Статьи журнала - Saratov Medical Journal
Все статьи: 62
Статья научная
Objective: based on the Russian Federation multicenter registry data, to assess the comprehensiveness of medicamentous therapy in patients with stable coronary artery disease (CAD) from the perspective of 2018 European Society of Cardiology (ESC-2018) recommendations for myocardial revascularization and 2017 American Appropriate Use Criteria (AUC-2017) for the expediency of revascularization. Materials and methods. Anamnestic data of 1531 patients with stable CAD (average age: 61.7 ± 9.8 years; 76% men) were studied. The data source was the Russian Federation multicenter registry of patients with arterial hypertension, CAD, and chronic heart failure. We identified the prescription of optimal medical therapy (OMT) sensu ESC-2018, maximal anti-ischemic therapy (MAT) sensu AUC-2017, and compliance of drug therapy with ESC-2018 and AUC-2017 simultaneously. OMT included at least one anti-ischemic medication + antiplatelet agent + statin + short-acting nitrate + blocker of the renin-angiotensin system in the presence of hypertension, diabetes mellitus, or heart failure. MAT included at least two anti-ischemic pharmaceutical drugs. Compliance with these criteria was determined in the groups of patients who underwent, or did not undergo, myocardial revascularization, as well as among those, for whom invasive treatment was indicated as the first priority, as the second priority, or was not indicated at all, according to ESC-2018 and AUC-2017. Results. Among patients who received solely medicamentous therapy (n=924), OMT was prescribed in 18%, while in the revascularization group (n= 07), in 9% of cases (p <0.001). MAT was also prescribed more often in the conservative therapy group (34%) than in the revascularization group (24%): p = 0.001. OMT sensu ESC-2018 and AUC-2017 in the groups with, or without, intervention was prescribed in 3% vs. 7% of cases, respectively (p <0.001). Conclusion. According to the Russian Federation multicenter registry, medicamentous therapy of stable CAD complies with the provisions of European and American clinical guidelines for myocardial revascularization in a small proportion of patients, regardless of the chosen treatment tactics.
Бесплатно
Methodology of designing specialized medical information registries
Статья научная
The objective. Developing information exchange methodology by means of specialized registries among the core healthcare partakers in the course of provisioning medical assistance to traumatology and orthopedic patients. Materials and Methods. We conducted the analysis and systematization of functionality for 31 registers of traumatology- and orthopedics-related medical information from the databases of the Federal Institute of Industrial Property, European Patent Office and developers’ websites. The search depth has been set at 1979 and defined by the date of the earliest discovered information source. Results. The analysis of specialized registries revealed that majority of those (70.9%) were mono-nosologic, hence containing information about the diagnosis and treatment procedures provided at the level of a specific medical institution. We developed the methodology for evaluating the functionality of specialized medical information registries, containing the data on used medical devices, medications, medical technologies, rehabilitation programs, and assessment of medical treatment effectiveness. Such methodology was designed to operate on data from the information systems of major healthcare partakers. Conclusion. The proposed information exchange methodology defined the necessity of integrated, target-oriented registry development. Its implementation would allow increasing the quality of management decisions proposed by healthcare participants.
Бесплатно
Microbiological aspects of acute odontogenic osteomyelitis in children
Статья научная
Objective: to identify the species composition of pathogens causing acute odontogenic inflammatory process in the children’s jaws; to examine the sensitivity and resistance of the isolated microflora to antibiotics of various groups; and to determine the dependence of the disease clinical course on the type of dominant pathogen. Materials and Methods.The results of a microbiological study of exudate from purulent odontogenic foci of 900 children regarding periostitis and osteomyelitis of the jaws were analyzed. Results. In 65.6% of cases, the causative agent was Streptococcus pyogenes known as group A beta-hemolytic streptococcus (GABHS) possessing a high sensitivity to vancomycin (99%), fluoroquinolones (98%), beta-lactam antibiotics (91%), and the highest resistance to macrolides (41%). We have also isolated Streptococcus viridans (6.1%), Streptococcus pneumoniae (4.3%) andmixed microflora (14.3%). The syndrome of endogenous intoxication of the body was manifested by high fever in 56% of cases, by leukocytosis in 38% of patents, and by acceleration of the erythrocyte sedimentation rate in 57.4% of study subjects. There was no statistically significant difference in the degree of endogenous intoxication between groups with different types of streptococci. Conclusion. The cause of the inflammatory process in the jaws was GABHS (65.6% of cases) with a high sensitivity to vancomycin (99%), fluoroquinolones (98%), and beta-lactam antibiotics (91%).
