An ultrasound-guided robot assisted system for percutaneous facet joint puncture: an experimental study / 中华创伤骨科杂志

Objective:To evaluate the accuracy of an ultrasound-guided robot-assisted system for percutaneous facet joint puncture in an animal experiment by registration of ultrasound images and two-dimensional X-ray fluorescence images.Methods:Six specimens of fresh adult sheep lumbar spine were prepared and soaked in gelatin solution. The specimens contained a total of 48 facet joints with 24 ones respectively on the left and right sides. Half of the joints were assigned by the random number table method into a robot-assisted group which were subjected to percutaneous facet joint puncture assisted by the ultrasound-guided robot-assisted system while the contralateral ones into a freehand group which were subjected to percutaneous facet joint puncture by freehand. In the robot-assisted group, the left facet joints were 3 L 1, 3 L 2, 3 L 3 and 3 L 4 ones while the right facet joints were 2 L 1, 3 L 2, 5 L 3 and 2 L 4 ones. In this self-control animal experiment, both the robot-assisted punctures and the freehand punctures were carried out in the same specimen. The puncture success rate, puncture needle adjustment, positioning deviation, orientation deviation and operation time were recorded. Results:The positioning deviation and orientation deviation in the robot-assisted group [(2.21 ± 1.12) mm and 1.51° ± 0.47°] were significantly lower than those in the freehand group [(3.26 ± 1.44) mm and 2.24° ± 0.89°] ( P < 0.05). All the articular facet joint punctures were successfully accomplished for the first time in the robot-assisted group while those required multiple adjustments in the freehand group. In the robot-assisted group, the total operation time [(463.84 ± 34.93) s] was significantly longer than that in the freehand group [(298.40 ± 27.48) s], but the puncture time [(37.97 ± 6.87) s] was significantly shorter than that in the freehand group [(261.61 ± 33.15) s] ( P < 0.05). Conclusion:The ultrasound-guided robot-assisted system for percutaneous facet joint puncture can lead to accurate puncture with limited needle adjustments.

Robot-assisted percutaneous minimally invasive pedicle screwing for multi-segmental thoracolumbar fractures / 中华创伤骨科杂志

Objective:To investigate the clinical effects of robot-assisted minimally invasive percutaneous pedicle screwing in the treatment of multi-segmental thoracolumbar burst fractures without neurological dysfunction.Methods:A retrospective analysis was conducted of the 24 patients who had been treated at Department of Orthopaedics, Hospital Affiliated to Inner Mongolia Medical University for multi-segmental thoracolumbar fractures from January 2019 to December 2020. They were randomly divided into a robot group ( n=12) in which the minimally invasive percutaneous pedicle screwing was assisted by a surgical robot and a manual group ( n=12) in which the minimally invasive percutaneous pedicle screwing was performed manually. There were 8 males and 4 females in the robot group, aged from 35 to 74 years; there were 7 males and 5 females in the manual group, aged from 36 to 69 years. The clinical effects were evaluated by comparing the 2 groups in terms of operation time, fluoroscopy frequency, fluoroscopy time, intra-operative needle adjustments, intra-operative blood loss, screwing accuracy, and visual analogue scale (VAS) scores, anterior vertebral height ratios and sagittal cobb angles at preoperation, postoperative 3 days and the last follow-up. Results:There was no statistically significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). A total of 128 screws were implanted in the robot group and 126 ones in the manual group. In the robotic group, operation time [(129.2±10.5) min], fluoroscopy frequency [(8.5±2.1) times], fluoroscopy time [(9.8±1.9) s], guide needle adjustments [(2.3±1.4) times], and intraoperative blood loss [(65.3±9.8) mL] were significantly less than those in the manual group [(153.8±18.1) min, (39.8±5.1) times, (43.9±4.8) s, (18.6±2.6) times and (96.8±10.9) mL] (all P<0.05). Regarding the screwing accuracy evaluated using CT scanning, the robot group was significantly higher (93.75%, 120/128) than the manual group (84.92%, 107/126) ( P<0.05). There was no significant difference between the 2 groups in VAS score, anterior vertebral height ratio or sagittal cobb angle at postoperative 3 days or the last follow-up ( P>0.05). The VAS scores, anterior vertebral height ratios and sagittal cobb angles at postoperative 3 days and the last follow-up were significantly improved than the preoperative values in all patients ( P<0.05). There was no supplementary surgery or screw loosening in either of the 2 groups. Conclusion:In the treatment of multi-segmental thoracolumbar fractures, robot-assisted percutaneous pedicle screwing can achieve satisfactory clinical effects, because, compared with traditional open surgery, it has exhibited advantages of less operation time, lower radiation exposure, less intraoperative blood loss, and higher screwing accuracy.

