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1.
Cancer Med ; 8(11): 5089-5096, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31313500

RESUMO

In this study, we performed a comprehensive estimation and assessment for the clinical value of prostate health index (PHI) in diagnosing prostate cancer. Using the bivariate mixed-effect model, we calculated the following parameters and their 95% confidence internals (CIs), including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and symmetric receiver operator characteristic. Twenty eligible studies with a total number of 5543 subjects were included in the final analysis. The estimated sensitivity was 0.75 (95% CI: 0.70-0.79) and the specificity was 0.69 (95% CI: 0.58-0.83). The pooled area under the curve was 0.78 (95% CI: 0.74-0.81). The combined positive likelihood ratio was 2.45 (95% CI: 2.19-2.73) and the negative likelihood ratio was 0.36 (95% CI: 0.31-0.43). The diagnostic odds ratio was 6.73 (95% CI: 5.38-8.44). The posttest probability was 40% under the present positive likelihood ratio of 2.45. It seems there was no significant difference between Asian population and Caucasian population population in sensitivity and specificity. But the overlap of AUC 95% CI indicated that the diagnostic accuracy of PHI was slightly higher in the Asian population population setting than that in the Caucasian population population population (0.83 vs 0.76). Similarly, there was also overlap in AUC 95% CI, which suggested that sample size may be one of heterogeneity source. The PHI has a moderate diagnostic accuracy for detecting prostate cancer. The discrimination ability of PHI is slightly prior to free/total prostate-specific antigen. It seems that ethnicity has an influence on the clinical value of PHI in the diagnostic of prostate cancer.

2.
Biosci Rep ; 39(5)2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31040200

RESUMO

Radiotherapy is the primary treatment option for nasopharyngeal carcinoma (NPC). Local recurrence and metastasis caused by radioresistance become a bottleneck of curative effect for patients with NPC. Currently, serum predictive biomarkers of radioresistance are scare. We enrolled NPC patients, who underwent radiotherapy in the Department of Oncology, Xiangya Hospital, Central Southern University, and analyzed the serum proteins profiles in NPC patients using with quantitative label-free proteomics using ultra-definition MS. Patients were divided into those who were radioresistant and radiosensitive by the overall reduction (≤50% or >50%, respectively) in tumor extent. The MS/MS spectrum database search identified 911 proteins and 809 proteins are quantitatable. Eight proteins significantly up-regulated and 12 serum proteins were significantly down-regulated in the radioresistance group compared with radiosensitivity group (P<0.05). Finally, five proteins entered the optimal models, including secreted protein acidic and cysteine rich (SPARC) (P =0.032), serpin family D member 1S (ERPIND1) (P =0.040), complement C4B (C4B) (P =0.017), peptidylprolyl Isomerase B (PPIB) (P =0.042), and family with sequence similarity 173 member A (FAM173A) (P =0.017). In all patient, the area under the curves (AUC) for SPARC, SERPIND, C4B, PPIB, and FAM173A were 0.716 (95% CI: 0.574-0.881), 0.697 (95% CI: 0.837-0.858), 0.686 (95% CI: 0.522-0.850), 0.668 (95% CI: 0.502-0.834) and 0.657 (95% CI: 0.512-0.825), respectively. The AUC of five selected proteins was 0.968 (95% CI: 0.918-1.000) with the sensitivity of 0.941 and the specificity of 0.926. Our result indicated that a panel including five serum protein (SPARC SERPIND1 C4B PPIB FAM173A) based on serum proteomics provided a high discrimination ability for radiotherapy effects in NPC patients. Studies with larger sample size and longer follow-up outcome are required.

