Objective To summarize magnetic the resonance imaging (MRI) features of choledochal traumatic neuroma,and investigate the key points of diagnosis and differentiation.Methods This was a retrospective descriptive study.The clinicopathological data of 1 patient with choledochal traumatic neuroma who was admitted to the Yantaishan Hospital on 18 August,2015 were collected.The patient received pre-contrast and dynamic-contrast-enhanced MRI and MR cholangiopancreatography (MRCP).Observational indexes included:(1) imaging features:location,size,signal intensity and enhancement characteristics of the lesion;(2) treatment and prognosis:surgical treatment,pathological findings,results of immunohistochemical staining and clinical follow-up.After preoperative related examinations,the patient and relatives were willing to receive surgical therapy,and postoperative pathological examinations and immunohistochemical staining were conducted.The follow-up using outpatient examination was performed to detect the patient's recovery and clinical symptoms up to January 2016.Ultrasound and laboratory examinations [alanine transaminase (ALT),aspartate transaminase (AST),γ-glutamyl transpeptidase (GGT) and total bilirubin (TBil)] were also recorded.Results (1) Imaging features:pre-contrast MRI revealed a stricture and intra-lumen nodular in the middle portion of common bile duct.The nodular was measured 1.2 cm × 0.9 cm at maximum cross-section.The nodular was well-demarcated and homogeneous of hypointensity on T1-weighted image comparing to hepatic parenchyma,slight hyperintensity on T2-weighted image and slight hypointensity on fat-suppressed T2-weighted image.MRCP could demonstrate the nodular more clearly and dilation of distal bile duct and intra-hepatic bile ducts.The width of common bile duct was 1.4 cm.After administration of contrast materials,the nodular showed avid enhancement and delay enhancement,which was mild enhancement at the artery phase,and gradual increase at the portal vein phase and the delay phase.The length of central stricture of the common bile duct was 1.3 cm.There was no abnormal enhancement in liver,spleen and pancreas.No retroperitoneal lymphadenopathy could be seen.The imaging diagnosis was cholangiocarcinoma with dilation of bile ducts.(2) Treatment and prognosis:the patient received surgery for tumor resection and Roux-en-Y reconstruction.The removed gross specimen was a grey-white nodular measured 2.0 cm × 1.0 cm.The cute surface was grey-white and stiff.The microscopic evaluation revealed haphazard arrangement of nerve bundles within the hyperplasia fibrotic stroma.Normal biliary epithelial cells can be seen beside the nerve bundles.Immunohistochemical staining showed S-100 and Vimentin were positive.The index of Ki-67 was 5％.The patient was discharged at 14 days postoperatively with the good recovery.During postoperative 5-month follow-up,the patient had good recovery and jaundice seleras were disappeared.Ultrasound showed the bile ducts were not dilated.The results of laboratory examinations were normal.Conclusion MRI features of choledochal traumatic neuroma include an intra-lumen nodular with biliary stricture and avid and delay enhancement after contrast materials administration.

Primary hepatic malignant fibrous histiocytoma(PHMFH)remains extremely rare with less than 60 cases reported in literature.From October 1999 to May 2008,5 patients with PHMFH had been admitted to Yantai Cancer Hospital,Yantai Yuhuangding Hospital and the First Affiliated Hospital of Wenzhou Medical College,and the results of spiral CT were analyzed.Six tumors were detected,and the maximum diameter of the tumors was more than 8.5 cm.CT plain scanning revealed that all tumors were hypodense,4 patients with tumor necrosis and cystic degeneration,and the tumor in 1 patient wag with homogen density.Enhanced CT scanning showed marked enhancement of the solid component of tumor in 4 patients,slight enhancement in 1 patient,and a"fast in and fast out"sign in 5 patients.Hepatic bile ducts and portal vein were not involved.One patient was with portal lymph node metastasis and 1 with ioferior vena cava involvement.The characteristics of spiral CT imaging of PHMFH include tumor necrosis,cystis and invasion,as well as"fast in and fast out"sign,which could help to diagnose,although the ultimate diagnosis depends on histopathological examination.

