bone fracture, mild col apse of the articular surface;femoral head deformation, bone fracture, articular surface col apse, hip degeneration. MRI of four categories of avascular necroses appeared as phase Ⅰ:line-like low signal of weight-bearing area of femoral head on T1WI, high signal on T2WI as the main change. Phase Ⅱ:clear boundary crescent-shaped uneven signal on T1WI, T2WI displayed moderately higher, uneven slightly lower signal around, showing a typical two-line sign. Phase Ⅲ:femoral head deformation, subchondral fracture, col apse, crescent formation, zonal low signal on T1WI, medium or high signal on T2WI. Phase Ⅳ, Ⅴ:complete destruction of articular cartilage, joint space narrowing, significant col apse and deformation of the femoral head, non-specific secondary osteoarthritis of the acetabulum, such as sclerosis, cystic degeneration and marginal osteophyte. The X-ray, CT, MRI performances of four types of avascular necroses at the same period were basical y the same.

Objective:To analyze imaging diagnosis and differential diagnosis of upper femur aneurysmal bone cyst.Methods: The pre-operation imaging appearances about digital radiography(DR), computerized tomography (CT) and magnetic resonance imaging (MRI) of 46 aneurysmal bone cyst cases confirmed by operation and pathology were retrospectively analyzed, and then these special imaging appearances were gained and analyzed.Results:①CT plain scans showed the irregular expansile lucency shadow in the upper femur with the uneven bone septum image; the complete or incomplete osteosclerosis edge can be found in some parts of lesions; some lesions extend to adjacent soft tissue, and the liquid-liquid level can be found in lesion of 8 cases, and their edge and separated intensity strengthening were visible after signals were enhanced.②MRI plain scans revealed that most lesions showed long T1, T2 signals, the periphery of lesions showed long T1, short T2 signal shadows, and septum image was visible within lesions, and the liquid-liquid level can be found in lesion of 8 cases; some lesions extend to adjacent soft tissue, and their edge and separated intensity strengthening were visible after signals were enhanced.Conclusion: Through combined examination of DR, CT and MRI, the specialty and diagnostic accuracy of aneurysmal bone cyst could be improved, and it was helpful in the differential diagnosis of other upper femur bone tumors.

Objective: To compare the safety and efficacy of stent-assisted and non-stent-assisted coil embolization in the treatment of posterior communicating ruptured wide-necked aneurysms. Methods: Data were collected from January 2014 to December 2018 in Dezhou People′s Hospital where patients with ruptured posterior communicating artery wide-necked aneurysm were treated by interventional embolization. All patients were admitted to hospital for subarachnoid hemorrhage, and the diagnosis of posterior communicating artery aneurysm of internal carotid artery was confirmed within 7 d of admission, and the patients were treated with interventional embolization. To compare the perioperative complications, mortality and clinical prognosis between stent-assisted embolization group (stent group, 45 patients) and non-stent-assisted embolization group(non-stent group, 38 patients) was analyzed. Results: The incidence of ischemic complications in stent group was 20.0% (9/45), in nonstent group was 5.3% (2/38), and there was significant difference (χ²=3.892, P < 0.05). The overall complication rate in stent group was 28.9%(13/45), in non-stent group was 10.5%(4/38), and there was significant difference (χ²=4.265, P < 0.05). There was no significant difference in bleeding complications, symptomatic vasospasm, mortality and clinical prognosis between the two groups (P > 0.05). Conclusions In the acute stage of posterior communicating artery aneurysm rupture, stent-assisted embolization has a high rate of thrombotic complication, and the clinical application needs to be cautious. Both the stent-assisted and non-stent-assisted embolization have a good clinical outcome in the treatment of wide-necked posterior communicating aneurysms in the acute phase.