3.
J Int Med Res ; 47(6): 2562-2570, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31079512

RESUMO

OBJECTIVE: This study was designed to evaluate the neurotoxicity of dexmedetomidine combined with ropivacaine for continuous femoral nerve block in rabbits. METHODS: Thirty New Zealand rabbits were randomly divided into 5 groups of 6 rabbits each and received a continuous femoral nerve block with saline; 0.25% ropivacaine; or 1, 2, or 3 µg/mL of dexmedetomidine added to 0.25% ropivacaine (Groups A-E, respectively). Sensory and motor function was assessed after the nerve block. The rabbits were anesthetized and killed after 48 hours of a continuous femoral nerve block, and the femoral nerves were removed for light and electron microscopy analyses. RESULTS: The behavior scores were highest in Group A at 2 and 6 hours after injection. The scores were higher in Groups B and C than in Groups D and E at these same time points. All groups showed normal pathological tissues in the femoral nerves under optical microscopy. Under electron microscopy, histological abnormalities were observed only in Group E; none of the other groups exhibited pathological abnormalities. Quantitative analysis of the myelin sheath area revealed no significant difference in the axonal area, total area of the myelin sheath, or ratio of the total axonal area to the total area of the myelin sheath in all groups. CONCLUSION: The lowest doses of dexmedetomidine (1 and 2 µg/mL) combined with 0.25% ropivacaine for continuous femoral nerve block resulted in no neurotoxic lesions, but the higher dose (3 µg/mL) resulted in neurotoxic lesions in this rabbit experimental model.

4.
Biosci Rep ; 39(6)2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31092699

RESUMO

Introduction: The treatment strategy for low-grade gliomas (LGGs) is still controversial, and there are no standardized criteria to predict the prognosis of patients with LGGs. Magnetic resonance imaging (MRI) is a routine test for preoperative diagnosis for LGG and can reflect the destructive features for the tumor. In the present study, we aimed to explore the relationship between the MRI features and prognosis in patients with LGG.Methods: Clinical data of 80 patients with pathologically proved LGGs between January 2010 and December 2016 were analyzed retrospectively. MRI features were classified as contrast enhancement pattern (focal enhancement, diffuse enhancement and ring-like enhancement), necrosis and cysts based on the preoperative MR images. Kaplan-Meier method and multivariate analysis were performed on the data by SPSS software to explore the prognostic significance of MRI features.Results: Patients with cystic LGG had a significantly longer 5-year progression-free survival (PFS) than that with no cyst (90.9 ± 8.7 vs 65.7 ± 9.1%, P=0.045). Multivariate analysis further verified cyst as an independent prognosis factor for PFS (P=0.027, hazard ratio [HR] = 0.084). Additionally, patients with ring-like enhancement exhibited significantly longer 5-year PFS time in the Kaplan-Meier survival curves (100 vs 67.2 ± 7.7%, P=0.049). There was no significant difference in PFS and overall survival (OS) between patients with or without necrosis.Conclusion: Our study suggests that cyst formation and ring-like enhancement on preoperative MR images can be useful to predict a favorable prognosis in patients with LGGs.

5.
Artigo em Inglês | MEDLINE | ID: mdl-30008056

RESUMO

PURPOSE: To examine the predictors of the second-time lateral patellar dislocation (LPD) in patients after acute first-time LPD in a 5-year follow-up. METHODS: Data were collected prospectively from patients after acute first-time LPD with conservative treatment. Factors included sex, age at the first-time LPD, anatomical variants [trochlear dysplasia, patellar height, tibial tuberosity-trochlear groove (TT-TG) distance], and injury patterns of medial patellofemoral ligament (MPFL) in acute first-time LPD. Logistic regression was carried out to identify the independent risk factors for the incidence of the second-time LPD. RESULTS: The incidence rate of a second-time LPD was 35.5% (59 of 166) in the 5-year follow-up. Univariate analysis revealed significant differences in the incidence rate of the second-time LPD among age at the first-time LPD (P = 0.04), trochlear dysplasia (P = 0.003), patella height (P = 0.017) and the TT-TG distance (P = 0.027). Risk factors for the second-time LPD were age < 18 years at the first-time LPD [odds ratio (OR) 4.088], low-grade trochlear dysplasia (OR 7.214), high-grade trochlear dysplasia (OR 18.945), patella alta (OR 8.416), elevated TT-TG distance (OR 12.742), complete MPFL tear at its isolated femoral-side (OR 6.04) and complete combined MPFL tear (OR 5.851). CONCLUSIONS: Trochlear dysplasia, elevated TT-TG distance, patella alta, age < 18 years at the first-time LPD, complete MPFL tear at its isolated femoral-side and complete combined MPFL tear in the first-time LPD are independently associated with a higher incidence rate of the second-time LPD. LEVEL OF EVIDENCE: III.

