After nearly 40 years of development,MRI has become an important imaging diagnostic method in clinical practice.Non-contrast enhanced MRI combined with contrast-enhanced MRI can provide multidimensional information,significantly improving lesion detectability and supporting the entire disease management cycle.With the decentralization of medical resources,contrast-enhanced MR technologies(such as magnetic resonance angiography,dynamic contrast-enhanced MRI and dynamic susceptibility contrast-enhanced MRI,etc.)have become popular in primary healthcare facilities.As a critical adjunct to contrast-enhanced imaging,high-pressure injection technology for contrast agents plays a determinant role in ensuring imaging quality and diagnostic validity.This technology offers distinct advantages in precise control of injection parameters(flow rate,dosage,timing),maintenance of bolus integrity and enhancement of inter-study reproducibility.However,the absence of standardized international and domestic guidelines for its application currently hinders the harmonization of imaging data and limits cross-institutional interoperability of diagnostic results.To address this gap,an expert group has developed the"Expert Consensus on the Application of High-Pressure Injection Technology for Magnetic Resonance Contrast Agents",referencing domestic and international guidelines and literature,and in conjunction with the current application status in the country.This consensus aims to provide radiology professionals with safe and effective technical application guidance and to promote standardized clinical practice.

Objective:To explore the clinical value of combination of contrast-enhanced ultrasound(CEUS)and magnetic reso-nance imaging(MRI)in the diagnosis of parotid gland tumors.Methods:167 patients with parotid gland tumors were diagnosed by CEUS and MRI respectively and in combination.With postoperative pathological diagnosis result as the gold standard,the diagnos-tic value of CEUS combined with MRI(CEUS+MRI)was analyzed.Results:171 tumors were confirmed by postoperative pathology in 167 patients,including 143 benign tumors(83.63％)and 28 malignant tumors(16.37％).The benign tumors were mainly pleo-morphic adenoma(65 tumors,45.45％),Warthin tumor(40 tumors,27.97％)and basal cell adenoma(13 tumors,9.09％).Among the malignant tumors,mucoepidermoid carcinoma(7 tumors,25.00％),adenoid cystic carcinoma(6 tumors,21.43％)and acinic cell carcinoma(3 tumors,10.71％)were the most common.CEUS showed 39 cases of malignant parotid gland tumors and 132 cases of benign parotid gland tumors.The sensitivity,specificity and accuracy rate of CEUS were 57.14％,83.92％and 79.53％respectively.The MRI ADC values were manifested as pleomorphic adenoma＞malignant tumor＞Warthin tumor(P＜0.05).MRI showed 53 cases of malignant parotid gland tumors and 118 cases of benign parotid gland tumors,and the sensitivity,specifici-ty and accuracy rate of MRI diagnosis were 67.86％,76.22％and 74.85％respectively.CEUS+MRI revealed 33 cases of malig-nant parotid gland tumors and 138 cases of benign parotid gland tumors,the sensitivity,specificity and accuracy rate of CEUS+MRI diagnosis were 78.57％,92.31％and 90.06％respectively.The specificity and accuracy rate of CEUS+MRI were significantly higher than those of single examination(x2=4.806,13.951,7.348,13.664,allP＜0.05).Conclusion:Both CEUS and MRI have certain clinical value in the diagnosis of parotid gland tumors,and the specificity and accuracy rate of CEUS+MRI are significantly higher than those of single examination.

