into the microtubule- and cytoskeleton-related biological process changes, identifying candidates for the further study of osteogenic differentiation of the mesenchymal stem cells.

Distribution and Morphological Measurement of Bony Spurs on the Coracoid Process in a Chinese Population.

BACKGROUND There are few studies on distributions or morphological measurements for bony spurs form at the attachment points of the ligaments and tendons on the coracoid process. The aim of this study was to investigate their most common sites and morphological characteristics, and to propose possible reasons. MATERIAL AND METHODS Scapulae with bony spurs on the coracoid process were selected from 377 intact and dry Chinese scapulae. The distribution, height, and transverse and longitudinal diameter of the bony spurs were measured in each coracoid process. RESULTS We selected 71 scapulae, 36 left and 35 right, that had bony spurs, from 377 scapulae. The bony spurs were most commonly located at the attachment point of the superior transverse scapular ligament (STSL) (31, 23.66%), while the trapezoid ligament (TL) accounted for the smaller proportion (8, 6.11%). The TSL was the highest, with the minimum transverse and longitudinal diameter, while the TL had the greatest transverse and longitudinal diameters. Only the TSL and TL had a statistically significant difference between the left and the right bony spur regarding the longitudinal diameter (P<0.05). CONCLUSIONS Bony spurs are more likely to form at the attachment points of ligaments and tendons on the coracoid process, which has a greater risk of traction injuries or attachment points avulsion fractures.

Long Noncoding RNA GAPLINC Promotes Cells Migration and Invasion in Colorectal Cancer Cell by Regulating miR-34a/c-MET Signal Pathway.

BACKGROUND: Gastric adenocarcinoma predictive long intergenic noncoding RNA (GAPLINC) has been detected in colorectal cancer (CRC) cells and reportedly performs many functions related to tumor proliferation and metastasis. Aim The present study aimed to comprehensively explore the biological functions of GAPLINC and their underlying mechanism in CRC cell. METHODS: The human cancer LncRNA PCR array was used to detect the differentially expressed long noncoding RNAs in human CRC samples. Real-time PCR, dual-luciferase assay, RNA pull-down assay, Transwell assay, and western blot analysis were performed to explore the molecular mechanism underlying GAPLINC functions related to migration and invasion of a human CRC cell line (HCT116). RESULTS: Compared to the non-cancerous tissues, GAPLINC expression was obviously increased in CRC tissues. In HCT116, silencing of GAPLINC weakened cell migration and invasion, while overexpression of GAPLINC significantly promoted cell migration and invasion. Through dual-luciferase, RNA pull-down, and Transwell assays, we verified that miR-34a was the downstream molecule of GAPLINC and that miR-34a negatively regulated the migration and invasion of HCT116 cell. Furthermore, we found that GAPLINC positively regulated the miR-34a target gene c-MET in CRC tissues. CONCLUSIONS: Our findings revealed that GAPLINC was up-regulated in CRC tissues and was involved in the migration and invasion of CRC cells by regulating miR-34a/c-MET signaling pathway.

Intratumoral genetic heterogeneity and number of cytogenetic aberrations provide additional prognostic significance in chronic lymphocytic leukemia.

PURPOSE: Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with cytogenetic aberrations that are still considered the gold standard of prognostic factors. However, heterogeneity remains within each cytogenetic group, especially in patients with concomitant cytogenetic aberrations. METHODS: A panel of DNA probes was used to detect cytogenetic aberrations, including RB1/D13S25 at 13q14, ATM at 11q22, TP53 at 17p13, CEP12 and IGH translocation at 14q32, by fluorescence in situ hybridization. A comprehensive method integrating the number of cytogenetic aberrations and intratumoral genetic heterogeneity was used to analyze the prognosis for patients with concomitant aberrations. RESULTS: Within the conventional favorable or neutral prognostic groups (i.e., with del 13q, trisomy 12, and/or t(14q32)), the coincidence of these three aberrations worsened survival in terms of time to first therapy, progression-free survival, and overall survival. However, within the conventional unfavorable prognostic group (i.e., del 11q or del 17p), patients with a minor unfavorable clone had an unexpected survival advantage compared with patients with a major unfavorable clone. A new cytogenetic prognostic system that integrates the number of cytogenetic aberrations and intratumoral genetic subclones was more precise than the conventional system. CONCLUSION: The number of cytogenetic aberrations and the size of intratumoral genetic subclones should be comprehensively considered to determine the prognosis for CLL.Genet Med 19 2, 182-191.

