Intramedullary nailing for irreducible spiral subtrochanteric fractures: A comparison of cerclage and non-cerclage wiring.

PURPOSE: Intramedullary nailing is the preferred internal fixation technique for the treatment of subtrochanteric fractures because of its biomechanical advantages. However, no definitive conclusion has been reached regarding whether combined cable cerclage is required during intramedullary nailing treatment. This study was performed to compare the clinical effects of intramedullary nailing with cerclage and non-cerclage wiring in the treatment of irreducible spiral subtrochanteric fractures. METHODS: Patients with subtrochanteric fractures admitted to our center from January 2013 to December 2021 were retrospectively analyzed. The patients were enrolled in the case-control study according to the inclusion and exclusion criteria and divided into the non-cerclage group and the cerclage group. The patients' clinical data, including the operative time, intraoperative blood loss, hospital stay, reoperation rate, fracture union time, and Harris hip score, were compared between these 2 groups. Categorical variables were compared using Chi-square or Fisher's exact test. Continuous variables with normal distribution were presented as mean ± standard deviation and analyzed with Student's t-test. Non-normally distributed variables were expressed as median (Q1, Q3) and assessed using the Mann-Whitney test. A p value < 0.05 was considered significant. RESULTS: In total, 69 patients were included in the study (35 patients in the non-cerclage group and 34 patients in the cerclage group). The baseline data of the 2 groups were comparable. There were no significant difference in the length of hospital stay (z = -0.391, p = 0.696), operative time (z = -1.289, p = 0.197), or intraoperative blood loss (z = -1.321, p = 0.186). However, compared with non-cerclage group, the fracture union time was shorter (z = -5.587, p < 0.001), the rate of nonunion was lower (χ2 = 6.030, p = 0.03), the anatomical reduction rate was higher (χ2 = 5.449, p = 0.03), and the Harris hip score was higher (z = -2.99, p = 0.003) in the cerclage group, all with statistically significant differences. CONCLUSIONS: Intramedullary nailing combined with cable cerclage wiring is a safe and reliable technique for the treatment of irreducible subtrochanteric fractures. This technique can improve the reduction effect, increase the stability of fracture fixation, shorten the fracture union time, reduce the occurrence of nonunion, and contribute to the recovery of hip joint function.

[Risk factors and prognosis of preoperative herat failure after hip fracture].

OBJECTIVE: To explore incidence, risk factors and the relationship between preoperative heart failure and prognosis in elderly patients with hip fracture. METHODS: A retrospective analysis was performed on 1 569 elderly patients with hip fracture treated from January 2012 to December 2019, including 522 males and 1 047 females, aged 81.00 (75.00, 90.00) years old;896 intertrochanteric fractures and 673 femoral neck fractures. Patients were divided into heart failure and non-heart failure groups according to whether they developed heart failure before surgery, and heart failure was set as the dependent variable, with independent variables including age, gender, fracture type, comorbidities and hematological indicators, etc. Univariate analysis was performed at first, and independent variables with statistical differences were included in multivariate Logistic regression analysis. Independent risk factors for preoperative heart failure were obtained. The length of hospital stay, perioperative complications, mortality at 30 days and 1 year after surgery were compared between heart failure and non-heart failure groups. RESULTS: There were 91 patients in heart failure group, including 40 males and 51 females, aged 82.00 (79.00, 87.00) years old;55 patients with intertrochanteric fracture and 36 patients with femoral neck fracture. There were 1 478 patients in non-heart failure groups, including 482 males and 996 females, aged 81.00(75.00, 86.00) years old;841 patients with intertrochanteric fracture and 637 patients with femoral neck fracture. There were significant differences in age, sex, coronary heart disease, arrhythmia and dementia between two groups(P<0.05). Multivariate Logistic analysis of statistically significant factors showed that males(OR=1.609, P=0.032), age(OR=1.032, P=0.031), arrhythmia(OR=2.045, P=0.006), dementia (OR=2.106, P=0.014) were independent risk factor for preoperative heart failure. The 30-day and 1-year mortality rates were 9.9% and 26.4% in heart failure group and 3.6% and 13.8% in non-heart failure group, respectively;and had statistical significance between two groups (P<0.05). There were significant differences in pulmonary infection, cerebrovascular complications and cardiovascular complications between two groups (P<0.05). The duration of hospitalization in heart failure group was (16.21±10.64) d compared with that in non-heart failure group (13.26±8.00) d, and the difference was statistically significant (t=2.513, P=0.012). CONCLUSION: Male, old age, arrhythmia and dementia are independent risk factors for heart failure after hip fracture in elderly patients. Patients with preoperative heart failure have a higher incidence of postoperative pulmonary infection, cerebrovascular and cardiovascular complications, higher mortality at 30 d and 1 year after surgery, and longer hospital stay.

Association between early response of alpha-fetoprotein and treatment efficacy of systemic therapy for advanced hepatocellular carcinoma: A multicenter cohort study from China.

