The risk and protective factors on the mental health of healthcare workers during the lockdown period due to covid-19 pandemic.

This study aimed to analyze the impact of the lockdown period due to COVID-19 pandemic on the mental health status of healthcare workers and identify the related risk factors of psychosomatic distress. We conducted an online questionnaire survey to investigate the general demographic characteristics, perceived stress level, adult attachment style (AAS), family cohesion and adaptability, social support, sleep state, emotional state, and physical health of healthcare workers during the lockdown period due to the pandemic in 2022. We compared the mental health status between doctors and nurses, and further analyzed the factors influencing sleep, emotions, physical symptoms, and severe psychosomatic distress separately. For factors that showed statistical significance in the univariate analysis, forward stepwise regression was used for logistic regression analysis to identify risk factors for the corresponding issues. A total of 622 healthcare workers participated in the survey. Among the participants, 121 (19.5%) reported sleep problems, 209 (33.6%) had negative emotional states, and 147 (23.6%) reported physical health problems. There were 48 (7.7%) healthcare workers with severe psychosomatic distress. Compared to the group of nurses, the group of doctors exhibit a higher prevalence of emotional issues, physical health problems and psychosomatic distress. Perceived stress was identified as a risk factor for sleep disturbance, while living with others during quarantine and family adaptability were identified as protective factors. Higher educational background and perceived stress were identified as risk factors for negative emotion, while subjective support was identified as a protective factor. Perceived stress and coming from a rural area were also identified as risk factors for physical health. Overall, for the comparison between the no psychosomatic distress and severe psychosomatic distress groups, perceived stress was identified as a risk factor for severe psychosomatic distress, while subjective support was identified as a protective factor. Healthcare workers' potential mental and physical health problems are related to their educational background, family cohesion and adaptability, perceived stress and social support. This makes it clearer on how to deal with and prevent adverse consequences when facing stressful situations.

Differences in Patellofemoral Alignment Between Static and Dynamic Extension Positions in Patients With Patellofemoral Pain.

Background: Considering that patellofemoral pain (PFP) is related to dynamic factors, dynamic extension on 4-dimensional computed tomography (4-DCT) may better reflect the influence of muscles and surrounding soft tissue than static extension. Purpose: To compare the characteristics of patellofemoral alignment between the static and dynamic knee extension position in patients with PFP and controls via 4-DCT. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 39 knees (25 patients) with PFP and 37 control knees (24 participants). For each knee, an image of the dynamic extension position (a single frame of the knee in full extension [flexion angle of -5° to 0°] selected from 21 frames of continuous images acquired by 4-DCT during active flexion and extension) and an image of the static extension position (acquired using the same equipment with the knee fully extended and the muscles relaxed) were selected. Patellofemoral alignment was evaluated between the dynamic and static extension positions and between the PFP and control groups with the following parameters: patella-patellar tendon angle (P-PTA), Blackburne-Peel ratio, bisect-offset (BO) index, lateral patellar tilt (LPT), and tibial tuberosity-trochlear groove (TT-TG) distance. Results: In both PFP patients and controls, the P-PTA, Blackburne-Peel ratio, and BO index in the static extension position were significantly lower (P < .001 for all), while the LPT and TT-TG distance in the static extension position were significantly higher (P ≤ .034 and P < .001, respectively) compared with values in the dynamic extension position. In the comparison between groups, only P-PTA in the static extension position was significantly different (134.97° ± 4.51° [PFP] vs 137.82° ± 5.63° [control]; P = .027). No difference was found in the rate of change from the static to the dynamic extension position of any parameter between the study groups. Conclusion: The study results revealed significant differences in patellofemoral alignment characteristics between the static and dynamic extension positions of PFP patients and controls. Multiplanar measurements may have a role in subsequent patellofemoral alignment evaluation.

Factors influencing magnetic resonance imaging changes associated with pelvic bone injury after high-intensity focused ultrasound ablation of uterine fibroids: a retrospective case-control study.