6.
Korean J Radiol ; 19(2): 292-300, 2018 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29520187

RESUMO

Objective: To evaluate the correlation between the injury patterns of the medial patellofemoral ligament (MPFL) on magnetic resonance imaging in an acute first-time lateral patellar dislocation (LPD) and incidence of a second-time LPD. Materials and Methods: Magnetic resonance images were prospectively analyzed in 147 patients after an acute first-time LPD with identical nonoperative management. The injury patterns of MPFL in acute first-time LPDs were grouped by location and severity for the analysis of the incidence of second-time LPD in a 5-year follow-up. Independent t tests, chi-square tests and Kruskal-Wallis tests were performed as appropriate. Results: Forty-six cases (46/147, 31.3%) of second-time LPD were present at the 5-year follow-up. Fourteen (14/62, 22.6%) and 31 cases (31/80, 38.8%) were present in the partial and complete MPFL tear subgroups, respectively. Twenty-five cases (25/65, 38.5%), 11 cases (11/26, 42.3%), and 8 cases (8/47, 17%) were present in the isolated femoral-side MPFL tear (FEM), combined MPFL tear (COM), and isolated patellar-side MPFL tear (PAT) subgroups, respectively. Compared with the partial MPFL tears, complete tears showed higher incidence of a second-time LPD (p = 0.04). The time interval between the two LPDs was shorter in the complete MPFL tear subgroup (24.2 months) than in the partial tear subgroup (36.9 months, p = 0.001). Compared with the PAT subgroup, the FEM and COM subgroups showed a higher incidence of a second-time LPD (p = 0.025). The time intervals between the two LPDs were shorter in the FEM and COM subgroups (20.8 months and 19.2 months) than in the PAT subgroup (32.5 months, p = 0.049). Conclusion: A complete MPFL tear, isolated femoral-side tear and combined tear in a first-time LPD predispose a second-time LPD.

7.
Knee Surg Sports Traumatol Arthrosc ; 26(3): 719-726, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28028571

RESUMO

PURPOSE: To evaluate the correlation between injury patterns of the medial patellofemoral ligament (MPFL) and vastus medialis obliquus (VMO) after acute first-time lateral patellar dislocation (LPD) in adults. METHODS: Magnetic resonance imaging (MRI) was prospectively performed in 132 consecutive adults with acute first-time LPD. Images were acquired and evaluated using standardized protocols. Injury patterns of MPFL were grouped by location and severity for analysis of the prevalence of VMO injury. RESULTS: MRI demonstrated VMO injury in 63 (47.7%) patients. Twenty (38.5%) and 43 cases (56.6%) were present in partial and complete MPFL tear subgroups, respectively. Compared with partial MPFL tears, complete tears showed a higher prevalence of VMO injury (P = 0.044). The mean coronal (28.5 mm) and mean sagittal VMO elevations (20.7 mm) were higher in the complete MPFL tear subgroup than in the partial tear subgroup (19.8 mm, P = 0.005; 11.9 mm, P < 0.001). No correlations were identified between the prevalence of VMO injury and location subgroups of MPFL injury (n.s.). Mean VMO elevations were higher in isolated femoral-side (FEM) and combined MPFL tear (COM) subgroups (mean coronal VMO elevation of 29 mm and mean sagittal VMO elevation of 20.8 mm in the FEM subgroup; mean coronal VMO elevation of 29.6 mm and mean sagittal VMO elevation of 23.1 mm in the COM subgroup) than in the isolated patellar-side MPFL tear (PAT) subgroup (P = 0.022, P < 0.001) (mean coronal VMO elevation of 20.7 mm and mean sagittal VMO elevation of 10.6 mm). CONCLUSIONS: Complete MPFL tear predisposes to VMO injury and has a higher elevation of torn VMO after acute first-time LPD in adults. Isolated femoral-side and combined MPFL tears predispose to higher elevation of torn VMO. LEVEL OF EVIDENCE: IV.