Background: Alpha-fetoprotein (AFP) is a well-identified biomarker in hepatocellular carcinoma (HCC). However, only limited AFP-related studies have evaluated its early response to systemic therapy. This study was performed with the aim of assessing the value of early AFP response in predicting overall survival (OS) and progression-free survival (PFS) in advanced HCC patients receiving systemic therapy. Methods: This cohort study included HCC patients with baseline AFP ≥ 200 ng/ml and no prior treatment history. A > 20% decline in the serum AFP level from baseline to the first follow-up (i.e., 4~6 weeks after treatment) was defined as an early AFP response. Patient demographic information, clinical characteristics, radiological response, and survival rates were compared between patients with early AFP response and patients without early AFP response. We further utilized multivariate Cox regression to seek characteristics related to OS and PFS. Results: Among 154 patients, 69 patients (44.8%) showed an early AFP response. The disease control rate (76.8 vs. 54.1%; P = 0.003) and objective response rate (38.4 vs. 11.8%; P = 0.001) were significantly higher in patients with an early AFP response. By performing multivariate analysis, early AFP response remained a prognostic factor for longer PFS (HR 0.546; 95% CI 0.371-0.804; P = 0.002) and longer OS (HR 0.529; 95% CI 0.335-0.834; P = 0.006). Conclusion: An early AFP response is correlated with longer overall survival and progression-free survival for advanced HCC patients receiving systemic therapy. Moreover, an early AFP response is an independent prognostic factor for longer OS and PFS.

Effects of Monovacancy and Divacancies on Hydrogen Solubility, Trapping and Diffusion Behaviors in fcc-Pd by First Principles.

The hydrogen blistering phenomenon is one of the key issues for the target station of the accelerator-based neutron source. In the present study, the effect of monovacancies and divacancies defects on the solution, clustering and diffusion behaviors of H impurity in fcc-Pd were studied through first principles calculations. Our calculations prove that vacancies behave as an effective sink for H impurities. We found that, although the H-trap efficiency of the larger vacancy defect was reduced, its H-trap ability strengthened. There is a short-ranged area around the vacancy defects in which H impurities tend to diffuse to vacancy defects, gather and form hydrogen bubbles. Therefore, the characteristic of large vacancy defects formation in materials should be considered when screening anti-blistering materials for neutron-producing targets or when designing radiation resistant composite materials.

Utility of DWI with quantitative ADC values in ovarian tumors: a meta-analysis of diagnostic test performance.

Background Diffusion-weighted imaging (DWI) and quantitative apparent diffusion coefficient (ADC) values are widely used in the differential diagnosis of ovarian tumors. Purpose To assess the diagnostic performance of quantitative ADC values in ovarian tumors. Material and Methods PubMed, Embase, the Cochrane Library, and local databases were searched for studies assessing ovarian tumors using quantitative ADC values. We quantitatively analyzed the diagnostic performances for two clinical problems: benign vs. malignant tumors and borderline vs. malignant tumors. We evaluated diagnostic performances by the pooled sensitivity and specificity values and by summary receiver operating characteristic (SROC) curves. Subgroup analyses were used to analyze study heterogeneity. Results From the 742 studies identified in the search results, 16 studies met our inclusion criteria. A total of ten studies evaluated malignant vs. benign ovarian tumors and six studies assessed malignant vs. borderline ovarian tumors. Regarding the diagnostic accuracy of quantitative ADC values for distinguishing between malignant and benign ovarian tumors, the pooled sensitivity and specificity values were 0.91 and 0.91, respectively. The area under the SROC curve (AUC) was 0.96. For differentiating borderline from malignant tumors, the pooled sensitivity and specificity values were 0.89 and 0.79, and the AUC was 0.91. The methodological quality of the included studies was moderate. Conclusion Quantitative ADC values could serve as useful preoperative markers for predicting the nature of ovarian tumors. Nevertheless, prospective trials focused on standardized imaging parameters are needed to evaluate the clinical value of quantitative ADC values in ovarian tumors.

Effect of a novel segmentation algorithm on radiologists' diagnosis of breast masses using ultrasound imaging.

We investigated the effect of using a novel segmentation algorithm on radiologists' sensitivity and specificity for discriminating malignant masses from benign masses using ultrasound. Five-hundred ten conventional ultrasound images were processed by a novel segmentation algorithm. Five radiologists were invited to analyze the original and computerized images independently. Performances of radiologists with or without computer aid were evaluated by receiver operating characteristic (ROC) curve analysis. The masses became more obvious after being processed by the segmentation algorithm. Without using the algorithm, the areas under the ROC curve (Az) of the five radiologists ranged from 0.70∼0.84. Using the algorithm, the Az increased significantly (range, 0.79∼0.88; p < 0.001). The proposed segmentation algorithm could improve the radiologists' diagnosis performance by reducing the image speckles and extracting the mass margin characteristics.