Background: The application of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids is becoming increasingly widespread, and postoperative collateral thermal damage to adjacent tissue has become a prominent subject of discussion. However, there is limited research related to bone injury. Therefore, the aim of this study was to investigate the potential factors influencing unintentional pelvic bone injury after HIFU ablation of uterine fibroids with magnetic resonance imaging (MRI). Methods: A total of 635 patients with fibroids treated with HIFU in the First Affiliated Hospital of Chongqing Medical University were enrolled. All patients underwent contrast-enhanced MRI (CE-MRI) pre- and post-HIFU. Based on the post-treatment MRI, the patients were divided into two groups: pelvic bone injury group and non-injury group, while the specific site of pelvic bone injury of each patient was recorded. The univariate and multivariate analyses were used to assess the correlations between the factors of fibroid features and treatment parameters and pelvic bone injury, and to further analyze the factors influencing the site of injury. Results: Signal changes in the pelvis were observed on CE-MRI in 51% (324/635) of patients after HIFU. Among them, 269 (42.4%) patients developed sacral injuries and 135 (21.3%) had pubic bone injuries. Multivariate analyses showed that patients with higher age [P=0.003; odds ratio (OR), 1.692; 95% confidence interval (CI): 1.191-2.404], large anterior side-to-skin distance of fibroid (P<0.001; OR, 2.297; 95% CI: 1.567-3.365), posterior wall fibroid (P=0.006; OR, 1.897; 95% CI: 1.204-2.989), hyperintensity on T2-weighted imaging (T2WI, P=0.003; OR, 2.125; 95% CI: 1.283-3.518), and large therapeutic dose (TD, P<0.001; OR, 3.007; 95% CI: 2.093-4.319) were at higher risk of postoperative pelvic bone injury. Further analysis of the factors influencing the site of the pelvic bone injury showed that some of the fibroid features and treatment parameters were associated with it. Moreover, some postoperative pain-related adverse events were associated with the pelvic bone injury. Conclusions: Post-HIFU treatment, patients may experience pelvic injuries to the sacrum, pubis, or a combination of both, and some of them experienced adverse events. Some fibroid features and treatment parameters are associated with the injury. Taking its influencing factors into full consideration preoperatively, slowing down treatment, and prolonging intraoperative cooling phase can help optimize treatment decisions for HIFU.

Prediction of recurrence risk factors in patients with early-stage cervical cancers by nomogram based on MRI handcrafted radiomics features and deep learning features: a dual-center study.

PURPOSE: To establish and validate a deep learning radiomics nomogram (DLRN) based on intratumoral and peritumoral regions of MR images and clinical characteristics to predict recurrence risk factors in early-stage cervical cancer and to clarify whether DLRN could be applied for risk stratification. METHODS: Two hundred and twenty five pathologically confirmed early-stage cervical cancers were enrolled and made up the training cohort and internal validation cohort, and 40 patients from another center were enrolled into the external validation cohort. On the basis of region of interest (ROI) of intratumoral and different peritumoral regions, two sets of features representing deep learning and handcrafted radiomics features were created using combined images of T2-weighted MRI (T2WI) and diffusion-weighted imaging (DWI). The signature subset with the best discriminant features was chosen, and deep learning and handcrafted signatures were created using logistic regression. Integrated with independent clinical factors, a DLRN was built. The discrimination and calibration of DLNR were applied to assess its therapeutic utility. RESULTS: The DLRN demonstrated satisfactory performance for predicting recurrence risk factors, with AUCs of 0.944 (95% confidence interval 0.896-0.992) and 0.885 (95% confidence interval 0.834-0.937) in the internal and external validation cohorts. Furthermore, decision curve analysis revealed that the DLRN outperformed the clinical model, deep learning signature, and radiomics signature in terms of net benefit. CONCLUSION: A DLRN based on intratumoral and peritumoral regions had the potential to predict and stratify recurrence risk factors for early-stage cervical cancers and enhance the value of individualized precision treatment.

Association between needle track bleeding and postoperative immediate pneumothorax in CT-guided percutaneous transthoracic lung biopsies: a cross-sectional study.

The relationship between Needle Track Bleeding (NTB) and the occurrence of postoperative immediate pneumothorax remains unclear. In our cross-sectional study, we conducted a retrospective collected of data from 674 consecutive patients who underwent CT-guided percutaneous transthoracic lung biopsies between 2019 and 2022. A logistic regression model was employed to explore the association between NTB and postoperative immediate pneumothorax, and restricted cubic spline curves was used to investigate the link and its explicit curve shape. A sensitivity analysis was performed by transforming the continuous NTB into categorical variable and calculated an E-value. A total of 453 participants (47.90% male) were included in our analysis. The postoperative immediate pneumothorax rate was 41.05% (186/453). We found a negative correlation between NTB and postoperative immediate pneumothorax (OR = 0.91, 95%CI 0.88-0.95) after adjusting for confounding factors. This relationship was nonlinear, with a key inflection point at NTB of 8 mm. No significant link was noted for NTB > 8 mm (OR = 0.98, 95%CI 0.95-1.02), while a protective association was observed for NTB ≤ 8 mm (OR = 0.74, 95%CI 0.66-0.81). NTB showed a nonlinear, protective correlation with postoperative immediate pneumothorax. However, when NTB exceeded 8 mm, the protective association was not observed.

