Objective To explore the diagnostic value of MRI in invasively pernicious placenta previa.Methods MRI and color doppler ultrasound were performed in 1 50 patients with pernicious placenta previa.According to the operation or pathology findings, the diagnostic value of placental invasion was compared among MRI,color doppler ultrasound and both of them.Analyzed and com-pared the MRI findings of 64 patients which were confirmed as invasive placenta including adherent placenta in 20 patients,implanted one in 38 and penetrated one in 6.Results Significant difference was not found among MRI,color doppler ultrasound and both in the diagnostic value of invasive placenta (P >0.05).There was a significant difference among adherent placenta,implanted one and pen-etrated one in the diagnostic value of MRI (P <0.05),and the highest and lowest values were penetrated placenta and adherent pla-centa respectively.Conclusion MRI is an important diagnostic method in invasively pernicious placenta previa,which was useful for its classification but with a limitation for the diagnosis of adherent placenta.

Objective To analyze the correlation between MRI features and pathological characterization of ovarian thecoma-fibro-ma.Methods MRI manifestations of 21 patients with ovarian thecoma-fibroma proved by pathological diagnosis were analyzed retro-spectively and compared with pathologic findings.Results The 21 cases involved 22 lesions (one patient had bilateral masses of the-cofibroma),including 13 fibrothecoma,4 thecofibroma and 5 fibroma.All lesions presented with well-defined margin,and cystic changes were found in 1 5 cases,7 lesions were solid masses ,1 9 lesions were round or oval masses ,2 lesions were lobulated mas-ses,and 1 lesion was irregular mass.The diameters of tumor ranged from 3.4 to 18.5 cm with mean diameter of 8.9 cm.On MR images,all lesions showed isointense or slight hypointense on T1 WI.On T2 WI,most tumors showed isointense or slight hypoin-tense,along with hyperintense cystic areas in 1 5 lesions,patchy slight hyperintense edema areas in 4 lesions,and homogeneous isointense or slight hypointense in 3 lesions.After contrast enhancement,all lesions demonstrated mild-to-moderate enhancement and delayed progressive enhancement slightly.13 cases associated with varied degrees of pelvic effusion,1 case with thickening of endometrium,and 1 case with endometrial carcinoma.Two patients had a higher level of CA125.Postoperative pathology demon-strated that all lesion were benign.Conclusion The MRI findings of the ovarian thecoma-fibroma are considerably characteristic and indirectly reflect pathology of tumor,thus beneficial to the correct diagnosis of tumor with relevant clinical information.

Objective To quantitatively study the features of cerebromspinal fluid(CSF)flow dynamies in normal sella region in MRI with phase-contrast method.Methods Seventeen healthy volunteers were studied.The CSF flow image in sella region was positioned at the middle sagittal T1WI or T2WI image.This pulse sequence used a encoding velocity of 20 cm/s.The waveforms were analyzed for the maximum flow velocity,flow volume rate and the change of the figures.From the velocity and area measurements on the cine images,mean CSF flow was calculated in millimeters per second and milliliters per cardiac cycle.Results The normal CSF flow of the sella region had two directions which was downward(caudal)flow during thesystolic period and upward(cranial)flow during the diastolic period of the cardiac cycle.The downward and upward peak flow velocity,mean downward and upward flow velocity and mean flow velocity was(1.44±0.99)cm/s,(302.71±248.15)ms,(1.16±0.64)cm/s,(331.00±225.38)ms,(0.49±0.39)cm/s.(0.67±0.44)cm/s,(0.54±O.30)cm/s,respectively.The downward and upward peak flow volume rate.mean downward and upward flow volume rate and mean flow volume rate was (0.014±0.009)ml/s.(0.012±0.006)ml/s,(0.047±0.041)ml/s,(0.053±0.003)ml/s,(0.005±0.003)ml/s,(0.034±0.031)ml/s,respectively.The mean cycle was(775.25±173.06)ms.Conclusion Phase-contrast method in MRI cine is a noninvasive method to study the CSF flow in physiological and pathological conditions for determining the pattern,direction,speed and quantity of the CSF flow.Therefore it is better than other invasive research modalities and has an important value in clinical application.