Assuntos
Imagem por Ressonância Magnética/métodos , Luxação Patelar/diagnóstico por imagem , Ligamento Patelar/lesões , Articulação Patelofemoral/lesões , Músculo Quadríceps/lesões , Adulto , Feminino , Humanos , Masculino , Procedimentos Ortopédicos , Luxação Patelar/cirurgia , Ligamento Patelar/diagnóstico por imagem , Ligamento Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Músculo Quadríceps/diagnóstico por imagem , Músculo Quadríceps/cirurgia , Ruptura/patologia , Adulto Jovem
8.
Oncotarget ; 8(42): 73105-73114, 2017 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-29069853

RESUMO

Achieving total glioma resection represents a major challenge to neurosurgeons with no distinct margin between tumor and surrounding brain tissue. Many imaging methods are employed in surgery visualization and resection control. We performed this meta-analysis to assess the diagnosis value of intraoperative ultrasound and judged whether ultrasound is a suitable tool in detecting glioma residual. The databases including PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang and Weipu were systematically searched to find out relevant studies and published up to May 5, 2017. A total of 14 studies involving 542 participants met the selection criteria and bivariate mixed effects models were used for analysis. The parameters and their corresponding 95% confidence interval (CI) were computed on Stata 12.0 software. The pooled sensitivity was 0.75 (95%CI: 0.62-0.84), specificity was 0.88 (95%CI: 0.79-0.94), positive likelihood ratios was 6.27 (95%CI: 3.76-10.47), negative likelihood ratios was 0.29 (95%CI: 0.20-0.42), diagnostic odds ratios was 21.83 (95%CI: 14.20-33.55) and area under the curve of summary receiver operator characteristic was 0.89. Stratified meta-analysis showed sensitivity and area under the curve in low-grade glioma were both higher than high-grade glioma. The Deek's plot showed no significant publication bias (t = -1.03, P = 0.33). Intraoperative ultrasound has high overall diagnostic value to identify glioma remnants, especially in low-grade glioma, which shows a benefit for prognosis and life quality of patients. In general, Intraoperative ultrasound is an effective tool for maximizing the extent of glioma resection.

9.
Biochem Biophys Res Commun ; 494(1-2): 390-396, 2017 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-28947213

RESUMO

Nasopharyngeal carcinoma (NPC) is a common head and neck malignancy in Southern China and Southeast Asia compared with Western countries. The standard treatment for NPC is radiotherapy. However, radioresistance remains a serious obstacle to satisfactory treatment, it can cause local recurrence and distant metastases in some patients after treatment by radiation. We retrospectively reviewed 108 NPC patients (7th AJCC Ⅲ-Ⅳa) who have received intensity modulated radiation therapy (IMRT) between August 2008 and January 2012 at Xiangya Hospital of Central South University. Ninety-eight patients with >60% reduction of tumor size after radiation treatment were regarded as radiation sensitive, Ten patients with <40% reduction of tumor size after radiation treatment were regarded as radiation resistant. Using immunohistochemistry, we found that the high expression rate of Ki-67 in radiation resistant and radiation sensitive patients was 80.0% and 42.6%, respectively, and the difference was statistically significant (p = 0.025). The 5-year progress free survival rates in patients with low and high expression of Ki-67 was 70.7% and 48.0%, respectively, and the difference was statistically significant (p = 0.0008). Multivariate Cox regression analysis identified that high expression of Ki-67 was an independent negative prognostic factor in nasopharyngeal carcinoma patients [Hazard ratio (95% CI), 2.098(1.101, 3.996); p = 0.024]. These results demonstrate that high expression of Ki-67 contributes to radiation resistance and acts a poor prognosis indicator in patients with locally advanced nasopharyngeal carcinoma.