The impact of obstructive sleep apnea on nonalcoholic fatty liver disease.

Obstructive sleep apnea (OSA) is characterized by episodic sleep state-dependent collapse of the upper airway, with consequent hypoxia, hypercapnia, and arousal from sleep. OSA contributes to multisystem damage; in severe cases, sudden cardiac death might occur. In addition to causing respiratory, cardiovascular and endocrine metabolic diseases, OSA is also closely associated with nonalcoholic fatty liver disease (NAFLD). As the prevalence of OSA and NAFLD increases rapidly, they significantly exert adverse effects on the health of human beings. The authors retrieved relevant documents on OSA and NAFLD from PubMed and Medline. This narrative review elaborates on the current knowledge of OSA and NAFLD, demonstrates the impact of OSA on NAFLD, and clarifies the underlying mechanisms of OSA in the progression of NAFLD. Although there is a lack of sufficient high-quality clinical studies to prove the causal or concomitant relationship between OSA and NAFLD, existing evidence has confirmed the effect of OSA on NAFLD. Elucidating the underlying mechanisms through which OSA impacts NAFLD would hold considerable importance in terms of both prevention and the identification of potential therapeutic targets for NAFLD.

Effect of body mass index (BMI) on image contrast in the hepatobiliary phase of Gd-EOB-DTPA-enhanced-MRI and the feasibility of the application of half-dose Gd-EOB-DTPA to hepatobiliary phase imaging in patients with a BMI less than 24: a comparative study.

Background: Gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) can detect more lesions through the image contrast of hepatobiliary phase. Body mass index (BMI) reflects the composition ratio of human tissue, which is an influencing factor of magnetic resonance image contrast. Meanwhile, Gd-EOB-DTPA is recommended to use the minimum dose when the diagnosis demands could be met. The aim of this paper was to investigate the effect of BMI on hepatobiliary phase image contrast and explore the feasibility of using low-dose Gd-EOB-DTPA to obtain good hepatobiliary phase image contrast in patients with normal and lean BMI. Methods: Eighty-two patients who had previously undergone Gd-EOB-DTPA-enhanced MRI (0.025 mmol/kg) were collected and divided into group A (BMI <24 kg/m2) and group B (BMI ≥24 kg/m2) according to Chinese BMI standards. Liver-to-portal vein contrast ratio (LPC20) and liver-to-spleen contrast ratio (LSC20) in hepatobiliary phase (20 min after injection) were calculated. Thirty patients with a BMI <24 kg/m2 who were about to receive Gd-EOB-DTPA-enhanced MRI were randomly divided into group C (0.0125 mmol/kg) and group D (0.025 mmol/kg). Image acquisition was performed at 10, 15, and 20 min after injection. LPC10, LPC15, LPC20 and LSC10, LSC15, LSC20 in corresponding phases were calculated. Results: In retrospective grouping study, compared with group B, group A's LPC20 was significantly higher [2.63 (2.42-3.00) vs. 2.22 (1.97-2.67); P<0.01]. In prospective grouping study, there were no differences in LPC15, LSC15, LPC20 and LSC20 between group C and group D. Intragroup comparison in each group showed that LPC15 (group C: 2.67±0.33; group D: 2.61±0.21) and LPC20 (group C: 2.74±0.37; group D: 2.72±0.27) were higher than LPC10 (group C: 2.19±0.18; group D: 1.94±0.17) (all P<0.01), while there were no changes between LPC15 and LPC20. Conclusions: Under conventional dose, hepatobiliary phase image contrast in patients with a BMI <24 was higher, which was mainly manifested in the high LPC. For patients with a BMI <24 kg/m2, using a half conventional dose (0.0125 mmol/kg), good hepatobiliary phase image contrast can still be obtained at 15-20 min after administration.

Quantitative analysis of vertebral fat fraction and R2* in osteoporosis using IDEAL-IQ sequence.