BCL-2 and MYC gain/amplification is correlated with central nervous system involvement in diffuse large B cell lymphoma at leukemic phase.

BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) of leukemic phase is a rare clinical manifestation, but is highly prevalent with central nervous system involvement (CNSI). Little is known about this rare clinical observation. METHODS: We reviewed the clinical characteristics of 40 DLBCL patients with leukemic phase identified by flow cytometry and analyzed BCL2 and MYC aberrations by fluorescence in situ hybridization. RESULTS: The median age of these 40 patients was 46 years (range, 15-75) with 19 men patients. All patients had bone marrow involvement, and fourteen (35.0%) had CNSI. There were respectively 14 patients (35.0%) had the BCL2 or MYC gain/amplification and nine of them (22.5%) simultaneously had both aberrations. Compared to those without CNSI, CNSI was found more commonly in male patients (71.4 vs. 34.6%, p = 0.046), in those with IPI scores of 4-5 (57.1% vs. 11.5%, p = 0.001), and in those with elevated serum LDH (100 vs. 61.5%, p = 0.007) and both MYC and BCL2 rearrangement (88.9 vs. 19.4%; p = 0.000). BCL2 and MYC rearrangements were the sole independent factor correlated with CNSI. CONCLUSION: It is possible that both BCL2 and MYC gene aberrations may contribute to the high incidence of CNSI observed in leukemic phase of patients with DLBCL.

Epiphyseal Arterial Network and Inferior Retinacular Artery Seem Critical to Femoral Head Perfusion in Adults With Femoral Neck Fractures.

BACKGROUND: A better understanding of the blood supply of the femoral head is essential to guide therapeutic strategies for patients with femoral neck fractures. However, because of the limitations of conventional techniques, the precise distribution and characteristics of intraosseous arteries of the femoral head are not well displayed. QUESTIONS/PURPOSES: To explore the characteristics and interconnections of the intraosseous vessel system between different areas of the femoral head and the possible blood supply compensatory mechanism after femoral neck fracture. METHODS: The three-dimensional (3-D) structures of the intraosseous blood supply in 30 uninjured normal human femoral heads were reconstructed using angiography methods and microCT scans. The data were imported in the AMIRA® and MIMICS® software programs to reconstruct and quantify the extra- and intraosseous arteries (diameter, length). In a separate experiment, we evaluated the residual blood supply of femoral heads in 27 patients with femoral neck fractures before surgery by analyzing digital subtraction angiography data; during the study period, this was performed on all patients in whom hip-preserving surgery was planned, rather than arthroplasty. The number of affected and unaffected subjects included in the three groups (superior, inferior, and anterior retinacular arteries) with different types of fractures (Garden Types I-IV) were recorded and analyzed (Fisher's exact test) to reflect the affected degrees of these three groups of retinacular arteries in patients after femoral neck fractures. RESULTS: The main results of our cadaver study were: (1) the main blood supply sources of the femoral head were connected by three main network structures as a whole, and the epiphyseal arterial network is the most widely distributed and the primary network structure in the femoral head; (2) the main stems of the epiphyseal arteries which were located on the periphery of the intraosseous vascular system have fewer anastomoses than the network located in the central region; (3) compared with the round ligament artery and anterior retinacular artery, the inferior retinacular artery has a relatively large caliber. Digital subtraction angiography of the 27 patients with hip fractures indicated that the inferior retinacular arterial system had a high likelihood of being unaffected after femoral neck fracture (100% [14 of 14] in nondisplaced fractures and 60% [six of 10] in Garden Type III fractures). CONCLUSIONS: The epiphyseal arterial network and inferior retinacular arterial system appear to be two important structures for maintaining the femoral head blood supply after femoral neck fracture. Increased efforts to protect these key structures during surgery, such as drilling and placing internal implants closer to the central region of the femoral head, might be helpful to reduce the effect of iatrogenic injury of the intraosseous vascular system. CLINICAL RELEVANCE: 3-D anatomic evidence of intraosseous arterial distribution of the femoral head and the high frequency with which the inferior retinacular arteries remained patent after femoral neck fracture lead us to consider the necessity of drilling and placing internal implants closer to the central region of the femoral head during surgery. Future controlled studies might evaluate this proposition.

Glabrous Flow-Through Flaps for Simultaneous Resurfacing, Revascularization, and Reinnervation of Digits.

