Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.
ObjectiveTo identify primary osteoporosis patients’ function and environment status based on International Classification of Functioning, Disability and Health (ICF) and provide evidence to clinical treatment, rehabilitation therapy and rehabilitation nursing.MethodsA questionnaire survey was conducted among osteoporosis patients hospitalized in the Center of rehabilitation Medicine of West China Hospital of SiChuan University, from May 2017 to December 2019. The research design was based on a cross-sectional survey. ICF was applied to simplify the core classification set, and a convenient sampling method was adopted.ResultsA total of 240 patients were investigated. All of the patients’ function showed limitation but different level. Meanwhile, including Walking (D450), Sensation of pain(B280), Structure of trunk (S760), Lifting and carrying objects (D430), Mobility of joint function (B710), the proportion of injuries were more than 90%, most of which the limitation level were light and moderate injuries indicating 5%-49% injuries; more than 50% pointed the three parts of environment factors were facilitative factors including Products or substances for personal consumption (E110), Health professionals (E355), Health services, systems and policies (E580), of which the proportion of Health services, systems and policies (E580) were highest.ConclusionOsteoporosis has a significant effect on patients’ function, we should develop clinical treatment, rehabilitation therapy, rehabilitation nursing based on the current evaluation of function.
Objective To evaluate the characteristics, classification, treatment methods, and cl inical outcomes of the spoke heel injuries in children. Methods From June 2001 to June 2008, 289 children with bicycle or motorcycle spoke heel injuries were treated, including 179 males and 110 females aged 2-12 years old (average 3.9 years old). There were 179 cases of skin contusion and laceration (type I), 83 cases of skin and soft tissue defect with Achilles tendon exposure (type II), and 27 cases of wide skin and soft tissue defect with the Achilles tendon defect and rupture (type III). The defect size of the skin or the soft tissues ranged from 3 cm × 2 cm to 11 cm × 7 cm in type II and type III injury. The time between injury and hospital admission was 1-53 days (average 14.5 days). Child patients with type I injury were managed with dressing or suturing after debridement. For the child patients with type II injury, the wound was repaired with the regional fascia flap in 53 cases, the reverse sural neurocutaneous vascular flap in 19 cases, the reverse saphenous neurocutaneous vascular flap in 9 cases, and the lateral supramalleolar flap in 2 cases. For the child patients with type III injury, 6 cases underwent primary repair of the Achilles tendon followed by the transposition of the reverse sural neurocutaneous vascular flap, 3 cases received primary repair of the wound with the reverse sural neurocutaneous vascular flap and secondary reconstruction of the Achilles tendon with the upturned fascia strip or the ipsilateral il iotibial tract transplant, and 18 cases underwent primary repair of the wound and the Achilles tendon with the sl iding bi-pedicled gastrocnemius musculocutaneous flap. The flap size ranged from 4 cm × 2 cm to 30 cm × 12 cm. All the donor sites were closed bypartial suture and spl it-thickness skins graft. The lower l imbs were immobil ized with plaster spl ints after operation. Results All the flaps survived except for 1 case of type II suffering from distal flap venous crisis 3 days after operation and 6 cases of type III suffering from distal flap necrosis 3-5 days after operation. All those flaps survived after symptomatic treatment. All the skin grafts at the donor site survived uneventfully. All the wounds healed by first intention. All child patients were followed up for 15-820 days (average 42 days). Child patients with type I and type II injury had a full recovery of ankle functions. While 25 cases of type III injury had ankle dorsal extension degree loss (10-30°) and unilateral plantar flexion strength decrease 3 months after operationwithout influence on walking, and 2 cases recovered well. Conclusion Spoke heel injury in children has special mec hanisms of injury, and the choice of proper treatment method should be based on the types of injury.