OBJECTIVE: To investigate the correlation between FF, R2* value of IDEAL-IQ sequence and bone mineral density, and to explore their application value in the osteoporosis. METHODS: We recruited 105 women and 69 men aged over 30 years who voluntarily underwent DXA and MRI examination of lumbar spine at the same day. Participants were divided into normal, osteopenia and osteoporosis group based on T-score and BMD value of DXA examination. One-way ANOVA was adopted to compare the quantitative parameters among the three groups. Independent samples t-test was utilized to compare FF and R2* value between men and women.Pearson correlation analysis was used to research the correlation between FF, R2* value and BMD. RESULTS: Age, height, weight, BMD and FF value were significantly different among three groups (p < 0.05). No significant difference was found in FF value between male and female group, while R2* value were significantly different. Vertebral FF was moderately negatively correlated with aBMD, especially in women (r = -0.638, p < 0.001). R2* was mildly to moderately positively correlated with aBMD in men (r = 0.350, p = 0.003), but not in women. Moreover, FF was positively correlated with age, R2* was negatively correlated with age in men, and BMD was negatively correlated with age. CONCLUSIONS: The vertebral FF value of IDEAL-IQ sequence has the potential to be a new biological marker for the assessment of osteoporosis. Vertebral FF is moderately negatively correlated with aBMD, especially in women, allowing accuratly quantify the bone marrow fat. R2* value is mildly to moderately correlated with BMD in men and can be served as a complementary tool in the assessment of osteoporosis.

Potential utility of [68Ga]DOTA-FAPI-04 as a broad-spectrum benign disease imaging agent-comparison with [18F]FDG and [99mTc]MDP.

OBJECTIVES: To compare the detection performance of [68Ga]DOTA-FAPI-04 positron emission tomography/computed tomography (PET/CT) and [18F]FDG PET/CT for patients with various benign diseases and that of [68Ga]DOTA-FAPI-04 PET/CT and [99mTc]MDP single-photon emission computed tomography/computed tomography (SPECT/CT) for patients with benign bone lesions. METHODS: This prospective study included 89 patients who underwent [18F]FDG and [68Ga]DOTA-FAPI-04 PET/CT and 22 patients who underwent [99mTc]MDP SPECT/CT and [68Ga]DOTA-FAPI-04 PET/CT. Detection performance of [68Ga]DOTA-FAPI-04, [18F]FDG PET/CT, and [99mTc]MDP SPECT/CT for benign lesions was compared using the T/B value, T value, and true positive rate. Paired sample t-tests were conducted for comparisons. RESULTS: This study comprised 53 men and 58 women (mean age, 53 ± 15.75 years). [68Ga]DOTA-FAPI-04 demonstrated a higher uptake and detection rate for fibrotic disease (SUVmax [FAPI vs FDG: 6.26 ± 1.61 vs 2.38 ± 1.26], p1 < 0.001; T/B value [FAPI vs FDG: 9.38 ± 2.78 vs 1.95 ± 1.33], p2 < 0.001; and true positive rate 100% vs 26.3%), infectious disease (T/B value [FAPI vs FDG: 14.15 ± 12.42 vs 6.70 ± 5.87], p2 < 0.05; and true positive rate 94% vs 82%), and benign tumor (T/B value [FAPI vs FDG: 6.49 ± 5.85 vs 1.96 ± 2.03], p2 < 0.05; and true positive rate 70% vs 52%) than [18F]FDG. [68Ga]DOTA-FAPI-04 demonstrated a lower uptake and a comparable detection rate for benign bone disease (T/B value [FAPI vs FDG: 5.46 ± 2.91 vs 23.58 ± 15.37], p < 0.001; and true positive rate 90% vs 99%) than [99mTc]MDP. CONCLUSION: [68Ga]DOTA-FAPI-04 could be used as a benign disease imaging agent to complement traditional nuclide imaging agents. CLINICAL RELEVANCE STATEMENT: Our study showed that [68Ga]DOTA-FAPI-04 PET/CT could provide reliable imaging evidence for clinical detection and diagnosis of various benign lesions, such as inflammatory, infectious, fibrotic diseases, and benign tumors. KEY POINTS: • [68Ga]DOTA-FAPI-04 demonstrated a higher uptake and detection rate for fibrotic disease, infectious disease, and benign tumor than [18F]FDG. • [68Ga]DOTA-FAPI-04 demonstrated an equivalent detection efficacy to [18F]FDG for inflammatory diseases. • [68Ga]DOTA-FAPI-04 demonstrated a lower uptake and a comparable detection rate for benign bone disease than [99mTc]MDP.