Objective To summarize the imaging characteristics of the hepatic epithelioid hemangioendothelioma (EHE).Methods The clinical data of 6 patients with hepatic EHE who were admitted to the Yantaishan Hospital (3 patients), Zhangzhou Hospital of Traditional Chinese Medicine (2 patients) and Zhangqiu Hospital of Traditional Chinese Medicine (1 patient) between March 2007 and June 2014 were retrospectively analyzed.All the patients underwent plain scan and dynamic enhanced scan of computed tomography (CT), and the number,shape, size, location, density or signal, level and method of enhancement of the lesions were observed and analyzed.Six patients were followed up by outpatient imaging examination up to June 2014, and the changes of lesions were observed.Results Among the 6 patients, 1 solitary lesion and 5 multiple lesions were detected, and the total lesions were 125 including 1 patient with 75 lesions.The lesions were round or round-like and originated commonly from the right lobe of liver and hepatic subcapsular with a maximum diameter of 0.5-3.5 cm.Plain scan of CT showed that the lesions in 6 patients had low density with the clear boundary.MRI showed that low T1 WI signal and high or slightly high T2WI signal of the lesions were detected in 4 patients.Two patients had liver capsular retraction sign.The ring-like enhancement of 1 lesion and homogeneous enhancement of 5 lesions were found by dynamic enhanced scan of CT in 6 patients and enhanced scan of MRI in 4 patients.Enhanced signal in all the lesions was detected in the delayed phase.Veins into or through lesions were found in 3 lesions, with normal or narrowing vascular cavity.One patient had visible lollipop sign.Of the 6 patients, 5 were confirmed as with metastatic carcinoma of liver, and 1 was suggested as with cholangiocarcinoma.Six patients were diagnosed with hepatic EHE by pathological examination using hepatic biopsy technique.Among the 2 patients with hepatic EHE who didn't receive antineoplastic treatment after the diagnosis, 1 patient received CT examination at year 2 after first visit, which showed capsular retraction sign, and then was diagnosed as with secondary hepatic cirrhosis by MRI at 4 years after first visit.Another patient was diagnosed as with hepatic cirrhosis by CT examination at year 6.5 after first visit.One patient was diagnosed with tumor recurrence of hepatic left lobe by CT reexamination at postoperative year 4, and underwent ultrasound-guided radio frequency ablation (RFA) treatment based on no enlargement of tumor during 1-year follow-up, and then returned a normal condition after half year follow-up.Other 3 patients undergoing operation were followed up at postoperative year 1 , 4, 5 with no recurrence and metastasis.Conclusions Intrahepatic single or multiple nodules and delayed reinforcement by dynamic enhanced scan of CT and MRI are the typical imaging performances of hepatic EHE.There are certain characteristics in the liver the lollipop sign, capsular retraction sign and veins into or through the lesions.Mutual fusion and fibrosis of lesions leading ultimately to secondary liver cirrhosis may be characteristics of EHE growth.

Hepatic eosinophilic granuloma is a rare benign liver lesion,which results from granuloma formation due to chronic inflammation.Two patients were admitted to the Yantaishan Hospital and Yuhuangding Hospital from July 2008 to April 2012,respectively.The results of laboratory examination showed the elevation of peripheral blood eosinophils,and ultrasound examinations revealed low-echo masses in the liver and no blood flow was detected.The results of computed tomography showed hypoattenuation lesions with well-demarcated boundary.After intravenous administration of contrast angent,the lesions demostrated delayed heterogeneous enhancement with internal grid.The results of magnetic resonance imaging of 1 patient showed the lesion had slight hyper-intensity to the surrounding liver parenchyma on T1-weighted images,and slight high signal with low signal separation strip inside on fat-suppressed T2-weighted images.An obvious high signal was detected in diffusion weighted imaging.Familiarity with the imaging characteristics and combination of the elevation of peripheral eosinophil can help surgeons to make a suggestive diagnosis.