After nearly 40 years of development,MRI has become an important imaging diagnostic method in clinical practice.Non-contrast enhanced MRI combined with contrast-enhanced MRI can provide multidimensional information,significantly improving lesion detectability and supporting the entire disease management cycle.With the decentralization of medical resources,contrast-enhanced MR technologies(such as magnetic resonance angiography,dynamic contrast-enhanced MRI and dynamic susceptibility contrast-enhanced MRI,etc.)have become popular in primary healthcare facilities.As a critical adjunct to contrast-enhanced imaging,high-pressure injection technology for contrast agents plays a determinant role in ensuring imaging quality and diagnostic validity.This technology offers distinct advantages in precise control of injection parameters(flow rate,dosage,timing),maintenance of bolus integrity and enhancement of inter-study reproducibility.However,the absence of standardized international and domestic guidelines for its application currently hinders the harmonization of imaging data and limits cross-institutional interoperability of diagnostic results.To address this gap,an expert group has developed the"Expert Consensus on the Application of High-Pressure Injection Technology for Magnetic Resonance Contrast Agents",referencing domestic and international guidelines and literature,and in conjunction with the current application status in the country.This consensus aims to provide radiology professionals with safe and effective technical application guidance and to promote standardized clinical practice.

Objective:To explore the clinical value of combination of contrast-enhanced ultrasound(CEUS)and magnetic reso-nance imaging(MRI)in the diagnosis of parotid gland tumors.Methods:167 patients with parotid gland tumors were diagnosed by CEUS and MRI respectively and in combination.With postoperative pathological diagnosis result as the gold standard,the diagnos-tic value of CEUS combined with MRI(CEUS+MRI)was analyzed.Results:171 tumors were confirmed by postoperative pathology in 167 patients,including 143 benign tumors(83.63％)and 28 malignant tumors(16.37％).The benign tumors were mainly pleo-morphic adenoma(65 tumors,45.45％),Warthin tumor(40 tumors,27.97％)and basal cell adenoma(13 tumors,9.09％).Among the malignant tumors,mucoepidermoid carcinoma(7 tumors,25.00％),adenoid cystic carcinoma(6 tumors,21.43％)and acinic cell carcinoma(3 tumors,10.71％)were the most common.CEUS showed 39 cases of malignant parotid gland tumors and 132 cases of benign parotid gland tumors.The sensitivity,specificity and accuracy rate of CEUS were 57.14％,83.92％and 79.53％respectively.The MRI ADC values were manifested as pleomorphic adenoma＞malignant tumor＞Warthin tumor(P＜0.05).MRI showed 53 cases of malignant parotid gland tumors and 118 cases of benign parotid gland tumors,and the sensitivity,specifici-ty and accuracy rate of MRI diagnosis were 67.86％,76.22％and 74.85％respectively.CEUS+MRI revealed 33 cases of malig-nant parotid gland tumors and 138 cases of benign parotid gland tumors,the sensitivity,specificity and accuracy rate of CEUS+MRI diagnosis were 78.57％,92.31％and 90.06％respectively.The specificity and accuracy rate of CEUS+MRI were significantly higher than those of single examination(x2=4.806,13.951,7.348,13.664,allP＜0.05).Conclusion:Both CEUS and MRI have certain clinical value in the diagnosis of parotid gland tumors,and the specificity and accuracy rate of CEUS+MRI are significantly higher than those of single examination.

Objective:To develop an Arteriovenous Fistula Physical Examination Knowledge, Attitude, and Practice Scale for Hemodialysis Nurses and test its reliability and validity.Methods:Based on the theory of knowledge, attitude, and practice, a preliminary scale draft was formed through a literature review, three rounds of Delphi expert consultation, and a pre-survey. Using convenience sampling, 311 hemodialysis nurses were selected for a survey from December 2022 to February 2023 for item analysis, exploratory factor analysis and reliability testing. Another survey was conducted on 260 hemodialysis nurses from February to June 2023 for confirmatory factor analysis, convergent validity, and discriminant validity testing.Results:The Arteriovenous Fistula Physical Examination Knowledge, Attitude, and Practice Scale for Hemodialysis Nurses included three subscales and five dimensions, with a total of 33 items. The content validity index at the item level was 0.867 to 1.000, and the content validity index at the scale level was 0.992. After exploratory factor analysis, two, one, and two common factors were extracted from the knowledge, attitude, and practice subscales, with cumulative variance contribution rates of 70.114%, 75.192%, and 67.467%, respectively.Confirmatory:factor analysis showed that the model fitted well. The Cronbach's α coefficients of the three subscales were 0.929 to 0.943, the half reliability coefficients were 0.861 to 0.903, and the retest reliability coefficients were 0.824 to 0.874. Conclusions The Arteriovenous Fistula Physical Examination Knowledge, Attitude, and Practice Scale for Hemodialysis Nurses has good reliability and validity and can be used to evaluate the physical examination ability of hemodialysis nurses for arteriovenous fistula.