Assisting Scalable Diagnosis Automatically via CT Images in the Combat against COVID-19

Introductory paragraphThe pandemic of coronavirus Disease 2019 (COVID-19) caused enormous loss of life globally. 1-3 Case identification is critical. The reference method is using real-time reverse transcription PCR (rRT-PCR) assays, with limitations that may curb its prompt large-scale application. COVID-19 manifests with chest computed tomography (CT) abnormalities, some even before the onset of symptoms. We tested the hypothesis that application of deep learning (DL) to the 3D CT images could help identify COVID-19 infections. Using the data from 920 COVID-19 and 1,073 non-COVID-19 pneumonia patients, we developed a modified DenseNet-264 model, COVIDNet, to classify CT images to either class. When tested on an independent set of 233 COVID-19 and 289 non-COVID-19 patients. COVIDNet achieved an accuracy rate of 94.3% and an area under the curve (AUC) of 0.98. Application of DL to CT images may improve both the efficiency and capacity of case detection and long-term surveillance.

Magnetic resonance imaging characteristics of neuromyelitis optica / 中国医学影像技术

Neuromyelitis optica (NMO) is an inflammatory-demyelinating disease of central nervous system that is characterized by severe attacks of optic neuritis (ON) and longitudinally extensive transverse myelitis (LETM).Conventional MRI is the most sensitive method in detection of NMO lesions in brain,spinal cord and optic nerve,which can objectively show the site,number,size and distribution of lesions.The MRI features of NMO lesion in brain,spinal cord and optic nerve lesions were reviewed in this article.

Neuroradiologist education training：the enlightenment from Vrije University Medical Center / 中华医学教育探索杂志

By taking Vrije University Medical Center as an example, this paper introduced the cur-rent Neuroradiologist education training system which had the characteristics of training in a comprehen-sive and focused way, multi-disciplinary integration and paying attention to the combination of academic and clinical research. Through the comparison of the status quo of China's sub specialist training, Neuro-radiologist education training system in the Netherlands provided an important reference for China's sub specialty training.

A clinical analysis of onset of high-risk demyelinating events in patients with neuromyelitis optica / 中华内科杂志

Objective To explore the clinical characteristics of the lesions of spinal cord and optic nerve as the onset of neuromyelitis optica (NMO).Methods A total of fifty-one patients with myelitis or optic neuritis (ON) as the onset of NMO who hospitalized in our Neurology Department during October 2010 to October 2012 were enrolled in the study.Clinical presentations and MRI findings of the spinal cord and brain were studied.Results (1) A total of 26 cases (51.0％) presented with myelitis as the index event,in which 30.8％ (8/26) were the longitudinally extensive transverse myelitis (LETM) and 69.2％ (18/ 26) were non-LETM (short segmental myelitis or non-transverse myelitis).Patients with non-LETM as the onset were found to have better prognosis than those with LETM (full recovery ratio was 13/18 vs 2/8,P ＜ 0.05),while shorter recurrence interval of myelitis and higher recurrence frequency of events were shown in patients with non-LETM (11.1 vs 18.6 months,3 times per year vs once per year,with all P ＜ 0.05).(2) A total of 25 cases (49.0％) presented with ON as the index event with 24.0％ (6/25) of unilateral ON and 76.0％ (19/25) of bilateral ON.Patients with bilateral ON had more severe visual impairment and shorter first remission period than those with unilateral ON (P ＜ 0.05).Conclusion Non-LETM and bilateral ON are the most common index demyelinating events in NMO cases.