INTRODUCTION: Composite injuries of the volar surfaces of fingers are frequently associated with digital vessel and nerve damage. Flow-through glabrous flaps can provide esthetic tissue coverage as well as revascularization, and using a neurovascular flap, allows primary reconstruction of the digital nerve. METHODS: Between June 2010 and August 2014, we prospectively studied the use of Microsurgical flow-through glabrous flaps to achieve simultaneously digital revascularization and soft tissue coverage in 13 fingers of 12 patients who experienced volar injuries, comprising 6 great toe fibular flaps, 3 medial plantar flaps, 1 pedis medialis flap, and 3 hypothenar flaps. The nerve passing through the great toe fibular flap or medial plantar flap was used to repair digital nerve defects. RESULTS: All flaps survived completely. During a mean follow-up period of 13.6 months, the majority recovered excellent appearance and function. The flaps had the characteristics of normal finger volar skin: hairless, with similar texture and color. The mean static 2-point discrimination and Semmes-Weinstein monofilament scores of finger pulp were 4.8 and 3.03 mmin the great toe fibular flap group, 7.3 and 3.89 mm in the medial plantar flap group, and 7.5 and 3.84 mm in the sural nerve group. CONCLUSIONS: Glabrous flow-through flaps provide excellent reconstruction for fingers with volar injuries associated with digital vessel damage. The great toe fibular flap and the medial plantar flap are reliable and useful options for complicated finger injuries associated with digital vessel and nerve injuries.

Full-Length Finger Reconstruction for Proximal Amputation With Expanded Wraparound Great Toe Flap and Vascularized Second Toe Joint.

BACKGROUND: Most of the frequently used methods for finger reconstruction have their own limitations. Reconstruction of a full-length finger with normal appearance, in patients with proximal digital amputation, remains a challenge. METHODS: Between January 2002 and November 2013, a total of 86 fingers (60 patients) with proximal phalanx amputation were surgically repaired. A compound flap comprising an expanded wraparound flap from the great toe and a vascularized proximal interphalangeal (PIP) joint from the second toe was harvested to reconstruct a full-length finger. The flap was used to reconstruct the nail, skin, and the distal phalanx; the PIP joint was used to reconstruct the PIP joint. To attain normal length of the finger and right PIP joint positioning, an iliac bone graft was inserted into the distal-middle or proximal phalanx. RESULTS: All reconstructed fingers retained their viability and natural appearance and were of near-normal length with a normal PIP joint positioning; 12.8% (9/86) of the procedures required re-exploration owing to compromised circulation. Secondary procedures were required in 71% (61/86) of the cases. With the exception of 1 case, the donor-site complications were mild; the average range of motion at the other PIP joints was 52 degrees (-15 to -5 degrees of extension, 25-90 degrees of flexion). Approximately 80% of the normal functionality and 93% of the normal appearance with respect to aesthetics were restored. CONCLUSIONS: The full-length finger reconstruction procedure allows for construction of natural-appearing full-length fingers with normal PIP joint positioning and a near-normal functional recovery for proximal digital amputation. The operation is technically complex and time consuming and demands a skilled operator for successful outcomes.

The posterior pedicled inferior turbinate-nasoseptal flap: a potential combined flap for skull base reconstruction.

OBJECTIVES: To develop a combined pedicled flap comprising the mucoperiosteum and mucoperichondrium of the inferior turbinate, lateral nasal wall, nasal floor, and nasal septum based on the posterior lateral nasal artery, a branch of the sphenopalatine artery, for the reconstruction of skull base defects resulting from endoscopic expanded endonasal approaches. METHODS: Eleven fresh adult cadaver heads were dissected. Arterial distribution patterns of the inferior turbinate, lateral nasal wall, nasal floor, and nasal septum were investigated. The posterior pedicled inferior turbinate-nasoseptal flap was designed, measured, and harvested, and its ability to cover ventral skull base defects was examined. RESULTS: The inferior turbinate artery and/or posterior lateral nasal artery had 3.19 ± 1.47 (range 2-7) branches [mean outer diameter of largest branch, 0.40 ± 0.10 (range 0.24-0.60) mm] that anastomosed with the nasoseptal artery. These anastomosing arteries allowed the posterior lateral nasal artery to supply arterial blood to the nasoseptal mucoperichondrium and mucoperiosteum. Mean flap length was 100.65 ± 5.61 (range 91.43-109.44) mm, and minimum and maximum widths were 25.21 ± 2.29 (range 22.36-30.23) and 44.53 ± 5.02 (range 36.45-54.10) mm, respectively. Mean flap area was 3090.69 ± 288.08 (range 2612.97-3880.09) mm(2). The flap covered defects extending from the frontal sinus to the foramen magnum in all specimens. CONCLUSIONS: Harvesting of a posterior pedicled inferior turbinate-nasoseptal flap is feasible. It should be considered a useful option for the reconstruction of large defects involving the anterior skull base, planum sphenoidale, sella turcica, and/or clivus.