Бесплатно
Morphological aspects of orbital defect reconstruction in rats with elastin-based biomaterial
Статья научная
The objective of the study was to identify morphological aspects of replacement of xenogeneic decellularized elastin matrix (ХDEM) transplanted into a bone defect of the upper orbital wall in rats. Materials and methods. The experiment was performed on 60 Wistar rats with artificially created 7×4 mm defect in the upper edge of their orbit. In the experimental group (n=30), DХEM was placed in the defect area. Its size matched the size of the defect, and it was attached with a suture material (50 μm silk). Soft tissues were sutured layer by layer in the control group (n=30). Tissue excision was performed after 1, 3 and 12 months. Histological, immunohistochemical and electron microscopic methods were employed. Results. We were gradually replacing DХEM with bone tissue against the background of a pronounced reaction of CD68+/MMP-9+ macrophages, which implied its resorption and lysis. Osteogenesis occurred via intramembranous ossification and endochondral ossification, which was preceded by centripetal migration of endothelial kidneys with subsequent differentiation into capillaries and overgrowth of loose fibrous connective tissue containing progenitor cells. The microenvironment, represented by reticulin fibers, TGF-β1, and sulfated glycosaminoglycans, could contribute to the differentiation of progenitor cells in the osteogenic direction and to osteogenesis per se. In the control group, the defect remained open throughout the experiment. Conclusion. Decellularized biomaterial, based on elastin matrix, has osteoconductive and osteoinductive properties and can serve an adequate biomimetic for reconstruction of the bone defects.
Бесплатно
Open-heart surgery in elderly patients: short-term vs. long-term effects
Статья научная
The objective of the study was to analyze in-hospital mortality and long-term survival of elderly patients who underwent open-heart surgery and met the criterion of frailty. Materials and Methods. The study involved 266 patients over 75 years old complying with the frailty criterion (F-index ≤5). A total of 155 operations of coronary artery bypass grafting (CABG), 47 surgeries of aortic valve replacement (AVR), and 64 procedures of CABG in combination with AVR were performed. Study subjects were distributed among the groups depending on the surgery type. Postoperative complications were evaluated, and short-term and long-term outcomes were compared. Results. In-hospital mortality was 5.3% in general group, 9.4% in CABG+AVR group, 3.9% in CABG group, and 4.2% in AVR group. There was no significant difference among the rates of in-hospital mortality between the groups (р>0.05). Long-term survival rates in general group were as follows: 98.3% for 1-year survival, 94.6% for 3-year survival, and 82.1% for 5-year survival. Type of surgery had no significant impact on the outcome (р>0.05). Conclusion. Short- and long-term effects of CABG, AVR, and combination of CABG with AVR in the group of elderly patients who meet the criterion of frailty were characterized by low mortality and low incidence of non-fatal complications. The type of cardiac surgery and old age did not affect significantly the outcome of a surgical treatment.