Objective:To investigate the effects of siRNA mediated interference with URG11 expression on the biological function of osteosarcoma cell line MG63 and Wnt/β-catenin signalling pathway.Methods:MG63 cells were divided into control group (un-transfected), NC-siRNA group (transfected with non-specific NC-siRNA) and URG11-siRNA group (transfected with URG11-siRNA). The expression of URG11 was detected by RT-PCR. The proliferation, invasion and apoptosis of MG63 cells were determined by CCK-8 assay, Transwell assay and flow cytometry, respectively. The protein expressions of URG11 and molecules in the Wnt/β-catenin signalling pathway (β-catenin, c-Myc, Cyclin D1, MMP-2 and Survivin) were detected by Western blot method.Results:Compared with the control group, URG11-siRNA transfection significantly reduced the mRNA and protein expressions of URG11 as well as the protein expressions of URG11, β-catenin, c-Myc, Cyclin D1, MMP-2 and Survivin in MG63 cells, which was accompanied by the decreased proliferation, inhibited invasion and enhanced apoptosis of MG63 cells (all P<0.05). There were no significant changes in the biological function and Wnt/β-catenin signalling pathway in the MG63 cells after NC-siRNA transfection. Conclusions:Interfering the expression of URG11 can inhibit the proliferation and invasion of MG63 cells and promote cell apoptosis, and the mechanism may be related to the inhibition of the activation of Wnt/β-catenin signaling pathway.

OBJECTIVETo study the feasibility and short-term effects of Intrafix fixation and remnants preservation in single -tunnel double-bundle reconstruction of anterior cruciate ligament (ACL) with anatomical placement of hamstring tendons.

METHODSFrom August 2011 to November 2011, 25 patients with ACL injuries were treated with arthroscopic reconstruction of ACL using hamstring tendon. There were 19 males and 6 females, with a mean age of (26.26 +/- 9.53) years (ranged, 16 to 50 years). Fifteen patients had injuries in left knees, and 10 patients had injuries in right knees. The duration of the disease ranged from 1 to 60 d, with a mean of 9.6 d. All patients with acute injuries had swelling and pain on the knee, and anterior drawer test showed positive results in 14 cases, Lachman test showed positive results in 17 cases. Among patients with old injuries, 5 patients had knee joint pain, 5 patients had unstability of knee joint, 5 patients had positive results of anterior drawer test, and 5 patients had positive results of Lachman test. The diagnosis of ACL injury was determined by the anterior drawer test and Lachman test. There were 20 patients with acute injuries and 5 patients with old injuries. MRI was performed in all patients to confirm the diagnosis of ACL injuries and provide additional information on meniscal and other ligament injuries. Preservation of the remnants was through patellar tendon portal using meniscus suture guide. The femoral tunnel was placed at lateral femoral condyle at 2:00 or 10:00 position through the anteromedial (AM) portal with the knee flexed to 120 degree using an offset guide (DePuy Mitek). The tibia tunnel was placed at the center of the ACL remnant through the AM portal using a tibia guide set 45 degree. The AM and PL bundles were rotated by rotating the positioning tool to achieve the desired positions of the bundles and were fixed by femoral Intrafix and tibia Bio-Intrafix fixation. The anterior drawer test, Lachman test and Lysholm scores were observed to determinate the function of the knee and the activity of the patients.

RESULTSAll the patients were followed up, and the duration ranged from 12 to 18 months. The Lysholm scores improved from preoperative 34.08 +/- 7.60 (25 to 49 scores) to 94.52 +/- 2.86 (89 to 98 scores) at the follow-up time (t = 21.29, P < 0.01). No postoperative complications such as synovitis, ligament rupture and movement restriction occurred.

CONCLUSIONIntrafix fixation and remnants preservation in single-tunnel double-bundle reconstruction of ACL with anatomical placement of hamstring tendons is simple, effective, useful, reproducible, and gives a satisfactory short-term results.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Arthroscopy ; Female ; Humans ; Internal Fixators ; Knee Injuries ; surgery ; Knee Joint ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Tendons ; surgery ; Young Adult

This paper systematically summarizes the practical experience of the 2025 Dingri earthquake emergency medical rescue in Tibet. It analyzes the requirements for earthquake medical rescue under conditions of high-altitude hypoxia, low temperature, and low air pressure. The paper provides a detailed discussion on the strategic layout of earthquake medical rescue at the national level, local government level, and through social participation. It covers the construction of rescue organizational systems, technical systems, material support systems, and information systems. The importance of building rescue teams is emphasized. In high-altitude and cold conditions, rapid response, scientific decision-making, and multi-party collaboration are identified as key elements to enhance rescue efficiency. By optimizing rescue organizational structures, strengthening the development of new equipment, and promoting telemedicine technologies, the precision and effectiveness of medical rescue can be significantly improved, providing important references for future similar disaster rescues.