Objective To analyze the differences in serum amino acid levels between preeclampsia(PE)and normal pregnant women in Urumqi,and to explore the correlation between amino acids with statistically significant differences and PE severity,as well as their diagnostic value for PE patients.Methods A total of 49 normal pregnant women who visited Urumqi Maternal and Child Health Hospital from June 2021 to June 2023 were selected as the control group and 55 PE pregnant women were selected as the PE group,and the PE group was further divided into mild PE group(25 cases)and severe PE group(30 cases).Liquid chromatogra-phy-tandem mass spectrometry technology was used to determine the levels of 25 metabolites in pregnant women's serum.Spearman correlation analysis was used to analyze the correlation between the amino acid lev-els and PE severity.Logistic regression was used to correct for potential confounding factors,and receiver op-erating characteristic curve was used to analyze the diagnostic efficacy of amino acids with significant differ-ences in PE.Results There were statistically significant differences in the body mass index(BMI)and deliv-ery method between the PE group and the control group(P＜0.05).The serum levels of histidine,threonine,glutamine,ethanolamine,methylhistidine,and canine uric acid in the PE group were higher than those in the control group(P＜0.05).The serum levels of threonine,glutamine,methylhistidine,and canine uric acid in the severe PE group were higher than those in the mild PE group and control group(P＜0.05).The serum ethanolamine levels in the mild group and severe PE group were higher than those in the control group(P＜0.05).The serum histidine levels in the severe PE group were higher than those in the control group(P＜0.05).Correlation analysis showed that serum glutamine,ethanolamine,methylhistidine,and canine uric acid were positively correlated with the severity of PE(P＜0.05).After adjusting for BMI,there were still statisti-cally significant differences in the levels of threonine,glutamine,and methylhistidine between the PE group and the control group(P＜0.05).The area under the curve of the combined detection of serum threonine,glu-tamine,and methylhistidine for diagnosing PE was 0.734.Conclusion There is a certain correlation between serum levels of threonine,glutamine,and methylhistidine and the severity of PE,and the combined detection has high diagnostic value for patients with PE.

Chronic myeloid leukemia(CML)is a hematological system malignant tumor characterized by the appearance of Ph chromosomes and the formation of BCR-ABL fusion gene.With the emergence of tyrosine kinase inhibitors,the efficacy and survival of CML have been improved significantly.However,there are still some patients with inevitable disease progression and recurrence.In CML patients,the body's own an-ti-tumor immunity can play a role in monitoring,recognizing and eliminating the leukemia cells,which is closely correlated with the occurrence,development,curative efficacy and prognosis of the disease.The immune cells such as natural killer(NK)cells,T cells,dendritic cells,Treg and MDSC play a key role in anti-tumor immunity.Therefore,this article reviews the characteristics of CML immune cells,correlation between the body's own anti-tumor immune status and therapeutic effect,and the recent progress of CML immunotherapy.