Objective To investigate the correlation between the features of multimodal magnetic resonance imaging (MRI) and the expression of human epidermal growth factor receptor-2 (HER-2) in ductal carcinoma in situ (DCIS). Methods A total of 53 patients with DCIS confirmed by surgery and pathology in Dezhou Second People’s Hospital from September 2018 to June 2021 were analyzed retrospectively. The patients were divided into HER-2 positive group (29 cases) and HER-2 negative group (24 cases). MRI features were compared between the two groups. Results There were significant differences in the internal enhancement characteristics, microvascular sign, and time-intensity curve type between the two groups (P < 0.05). There were no significant differences in lesion morphology, non-mass-like enhancement pattern, and apparent diffusion coefficient value (P > 0.05). The HER-2 positive group showed clumped enhancement (65.5%), type Ⅱ (48.1%) andtype Ⅲ (29.6%) time-intensity curves, and microvascular sign (89.7%). The HER-2 negative group showed clusteredring enhancement (50.0%), type Ⅱ (45.8%) and type I (54.2%) time-intensity curves, and microvascular sign (54.2%). A combination of clumped enhancement, microvascular sign, and type Ⅲ time-intensity curve showed 100% specificity and 100% positive predictive value for the diagnosis of HER-2 positive DCIS. Conclusion Clumped enhancement, microvascular sign, and type Ⅱ or Ⅲ time-intensity curve on MRI can largely reflect the expression of HER-2 in DCIS. The three can be used in combination to improve the diagnostic efficiency of HER-2 positive DCIS.

Objective: To investigate the effects of postoperative analgesia with Dexmedetomidine combined with Sufentanil on pulmonary infection complications and immune function in patients with lung cancer. Methods: A total of 200 patients with lung cancer who underwent radical lung cancer in our hospital from July 2014 to June 2018 were randomly divided into the group A(n=100, receiving Sufentanil analgesia)and group B(n=100, receiving Sufentanil combined with Dexmedetomidine analgesia)according to the random number table method.The analgesic effect, pulmonary complication incidence and immune function were compared between the two groups. Results: The analgesic and sedative effects were better in the group B than in the group A at 4, 8, 12 and 24 hours after surgery, respectively(P<0.05). The visual analogue scale(VAS)and Ramesay score had statistically significant differences between the two groups at 4, 8, 12 and 24 hours after surgery, respectively(VAS: t=4.137, 2.575, 3.869, 12.676 and 9.945, all P<0.05; Ramesay score: t=6.771, 5.647, 16.763, 21.154 and 6.556, all P<0.05). The pulmonary infection, acute lung injury, focal lung infiltration, atelectasis and respiratory failure occurred in 1, 0, 1, 1 and 0 case in the group B and 3, 2, 3, 1 and 1 case in the group A, respectively.The incidence of pulmonary complications was lower in the group B than in the group A(3% or 3/100 vs.10% or 10/100, χ²=4.031, P=0.045). There were no significant difference in the levels of CD3⁺, CD4⁺, CD8⁺ and CD4⁺ /CD8⁺ cells before surgery between the two groups(P>0.05). The levels of CD3⁺, CD4⁺, CD8⁺ and CD4⁺ /CD8⁺ cells were higher in group B than in group A at 1 day after surgery(t=7.419, 7.867, 11.968 and 8.755, P=0.000). Conclusions Postoperative Dexmedetomidine combined with Sufentanil analgesia not only helps to reduce the incidence of pulmonary complications, but also improves the analgesic effect and immune function in patients with lung cancer undergoing radical surgery.