A voxel-based morphometry study of brain volume changes in patients with neuromyelitis optica / 中华放射学杂志

Objective To detect changes of regional grey matter and white matter volume in patients of neuromyelitis optica (NMO) by voxel-based morphometry (VBM),and investigate its relationship with clinical variables.Methods Conventional magnetic resonance imaging (MRI) and structural threedimensional MRI were obtained from 20 NMO and 20 sex-and age-matched healthy volunteers.The comparison of grey matter and white matter volume between the two groups was analyzed by VBM tools of statistical parametric mapping (SPM) 5.Pearson correlational analysis was used to assess correlations between regional volume decrease and disease duration and expanded disability status scale (EDSS) scores in NMO patients.Results Compared with normal controls,NMO patients had grey matter atrophy in several cortical regions,such as right inferior frontal gyrus (cluster size 514),left superior temporal gyrus (282),right middle temporal gyvus (229) and right insula (211) (t =3.58-5.11,AlphaSim corrected,P ＜0.05).White matter atrophy was found in several subcortical regions in NMO patients,such as right precentral and postcentral gyrus (cluster size 457,110),left middle frontal gyrus (285),and right inferior parietal lobule (231) (t =2.90-4.25,AlphaSim corrected,P ＜ 0.05).Grey matter and white matter volume loss were not significantly correlated with clinical duration or EDSS score in NMO.Conclusion By means of VBM,regional atrophy of grey matter and white matter is found in NMO patients,which may provide evidence for brain structural abnormality in NMO.

Feature of grey matter atrophy in relapsing-remitting multiple sclerosis:a voxel-based morphometry Study / 中华神经科杂志

Objective To investigate the feature of regional grey matter volume changes in relapsing-remitting multiple sclerosis (RRMS) patients by voxel-based morphometry ( VBM) and presume the possible pathophysiological basis.Methods Conventional magnetic resonance imaging (MRI) and T1-weighted three-dimensional MRI were obtained from 32 RRMS and 32 sex- and age-matched normal controls.The comparison of grey matter volume between the two groups was analyzed by statistical analysis software SPM5 and VBM.A Pearson correlational analysis was used to assess correlation between gre matter loss and disease duration,expanded disability status scale (EDSS) and visible brain lesion volume.Results Compared with normal controls,RRMS patients had extensive bilateral grey matter atrophy in thalami (left 2031 and right 1711),caudate (left 815 and right 1031) and parahippocampal gyrus (left 313 and right 467),as well as several cortical regions in frontal,temporal,parietal,and occipital lobes (t value were between 8.853 and 11.163,all P ＜ 0.01).Regional grey matter loss in bilateral thalami ( r value were - 0.596 on left and were - 0.694 on right) and right caudate ( r = - 0.409 ) were strongly negatively correlated with visible brain lesion volume in RRMS (all P ＜ 0.05 ).Conclusions By means of VBM,extensive grey matter atrophy are found in RRMS patients,especially in deep grey matter.Axonal degeneration secondary to visible brain lesions may be a key pathogenesis of grey matter atrophy in RRMS.

The clinical and magnetic resonance imaging studies of brain damages in neuromyelitis optica / 中华内科杂志

Objective To investigate the feature brain damage and clinical manifestations in neuromyelitis optica (NMO) patients; To investigate the relationship between serum NMO-IgG antibody and NMO brain damage. Methods Clinical data of 37 NMO patients and their head and spinal cord MRI by 1.5T superconducting MR scanner, were analyzed; serum NMO-IgG antibody were measured by immunofluorescence. Results 17 cases were found to have abnormal signals on MRI, which were mainly in the white matter, pons, medulla, ventricle, aqueduct, and around the corpus callosum; According to pathological changes, brain damage can be divided into scattered irregularity (13 cases), fusion (3 cases),multiple sclerosis-like (1 case) ,with scattered irregularity more common,5 cases had clinical manifestations of brain damage: somnolence, vomiting, diplopia, visual rotation, 11 cases patients with brainstem damage show positive serum NMO-IgG antibodies. Conclusions Brain damage can be seen in half of NMO patients, they often located in the high expression area of AQP4: brain white matter, periventricular,brainstem and so on. Clinical symptoms has nothing to do with the size of lesions but the location, they often occur when brainstem was involved. Serum NMO-IgG is helpful in differentiating NMO with brain damage and MS.