Background Tributyl phosphate (TBP) is widely used as an organophosphate flame retardant. However, there are limited studies on the toxicity of TBP to aquatic organisms at low levels of exposure. Objective To investigate the effects of TBP on early development of zebrafish (Danio rerio). Methods Zebrafish embryos were randomly divided into four groups at 2 h post-fertilisation (2 hpf), namely, the 0.01% dimethyl sulfoxide (DMSO) control group and TBP exposure groups (0.02, 0.2 and 2 μg·L⁻¹). The exposure time was from 2 hpf to 120 hpf and the hatching rate, malformation rate, heart rate and body length of zebrafish embryos at 72 hpf, the frequency of tail curling at 24-29 hpf, the locomotor ability at 96 hpf and the survival rate at 120 hpf were evaluated, respectively. The whole-body triiodothyronine (T₃) and tetraiodothyronine (T₄) levels of juvenile fish were measured by enzyme immunoassay at the end of the infection, and the expression levels of hypothalamic-pituitary-thyroid axis (HPT) and neurodevelopmental-related genes were detected by quantitative real-time PCR (q-PCR). Results The heart rates of zebrafish embryos were significantly decreased in all TBP-treated groups (P<0.001), the survival rates of the 0.02 and 2 μg·L⁻¹ TBP groups were significantly decreased (P<0.05), and the malformation rate of the 2 μg·L⁻¹ treated group was significantly increased (P<0.05), which was mainly manifested by pericardial oedema. The frequency of tail curling of zebrafish embryos in all groups reached the highest at 25 hpf, which was significantly lower (P<0.001) in all exposure groups than in the control group (P<0.001). In the locomotor behaviour experiments, the swimming speed of zebrafish larvae in the dark cycle was significantly decreased in the 0.02 and 0.2 μg·L⁻¹ TBP groups (P<0.05), and similar results were found for the light cycle in the 0.2 and 2 μg·L⁻¹ TBP groups (P<0.05). Compared with the control group, the T₃ level of zebrafish juveniles in the 0.2 μg·L⁻¹ TBP group increased significantly (P<0.05). The q-PCR results showed that the expression levels of HTP axis-related genes [thyroid hormone receptors (trα, \begin{document}$tr\beta $\end{document}), thyroglobulin (tg), and sodium/iodide co-transporter (nis)] were significantly down-regulated in the exposure groups, the expression level of transthyretin (ttr) was significantly up-regulated in the 0.02 μg·L⁻¹ TBP group, and the iodothyronine deiodinase 2 (dio2) expression level was significantly down-regulated in the 0.02 μg·L⁻¹ TBP group (P<0.05); the neurodevelopment-related gene acetylcholinesterase (ache) was significantly down-regulated in the exposure groups, and the expression levels of myelin basic protein (mbp) and Elav like neuron-specific RNA binding protein 3 (elavl3) were significantly down-regulated in the 0.02 μg·L⁻¹ TBP group (P<0.05). Conclusion TBP exposure can lead to early developmental abnormalities in zebrafish, manifested as developmental toxicity, thyroid endocrine disruption and neurotoxicity during hatching and early juvenile stages.