Assuntos
Biomarcadores Tumorais/genética , Carcinoma/diagnóstico , Carcinoma/genética , Antígeno Ki-67/genética , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos/uso terapêutico , Biomarcadores Tumorais/metabolismo , Carcinoma/mortalidade , Carcinoma/terapia , Cetuximab/uso terapêutico , Feminino , Raios gama/uso terapêutico , Humanos , Antígeno Ki-67/metabolismo , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/mortalidade , Neoplasias Nasofaríngeas/terapia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
10.
Eur Radiol ; 27(3): 1322-1330, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27352088

RESUMO

OBJECTIVES: To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. METHODS: MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. RESULTS: Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 52 cases, an isolated femoral attachment (FEM) in 42 cases and an isolated mid-substance (MID) in five cases. More than one site of injury was identified in 34 cases. Compared with Wiberg patellar type C, Wiberg patellar type B predisposed to complete MPFL tear (P = 0.042). No correlations were identified between injury patterns of MPFL and trochlear dysplasia, patellar height and tibial tuberosity-trochlear groove distance (P > 0.05). Compared with partial MPFL tear, complete MPFL tear predisposed to Grade-IV and Grade-V patellar chondral lesion (P = 0.02). There were no correlations between incidence of patellar cartilage lesion and injury locational-subgroups of MPFL (P = 0.543). CONCLUSIONS: MPFL is most easily injured at the PAT in children. Wiberg patellar type B predisposes to complete MPFL tear. Complete MPFL tear predisposes to a higher grade of patellar chondral lesion. KEY POINTS: • MPFL is most easily injured at its patellar insertion in children. • Wiberg patellar type B predisposes to complete MPFL tear. • No correlations between injury patterns of MPFL and other three anatomical variants. • Complete MPFL tear predisposes to higher grade patellar chondral lesion. • No correlations between injury locations of MPFL and patellar cartilage lesion.


Assuntos
Ligamentos Articulares/anatomia & histologia , Ligamentos Articulares/lesões , Luxação Patelar/complicações , Articulação Patelofemoral/anatomia & histologia , Articulação Patelofemoral/lesões , Adolescente , Criança , Feminino , Humanos , Ligamentos Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Luxação Patelar/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Ruptura
11.
Springerplus ; 5(1): 1335, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27563530

RESUMO

OBJECTIVE: The aim of this study was to observe whether there existed significant differences in the maxilla-nasion-mandible angle (MNM) between the first- and second-trimester of pregnancy, and to observe its predictive values for trisomy 18. METHODS: Two experienced ultrasonologists used 2D and 3D ultrasound imaging techniques to obtain the facial sagittal sections of fetuses in the first-trimester of pregnancy (crown-rump length 45-84 mm), respectively, so as to measure MNM. RESULTS: MNM could be measured in 91 % of normal fetuses, and the measurement differences by different operators in different groups were <1.1°; average MNM was 11.0°, and no significant change was observed in different gestational ages (P = 0.15). The average of MNMs in fetuses with trisomy 18 was 16.6°, which were all higher than the 95th percentile of normal measurement data. The sensitivity and specificity of increased MNM on the abnormal detection of trisomy 18 were 54.7 and 97.4 %, respectively. CONCLUSIONS: The feasibility and reproducibility of measuring MNM in early pregnancy were good. MNM had certain suggestive roles for aneusomic chromosomal abnormalities, especially for fetuses with trisomy 18.

12.
J Craniofac Surg ; 27(3): e275-6, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27159870

RESUMO

The gastrointestinal tract is the most commonly involved extranodal site in non-Hodgkin lymphomas (NHL). Oral cavity as primary site constitutes only 2% of all extranodal non-Hodgkin lymphomas. The oral buccal mucosa involvement by lymphoma is very rare. Here, the authors report a case of primary mucosa-associated lymphoid tissue lymphoma of the oral mucosa. The sonographic features of the mass are described in depth.