Бесплатно
Статья научная
Objective: analysis of opinion dynamics in young people on prevention and treatment of sexually transmitted infections (STIs) against the background of COVID-19 pandemic vs. the pre-pandemic period. Materials and Methods. Our research was based on a comparison of data from a sociological survey of 400 respondents 16-21 years of age in 2021 and an analysis of 838 questionnaires from participants of the same age in a similar study in 2017. The research employed the methodology of sociological questionnaire. The original questionnaire was used, consisting of 46 questions, combined into five thematic blocks: assessment of the STI problem relevance, likelihood of infection risk, readiness to undergo preventive screening examinations, preferred directions for seeking medical help in the event of STI, and consent to examination and treatment in conjunction with a sexual partner. By gender, the distribution of study subjects was as follows: 51% of women (n=427) in 2017 vs. 52% (n=208) in 2021; 49% of men (n=411) in 2017 vs. 48% (n=192) in 2021. In processing and presenting the data, extensive indicators were used, compared with the assessment of the significance of differences sensu Student’s t-test. Results. In 2021, we observed an increase in the interest of young people in undergoing screening examinations (79.5% vs. 63% in 2017, p=0.006) and seeking medical help (93.5% vs. 89.5%, p=0.007); on the other hand, in 2021, young people were more likely to conceal their health status from a partner (32.2% vs. 8.3%, p=0.003). Conclusion. The study revealed a change in the opinions of respondents regarding STIs during the pandemic, specifically, an increase in understanding the need for regular examinations and seeking medical help in the event of STI symptoms, but at the same time, there was a reduced responsibility for the sexual health of their partner.
Бесплатно
Optimizing the process of developing human blood vessel models
Статья научная
Objective: to optimize the process of blood vessel biomechanical modeling via developing models of cerebral arterial circle. Materials and methods. Biomechanical modeling requires development of a patient-oriented three-dimensional (3D) solid-state geometric model of the object under study. This task can be resolved by computed tomography (CT) or magnetic resonance imaging (MRI). We developed the program that implements the construction of blood vessel contours from separate slices of MRI in a semi-automatic mode. These contours are exported as saved curves in a specific format to SolidWorks, where they are used to create 3D models of blood vessels. The models obtained this way take into account individual characteristics of the vascular system structure of a particular patient, and can be used in the process of biomechanical modeling. Results. The results of the program implementation of the recursive frontal growth method for processing 2D slices of tomograms are presented. Conclusion. The developed software allows semi-automatic loading of DICOM images and obtaining flat cross-sections (MRI slices) of vessels on their basis, as well as transferring them for further processing into computer-aided design systems.
Бесплатно
Pathomorphological characteristics of the wound bed prior to skin autografting
Статья научная
Objective: to conduct a comparative pathomorphological analysis of wounds of various origins requiring full-thickness skin autografting. Materials and Methods. Histomorphological comparison of the wound bed prior to plastic surgery with full-thickness skin autografts was performed in three groups of patients: (1) during excision of scar tissue in elective surgery; (2) in case of traumatic skin detachments with autografting sensu Krasovitov; (3) when excising the granulation tissue to the fibrous layer. The object of the study included biopsy specimens from patients of three study groups. Results. The histological picture of wounds after removal of scars was characterized by well-developed dense fibrocellular connective tissue and had signs of chronic inflammation. In contrast to the cicatricial wound, acute lesions were characterized by granulation and mature dense fibrous connective tissues with pronounced inflammatory changes, each of which had its own characteristics. Conclusion. The results of the comparative analysis revealed the features of the morphological picture of wounds depending on the type of damage. In the group of acute injuries, traumatic and burn wounds, the most pronounced tissue damage was revealed. Given the obtained data, it should be assumed that full-thickness skin autografting will yield the best result in the group of patients after the planned excision of scar tissue.