Comparison of ultrasound-based ADNEX model with magnetic resonance imaging for discriminating adnexal masses: a multi-center study.

Objectives: The ADNEX model offered a good diagnostic performance for discriminating adnexal tumors, but research comparing the abilities of the ADNEX model and MRI for characterizing adnexal tumors has not been reported to our knowledge. The aim of this study was to evaluate the diagnostic accuracy of the ultrasound-based ADNEX (Assessment of Different NEoplasias in the adneXa) model in comparison with that of magnetic resonance imaging (MRI) for differentiating benign, borderline and malignant adnexal masses. Methods: This prospective study included 529 women with adnexal masses who underwent assessment via the ADNEX model and subjective MRI analysis before surgical treatment between October 2019 and April 2022 at two hospitals. Postoperative histological diagnosis was considered the gold standard. Results: Among the 529 women, 92 (17.4%) masses were diagnosed histologically as malignant tumors, 67 (12.7%) as borderline tumors, and 370 (69.9%) as benign tumors. For the diagnosis of malignancy, including borderline tumors, overall agreement between the ADNEX model and MRI pre-operation was 84.9%. The sensitivity of the ADNEX model of 0.91 (95% confidence interval [CI]: 0.85-0.95) was similar to that of MRI (0.89, 95% CI: 0.84-0.94; P=0.717). However, the ADNEX model had a higher specificity (0.90, 95% CI: 0.87-0.93) than MRI (0.81, 95% CI: 0.77-0.85; P=0.001). The greatest sensitivity (0.96, 95% CI: 0.92-0.99) and specificity (0.94, 95% CI: 0.91-0.96) were achieved by combining the ADNEX model and subjective MRI assessment. While the total diagnostic accuracy did not differ significantly between the two methods (P=0.059), the ADNEX model showed greater diagnostic accuracy for borderline tumors (P<0.001). Conclusion: The ultrasound-based ADNEX model demonstrated excellent diagnostic performance for adnexal tumors, especially borderline tumors, compared with MRI. Accordingly, we recommend that the ADNEX model, alone or with subjective MRI assessment, should be used for pre-operative assessment of adnexal masses.

A Deep Learning Radiomics Nomogram to Predict Response to Neoadjuvant Chemotherapy for Locally Advanced Cervical Cancer: A Two-Center Study.

Purpose: This study aimed to establish a deep learning radiomics nomogram (DLRN) based on multiparametric MR images for predicting the response to neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC). Methods: Patients with LACC (FIGO stage IB-IIIB) who underwent preoperative NACT were enrolled from center 1 (220 cases) and center 2 (independent external validation dataset, 65 cases). Handcrafted and deep learning-based radiomics features were extracted from T2WI, DWI and contrast-enhanced (CE)-T1WI, and radiomics signatures were built based on the optimal features. Two types of radiomics signatures and clinical features were integrated into the DLRN for prediction. The AUC, calibration curve and decision curve analysis (DCA) were employed to illustrate the performance of these models and their clinical utility. In addition, disease-free survival (DFS) was assessed by Kaplan-Meier survival curves based on the DLRN. Results: The DLRN showed favorable predictive values in differentiating responders from nonresponders to NACT with AUCs of 0.963, 0.940 and 0.910 in the three datasets, with good calibration (all p > 0.05). Furthermore, the DLRN performed better than the clinical model and handcrafted radiomics signature in all datasets (all p < 0.05) and slightly higher than the DL-based radiomics signature in the internal validation dataset (p = 0.251). DCA indicated that the DLRN has potential in clinical applications. Furthermore, the DLRN was strongly correlated with the DFS of LACC patients (HR = 0.223; p = 0.004). Conclusion: The DLRN performed well in preoperatively predicting the therapeutic response in LACC and could provide valuable information for individualized treatment.

The SP-ET index is a new index for assessing the vertical position of patella.