Assuntos
Linfoma de Zona Marginal Tipo Células B/diagnóstico , Mucosa Bucal/patologia , Neoplasias Bucais/diagnóstico , Ultrassonografia/métodos , Idoso , Biópsia , Humanos , Masculino
13.
Injury ; 46(12): 2413-21, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26462959

RESUMO

OBJECTIVES: The purpose of this study was to investigate the injury characteristics of medial patellofemoral ligament (MPFL), and to analyse the correlations between the injury patterns of MPFL and articular cartilage lesions of the lateral femoral condyle in adults with acute lateral patellar dislocation (LPD). METHODS: Magnetic resonance (MR) images were prospectively obtained in 121 consecutive adults with acute LPD. Images were acquired using standardised protocols and these were independently evaluated by two radiologists. RESULTS: Forty-eight cases of partial MPFL tear and 71 cases of complete MPFL tear were identified. Injuries occurred at an isolated femoral attachment (FEM) in 48 cases, an isolated patellar insertion (PAT) in 36 cases and an isolated mid-substance (MID) in five cases. More than one site of injury to the MPFL (COM) was identified in 30 cases. The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 4.2% (2/48) and 6.3% (3/48) in the FEM subgroup, 19.4% (7/36) and 22.2% (8/36) in the PAT subgroup and 6.7% (2/30) and 13.3% (4/30) in the COM subgroup, respectively. The PAT subgroup showed significantly higher prevalence rate of chondral and osteochondral lesions in the lateral femoral condyle when compared with the FEM subgroup. The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 8.5% (6/71) and 19.7% (14/71) in the complete MPFL tear subgroup and 10.4% (5/48) and 4.2% (2/58) in the partial MPFL tear subgroup, respectively. The subgroup of the complete MPFL tear showed significantly higher prevalence rate of osteochondral lesions in the lateral femoral condyle when compared with the subgroup of the partial MPFL tear. CONCLUSIONS: Firstly, the MPFL is most easily injured at the FEM, and secondly at the PAT in adults after acute LPD. The complete MPFL tear is more often concomitant with osteochondral lesions of the lateral femoral condyle than the partial MPFL tear. The isolated patellar-sided MPFL tear is more easily concomitant with chondral lesions and osteochondral lesions of the lateral femoral condyle than the isolated femoral-sided MPFL tear.


Assuntos
Cartilagem Articular/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética , Patela/diagnóstico por imagem , Luxação Patelar/diagnóstico por imagem , Cartilagem Articular/lesões , Cartilagem Articular/patologia , Feminino , Humanos , Instabilidade Articular , Traumatismos do Joelho/complicações , Traumatismos do Joelho/patologia , Ligamentos Articulares/lesões , Ligamentos Articulares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Patela/lesões , Patela/patologia , Luxação Patelar/diagnóstico , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes
14.
Injury ; 46(6): 1137-44, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25724397

RESUMO

OBJECTIVES: The purpose of this study was to investigate the injury characteristics of medial patellofemoral ligament (MPFL), and to analyse the correlations between the injury patterns of MPFL and articular cartilage lesions of the lateral femoral condyle in children and adolescents with acute lateral patellar dislocation (LPD). METHODS: Magnetic resonance (MR) images were prospectively obtained in 127 consecutive children and adolescents with acute LPD. Images were acquired using standardised protocols and these were independently evaluated by two radiologists. RESULTS: Fifty-four cases of partial MPFL tear and 69 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 47 cases, an isolated femoral attachment (FEM) in 41 cases and an isolated mid-substance (MID) in four cases. More than one site of injury to the MPFL (COM) was identified in 31 cases. The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 23.4% (11/47) and 29.8% (14/47) in the PAT subgroup, 7.3% (3/41) and 9.8% (4/41) in the FEM subgroup and 25.8% (8/31) and 32.3% (10/31) in the COM subgroup, respectively. The PAT and COM subgroups showed significantly higher prevalence rate of chondral and osteochondral lesions in the lateral femoral condyle when compared with the FEM subgroup. The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 17.4% (12/69) and 30.4% (21/69) in the complete MPFL tear subgroup and 20.4% (11/54) and 13% (7/54) in the partial MPFL tear subgroup, respectively. The subgroup of the complete MPFL tear showed significantly higher prevalence rate of osteochondral lesions in the lateral femoral condyle when compared with the subgroup of the partial MPFL tear. CONCLUSIONS: Firstly, the MPFL is most easily injured at the PAT, and secondly at the FEM in children and adolescents after acute LPD. The complete MPFL tear is more often concomitant with osteochondral lesions of the lateral femoral condyle than the partial MPFL tear. The isolated patellar-sided MPFL tear and the combined MPFL tear are more easily concomitant with chondral lesions and osteochondral lesions of the lateral femoral condyle than the isolated femoral-sided MPFL tear.