Objective To investigate temperature changes in prefrontal cortex and hippocampus of heroin addicts with magnetic resonance spectroscopy (MRS).Methods 18 heroin addicts in the withdrawal state and 18 healthy volunteers (control group) were performed with MRS scan.First, resting-state MRS scan was performed on all subjects, and then did MRS scan again under visual stimulation while subjects were asked to carefully watch the heroin-related cue images.Measurements of NAA of the identified regions (the prefrontal cortex, bilateral hippocampus) were obtained from all subjects.Brain temperatures were calculated by the modified brain temperature-chemical shift equation.Results In resting state, the temperature of prefrontal cortex in heroin addicts group was higher than the control group, the difference was statistically significant (P<0.05),and the brain temperature was positively correlated with total dose of heroin (P<0.05).The prefrontal cortex/hippocampus temperature of heroin addicts group did not showed statistical significance between resting state and visual stimulation state (P>0.05).Conclusion MRS can be used to measure brain temperature noninvasively.Temperature change of brain may be helpful for exploring the mechanism of drug addiction and craving.

Background and purpose:Esophageal cancer is one of the common malignant tumors in our country. Anastomotic stenosis is a common complication after resection of esophageal cancer, seriously affecting the quality of life of patients after operation. By changing anastomosis, this study explored the methods for prevention of anastomotic stenosis after esophageal cancer surgery.Methods:Patients were randomly divided into groups. Patients admitted on odd dates were placed in the control group whereas patients admitted on even dates were placed in the experimental group. Patients in the control group were treated with gastroesophageal anastomosis using anastomat for gastroesophageal anastomosis. Anastomotic stomach was contracted by purse string suture at first, and then treated with stapler gastroesophageal anastomosis, before the gastroesophageal anastomosis was carried out on patients in the experimental group. After 6 months’ follow-up, the incidences of anastomotic stenosis between the two groups were compared.Results:The postoperative anastomotic stenosis rate in the control group was 19.2%, while that in the exper-imental group was 0%. There were statistically signiifcant differences between them (χ2=22.8,P<0.005). The incidence of anastomotic stenosis in the control group was signiifcantly higher than that in the experimental group.Conclusion:Anastomotic stomach contracted by purse string suture before stapler gastroesophageal anastomosis can effectively reduce the occurrence of anastomotic stenosis after esophageal cancer surgery.

Objective To analyze the adverse drug reactions (ADR) during the standardized treatment of multidrug-resistant pulmonary tuberculosis (MDR-PTB), and to evaluate its impact on treatment outcomes.Methods A retrospective study was carried out on 305 MDR-PTB patients.Medical records of clinical treatment and laboratory examinations were collected, and the ADR data were analyzed.Chi-square test or Fisher exact test was used for discontinuous variables, and t test or non-parametric test was used for continuous variables.Results Among 305 MDR-PTB patients , 282 (92.5%) had at least one ADR.The major ADR were gastrointestinal reaction (46.9%), thyroid dysfunction (41.3%), hypokalemia (34.1%), renal injury (29.8%), hematological system impairment (21.6%), hepatotoxicity (19.0%), arthralgia or courbature (11.1%), and ototoxicity and vestibular dysfunction (8.5%).Sex, age, native place, the history of using second-line TB drugs or the history of diabetes mellitus had no significant effect on the incidence of ADR (all P>0.05).As per the Naranjo causality assessment of ADR, 34 patients had definite, 236 had probable, 12 had possible and 0 had doubtful causal relations.Among the 282 cases with ADR, 175 (62.1%) patients continued the original treatment regimen, 89 (31.6%) patients changed or stopped ADR-related drugs, only 18 (6.4%) cases stopped MDR-PTB treatment.The episodes of ADR had no significant effect on the treatment outcomes (P>0.05).Conclusions Although ADR are common in MDR-PTB patients during the treatment course, most of the ADR can be managed.Through timely monitoring and appropriate treatment of ADR, most of the patients could continue MDR-PTB treatment.