[Clinical and biological characteristics multiple myeloma with 1q21 amplification].

OBJECTIVE: To study the clinical features of multiple myeloma (MM) patients with 1q21 amplification and the detection and biological characteristics of 1q21 copy number variation among different stages of plasma cell dyscrasias. METHODS: We analyzed the amplification and copy number variation of 1q21 in a cohort of 397 MM patients (290 newly diagnosed patients and 107 relapsed/refractory patients) in Institute of Hematology and Blood Diseases Hospital in the period between January 2009 and December 2012, using fluorescence in situ hybridization (FISH). We compared the incidence and biological characteristics of 1q21 gains among different stages of MM. RESULTS: Among the newly diagnosed MM patients, the cases without 1q21 gains (148 cases) had difference prevalence of q13 deletion (38.3% (56/146) vs 57.7% (82/142), P=0.001), t(4; 14) translocation (17.4% (25/144) vs 30.7% (42/137), P=0.009), and high-risk cytogenetic abnormalities (28.3% (39/138) vs 41.9% (57/136), P=0.018), and International Staging System (ISS) stage (P=0.010) compared to those with 1q21 gains (142 cases); however, there were no significant differences in age(P=0.448), Durie-Salmon clinical stage (P=0.352) and ß2-microglobulin level (P=0.414). In the newly diagnosed patients, the incidence of this 1q21 aberration with the percentages of plasma cells involved being ≥10%, ≥20%, and ≥30% was 52.4% (152/290), 49.0% (142/290), and 46.2% (134/290), respectively, lower than that in the relapsed/refractory patients (71.0% (76/107), P=0.001; 68.2% (73/107), P=0.001; 63.6% (68/107), P=0.002). Differences were found between the newly diagnosed MM patients and the relapsed/refractory ones in terms of the incidence of 1q21 copy number gains being 2 (52.2% (145/278) vs 33.3% (34/102), P=0.001), but not in the incidence of 1q21 copy number gains being 3, 4, and >5 (all P>0.05). CONCLUSIONS: Amplification of chromosome 1q21 is a common genetic abnormality in MM patients. The copy number varies in patients carrying 1q21 gains, mainly with two or more copies of 1q21. It may therefore be recommended to include testing for 1q21 gains in routine genetic testing of MM patients.

Computer-aided rigid choledochoscopy lithotripsy for hepatolithiasis.

BACKGROUND: Hepatolithiasis is challenging for surgeons to treat especially in patients with previous hepatobiliary surgery. The aim of the study was to report our experience of rigid choledochoscopy lithotripsy in targeted treatment of hepatolithiasis under the guidance of a medical image three-dimensional visualization system, which we developed and patented (software copyright no: 2008SR18 798) by comparing it with hepatectomy without a three-dimensional (3D) reconstruction technique. METHODS: Between December 2007 and March 2013, 64 patients underwent rigid choledochoscopy lithotripsy based on 3D visualization technology conducted by a medical image three-dimensional visualization system for hepatolithiasis (group A). During the same period, 61 patients with hepatolithiasis were selected for hepatectomy (group B). Comparative analysis was made of demographic and perioperative characteristics of the two groups. RESULTS: 3D visualization was instructive for surgeons on how the stones were distributed and what the spatial relationship was between stones and the intrahepatic vascular system. Compared with patients in group B, those in group A had a significantly lower intermediate residual stone rate, a faster operating time, a lower intraoperative blood loss and intraoperative blood transfusion, a shorter postoperative hospital stay, less postoperative complications, and more liver function reserved (P < 0.05 for all). Final residual stone rate, stone recurrence rate, and recurrent cholangitis rate were similar. CONCLUSIONS: 3D visualization technology provides an important reference and a valuable planning for rigid choledochoscopy lithotripsy, which is a feasible and effective method for management of hepatolithiasis.

