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Tang Y, Hu WH, Wang H, Wu J, Wen MB, Su B, Jiang ZJ, Jiang X, Zhu LJ, Ding N, Yang MT, Yin S, Hu HQ, Xu F, Li J, Shi Q. Magnetic Resonance Imaging-Based Classification Systems for Informing Better Outcomes of Adenomyosis After Ultrasound-Guided High-Intensity Focused Ultrasound Ablating Surgery. J Magn Reson Imaging 2024; 59:1787-1797. [PMID: 37671487 DOI: 10.1002/jmri.28943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND A referenced MRI-based classification associated with focused ultrasound ablation surgery (FUAS) outcomes is lacking in adenomyosis. PURPOSE To identify an MRI-based classification system for informing the FUAS outcomes. STUDY TYPE Retrospective. POPULATION Patients with FUAS for adenomyosis, were divided into a training set (N = 643; 355 with post-FUAS gonadotropin-releasing hormone/levonorgestrel, 288 without post-FUAS therapy) and an external validation set (N = 135; all without post-FUAS therapy). FIELD STRENGTH/SEQUENCE 1.5 T, turbo spin-echo T2-weighted imaging and single-shot echo-planar diffusion-weighted imaging sequences. ASSESSMENT Five MRI-based adenomyosis classifications: classification 1 (C1) (diffuse, focal, and mild), C2 (intrinsic, extrinsic, intramural, and indeterminate), C3 (internal, adenomyomas, and external), C4 (six subtypes on areas [internal or external] and volumes [<1/3 or ≥2/3]), and C5 (internal [asymmetric or symmetric], external, intramural, full thickness [asymmetric or symmetric]) for FUAS outcomes (symptom relief and recurrence). STATISTICAL TESTS The optimal classification was significantly associated with the most subtypes of FUAS outcomes. Relating to the timing of recurrence was measured using Cox regression analysis and median recurrence time was estimated by a Kaplan-Meier curve. A P value <0.05 was considered statistically significant. RESULTS Dysmenorrhea relief and recurrence were only associated with C2 in training patients undergoing FUAS alone. Compared with other subtypes, the extrinsic subtype of C2 was significantly associated with dysmenorrhea recurrence in the FUAS group. Besides, the median dysmenorrhea recurrence time of extrinsic subtype was significantly shorter than that of other subtypes (42.0 months vs. 50.3 months). In the validation cohort, C2 was confirmed as the optimal system and its extrinsic subtype was confirmed to have a significantly shorter dysmenorrhea recurrence time than other subtypes. DATA CONCLUSION Classification 2 can inform dysmenorrhea relief and recurrence in patients with adenomyosis undergoing FAUS only. Itsextrinsic subtype was associated with an earlier onset of dysmenorrhea recurrence after treatment. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Ying Tang
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Wen-Hao Hu
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Hang Wang
- Department of Obstetrics and Gynecology, Si Chuan Mian Yang 404 Hospital, Mian Yang, Sichuan, China
| | - Jia Wu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Ming-Bo Wen
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Bin Su
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Zhi-Jun Jiang
- Department of Radiology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xiao Jiang
- Department of Obstetrics and Gynecology, The Affiliated Hospital of West Normal University, Nanchong, Sichuan, China
| | - Li-Juan Zhu
- Department of Radiology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Na Ding
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ming-Tao Yang
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Shu Yin
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hui-Quan Hu
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Fan Xu
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jun Li
- Department of Obstetrics and Gynecology, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Tang NH, Fang CL, Hu WH, Tian L, Lin C, Hu HQ, Shi QL, Xu F. Age-stratified risk factors of re-intervention for uterine fibroids treated with high-intensity focused ultrasound. Int J Gynaecol Obstet 2024; 164:1212-1219. [PMID: 37953647 DOI: 10.1002/ijgo.15217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/17/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To estimate the rate and risk factors of re-intervention for patients with uterine fibroids (UFs) undergoing high-intensity focused ultrasound (HIFU) at different age distributions. METHOD A retrospective cohort study was conducted in Nanchong Central Hospital, recruiting a total of 672 patients with UFs undergoing HIFU from June 2017 to December 2019. Using univariate and multivariate logistic regression, risk factors for re-intervention were assessed. RESULTS Among 401 patients with UFs who completed the follow-up visits (median 47 months, range 34-61), 50 (12.46%) patients underwent re-intervention (such as high-intensity focused ultrasound, uterine artery embolization, myomectomy and hysterectomy). In the different age distributions, the re-intervention rate was 17.5% (34/194) in patients aged <45 years and 7.7% (16/207) in those aged ≥45 years. Regarding the younger patient group (aged <45 years), hypo- or iso-intensive fibroids in T2-weighted magnetic resonance imaging (T2WI) intensity may elevate the risk of re-intervention for UFs (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.37-6.62; P = 0.007). Among the older patient group (aged ≥45 years), preoperative anemic patients had an increased risk of re-intervention compared with those without anemia (OR 3.30, 95% CI 1.01-10.37; P = 0.041). CONCLUSION The re-intervention rate of HIFU decreased with increasing age. Among those aged <45 years, T2WI intensity was the independent risk factor for re-intervention, and among those aged ≥45 years, preoperative anemic status may be related to re-intervention outcome.