Abstract: Objective　The aim of this study was to observe the expression levels and clinical significance of peripheral blood interferon γ-inducible protein-10 (IP-10) and various cytokines in patients with different infection statuses of tuberculosis and to assess the efficacy of latent tuberculosis infection (LTBI) in the progression to active tuberculosis (ATB). Methods　Seventy-six outpatient and inpatient cases from the Third People's Hospital of Kunming were collected and analyzed from March 2023 to February 2024. The patients were divided into three groups: ATB group (31 cases, 17 males, median age 33 years), LTBI group (27 cases, 17 males, median age 29 years), and healthy control (HC) group (18 cases, 11 males, median age 25 years). Peripheral blood samples from the three groups were taken and the expression levels of IP-10 and cytokines IL-6, IL-4, IL-8, IL-10, IL-12, IL-2, and TNF-α were detected using enzyme-linked immunosorbent assay (ELISA) methods. The t-test was used for normally distributed samples, while the Mann-Whitney U test was used for skewed distributions. For comparisons between multiple groups, the Kruskal-Wallis H test was first employed, followed by Dunn's multiple comparison test for pairwise comparisons. Finally, the effectiveness of each cytokine in distinguishing different population groups was analyzed. Results　The expression levels of peripheral blood IP-10 were higher in the LTBI and ATB groups than in the HC group, but the area under the curve (AUC) of the receiver operating characteristic (ROC) of the subjects showed moderate sensitivity (AUC:0.7-0.9) and low specificity (AUC:0.5-0.7). The IL-6 expression levels were in the order of high to low in the ATB group, LTBI group, and HC group, where the HC group was significantly lower than the ATB and LTBI groups (F=12.15, P<0.001). The sensitivity and specificity of the ATB group were higher than those in the HC group. Conclusions　IP-10 exhibits unique advantages in distinguishing different tuberculosis statuses. The predictive efficacy of a single cytokine is limited. Combining multiple cytokines such as IL-6 with clinical manifestations, a more accurate and comprehensive prediction model can be established.

Objective To compare of the difference about ectopic activation between autogenous bone graft and allograft from large segment tibia of rabbits.Methods Eighty healthy adult Chinese rabbits (6 months of age),weighing (2.5 ±-0.5)kg,were randomly divided into experimental group (allogeneic bone group) and the control group (autograft group),40 rabbits in each group.Another 10 rabbits were allogeneic bone donor.In experimental group,when 1.5 cm long rabbit tibial allograft were finishied,they were implanted into spatium intermusculare between the musculus rectus femoris and medial vastus muscle of the rabbit around the saphenous artery and were fastened to the femur by 1.0 mm Kirschner-wire.In control group,autologous tibias were done,the same as experimental group including length and position and method.Four weeks and 8 weeks and 12 weeks postoperative,respectively,the postmortem specimens were examined gross and immunohistochemistry and the expression of BMP-2 and collagen type Ⅰ of transplanted bone tissue were detected.Results BMP-2 mainly exist in cytoplasm of osteoblasts and chondrocytes undifferentiated mesenchymal cells.Collagen type Ⅰ primarily exist in the bone matrix around the pit of bone.The expression level of BMP-2 of experimental group in postoperative 4,8,12 and 16 weeks were 85.25 ± 4.47,109.44 ± 14.69,141.85 ± 9.45,116.25 ± 14.18,respectively,and the expression level of BMP-2 of control group were 103.78 ±-6.59,124.95 ± 14.94,145.46 ± 8.10,112.48 ± 13.27,respectively.The expression level of collagen type Ⅰ of experimental group in postoperative 4,8,12 and 16 weeks were 78.74 ± 7.99,95.95 ± 6.99,139.91 ± 4.32,137.76 ± 3.48,respectively,and the expression level of BMP-2 of control group were 88.87 ± 11.26,102.45 ± 2.82,140.76 ± 4.62,139.05 ± 4.55.Compared with control group,there was a significant difference in the expression level of the BMP-2 and collagen type Ⅰ of experimental group in postoperative 4,8 weeks (P ＜ 0.05),but,there was no significant difference in the expression level of the BMP-2 and collagen type Ⅰ of experimental group in postoperative 12,16 weeks (P ＞ 0.05).The amount increased gradually during 4 weeks,8 weeks,12weeks,peaked at 12 weeks,BMP-2 displayed a downward trend at 16 weeks,and collagen type Ⅰ basiclly maintain the level of 12 weeks.Conclusion Allograft segment could complete activation while they are implanted into spatium intermusculare containing famous blood supply within 3 months,there is no significant difference between autologous bone and allograft,it shows the feasibility of ectopic activation about allograft segment.