Бесплатно
Статья научная
Objective: development and efficacy assessment of the tactic of actions in reverse shoulder arthroplasty in bone mass defects and deficiency of the scapular glenoid fossa. Materials and Methods. At the Division of Adult Orthopedics, N.N. Priorov National Medical Research Center of Traumatology and Orthopedics, Ministry of Healthcare of the Russian Federation, 6 patients with glenoid bone mass deficiency were subjected to the reverse shoulder arthroplasty: 4 of those received the replacement of marginal bone defects, whereas 2 subjects underwent the replacement of extensive bone defects. Results. During the follow-up period of the operated patients, which lasted 6-24 months, good clinical, radiological and functional results were obtained. There were no intraoperative or postoperative complications. Conclusion. The proposed replacement method of glenoid defects in reverse arthroplasty exhibited high efficacy.
Бесплатно
Perimortem and postmortem caesarean section: a systematic review
Статья научная
Rationale: Perimortem caesarean section (PMCS) is an emergency procedure performed in pregnant women over 20 weeks of gestation with cardiac arrest, in order to save the mother and the foetus, or only one of them. The objective of the review was to present clinical traits and evaluate survival of mothers and newborns as well as the complications following PMCS. Materials and methods: A systematic review between March and May 2021 was performed using the PRISMA method with the terms "perimortem caesarean section" "postmortem caesarean section", "maternal cardiac arrest", "perimortem caesarean section "AND "case report" "postmortem caesarean section" AND "case report". Results: 23 papers from 12 countries with 39 cases were counted. Of the total sample, 17.94% of the mothers survived and of these, 42.85% had neurological complications. Of 39 newborns counted, 69.23% survived, 28.20% died and in 2.56% the information was missing. 30.76% of the cases followed the five-minute rule and 56.41% required 6 or more minutes, 12.82% did not specify time. Conclusion: The results of this analysis demonstrated higher mortality in women who had a cardiac arrest during pregnancy related to the neonates who survived. The possibility of performing PMCS should neither be ruled out even if the established five-minute time frame has passed, nor should time be invested in verifying foetal viability.
Бесплатно
Статья научная
Objective: assessment of the anatomical and topographical parameters of the wound channel formed in the course of the posterolateral musculofascial approach with the purpose of identifying the possibility of its clinical use in decompressive and stabilizing surgical interventions. Materials and Methods: a posterolateral musculofascial approach to the lumbar spine was modeled using material from 20 male and female cadavers 54 – 76 years of age (median 67.5 years) who died from diseases not associated with the pathology of the spine. The study examined wound length, depth, wound depth index, and wound access zone, as well as the angle of intersection of the wound edges with the surface of surgical instruments. Results: the mean length of the surgical wound when performing the lateral musculofascial approach was 149.75±6.35 mm. The mean depth of the wound was 116.75±8.85 mm. The mean value of the surgical wound depth index with interfascial approach was 77.96±5.04. The mean area of the intervertebral disc available for removal was 71.2±2.8%. The length of the aperture in the annulus fibrosus was on average 15.8±0.78 mm. The mean angle of the intersection of the wound edge by the trajectory of transpedicular screw implantation was 3.15±1.25°. Conclusion:the assessment of the anatomical and topographical parameters of the wound channel formed during the posterolateral musculofascial approach allowed concluding that such surgical approach could be used to improve the functional outcomes of decompressive and stabilizing interventions on the lumbar spine.
Бесплатно
Republican Arthrology Center and its contribution to the development of orthopedic rheumatology
Статья научная
The article provides information on the organization and functioning achievements of the Republican Arthrology Center (RAC), which has become the first specialized clinic in the Russian Soviet Federative Socialist Republic (RSFSR) that provided arthrological assistance to the population. The result of the organizational and methodological efforts of the RAC employees was the development of a network of rheumatology rooms in almost all territories of the country, along with the organization of the orthopedic rheumatology service and its separation from the cardiovascular rheumatology service. In the RAC, scientific developments were successfully carried out on the problems of arthroplasty of large joints, surgical and conservative treatment of patients with rheumatoid arthritis, osteoarthritis of large joints, prevention of contractures of the knee joint. Saratov Research Institute of Traumatology and Orthopedics (SRITO) hip joint endoprosthesis, a collapsible endoprosthesis and other constructions that have received wide recognition were created at the RAC. In the absence of international experience in creating an orthopedic rheumatology service network, the RAC was, on one hand, a pioneering phenomenon in world health care, and on the other hand, a natural consequence of the power vertical centralization in the USSR. At the same time, it should be emphasized that the need to create the RAC in the Russian Federation was caused by the growth in morbidity of rheumatic diseases, along with population aging and the prospects of orthopedic rheumatology associated, first of all, with the active introduction of total joint replacement with artificial structures in developed countries of the world. Over three decades of its existence, the RAC has been an organizational, methodological, medical, scientific and consulting center providing an orthopedic care to patients with diseases and injuries of large joints throughout the Russian Federation.