BACKGROUND: Some parameters in previous studies did not better reflect the vertical position of the patella relative to the femoral trochlear. This study aimed to assess the value of the most superior point of patella-entrance of femoral trochlea distance ratio (SP-ET index) as a newer index in defining the vertical position of patella relative to the trochlea, correlate it with the Insall-Salvati ratio, and investigate the effect of the new index on patellar cartilage lesions. METHODS: A total of 99 knees of 77 patients with patellar cartilage lesions were retrospectively analyzed using magnetic resonance imaging (MRI) data. The Insall-Salvati ratio and SP-ET index were measured on MR images. Ninety-nine knees just with meniscus rupture were enrolled as the control group. The two parameters of the patellar cartilage lesions were compared with those of the control group. RESULTS: The Insall-Salvati ratio and SP-ET index in the patellar cartilage lesions group were significantly higher than those in the control group (p < 0.001). The SP-ET index showed a moderate positive correlation with the Insall-Salvati ratio (r = 0.307, p < 0.001). Receiver operating characteristic (ROC) analysis showed that the diagnostic efficiency of the SP-ET index was better than that of the Insall-Salvati ratio in patients with patellar cartilage lesions. CONCLUSION: The SP-ET index may be a useful complement parameter to define the vertical position of the patella relative to the femoral trochlear. Increased SP-ET index may be an important risk factor for patellar cartilage lesions.

Factors influencing magnetic resonance imaging finding of endopelvic fascial edema after ultrasound-guided high-intensity focused ultrasound ablation of uterine fibroids.

OBJECTIVE: Investigate the relationships between endopelvic fascial edema and its influencing factors after ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation of uterine fibroids. METHODS: This retrospective study included 688 women with uterine fibroids treated by USgHIFU; based on post-treatment MRI, the patients were divided into two groups: endopelvic fascial edema group and nonedema group. The specific location of fascial edema of each patient was also recorded. Fascial edema and fibroid features and treatment parameters were set as the dependent and independent variables, respectively, and the correlations were studied using univariate and multivariate analyses. The relationship between the pain-related adverse events and location of fascial edema was analyzed by χ2 and fisher's exact tests. RESULTS: Edema and nonedema groups had 556 and 112 patients, respectively. Among the edema patients, posterior fascial edema incidence was the highest. Multifactorial analysis showed that the energy efficiency factor (EEF), fibroid location, and enhancement type were positively associated with endopelvic fascial edema (p < 0.05), while the distance from dorsal surface of the fibroid to sacrum was negatively correlated (p < 0.001). Patients with anterior, posterior and perirectal, and right lateral fascial edemas were associated with lower abdominal pain, sacrococcygeal pain, and leg numbness/pain, respectively. CONCLUSION: Post-USgHIFU ablation, patients were prone to developing endopelvic fascial edema, and some of them experienced pain-related adverse events. The fibroid location, its types of contrast enhancement, the distance from the dorsal surface of the fibroid to the sacrum, and EEF were the influencing factors resulting in the endopelvic fascial edema after USgHIFU ablation.

Tuberculous Thoracic Aortic Pseudoaneurysm Associated With Spinal Tuberculosis: A Case Report and Literature Review.

Background: Thoracic aortic pseudoaneurysm associated with spinal tuberculosis is a rare but fatal condition. The risk of pseudoaneurysm rupture is extremely high and this disease needs greater awareness. The present study reported a case of thoracic aortic pseudoaneurysm caused by paravertebral cold abscess with spinal tuberculosis. Case presentation: A 35-year-old woman with back pain was diagnosed with thoracic aortic pseudoaneurysm with spinal tuberculosis, and endovascular aneurysm repair (EVAR) was performed. The patient's symptoms disappeared after EVAR, following which she was discharged. Conclusions: The case highlighted that in cases where non-enhanced computed tomography (CT) revealed that the aortic vessel was surrounded by a paravertebral abscess, magnetic resonance imaging (MRI) should be performed to confirm whether the presence of a pseudoaneurysm. Upon diagnosis of pseudoaneurysm, surgery should be performed immediately. In recent times, EVAR has emerged as a promising alternative to open surgery.

Patellar shape is associated with femoral trochlear morphology in individuals with mature skeletal development.