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Affiliation(s)
- Neng-Huan Tang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Chun-Ling Fang
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Wen-Hao Hu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
| | - Ling Tian
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Chuan Lin
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Hui-Quan Hu
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
| | - Qiu-Ling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
- School of Public Health and Management, Chongqing Medical University, Chongqing, People's Republic of China
| | - Fan Xu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
- Department of Obstetrics and Gynecology, Affiliated Nanchong Central Hospital of North Sichuan Medical University, Nanchong, People's Republic of China
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Gao W, Lu J, Gao X, Zhou J, Dai H, Sun M, Xu J. Biomechanical effects of joint disc perforation on the temporomandibular joint: a 3D finite element study. BMC Oral Health 2023; 23:943. [PMID: 38031042 PMCID: PMC10685656 DOI: 10.1186/s12903-023-03521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Disc perforation (DP) is a severe type of Temporomandibular Disorder (TMD). DP may induce changes in the internal stresses of the temporomandibular joint (TMJ). Herein, this study attempts to investigate the biomechanical effects of different positions and sizes of DP on the TMJ using a biomechanical approach, to explore the mechanical pathogenesis of TMD. METHODS Eleven three-dimensional finite element (FE)models of the TMJ were constructed based on CBCT imaging files of a patient with DP on the left side. These models included the disc with anterior displacement and discs with different locations and sizes of perforations on the affected disc. FE methods were conducted on these models. RESULTS Anterior displacement of the disc leads to a significant increase in the maxim von Mises stress (MVMS) in both TMJs, with the affected side exhibiting a more pronounced effect. DP occurring at the posterior band and the junction between the disc and the bilaminar region has a greater impact on the MVMS of both TMJs compared to perforations at other locations. As the size of the perforation increases, both sides of the TMJs exhibit an increase in the magnitude of MVMS. CONCLUSIONS Unilateral disc anterior displacement results in an increased stress on both TMJs. Unilateral DP further affects the stress on both sides of the TMJs. TMD is a progressive condition, and timely intervention is necessary in the early stages to prevent the worsening of the condition.
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Affiliation(s)
- Wentong Gao
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jie Lu
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xiang Gao
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jianping Zhou
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Hongwei Dai
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Min Sun
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Knee Joint Sports Injury, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan Province, China.
| | - Jie Xu
- Stomatological Hospital of Chongqing Medical University, No. 426 Songshi North Road, Chongqing, China.
- Chongqing Key Laboratory for Oral Diseases and Biomedical Science, Chongqing, China.
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
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Yang S, Bai L, Xu W, Zhang R, Hu D, Nie Y, Xiang R, Shi Q. Profiling the real-world management status of high-risk human papillomavirus infection: a protocol to establish a prospective cohort of high-risk human papillomavirus-infected women in Lueyang County, China. BMJ Open 2022; 12:e062678. [PMID: 36123075 PMCID: PMC9486292 DOI: 10.1136/bmjopen-2022-062678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Persistent infection with high-risk human papillomavirus (hrHPV) is the main cause of cervical cancer. Thus, the effective treatment against HPV represents an opportunity to reduce the incidence of cervical cancer. Although various treatments are effective in treating HPV infection, they still provide limited benefit in reducing the rate of cervical cancer due to the lack of implementation of a standardised protocol in many low/middle-income areas. This proposed cohort study aims to describe the status quo of treatment, attributions of the treatment decision-making process and potential factors influencing treatment decisions. METHODS AND ANALYSIS This is a mixed-method, 5-year prospective longitudinal study in Lueyang County, China, one of the areas with the highest cervical cancer incidence rates and lowest mean income in China. We will enrol women with hrHPV infection (at least one HPV type in the 13 high-risk subtypes) diagnosed via a county-wide HPV infection and cervical cancer screening programme. The study procedures describe the treatment patterns and explore the potential influencing factors in treatment decision-making through questionnaires, laboratory examinations and in-depth interviews. All participants will be evaluated at baseline and at 6, 12, 24, 36, 48 and 60 months. The primary outcome is the treatment pattern, the type and duration of which will be described later. The secondary outcomes include guideline compliance and changes in the HPV infection status. The HPV impact profile, intimate relationship satisfaction, and costs within different management groups are also described and compared. ETHICS AND DISSEMINATION This study was reviewed, and all of the relevant approvals were obtained from the Ethics Committee of the Maternity Service Centre of Lueyang Maternal and Child Health Care Hospital (2021-001). The findings from this study will be disseminated through peer-reviewed publications, conference presentations and academic workshops. TRIAL REGISTRATION NUMBER ChiCTR2100053757.
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Affiliation(s)
- Siyuan Yang
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
| | - Li Bai
- Maternal and Child Health, The Maternity Service Centre of Lueyang Maternal and Child Health Care Hospital, Lueyang, Shaanxi, China
| | - Wei Xu
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Ruoyi Zhang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Dehua Hu
- Maternal and Child Health, The Maternity Service Centre of Lueyang Maternal and Child Health Care Hospital, Lueyang, Shaanxi, China
| | - Yuxian Nie
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
| | - Rumei Xiang
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, China
- School of Public Health, Chongqing Medical University, Chongqing, China
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