Бесплатно
Skin autofluorescence as a factor of adverse prognosis in patients with peripheral atherosclerosis
Статья научная
Objective: to determine the prognostic value of skin autofluorescence (SAF) as a factor of cardiovascular complications and mortality. Materials and Methods. Our prospective study included 122 patients with peripheral arterial disease (PAD): atherosclerotic stenosis of the brachiocephalic trunk was detected in 95 patient (77.9%), while chronic arterial insufficiency (CAI) of the lower limbs was found in 47 study participants (38.5%). SAF was measured by an original device developed by the authors. Clinical, anthropometric and biochemicalparameters, along with instrumental parameters of the heart and blood vessels, were studied via ultrasound examination. The prospective part of the study (follow-up) was carried out for up to 1,043 (on average, 736) days. Results.The SAF parameter correlated directly and significantly with scores on the scale of clinical prognostic signs, CAIof the lower limbs, and history of surgeries on the leg arteries. In the course of the follow-up period, there were seven deaths and at least one hospitalization for cardiovascular reasons in 42 patients. The most common were hospitalizations due to conservative treatment of CAI, the need for coronary artery bypass grafting, and coronary stenting. Using the logistic regression method, we determined that the incidence of hospitalization or mortality was associated with SAF values, plasma glucosecontent, and the presence of chronic heart failure above functional class 1. The sensitivity and specificity of the model were 71% and 68%, respectively. Conclusion.The SAF parameter can be used as an integral independent predictor in patients with multifocal atherosclerosis.
Бесплатно
Stress-strain properties of aponeurotic suture in anterior abdominal wall after a midline laparotomy
Статья научная
Objective: method development for preventing postoperative ventral hernias based on experimental assessment of the stress-strain properties of aponeurosis in various types of a midline laparotomy. Materials and methods. We evaluated 42 fascia muscular aponeurotic complexes of the anterior abdominal wall. Based on the technique for dissecting the aponeurosis and its suturing, the complexes were divided into two groups (each containing 21 samples): Group 1 with a bypass of the umbilical ring on the left, and Group 2 with umbilical ring dissection. Results. Fascia aponeurotic complexes dissected and sutured through the umbilical ring (Group 2) had, on the average, higher values of mechanical characteristics. E.g., mean values of tensile stress (S), tensile stress at a maximum load (Smax), Young’s modulus (E), aponeurotic tensile strain (D), aponeurotic tensile strain at a maximum load (Dmax), and maximum load level (Load) were higher in Group 2 by 35.4; 39.8; 14.9; 34.6; 30.2 and 40.2 (%), respectively. Conclusion. We conducted the development, experimental application and evaluation of a novel method for preventing postoperative ventral hernias after a midline laparotomy based on the assessment of the stress-strain properties of aponeurosis.