Assuntos
Cartilagem Articular/lesões , Traumatismos do Joelho/diagnóstico , Ligamentos Articulares/lesões , Imagem por Ressonância Magnética , Patela/lesões , Luxação Patelar/diagnóstico , Doença Aguda , Adolescente , Cartilagem Articular/patologia , Criança , China/epidemiologia , Feminino , Humanos , Traumatismos do Joelho/complicações , Traumatismos do Joelho/patologia , Ligamentos Articulares/patologia , Imagem por Ressonância Magnética/métodos , Masculino , Patela/patologia , Luxação Patelar/etiologia , Prevalência , Estudos Prospectivos , Reprodutibilidade dos Testes , Ruptura
15.
Eur Radiol ; 25(1): 274-81, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25187383

RESUMO

OBJECTIVES: The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). METHODS: High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury. RESULTS: Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8%, 96.3%, and 94.6%, respectively, for partial MPFL tear and 86.3%, 96.3%, and 94%, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6%, 95.7%, and 91.3%, respectively, for partial MPFL tear and 80.4%, 95.7%, and 92.1%, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR. CONCLUSIONS: Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD. KEY POINTS: • High-frequency ultrasound and MR were able to detect MPFL lesions after acute lateral patellar dislocation. • High-frequency ultrasound and MR showed similarly high accuracy in diagnosing MPFL lesions. • Interobserver agreement was very good for high-frequency ultrasound and good for MR.


Assuntos
Traumatismos do Joelho/diagnóstico , Ligamentos Articulares/lesões , Imagem por Ressonância Magnética/métodos , Patela/lesões , Luxação Patelar/diagnóstico , Doença Aguda , Adolescente , Adulto , Criança , Feminino , Humanos , Traumatismos do Joelho/complicações , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/patologia , Masculino , Patela/diagnóstico por imagem , Patela/patologia , Luxação Patelar/etiologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Ruptura , Ultrassonografia , Adulto Jovem
17.
Hepatobiliary Pancreat Dis Int ; 12(5): 520-4, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24103283

RESUMO

BACKGROUND: Low central venous pressure (CVP) affects hemodynamic stability and tissue perfusion. This prospective study aimed to evaluate the optimal CVP during partial hepatectomy for hepatocellular carcinoma (HCC). METHODS: Ninety-seven patients who underwent partial hepatectomy for HCC had their CVP controlled at a level of 0 to 5 mmHg during hepatic parenchymal transection. The systolic blood pressure (SBP) was maintained, if possible, at 90 mmHg or higher. Hepatitis B surface antigen was positive in 90 patients (92.8%) and cirrhosis in 84 patients (86.6%). Pringle maneuver was used routinely in these patients with clamp/unclamp cycles of 15/5 minutes. The average clamp time was 21.4+/-8.0 minutes. These patients were divided into 5 groups based on the CVP: group A: 0-1 mmHg; B: 1.1-2 mmHg; C: 2.1-3 mmHg; D: 3.1-4 mmHg and E: 4.1-5 mmHg. The blood loss per transection area during hepatic parenchymal transection and the arterial blood gas before and after liver transection were analyzed. RESULTS: With active fluid load, a constant SBP ≥90 mmHg which was considered as optimal was maintained in 18.6% in group A (95% CI: 10.8%-26.3%); 39.2% in group B (95% CI: 29.5%-48.9%); 72.2% in group C (95% CI: 63.2%-81.1%); 89.7% in group D (95% CI: 83.6%-95.7%); and 100% in group E (95% CI: 100%-100%). The blood loss per transection area during hepatic parenchymal transection decreased with a decrease in CVP. Compared to groups D and E, blood loss in groups A, B and C was significantly less (analysis of variance test, P<0.05). Compared with the baseline, the blood oxygenation decreased significantly when the CVP was reduced. Base excess and HCO3- in groups A and B were significantly decreased compared with those in groups C, D and E (P<0.05). CONCLUSION: In consideration of blood loss, SBP, base excess and HCO3-, a CVP of 2.1-3 mmHg was optimal in patients undergoing partial hepatectomy for HCC.