BACKGROUND: As several studies have detected correlations between patellar and femoral trochlear development, this raises the question of whether patellar shape is associated with trochlear developmental outcomes. METHODS: Patellar shape and femoral trochlear morphology were retrospectively analyzed in 183 subjects, of whom 61 each were classified as having Wiberg type I, II, and III patellae (groups A, B, and C, respectively). The sulcus angle (SA), lateral trochlea inclination angle (LTA), medial trochlear inclination angle (MTA), lateral facet length (LFL), medial facet length (MFL), lateral trochlear height (LTH), medial trochlear height (MTH), trochlea sulcus height (TH), and lateral-medial trochlear facet distance (TD) were analyzed as a means of evaluating trochlear morphology. Trochlear depth, trochlear condyle asymmetry, and trochlear facet asymmetry were additionally calculated, and differences in trochlear morphology and correlations between trochlear morphology and patellar shape were evaluated. RESULTS: The femoral trochlear parameters of patients in group A differed significantly from those of patients in groups B and C. No significant differences between groups B and C were evident. Patellar shape was positively correlated with LTA, MTA, MFL, trochlear condyle asymmetry, and trochlear facet asymmetry, and was negatively correlated with SA. CONCLUSIONS: These data indicated that patellar shape and trochlear morphology are related to one another,which suggest normalized patella morphology surgery and trochlear surgery are better choices for patients with patella instability. TRIAL REGISTRATION: Retrospectively registered.

Multiscale analysis of factors affecting food security in China, 1980-2017.

Food security is an important issue affecting people's lives and social stability. Clarifying levels of food security and the factors affecting it (social, economic, agricultural, climatic) can help improve regional food security. The spatiotemporal patterns and driving factors of food security vary at different scales. There is, however, a lack of research that considers the various factors affecting food security at multiple scales. This study, therefore, analyzed dynamic spatiotemporal changes in food security at small (city), medium (province), and large (country) scales; identified hot and cold areas of food security; and revealed the main factors affecting food security at different scales. A food security index (FSI) was built based on the coupling of grain yield, population, and GDP, and spatial analysis was used to evaluate dynamic spatiotemporal changes in China's food security from 1980 to 2017. Further, the relationship between food security and its driving factors was quantitatively analyzed using stepwise regression. The results showed greater heterogeneity in food security at the smaller scale than at the larger scale. The key factors affecting food security varied substantially at different scales: the added value of tertiary industry dominated the prefecture level, and gross agricultural output value was the main factor at the provincial and national levels. Multiple-scale research can reveal the status and primary factors of food security and provide a decision-making basis for improving regional food security.

Molecular characterization of solitary pulmonary nodules in dual-energy CT nonlinear image fusion technology.

OBJECTIVE: To investigate the feasibility and to optimize the parameters of nonlinear blending technique in dual-energy CT on solitary pulmonary nodules (SPN). METHODS: The simulated enhanced SPN were used the mixture of nonionic iodinated contrast agent (Iopromide 370mgI/100 ml) and normal saline and then randomly placed inside an anthropomorphic chest phantom. The phantom was examined on SOMATOM definition flash with dual mode (80/140 kV) and single energy mode (120 kV) (the same CTDIvol). Nonlinear blending images and linear blending images with a weighting factor of 0.3 were generated and the image qualities were analyzed. RESULTS: For different simulated density SPN, when 0 HU was chosen as the Blending Center (BC) and 0 to 30 HU were chosen as the Blending width (BW), the nonlinear blending images yielded a higher contrast-to-noise (CNR). There were significant differences in the image noise and signal-to-noise (SNR) of different simulated density SPN at non-linear blending images, linear blending images and 120 kV images (p < .05); But the differences of CNR between the three groups were not statistically significant (p > .05). The SNR of different simulated density SPN at non-linear blending images was significantly increased compared with it at linear blending images and 120 kV images (p < .05); And the image noise at non-linear blending was lower than it at linear blending images (p < .05). CONCLUSION: Nonlinear blending technique in dual-energy CT can increase the SNR of enhanced SPN, and it is helpful in diagnosis of SPN.

Influence of porous tantalum scaffold pore size on osteogenesis and osteointegration: A comprehensive study based on 3D-printing technology.

The emerging role of porous tantalum (Ta) scaffold for bone tissue engineering is noticed due to its outstanding biological properties. However, it is controversial which pore size and porosity are more conducive for bone defect repair. In the present work, porous tantalum scaffolds with pore sizes of 100-200, 200-400, 400-600 and 600-800 µm and corresponding porosities of 25%, 55%, 75%, and 85% were constructed, using computer aided design and 3D printing technologies, then comprehensively studied by in vitro and in vivo studies. We found that Ta scaffold with pore size of 400-600 µm showed stronger ability in facilitating cell adhesion, proliferation, and osteogenic differentiation in vitro. In vivo tests identified that porous tantalum scaffolds with pore size of 400-600 µm showed better performance of bone ingrowth and integration. In mechanism, computational fluid dynamics analysis proved porous tantalum scaffolds with pore size of 400-600 µm hold appropriate permeability and surface area, which facilitated cell adhesion and proliferation. Our results strongly indicate that pore size and porosity are essential for further applications of porous tantalum scaffolds, and porous tantalum scaffolds with pore size 400-600 µm are conducive to osteogenesis and osseointegration. These findings provide new evidence for further application of porous tantalum scaffolds for bone defect repair.