ObjectiveTo investigate the association between spontaneous portosystemic shunt （SPSS） and hepatorenal syndrome （HRS） in patients with liver cirrhosis. MethodsA retrospective analysis was performed for 93 patients with SPSS from Dezhou Hospital， Qilu Hospital of Shandong University， from January 2015 to January 2022， and the patients were followed up for 12 months with the onset of HRS as the observation endpoint. According to the presence or absence of HRS， the 93 patients with SPSS were divided into HRS group with 38 patients （40.86%） and non-HRS group with 55 patients （59.14%）， and the two groups were compared in terms of clinical data， laboratory data， complication， and shunt diameter. Based on the maximum shunt vein diameter of 1.5 cm， the 93 patients with SPSS were divided into high shunt group with 52 patients （55.91%） and low shunt group with 41 patients （44.09%）， and with the onset of HRS as the observation endpoint， the two groups were compared in terms of the incidence rate of HRS and survival time curve. The independent-samples t test was used for comparison of normally distributed continuous data with homogeneity of variance between two groups， and the chi-square test was used for comparison of categorical data between two groups. The receiver operating characteristic （ROC） curve was used to predict cut-off values， the Kaplan-Meier curve was used for comparison of survival time， and the Log-rank test was used to compare the differences in survival curves. The multivariate Cox regression analysis was used to investigate risk factors. ResultsCompared with the non-HRS group， the HRS group had significant increases in Child-Pugh score， Child-Pugh class， MELD score， serum creatinine， blood urea nitrogen， alanine aminotransferase， aspartate aminotransferase， maximum shunt vein diameter， the incidence rates of hepatic encephalopathy and spontaneous bacterial peritonitis， and the degree of ascites， as well as significant reductions in main portal vein diameter， serum sodium and albumin （all P<0.05）. Compared with the low shunt group， the high shunt group had a significant increase in the incidence rate of HRS （51.92% vs 26.83%， χ²=5.974， P=0.015） and a significant reduction in the time to the onset of HRS （Log-rank P=0.033）. A maximum shunt vein diameter of >1.5 cm （hazard ratio ［HR］=1.123， 95% confidence interval ［CI］： 1.041‍ ‍—‍ ‍1.211， P=0.003）， an increase in MELD score （HR=1.205， 95%CI： 1.076‍ ‍—‍ ‍1.437， P=0.039）， a reduction in serum albumin （HR=0.890， 95%CI： 0.814‍ ‍—‍ ‍0.974， P=0.011）， an increase in the degree of ascites （HR=2.099， 95%CI： 1.066‍ ‍—‍ ‍4.130， P=0.032）， and spontaneous bacterial peritonitis （HR=2.259， 95%CI： 1.020‍ ‍—‍ ‍5.003， P=0.045） were independent risk factors for the onset of HRS in SPSS patients. ConclusionThere is an association between SPSS and HRS， and shunt diameter >1.5 cm was an independent risk factor for HRS in SPSS patients， which should be taken seriously and require early intervention in clinical practice.

Objective To investigate the correlations of computed tomography (CT), clinical, and pathological features in patients with invasive lung adenocarcinoma positive and negative for spread through air spaces (STAS). Methods A total of 236 patients with invasive lung adenocarcinoma confirmed by surgery and pathology were selected, including 118 patients in STAS-positive group and 118 patients in STAS-negative group. The clinical data, CT signs, and pathological features of the two groups were collected and analyzed. Results There was a correlation between age and the occurrence of STAS. The age of the positive group was higher than that of the negative group. Smoking history and family history of tumor had no correlation with the occurrence of STAS. CT features signs such as nodule type and shape, tumor-lung interface, lobulation sign, spiculation sign, vacuole/cavity, air-bronchogram, pleural indentation sign, vascular changes, mean diameter of tumor, mean diameter of solid component, and the percentage of tumor solid components were significantly different between patients with and without STAS. The incidence of STAS in patients with solid nodules and partial solid nodules was significantly higher than that in patients with ground glass nodules. Multivariate analysis showed that the percentage of tumor solid components, air-bronchogram sign, lobulation sign, and tumor-lung interface were independent risk factors for predicting the occurrence of STAS. Conclusion The clinical data and CT signs of patients with invasive lung adenocarcinoma are related to the occurrence of STAS. CT signs such as the percentage of tumor solid components, air-bronchogram, lobulation sign, and tumor-lung interface are of great significance to STAS prediction. Our findings provide an important basis for selection of personalized clinical treatment plans.