The value of 64-slice CT angiography in diagnosing spinal vascular malformations / 中华放射学杂志

Objective To evaluate 64-slice CT angiography in diagnosing spinal vascular malformations. Methods Fifteen patients,who were suggestive of spinal vascular malformations bv clinical manifestation and MRI,underwent CT angiography with a 64-slice spiral CT(GE lightspeed VCT).DSA were performed later within 1 week in all the patients and four of them were treated with operation as well.We evaluated CTA images in displaying the lesions according to the following aspects:the type of malformation,lesion range,feeding artery,draining vein and possible fistula.and compared those details with DSA and operation findings.Results All 15 patients acquired their final diagnosis by DSA and operation,which were intramedullary axteriovenous malformation in 6 cases,perimedullary arteriovenous fistula in 2,spinal dural arteriovenous fistula in 3 and Cobb syndrome in 4 cases. CTA was consistent with DSA in the classification of lesions and in the determination of the involved regions and it reveaIed the main feeding arteries and draining veins in all patients.CTA showed four arteriovenous fistulae confinned bv DSA.but it failed in a complex arteriovcnous fistula.In Cobb syndrome patients,not only the intramedullary but also paravertebral and subcutenous vascular malformation could be clearly seen on CTA images.Conclusion 64-slice CT angiography can be a preliminary method in spinal vascular malformation because it can determine the classification and reveal almost all the main lesions quickly,atraumatically.

A comparative study of MR diffusion tensor imaging histogram between clinically isolated syndrome and relapsing-remitting multiple sclerosis in normal appearing white matter and grey matter / 中华放射学杂志

Objective To investigate whether abnormalities can be detected in normal-appearing white matter(NAWM)and normal-appearing white matter(NAGM)in patients with clinically isolated syndrome(CIS)and comparing them to the abnormalities in relapsing-remitting multiple sclerosis(RRMS)by using diffusion tensor imaging(DTI)histogram.To detect the potential relationship between DTI indices of NAWM,NAGM and patient's clinical condition.Methods Nineteen patients with CIS,19 clinically diagnosed RRMS patients and 19 sex-and age-matched healthy volunteers were included in this study.Conventional MRI and DTI images were obtained using Siemens 1.5 T Magnetom sonata scanner.DTI histograms of NAWM and NAGM were obtained after post-processing.The mean value,peak height,peak location of the histogram were used for analysis.All data was statistically processed with SPSS for Windows.Results NAWM average MD was higher and FA was lower in RRMS[MD(0.83±0.04)×10-3mm2/s,FA 0.36±0.03]when compared to CIS[MD(0.79±0.02)×10-3mm2/s,FA 0.40±0.02]and control[MD(0.78±0.02)×10-3mm2/s,FA 0.41±0.01](P＜0.01).But no statistically significant difference was found between CIS and control.The peak height of NAWM average MD histogram was significantly lower in CIS than control(P＜0.05),while the peak location of average FA histogram shifted to the left(P＜0.01).Patients with CIS[(1.08±0.06)×10-3mm2/s]showed significantly higher NAGM average MD than control[(1.03±0.05)×10-3mm2/s](P＜0.05),but,lower than RRMS[(1.18±0.12)×10-3mm2/s](P＞0.01).There were no correlation between DTI indices and EDSS scores in patients with CIS.Moderate correlation between NAGM average MD(r=0.568,P＜0.05)and EDSS scores were found in patient with RRMS.Conclusion NAWM and NAGM abnormalities do occur in CIS which can be detected by DTI.The underlying pathological changes in NAWM and NAGM in CIS may be milder than RRMS as demonstrated by DTI histogram.

Effect of Shuanghuang Tongfeng Capsules on Experimental Gouty Arthritis / 中国药房

OBJECTIVE:To observe the effect of Shuanghuang tongfeng capsule(SHTF) on the gouty arthritis.METH-ODS:The gouty arthritis model of rats and rabbits were induced using sodium urate(MSU). The swollen degree of the rat foot,and the amount of synovial fluid,the leucocyte count in synovial fluid and the degree of inflammation of the synovial tissue of joints in rabbits were measured.The effect of SHTF on gouty arthritis was observed. RESULTS:The swollen degree of the foot of rat was lessened obviously by SHTF capsule(5、10、20 g?kg-1,ig).The amount of synovial fluid and the leucocyte count in synovial fluid of the rabbit were decreased significantly by SHTF capsule (4、8、16 g?kg-1,po).The inflammation of the synovial tissue in rabbits was improved obviously by SHTF capsule (8 and 16 g?kg-1,po). CONCLUSION: SHTF capsule have remarkable protective effect on the gouty arthritis induced by sodium urate.