Background: This study aimed to evaluate the efficiency of gadoxetic acid-enhanced MRI-based radiomics features for prediction of overall survival (OS) in hepatocellular carcinoma (HCC) patients after surgical resection.Methods: This prospective study approved by the Institutional Review Board enrolled 120 patients with pathologically confirmed HCC. Radiomics signatures (rad-scores) were built from radiomics features in 3 different regions of interest (ROIs) with the least absolute shrinkage and selection operator (LASSO) cox regression analysis. Preoperative clinical characteristics and semantic imaging features potentially associated with patient survival were evaluated to develop a clinic-radiological model. The radiomics features and clinic-radiological predictors were integrated into a joint model using multivariable Cox regression analysis.Kaplan-Meier analysis and log-rank tests were performed to compare the discriminative performance and evaluated on the validation cohort. Results:The radiomics signatures showed a significant association with patient survival in both cohorts (all P<0.001). The BCLC (Barcelona clinic liver cancer) stage, non-smooth tumor margin, and the combined rad-score were independently associated with OS. Moreover, the combined model incorporating with clinicradiological and radiomics features showed an improved predictive performance with C-index of 0.92 [95% confidence interval (CI): 0.87-0.97], compared to the clinic-radiological model (C-index, 0.86, 95% CI: 0.79-0.94; P=0.039) or the combined rad-score (C-index, 0.88, 95% CI: 0.81-0.95; P=0.016).Conclusions: Radiomics features along with clinic-radiological predictors can efficiently aid in preoperative HCC prognosis prediction after surgical resection and enable a step forward precise medicine.

Objective. To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). Methods. RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. Results. 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P=0.04 and P=0.003, respectively). PSI reduced operative time (P=0.03) and blood loss (P=0.002) and improve the KSS (P=0.02) compared with CI, but for CT-based PSI, the difference of operative time becomes insignificant. PSI showed no significant difference with CI regarding risk of complication, length of stay in hospital, and functional outcomes of OKS. Conclusion. PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems.

Background Adhesive capsulitis is one of the most well-known causes of pain and stiffness of the shoulder. Corticosteroid injections have been used for many years. However, it is still controversial where corticosteroid should be injected, whether subacromial or intra-articular. Objective The objective of this meta-analysis was to compare the effects of intra-articular (IA) and subacromial (SA) corticosteroid injections for the treatment of adhesive capsulitis. Materials and Methods Four foreign databases and two Chinese databases were searched for RCTs and quasi-RCTs involving the comparison of IA and SA corticosteroid injection for the treatment of adhesive capsulitis. The Cochrane risk of bias tool and PEDro score were used to evaluate the quality of the studies. The primary clinical outcomes including VAS, Constant score, ASES score, and ROM were collected. The secondary outcome of corticosteroid-related adverse reactions was also compared between the two groups. The results were evaluated and compared at five time points. Subgroup analyses were performed to further explore the differences between groups. Results Eight RCTs and one quasi-RCT, involving 512 participants, were identified and included in this meta-analysis. All studies were of low risk of bias and medium-high quality with the PEDro score ≥5 points. The pooled effect showed that there was no significant difference in the primary outcomes between IA injection and SA injection, with an exception of VAS at 2-3 weeks (P=0.02) and ROM of internal rotation at 8–12 weeks (P=0.02). According to the results of subgroup analyses, the differences of VAS and ROM of internal rotation did not last beyond the 2-3-week time period. Additionally, SA injection had the advantage of avoiding adverse reactions from the corticosteroid, especially in avoiding a large fluctuation of serum blood glucose levels. Conclusions When corticosteroid injection is used to treat adhesive capsulitis, both injection sites can be selected. However, due to the scarcity of related studies, more rigorous trials are needed to confirm the current findings.