Objective To investigate the clinical effect of the chimeric flap based on the perforator of the posterior tibial artery for reconstruction of bone and skin defect in extremities.Methods From March,2007 to June,2013,the legs of the patients with bone nonunion,bone defect and skin soft tissue defect in extremities accepted digital subtraction angiography to find the larger perforators in the upper middle section of posterior tibia1 artery.Color doppler flow imaging (CDFI) was used to track branches and directions of the larger perforators and to look for the perforators which gave off secondary branches respectively to the skin and periosteum.According to the length of bone defect and the area of skin defect,the composite flap with the bone flap and skin flap was designed and cut out.It was based on the right single perforator of the posterior tibial artery which was chosen.The free composite flap was called the chimeric flap based on the perforator of the posterior tibial artery and repaired bone and skin defect in extremities.The size of osseous flaps ranged from 1.5 cm × 0.6 cm × 0.4 cm to 4.0 cm × 2.0 cm × 1.0 cm,and the size of cutaneous flaps of total 17 cases ranged from 2.0 cm × 2.0 cm to 7.0 cm × 6.0 cm.Results Followed-up for 3 to 18 months,all osseous flaps and cutaneous flaps survived,and all donor sites healed well.Nine cases of all cutaneous flaps were flat with the surrounding tissue and others bloated,but they were flat with the surrounding tissue after second phase to fat plastic.The fracture line disappeared and bone healed well at the time of 3-6 months after operation of bone graft to repair bone defect.According to the related evaluation criteria made by the Chinese Medical Association,the results of 10 cases of hand trauma patients were excellent in 7 cases,good in 2 cases,may in 1 case.Seven cases of lower leg and foot trauma patients could walk with load without pain.Conclusion Application of the chimeric flap based on the perforator of the posterior tibia1 artery is an ideal method to repair the small pieces of bone defect with skin soft tissue defect caused by various reasons in extremities.Because this kind of surgery doesn't sacrifice known vessels with minimal donor site morbidity,and healing time of the bone graft is short and the bone is not easy to absorb.

Objective To evaluate the clinical efficacy of interventional techniques in the diagnosis and therapy of Dieulafoy disease. Methods A retrospective study was performed, including 17 patients with massive upper gastrointestinal hemorrhage (patients without peptic ulcer and portal hypertension or diagnosed with Dieulafoy disease by endoscopic examination). All patients had both DSA and interventional embolization treatment, and were followed for 12 months to appraise the clinical effectiveness. Results Sixteen patients were diagnosed as Dieulafoy disease by using DSA. Fifteen of the 16 patients were treated with embolization successfully withoutserious complications. One patient received subtotal gastrectomy because of upper gastrointestinal hemorrhage recurrence. Nine patients with irregular upper abdominal pain and burning sensation had complete remission after symptomatic management. Fifteen patients who had embolization showed no serious complications during the follow-up period of 12 months, there was no hematemesis and melena for the 15 cases with successful embolization. Conclusion The angiography and embolization are safe and efficacious in the diagnosis and therapy of Dieulafoy disease.