Бесплатно
Статья научная
Objective: to evaluate total testosterone level in men with type 2 diabetes mellitus (DM) and varying degrees of carbohydrate metabolic compensation. Materials and Methods. The continuous cross-sectional non-interventional screening study included 100 men 45 [43; 48] years of age with newly diagnosed type 2 DM. The study continued from February through May of 2021. The level of glycated hemoglobin (HbA1c) and total blood testosterone were determined. Group comparisons were performed via Mann–Whitney U test, Kruskal–Wallis test and Fisher’s exact test. The differences were assumed statistically significant at p<0.05. Results. When comparing patients with different HbA1c content, we discovered that in patients with HbA1c from less than 6.5 to 9.9%, total testosterone levels as well as testosterone deficiency prevalence did not differ statistically significantly. At HbA1c -12%, the prevalence of testosterone deficiency increased statistically significantly (p<0.001), and testosterone levels decreased (p<0.001). Comparison of patient groups with HbA1c levels from less than 6.5 to 9.9% and from 10 to 11.9% did not yield statistically significant differences in the testosterone deficiency prevalence and testosterone content. However, there was a trend towards worse parameter values in the latter group, especially because patients with HbA1c levels from less than 6.5 to 9.9% were older. Conclusion. Total testosterone levels in type 2 DM patients are associated with carbohydrate metabolic compensation. Negative impact on testosterone production was detected in patients with HbA1c content of ≥10%.
Бесплатно
Статья научная
Objective: to identify the nature of proliferation and apoptosis process disorders in the gingival epithelium in postmenopausal women with varying degrees of bone mineralization for early diagnosis and optimization of combination therapy. Materials and Methods. We examined 80 women aged 55–60 years with chronic generalized periodontitis (CGP) and reduced bone mineral density (BMD). All patients underwent a standard dental examination, including an index assessment of periodontal tissues. BMD was quantified via a densitometric analysis of the bone tissue condition. The investigation of periodontal epithelial cell renewal was performed using immunohistochemical studies. Results. We discovered that in postmenopausal patients with CGP and BMD disorders, there was a reduction in the proliferation of gingival epithelial cells with activation of their apoptosis (Iapt=0.73±0.03%, Iki-67=11.77±0.27%) vs. the patients with intact periodontium (Iapt 0.29±0.04%, Iki-67=9.88±0.09%), p=0.04. Conclusion. We discovered that CGP in postmenopausal women occurs with enlarged activity of apoptosis of gingival epithelial cells against the background of their reduced proliferation. The activity of inflammatory destructive processes in periodontal tissues is higher in patients with osteopenia vs. those without BMD impairment.
Бесплатно
Статья научная
Background. The formation and development of industrial model for social processes and systems in the early twentieth century brought to life a novel form of organizing scientific activity via establishing research institutions. Objective. This study aimed to investigate the gaps in the history of traumatology institutions in the early years of the Soviet State. Materials and methods. We carried out a comprehensive analysis to retrieve the data from both State and institutional archives, as well as from the literature sources. The narrative analysis was chosen as the method of data interpretation. Most archive documents are made available to the scientific community for the first time. Our study covered the period of time from 1917 to 1930. Over 500 sources were analyzed. Results. We established that the first five traumatology institutions were founded in the following sequence: Saratov Traumatology Institute in 1919, Rostov Traumatology Institute in 1920; Astrakhan, Moscow Oblast, and Voronezh Traumatology Institutes in 1921. The concept of research institution was mainly designed to achieve the systematic augmentation of scientific knowledge and form a new employee type called a professional scientist. Conclusion. Discovering the history of establishing first traumatology institutions that provided healthcare services and conducted independent scientific studies led us to defining a new, previously unexplored institutionalization stage of Russian traumatology and orthopedics. In the early years of the Soviet State, research institutions facilitated the development and implementation of efficient medical technologies into healthcare practice.