A quantitative MRI investigation of the association between iliotibial band syndrome and patellofemoral malalignment.

BACKGROUND: The iliotibial band (ITB) has a wide patellar insertion that provides lateral restraint to the patella and maintains the patellofemoral joint's stability. There has been limited investigation into the relationship between patellofemoral malalignment and iliotibial band syndrome (ITBS). METHODS: We retrospectively analyzed 47 knees with ITBS by retrieving magnetic resonance imaging (MRI) data collected over an approximately 6-year period from our database. The Insall-Salvati ratio, lateral patellofemoral angle (LPA), lateral patellar tilt (LPT), lateral trochlear length (LTL), angle of the non-weight-bearing facet of the lateral femoral condyle (nwb-LFCA), and the ITB-lateral femoral condyle (IT-LFC) distance were measured on MR images. The knees of 47 age- and gender-matched subjects were enrolled as the normal group. RESULTS: In the ITBS group, over one third (34%, 16/47) of knees had abnormal patellofemoral measurements, including 8 (17%, 8/47) knees with patellar alta, 11 (23.4%, 11/47) knees with an abnormally decreased LPA, and 5 (10.6%, 5/47) knees with an abnormally increased LPT indicating lateral patellar tilt. Moreover, 8 knees had simultaneous combinations of two or three abnormality parameters, and 8 (17%, 8/47) knees presented with superolateral Hoffa's fat pad edema. The Insall-Salvati ratio, LPT, and nwb-LFCA in the ITBS group were significantly higher than those in the normal group (P=0.001, P<0.001, and P<0.001, respectively); the LPA and IT-LFC distances in the ITBS group were significantly lower (P=0.003, P<0.001, respectively) than those in the normal group. There were mild to moderate correlations between the MRI parameters and ITBS (P=0.006, P<0.001, respectively). CONCLUSIONS: This study confirmed that a higher position or lateral tilt of the patella and a steeper morphology of the anterior part of the lateral femoral condyle were associated with the development of ITBS, which is helpful in understanding and further exploring the mechanism of ITBS.

Mechanisms of non-contact anterior cruciate ligament injury as determined by bone contusion location and severity.

BACKGROUND: The location and severity of tibiofemoral bone contusions in magnetic resonance imaging scans in patients with acute non-contact anterior cruciate ligament injuries can reflect the primary mechanisms of anterior cruciate ligament injuries. There has been limited investigation to subdividing the bone contusion model in the medial and lateral directions of the tibial plateau and the femoral condyle. METHODS: A retrospective review of 93 consecutive magnetic resonance imaging examinations of patients with acute non-contact anterior cruciate ligament injuries was conducted to identify bone contusions of the knee. The locations and the severity of the bone contusions were determined using magnetic resonance imaging scans for each anatomic site, including the lateral femoral condyle, the lateral tibial plateau, the medial femoral condyle, and the medial tibial plateau. The bone contusions in the lateral-medial and anterior-posterior directions of four anatomical sites were subdivided into six compartments. The severity of the bone contusions was graded on a scale of 1-4. The location and the severity of bone contusions were accessed in the sagittal and coronal planes on the femoral and tibial sides of the knee using the radiology information system. RESULTS: The prevalence of bone contusions on the magnetic resonance imaging scans was as follows: 78.49% on the lateral femoral condyle, 88.17% on the lateral tibial plateau, 49.46% on the medial femoral condyle, and 69.89% on the medial tibial plateau. The most common and severe compartments of the lateral femoral condyle, the lateral tibial plateau, the medial femoral condyle, and the medial tibial plateau were the central-lateral (CL), the posterior-medial (PM), the CL, and the posterior-lateral (PL) compartments, respectively. CONCLUSIONS: The location patterns and severity of bone contusions in patients indicated that internal tibial rotation, valgus, and the anterior and lateral translation of the tibia were the primary mechanisms of non-contact anterior cruciate ligament injury.