[Comparison of levator ani muscles in three-dimensional MRI-based models in women with and without pelvic organ prolapse at rest].

OBJECTIVE: Comparison of the levator ani muscles in three-dimensional (3D) MRI-based models in women with and without pelvic organ prolapse at rest to analyze the morphological characteristics of levator ani muscles in women with POP. METHODS: Twenty-five women with POP and 22 women with normal pelvic support were selected from Nanfang Hospital of Southern Medical University. Axial, sagittal, and coronal T2-weighted pelvic magnetic resonance scans were obtained with the women in the supine position.The 3D models were reconstructed from the source images. Morphological changes was compared within the two groups of levator ani muscles, and the 3D models were measured to determine the levator ani muscle volume (LVOL), levator plate angle (LPA), levator hiatus width (LH-W) and length (LH-L), distance between symphysis and levator sling muscle (LSG). RESULTS: There were no puborectalis avulsions in control, in POP, 3 cases of avulsions just in left, 3 cases of avulsions just in right, 7 cases in bilateral. The shape of iliococcygeus were all dome-shaped in control, 11 cases were U-shaped and 14 cases were dome-shaped in POP. The shape of levator hiatus were 7 cases of U-shape, 12 cases of V-shape, 3 cases of irregular in control; 5 cases of U-shape, 4 cases of V-shape, 16 cases of irregular in POP. POP versus control: LH-L: (68.0 ± 8.9) versus (61.6 ± 7.2) mm (P < 0.05); LH-W: (41.4 ± 3.9) versus (38.0 ± 3.2) mm (P < 0.05); LSG-L: (29.6 ± 7.4) versus (24.6 ± 3.7) mm (P < 0.05); LSG-R: (28.4 ± 6.8) versus (23.9 ± 3.2) mm (P < 0.05); LPA: (51.0 ± 11.3)° versus (40.6 ± 6.3)° (P < 0.05); LVOL: (23.7 ± 5.8) versus (24.6 ± 5.0) cm³ (P > 0.05). CONCLUSIONS: It is possible to assess the morphologic changes of levator ani by using 3D MRI models objectively, our 3D data demonstrate larger in LVOL, LPA, LH-W, LH-L, LSG, and the changes in shape. It is helpful to diagnose and assess the specific situation of patients POP in clinic.

A comparative study of the diagnostic accuracy of the medical image three-dimensional visualization system, MRCP, CT and US in hepatolithiasis.

BACKGROUND/AIMS: The aim of this study was to compare the results of the Three-Dimensional Visualization System (MI-3DVS or 3D) in the diagnostic accuracy of hepatolithiasis. METHODOLOGY: From February 2007 to March 2013, forty-eight patients with hepatolithiasis were admitted to our department. Meanwhile, choosing forty-one patients without hepatolithiasis as controlgroup. MI-3DVS, MRCP, CT, and US were performed and the results of these imaging methods in detecting calculi distribution, bile duct dilatation/stricture, and liver atrophy/hypertrophy were analyzed. RESULTS: The total display accuracy on bile duct stricture/dilatation using by 3D was higher than using by MRCP, CT, US. The total accuracy of 3D in detecting the liver atrophy was 96.6%, which was superior to that of US (p=0.009) and CT (p=0.044), and there was no significant difference compared with MRCP (P=0.120). The results on diagnosis of calculi distribution by 3D was better than US (p=0.003) and MRCP (p=0.029), but had no significantly difference compared with CT (P=0.246), and they were all close to intraoperative findings. CONCLUSIONS: MI-3DVS could be used to select patients with hepatolithiasis as a supplement approach to other imaging methods and as an innovative means in pre-operative assessment and post-operative follow-ups in hepatolithiasis.

Management complicated hepatolithiasis with operative rigid choledochoscope guided by computed tomography (CT)-based 3D reconstruction technique.