Бесплатно
Ultrasonography screening of carotid arteries in asymptomatic patients
Статья научная
Objective: to identify the most important predictors of carotid artery stenosis in ambulatory patients of Saratov and Saratov Oblast, using multivariate analysis, and to specify an ideal patient for ultrasonographic screening. Materials and methods. In 2014-2018, field consultations and ultrasonographic examinations were performed for asymptomatic patients with suspected carotid artery disease at outpatient clinics of Saratov and Saratov Oblast. Such patients were referred for screening by neurologists and general practitioners. The study encompassed 470 medical charts. The multivariate regression analysis was performed to identify independent predictors of carotid artery stenosis of 50 per cent or more. Results. Carotid artery stenosis of ≥30% was detected in 24.5% (i.e., 115 of 470) of study participants; of ≥50% in 10.2% (48 of 470) patients, and of ≥70% stenosis in 2.9% (14/470) of participants. The multivariate analysis revealed that the odds of finding stenosis of ≥50% in patients, selected by neurologists and general practitioners for ultrasonographic screening, were significantly higher in the presence of the following factors: age exceeding 72, male gender, acute cerebrovascular event in anamnesis > 6 months ago, atherosclerosis of leg arteries, and episodes of speech impairment. We developed the point scale for risk assessment. A point scale for risk assessment has been created. In the absence of prognostic factors, the absolute risk of detecting stenosis ≥50% was just 3%, with 1 point it was 16%, and with 4 points it amounted to >50%. Conclusion. Our analysis enabled us to specify the most significant predictors of carotid artery stenosis in patients observed at outpatient clinics of Saratov and Saratov Oblast, and to obtain a patient model helping to optimize optimize selection for ultrasonographic examination.
Бесплатно
Using endoscopic hemithyroidectomy in patients with benign thyroid diseases
Статья научная
Objective: the development and assessment of endoscopic hemithyroidectomy technique improving visualization of anatomical structures and excluding the so-called conflict of instruments in the operative field. Materials and methods. We analyzed the treatment results of 103 patients who underwent hemithyroidectomy with endoscopic or traditional approaches during 2014-2018 at the S.R. Mirotvortsev Hospital of Saratov State Medical University. In terms of approach mode, patients were divided into two groups. The compression syndrome, functional autonomy of a thyroid, and results of a punch biopsy were indications to operation. Results. Unilateral vocal cord paralysis (UVCP) was diagnosed in one patient after traditional intervention, diminishing after 1.5 months; and in three patients after endoscopic hemithyroidectomy, diminishing anywhere between 7 days and 1.5 months. Signs of hypoparathyroidism were not found in any of the patient groups. There were no complications associated with the introduction of carbon dioxide. No conversion was required in any of the cases. Conclusion. Development, application and assessment of a new endoscopic hemithyroidectomy technique, which proved itself feasible, safe and provisioning highly esthetic outcome were conducted.
Бесплатно
Using neural network for restoring the lost surface of skull bones
Статья научная
Objective: To assess the sensitivity, specificity and accuracy of a digital algorithm based on convolutional neural networks used for restoring the lost surface of the skull bones. Materials and methods. The neural network was trained over 6,000 epochs on 78,000 variants of skull models with artificially generated skull injuries. The key parameters of the algorithm were assessed on 222 series of multislice computed tomography (MSCT) of patients with defects of the skull bones, presented in DICOM format. Results. For the group as a whole, the sensitivity, specificity, and accuracy rates were 95.3%, 85.5%, and 79.4%, respectively. Multiple experiments were conducted with a step-by-step elimination of 3D models in order to find the underlying cause of unsatisfactory outcomes of the skull lost surface restoration. Incorrect identification of the defect zone most often occurred in the area of the facial skeleton. After excluding series with the presence of artifacts, the mean increase in metrics was 2.6%. Conclusion. The accuracy of identifying the reference points (specificity) on a 3D model of the skull by the algorithm had the greatest impact on the ultimate accuracy of repairing the lost surface. The maximum accuracy of the algorithm allowing the use of the resulting surfaces without additional processing in a 3D modeling environment was achieved in series without the presence of artifacts in computed tomography (83.5%), as well as with defects that did not extend to the base of the skull (79.5%).
Бесплатно