This article aims to combine deep learning with image analysis technology and propose an effective classification method for distal radius fracture types. Firstly, an extended U-Net three-layer cascaded segmentation network was used to accurately segment the most important joint surface and non joint surface areas for identifying fractures. Then, the images of the joint surface area and non joint surface area separately were classified and trained to distinguish fractures. Finally, based on the classification results of the two images, the normal or ABC fracture classification results could be comprehensively determined. The accuracy rates of normal, A-type, B-type, and C-type fracture on the test set were 0.99, 0.92, 0.91, and 0.82, respectively. For orthopedic medical experts, the average recognition accuracy rates were 0.98, 0.90, 0.87, and 0.81, respectively. The proposed automatic recognition method is generally better than experts, and can be used for preliminary auxiliary diagnosis of distal radius fractures in scenarios without expert participation.
Feature extraction methods and classifier selection are two critical steps in heart sound classification. To capture the pathological features of heart sound signals, this paper introduces a feature extraction method that combines mel-frequency cepstral coefficients (MFCC) and power spectral density (PSD). Unlike conventional classifiers, the adaptive neuro-fuzzy inference system (ANFIS) was chosen as the classifier for this study. In terms of experimental design, we compared different PSDs across various time intervals and frequency ranges, selecting the characteristics with the most effective classification outcomes. We compared four statistical properties, including mean PSD, standard deviation PSD, variance PSD, and median PSD. Through experimental comparisons, we found that combining the features of median PSD and MFCC with heart sound systolic period of 100–300 Hz yielded the best results. The accuracy, precision, sensitivity, specificity, and F1 score were determined to be 96.50%, 99.27%, 93.35%, 99.60%, and 96.35%, respectively. These results demonstrate the algorithm’s significant potential for aiding in the diagnosis of congenital heart disease.
Objective To recognize and reevaluate the pathologic anatomic classification of ventricular septal defect （VSD）. Methods From January,2002 to October,2004,119 patients less than 10kg of body weight with simple VSD whose pathologic anatomic classification was determined by preoperative echocardiography and ascertained during surgery were choosed randomly. Results （1） There were fihy-one patients with perimembranous VSD （diameter 0. 6±1.0 cm）, 8 VSD situated in the membranous septum （diameter 0. 5±0.4 cm）, 21 VSD extending to inlet （diameter 0.8±0.5 cm）, 14 extending to outlet （diameter 1.0±0. 6 cm） and 8 extending to trabecula （diameter 0. 8±0.6 cm）. In this group, accessory tricuspid valve tissue was formed in 14 patients（diameter 0. 5±0.3 cm）. （2） Twenty-one patients had conoventricular VSD （diameter 1.2±0. 8 cm）, among them 13 VSD had muscle margins, 8 extending to membranous septum, 14 had septal band hypertrophy, and 5 had subaortic stenosis. （3） Twenty-six patients had subpulmonary VSD（diameter 0.8±0.8 cm）, 18 VSD lay immediately below pulmonary valve, 8 had muscle distant from pulmonary valve, 20 lay completely below pulmonary valve, and 6 lay below pulmonary valve and aortic valve. （4） Ten patients were atrioventricular canal type or inlet VSD （diameter 1.2±0.8 cm）. （5）Eleven patients had muscular VSD, among them 3 were single ,and 8 multiple （diameter 0. 4±0.3 cm）. Conclusion It will be more clinically significant that VSD is classified into perimembranous, conoventricular, atrioventricular canal or inlet, muscular and subpulmonary artery or conical types.
ObjectiveTo introduce and interpret ABCD classification system for subaxial cervical spine injury.
MethodsThe literature related to subaxial cervical spine injury classification system was extensively reviewed, analyzed, and summarized so as to introduce the ABCD classification system.
ResultsThe ABCD classification system for subaxial cervical spine injury consists of 3 parts. The first part of the proposed classification is an anatomical descri ption of the injury; it del ivers the information whether injury is bony, ligamentous, or a combined one. The second part is the classification of nerve function, spinal stenosis, and spinal instabil ity. The last part is optional and denotes radiological examination which is used to define injury type. Several letters have been used for simplicity to del iver the largest amount of information. And a treatment algorithm based on the proposed classification is suggested.