Objective:To summarize the clinical features and postoperative efficacy of patients with oval window atresia accompanied by facial nerve aberration.Methods:The clinical data of patients with congenital middle ear malformation with facial nerve aberration admitted to our hospital from January 2015 to March 2023 were retrospectively analyzed. There were 97 cases (133 ears) in total. Among them, 39 patients (44 ears) had complete follow-up data, including 27 male patients and 12 females, aged 7-48 years old, with an average age of 17.8 years old. Of these, 14 cases (16 ears) were patients combined with facial nerve aberration, and 25 cases (28 ears) were without facial nerve aberration. The results of imaging examination, pure-tone audiometry, selection of surgical strategy, intraoperative findings and postoperative hearing improvement were summarized and analyzed. The malformations of malleus, incus, stapes, oval window and facial nerve were recorded. Prism 9 software was used to statistically analyze the mean bone conductance and air-bone gap of patients before and after surgery.Results:All the 14 patients (16 ears) with middle ear malformation accompanied by facial nerve aberration and oval window atresia showed poor hearing and no facial palsy since childhood. High resolution CT (HRCT) examination of temporal bone, pure tone audiometry and Gelle test were performed before surgery. The malformations of malleus, incus, stapes, oval window and facial nerve were recorded. Preoperative high-resolution CT (HRCT) examination of temporal bone found 12 ears with 4 or more deformities, accounting for 75.00%, in the group of patients with facial nerve malformation. The preoperative average bone conductive threshold was (15.3±10.4) dB and the average air-bone gap was (46.3±10.6) dB in pure-tone audiometry (0.5, 1, 2, 4kHz). According to the different degrees of facial nerve and ossicle malformation, we performed three different hearing reconstruction strategies for the 14 patients (16 ears) with facial nerve aberration and oval window atresia, including 7 ears of incus bypass artificial stape implantation, 7 ears of Malleostapedotomy (MS) and 2 ears of Malleus-cochlear-prothesis (MCP). After 3 months to 18 months of follow-up, all patients showed no facial paralysis. The postoperative mean bone conductive threshold was (15.7±7.9) dB and air-bone gap was (19.8±8.5) dB. There were significant differences in mean air-bone gap before and after operation ( t=7.766, P<0.05), and there was no significant difference between the mean bone conductive threshold before and after surgery ( t=0.225, P=0.824). There was no significant difference of mean reduction of air-bone gap between patients with and without facial nerve aberration ( t=1.412, P=0.165). There was no significant difference between the three hearing reconstruction strategies. There was no significant displacement of the Piston examined by U-HRCT. Conclusion:For patients of middle ear malformation whose facial nerve cover the oval window partially, incus bypass artificial stape implantation or Malleostapedotomy (MS) can be selected according to the specific condition of auditory ossis malformation, and for patients whose facial nerve completely covers the oval window area, Malleus-cochlear-prothesis (MCP) can be selected. Three types of stapes surgery are safe and reliable for patients with oval window atresia accompanied by facial nerve aberration. There was no significant difference in efficacy between them. Preoperative HRCT assessment of middle ear malformation is effective. There is no significant difference of surgical effect with or without facial nerve aberration. The U-HRCT can be used to evaluate the middle ear malformation before surgery and the Piston implantation status after surgery. Due to the risks of surgery, those who do not want to undergo surgery can choose artificial hearing AIDS, such as hearing aid, vibrating soundbridge, bone bridge or bone-anchored hearing aid.

Objective:To analyze the efficacy of endoscopic surgery for frontal sinus meningoencephalocele and cerebrospinal fluid (CSF) leaks, and to explore endoscopic surgical strategy.Methods:A total of 35 patients with frontal sinus meningoencephalocele and CSF leaks who underwent endoscopic transnasal surgery at Beijing Tongren Hospital, Capital Medical University between May 2007 and December 2023 were enrolled in this retrospective case series, including 29 males and 6 females, with the age of (35.23±15.76) years. High-resolution sinus CT and magnetic resonance cisternography were undertaken before surgery. The primary outcome measure was the success rate of endoscopic surgical repair. Statistical analysis was conducted using SPSS 27 and GraphPad Prism 8 software.Results:Of the 35 cases, 21 (60.0%) were traumatic, and 14 (40.0%) were non-traumatic. The most common defect was in the posterior frontal sinus wall (24 cases, 68.6%), with a defect size of (10.4±4.8) mm 2. Twenty-six cases (74.3%) underwent endoscopic transnasal Draf Ⅱa-Ⅲ frontal sinusotomy, and 9 cases (25.7%) underwent endoscopic transnasal Darf Ⅱb-Ⅲ frontal sinusotomy combined with frontal trephination. The average follow-up time was (84.72±57.42) months. The success rate of one-time endoscopic repair was 97.1% (34/35). One patient required a second procedure, resulting in an overall success rate of 100%. Thirty-three patients had a widely patent frontal sinus ostium postoperatively, while two experienced stenosis. Conclusions:Endoscopic surgery is effective for treating frontal meningoencephalocele and CSF leaks while preserving frontal sinus drainage. Combined frontal trephination is recommended for defects that are difficult to repair using the conventional transnasal approach.