BACKGROUND: Treatment of complicated hepatolithiasis is complex and difficult. In this report, we present a novel approach to manage complicated hepatolithiasis using the rigid choledochoscope guided by CT-based 3D reconstruction technique with or without hepatectomy. METHODS: Between February 2012 to December 2013, 25 patients with complicated hepatolithiasis underwent rigid choledochoscope guided by CT-based 3D reconstruction technique combined with or without hepatectomy. 27 patients with complicated hepatolithiasis underwent a traditional operation (traditional method group) from June 2011 to January 2012. All operations were performed by the authors. RESULTS: The final stone clearance rate of the rigid choledochoscope group was 96%, whereas that of the traditional method group was 74.1% (P=0.032). There was no patient died of postoperative mortality in two groups. Moreover, the operative time in the traditional method group was significantly longer than that in the rigid choledochoscope group (P=0.010). Recurrent intrahepatic bile duct stones were not found during the follow-up period in the two groups. CONCLUSIONS: Operative rigid choledochoscope guided by CT-based 3D reconstruction technique combined with or without hepatectomy may be an effective and safe treatment for complicated hepatolithiasis.

3D Reconstruction Aids Surgery For Complicated Hepatolithiasis.

BACKGROUND/AIMS: Three-dimensional (3D) imaging may improve surgical interventions for complicated hepatolithiasis. METHODOLOGY: Between July 2008 and December 2012 a total of 131 patients with complicated hepatolithiasis underwent surgical therapy in the Department of Hepatobiliary Surgery Zhujiang Hospital, Southern Medical University. 77 patients received preoperative planning using a computed tomography (CT)-based 3D reconstruction technique, and 54 received treatment based on preoperative planning with traditional imaging (CT, ultrasonography, magnetic resonance imaging/magnetic resonance cholangiography). Perioperative and long-term outcomes were analyzed. RESULTS: 3D reconstruction facilitated significantly more accurate diagnosis of pathological morphology than conventional imaging methods, as confirmed during surgery. Patients that received 3D reconstruction preoperative planning had significantly better clinical outcomes. The immediate stone clearance rates were 92.2% and 61.1%, respectively. Additional postoperative choledochoscopic lithotripsy raised the clearance rates to 94.8% and 81.5%, respectively. The hospital mortality rates were 0% and 1.9%, respectively, and the complication rates were 33.8% and 44.4%, respectively. With a median follow-up of 28 months (5-38 months), the long-term overall asymptomatic survival rates were 80.5% and 46.3%, respectively. 3D reconstruction preoperative planning was a significant prognostic protective factor of long-term asymptomatic survival for the patients with complicated hepatolithiasis (Cox regression analysis, RR = 0.348, 95% confidence interval 0.185-0.657, p = 0.001). CONCLUSION: Surgical therapy conducted following preoperative planning using 3D reconstruction achieved better clinical outcomes than conventional imaging techniques. Whilst conventional imaging techniques accurately identify intrahepatic stones, they are less capable of identifying bile duct stricture.

[Reconstruction and characteristics of the three-dimensional models of uterine arterial vascular network for healthy females aged 20-26 years].

OBJECTIVE: To analyze the characteristics of anatomy and blood distribution of uterine arterial vascular network in vivo for healthy women aged 20-26 years by reconstructing the digital three-dimensional models based on computerized tomographic angiography (CTA) scanning technology. METHODS: From August to December 2012, a total of 25 female volunteers aged 20-26 years were recruited. All of them accepted CTA scanning. Their datasets were collected for reconstructing the digital three-dimension models of normal uterine arterial vascular network by using Mimics Version 10.01 software. After recognizing the supply arteries of each part of uterus, the three dimension models were divided into corpus and cervix arterial vascular network, left and right corpus arterial vascular network, left and right cervical artery vasc ular network and then calculated the proportion of vascular volume. RESULTS: Digital three-dimension models of normal uterine arterial vascular network of 25 cases were successfully reconstructed, which clearly showed the structure of the uterine artery and its branches at all levels. Under normal physiological conditions, vascular network of corpus developed in 21 cases (84%, 21/25). In these cases, bilateral vascular network were developed and supplied by the ipsilateral uterine artery respectively, where the distribution of vascular were bilateral balanced in 18 cases and unilateral predominant in 3 cases.However, 4 cases (16%, 4/25) of vascular network of corpus were not developed. There were not statistically significant of vascular network volume between both sides of uterine corpus of 25 cases digital three dimension models of normal uterine arterial vascular network (t = 1.817, P = 0.077). The cervical arterial vascular networks didn't develop in 23 cases (92%, 23/25), whereas it developed in 2 cases (8%, 2/25). CONCLUSIONS: This study successfully reconstructed the three dimensional models of uterine arterial vascular network for healthy females aged 20-26 years, confirming that the overall normal uterine vascular network distribution has the characteristics of bilateral, ipsilateral blood tendentious and balanced. But the cervical vascular network is rarely developing.