CAD algorithms for solid breast masses discrimination: evaluation of the accuracy and interobserver variability.

For a successful computer-aided diagnosis (CAD) approach, investigating the benefit of the output for radiologist diagnosis is as important as developing the computer algorithm itself. To evaluate the accuracy and the interobserver variability of two newly developed CAD algorithms for breast mass discrimination, eight radiologists with varied experience in breast ultrasonography (US) independently reviewed the lesions according to Breast Imaging Reporting and Data System (BI-RADS)-US. They interpreted the original ultrasound images, provided a final assessment category to indicate the probability of malignancy and then made a further diagnosis using the images processed by the proposed CAD algorithms. The receiver operating characteristic (ROC) curve and Cohen's kappa statistics were employed to evaluate the effect of the CAD algorithms on radiologist diagnoses. By using the proposed CAD approach, the quality of the images was improved and more information was provided to the observers. With the processed images, the areas under the ROC (Az) of each reader (0.86 approximately 0.89) were greater than those with the original ultrasound images (0.81 approximately 0.86) and all the radiologists improved their performance significantly (p < 0.05) except two senior radiologists (p > 0.05). The Az values of the junior radiologists with CAD were comparable to those of the senior radiologists. Cohen's kappa statistics showed that better interobserver agreement was obtained by using the processed images. We conclude that the proposed CAD method is more helpful for the junior radiologists than for the senior ones and it also showed the advantage of decreasing interobserver variability.

[Quantitative evaluation of myocardial perfusion and regional systolic function by myocardial contrast stress echocardiography with computer-assisted technique in ischemic myocardium of rabbits].

OBJECTIVE: To evaluate the feasibility and value of determining myocardial perfusion and regional systolic function by myocardial contrast stress echocardiography (MCSE) with computer-assisted technique in a rabbit model of ischemia/reperfusion injury. METHODS: Rabbits underwent 30-(Group I, n = 15) and 120-(Group II, n = 15) minute left ventricular branch of the left circumflex coronary artery occlusion foll owed by 60-minute reperfusion, dobutamine at increasing doses (5, 10, 15 and 20 microg.kg(-1).min(-1)) was then infused after reperfusion for 15 min. Bolus myocardial contrast agent was injected and MCSE performed at baseline, at the end of coronary occlusion and reperfusion, at the end of each dobutamine infusion. Images were analyzed by computer-assisted technique and myocardial calibrated contrast intensity (CI) of each segment was measured and a color-coded map was then obtained automatically (yellow: from 0 to -20 pix, blue:from -21 to -40 pix, green: from -41 to -70 pix, red: < -70 pix). The area at risk and infarct area obtained by red-coded map were compared with ex vivo results determined by fluorescent microsphere and triphenyl-tetrazolium chloride (TTC) staining. Percentage wall thickening (WT) of each risk segment at each stage were also measured. RESULTS: (1) During occlusion, WT in the areas at risk decreased to zero or negative and the calibrated CI values were significantly lower than those at baseline. Area at risk obtained by red-coded map correlated well with that obtained by fluorescent staining (r = 0.91, P < 0.01). (2) After reperfusion and 5 microg.kg(-1).min(-1) dobutamine administration, WT and calibrated CI in all rabbits remained depressed. Calibrated CI at -70 pix was an optimal cutoff point to identify infarcted segments (sensitivity 95%, specificity 87%). The correlation between the infarct size by red-coded image and TTC was 0.89 (P < 0.01). (3) Calibrated CI and WT significantly improved in Group I rabbits while these parameters remained unchanged in Group II rabbits after increasing doses of dobutamine post ischemia. CONCLUSIONS: Myocardial contrast stress echocardiography in combination with computer-assisted analysis technique are valuable techniques to quantitatively assess myocardial perfusion and regional systolic function and exactly identify stunned myocardium and infarcted myocardium.

Computerized-aid diagnosis of breast mass using ultrasound image.

This paper presents a comparative study of the diagnostic results of the ultrasologists with/without using a novel enhancement algorithm for breast ultrasonic images based on fuzzy entropy principle and textural information. Totally, 350 ultrasound images of 115 cases were analyzed including 59 benign and 56 malignant lesions. The original breast images were fuzzified, the edge and textural information were extracted, and the images were enhanced. The original and enhanced images were assessed and evaluated by ultrasologists using double blind method before and after enhancement. The diagnostic sensitivity and specificity were calculated by the areas (Az) under the receiver operating characteristic (ROC) curves. And the two diagnostic results before and after enhancement were compared by Chi-square test in a 2 x 2 table. The results demonstrated that the discrimination rate of breast masses had been highly improved after employing the novel enhancement algorithm. The result indicates the sensitivity could be raised from 74.3% to 89.3% with the false-positive rate 14.3%, and the area (Az) under the ROC curve of diagnosis also increased from 0.84 to 0.93. The novel enhancement algorithm can increase the classification accuracy and decrease the rate of missing and misdiagnosis, and it is useful for breast cancer control.