Assuntos
Carcinoma Hepatocelular/cirurgia , Pressão Venosa Central , Hepatectomia/instrumentação , Neoplasias Hepáticas/cirurgia , Monitorização Intraoperatória/métodos , Equilíbrio Ácido-Base , Adulto , Perda Sanguínea Cirúrgica , Carcinoma Hepatocelular/fisiopatologia , China , Feminino , Hidratação , Humanos , Neoplasias Hepáticas/fisiopatologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
18.
Injury ; 44(12): 1892-8, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24074831

RESUMO

OBJECTIVE: The purpose of this study was to investigate the accuracy of high-frequency ultrasonography in the diagnosis of injuries of medial patellofemoral ligaments (MPFLs), analyse the characteristics of MPFL injury and correlations between injury of the MPFL and articular cartilage of the inferomedial patella in patients with acute traumatic lateral patellar dislocation. METHODS: High-frequency sonographic images of 49 patients with acute traumatic lateral patellar dislocations treated surgically were reviewed. The χ(2) tests were performed for statistical analysis. RESULTS: Twenty-eight cases of complete MPFL tear and 21 cases of partial MPFL tear were identified in operation, with 27 cases of MPFL tear located at their femoral attachment, 21 cases of tear at the patellar attachment and one case of midsubstance tear. The diagnostic accuracy of sonography regarding partial MPFL tear and complete MPFL tear was 89.8% and 89.8%. Among the patients with MPFL tear at the patellar attachment, eight and six cases were concomitant with chondral and osteochondral lesions in the inferomedial patella, respectively, in contrast to nine and six cases in patients with MPFL tear at the femoral attachment, respectively. There was no significant difference between the two locations described above regarding the prevalence rates of chondral or osteochondral lesions of the inferomedial patella (P=0.732, P=0.614). Among the patients with complete MPFL tear, 12 and 10 cases were concomitant with chondral and osteochondral lesions in the inferomedial patella, respectively, while six and two cases were concomitant with partial MPFL tear. There was no significant difference between the two types of injuries discussed above on the prevalence rates of chondral lesions of the inferomedial patella (P=0.305), but the prevalence rate of osteochondral lesions between the two types of injuries discussed above was statistically different (P=0.035). CONCLUSIONS: The MPFL is most easily injured at the femoral attachment, secondly at the patellar attachment. High-frequency ultrasonography is an accurate method in the diagnosis of an MPFL tear. There are neither significant differences on the prevalence rates of chondral or osteochondral lesions of the inferomedial patella between locations of MPFL injuries, nor significant difference on the prevalence rates of chondral lesions between MPFL injury types; but the complete MPFL tear is more often concomitant with inferomedial patellar osteochondral lesions than the partial MPFL tear.


Assuntos
Cartilagem Articular/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Ligamento Colateral Médio do Joelho/diagnóstico por imagem , Patela/diagnóstico por imagem , Patela/lesões , Luxação Patelar/diagnóstico por imagem , Adolescente , Adulto , Cartilagem Articular/lesões , Feminino , Humanos , Masculino , Ligamento Colateral Médio do Joelho/lesões , Patela/fisiopatologia , Luxação Patelar/fisiopatologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índices de Gravidade do Trauma , Ultrassonografia
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