ConclusionThe ABCD classification system is proposed for simplification. However further evaluation of this classification is needed.
ObjectiveTo define the classification of sternal wound complications after cardiac surgery and to explore the appropriate surgical treatment.
MethodsBetween July 2008 and January 2014, 260 patients with sternal wound complications after cardiac surgery were treated. There were 124 males and 136 females, aged 11-75 years (mean, 49.5 years). The disease duration was 13-365 days (mean, 26.6 days) with a wound length of 1-25 cm (mean, 13.4 cm). The wounds were divided into type I (n=70), type Ⅱ (n=64), type Ⅲ (n=42), type IV (n=78), and type V (n=6) according to self-generated classification for sternal wound complications after cardiac surgery. After debridement, wounds of type I and type Ⅱ were repaired with local flap transplantation; wounds of type Ⅲ were repaired with local flap transplantation combined with butterfly sternal fixation (n=28), with bilateral pectoralis muscle flap combined with butterfly sternal fixation (n=11), and with bilateral pectoralis muscle flap (n=3); wounds of type IV were repaired with bilateral pectoralis muscle flap (n=65), rectus abdominis muscle flap (n=5), and pedicled omental flap (n=8); and wounds of type V were repaired with pedicled omental flap.
ResultsAll the operations were successfully performed. Three patients died after pedicled omental flap repair, including 1 case of type IV and 2 cases of type V. The hospitalization time were 4-86 days (mean, 18.3 days). Primary wound healing was obtained in 248 cases (96.5%); poor healing occurred in 9 patients, which were cured after second surgery in 8 cases and after the third surgery in 1 case.
ConclusionThe surgical treatment based on self-generated classification is appropriate to sternal wound complications after cardiac surgery. It can provide clinical evidence for the choice of subsequent operation.
Alzheimer’s disease (AD) is an irreversible neurodegenerative disorder that damages patients’ memory and cognitive abilities. Therefore, the diagnosis of AD holds significant importance. The interactions between regions of interest (ROIs) in the brain often involve multiple areas collaborating in a nonlinear manner. Leveraging these nonlinear higher-order interaction features to their fullest potential contributes to enhancing the accuracy of AD diagnosis. To address this, a framework combining nonlinear higher-order feature extraction and three-dimensional (3D) hypergraph neural networks is proposed for computer-assisted diagnosis of AD. First, a support vector machine regression model based on the radial basis function kernel was trained on ROI data to obtain a base estimator. Then, a recursive feature elimination algorithm based on the base estimator was applied to extract nonlinear higher-order features from functional magnetic resonance imaging (fMRI) data. These features were subsequently constructed into a hypergraph, leveraging the complex interactions captured in the data. Finally, a four-dimensional (4D) spatiotemporal hypergraph convolutional neural network model was constructed based on the fMRI data for classification. Experimental results on the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database demonstrated that the proposed framework outperformed the Hyper Graph Convolutional Network (HyperGCN) framework by 8% and traditional two-dimensional (2D) linear feature extraction methods by 12% in the AD/normal control (NC) classification task. In conclusion, this framework demonstrates an improvement in AD classification compared to mainstream deep learning methods, providing valuable evidence for computer-assisted diagnosis of AD.
One hundred and thirty patients with uveitis in north-western zone of our country were analyzed based on anatomical classification and their causes. It was found that anterior uveitis was the commonest type in uveitis,accounting for 86.15% of total patients. Intermediate uveitis, pan-uveitis and posterior uveitis accounted repectively for 6.92%, 3.85%and3.08% of the total patients. Rheumatic arthritis was the most frequently accompanied systemic disease in patients with uveitis,showing a possibly causative link between them in their pathogenesis.
（Chin J Ocul Fundus Dis,1994,10:156-158）