BackgroundFacet tropism is the angular asymmetry between the left and right facet joint orientation. Although debatable, facet tropism was suggested to be associated with disc degeneration, facet degeneration and degenerative spondylolisthesis in the lumbar spine. The purpose of this study was to explore the relationship between facet tropism and facet degeneration in the sub-axial cervical spine.MethodsA total of 200 patients with cervical spondylosis were retrospectively analyzed. Facet degeneration was categorized into 4 grade: grade I, normal; grade II, degenerative changes including joint space narrowing, cyst formation, small osteophytes (<3 mm) without joint hypertrophy; grade III, joint hypertrophy secondary to large osteophytes (>3 mm) without fusion of the joint; grade IV, bony fusion of the facet joints. Facet orientations and facet tropisms with respect to the transverse, sagittal and coronal plane were calculated from the reconstructed cervical spine, which was based on the axial CT scan images. The paired facet joints were then categorized into three types: symmetric, moderated tropism and severe tropism. Univariate and multivariate analysis were performed to evaluate the relationship between any demographic and anatomical factor and facet degeneration.ResultsThe mean age of enrolled patients was 46.23 years old (ranging from 30 to 64 years old). There were 114 males and 86 females. The degrees of facet degeneration varied according to cervical levels and ages. Degenerated facet joints were most common at C2-C3 level and more common in patients above 50 years old. The facet orientations were also different from level to level. By univariate analysis, genders, ages, cervical levels, facet orientations and facet tropisms were all significantly different between the normal facets and degenerated facets. However, results from multivariate logistic regression suggested only age and facet tropism with respect to the sagittal plane were related to facet degeneration.ConclusionFacet degeneration were more common at C2-C3 level. Older age and facet tropism with respect to the sagittal plane were associated with the facet degeneration.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1448-x) contains supplementary material, which is available to authorized users.

Background: The “killer turn” effect after posterior cruciate ligament (PCL) reconstruction is a problem that can lead to graft laxity or failure. Solutions for this situation are currently lacking. Purpose: To evaluate the clinical outcomes of a modified procedure for PCL reconstruction and quantify the killer turn using 3-dimensional (3D) computed tomography (CT). Study design: Case series; Level of evidence, 4. Methods: A total of 15 patients underwent modified PCL reconstruction with the tibial aperture below the center of the PCL footprint. Next, 2 virtual tibial tunnels with anatomic and proximal tibial apertures were created on 3D CT. All patients were assessed according to the Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Tegner score, side-to-side difference (SSD) in tibial posterior translation using stress radiography, and 3D gait analysis. Results: The modified tibial tunnel showed 2 significantly gentler turns (superior, 109.87° ± 10.12°; inferior, 151.25° ± 9.07°) compared with those reconstructed with anatomic (91.33° ± 7.28°; P < .001 for both comparisons) and proximal (99° ± 7.92°; P = .023 and P < .001, respectively) tibial apertures. The distance from the footprint to the tibial aperture was 16.49 ± 3.73 mm. All patient-reported outcome scores (mean ± SD) improved from pre- to postoperatively: Lysholm score, from 46.4 ± 18.87 to 83.47 ± 10.54 ( P < .001); Tegner score, from 2.47 ± 1.85 to 6.07 ± 1.58 ( P < .001); IKDC sports activities score, from 19 ± 9.90 to 33.07 ± 5.35 ( P < .001); and IKDC knee symptoms score, from 17.87 ± 6.31 to 25.67 ± 3.66 ( P < .001). The mean SSD improved from 9.15 ± 2.27 mm preoperatively to 4.20 ± 2.31 mm postoperatively ( P < .001). The reconstructed knee showed significantly more adduction (by 1.642°), less flexion (by 1.285°), and more lateral translation (by 0.279 mm) than that of the intact knee ( P < .001 for all). Conclusion: Lowering the tibial aperture during PCL reconstruction reduced the killer turn, and the clinical outcomes remained satisfactory. However, SSD and clinical outcomes were similar to those of previously described techniques using an anatomic tibial tunnel.