Objective To study the application of spiral CT three-dimensional reconstruction in diagnosing intra-articular and other bone fractures in the earthquake of Wenchuan.Methods 25 cases with joint and other bone fractures in Wenchuan earthquake underwent multi-slice spiral CT volume scanning,the images were dealed with three-dimensional reconstruction at workstation including multiplanar reconstruction (MPR) and surface shaded display(SSD) to observe the fractures.Results 36 fractures in 25 cases were found by three-dimensional reconstruction(MPR and SSD),which included knee joint bone fracture in 6,one case was avulsion fracture of the point attached to the tibia by posterior cruciate ligament and missed by X-ray;ankle fracture in 3,1 case was Pilon fracture;shoulder fracture in 5,one case with glenoid anterior labrum missed by radiography;elbow fracture in 3;spinal fractures including cervical vertebra in 2,thoracic vertebra in 4 and lumbar vertebra in 5,2 cases were burst fracture accompanied with the articular process fracture; pelvis bone fracture in 8,1 case was sacroiliac fracture accompanied with sacroiliac separation.There were open bone fractures in 4 cases,fractures with dislocation in 6 cases,soft tissue swelling in different degree around the fractures in 25 cases.Conclusion Spiral CT three-dimensional reconstruction of bone can directly and really show the fractures that will provide in-formations for the clinical diagnosis and treatment .

BACKGROUND: Ischiofemoral impingement (IFI) syndrome has attracted more and more attention, but there is little report on IFI because of its low incidence. Moreover, its imaging characters have not yet been fully understood.OBJECTIVE: To discuss the MRI diagnostic criteria for IFI, thus understanding the imaging characters of IFI revealed on MRI.METHODS: Sixteen cases (21 hips) of suspected IFI were selected as experimental group, and 25 healthy volunteers as control group. The bilateral ischiofemoral space (IFS, the shortest distance between the ischial tuberosity and lesser trochanter of femur) and quadratus femoris space (QFS, distance between the lesser trochanter of femur and hamstring tendon insertion) were measured on MRI axial image. The signal and morphology of the quadratus femoris were observed. The differences in QFS and IFS were compared between two groups.RESULTS AND CONCLUSION: (1) Among 16 patients, there were 13 females, and 3 males, and 5 female cases of bilateral IFI. (2) In the experimental group, the IFS ((13.65±3.87) mm versus (22.17±5.75) mm) and QFS ((7.15±3.50) mm versus (12.89±3.13) mm) showed significant differences between affected and opposite sides (P < 0.01). (3) In the control group, the IFS ((23.59±6.14) mm versus (23.08±5.82) mm) and QFS ((12.41±3.75) mm versus (13.22±3.84) mm) did not differ significantly between left and right sides (P > 0.05). (4) Compared with the control group, there were significant differences in IFS and QFS of the affected side in the experimental group, and no significant differences in IFS and QFS of the opposite side. (5) In the experimental group, quadratus femoris appeared with deformation, edema and atrophy. (6) To conclude, the incidence of IFI in females is significantly higher than that in males, and bilateral hips are usually affected. MRI diagnostic criteria for IFI are IFS ≤ 11.46 mm, QFS ≤ 5.53 mm of the affected side, and quadratus femoris present edema and deformation, which are more sensitive on axial fat-suppressed MRI imaging.

Nasal cancer has not been included in the current list of legal occupational diseases in China. There is also a lack of systematic and in-depth study on the relationship between nasal cancer and occupational exposure factors in China. In September 2018, the department for work and pensions of UK released the latest edition of the "List of diseases covered by industrial injuries disablement benefit", which lists nasal cancer and nasopharyngeal carcinoma associated with wood dust exposure on the UK's occupational disease list. In order to better protect the health of workers, the relationship between occupational wood dust exposure and nasal cancer is reviewed, which provides a reference for further revision and improvement of occupational disease catalogue.