Objective:To analyze the imaging features of primary leiomyosarcoma of the inferior vena cava (PLV).Methods:This study was a case series analysis. The clinical and imaging data of 17 patients with PLV confirmed by pathology who underwent CT, MRI and/or PET-CT examinations in the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2012 to September 2022 were retrospectively collected. The CT or MRI findings, including the number, location, size, shape, margin, density (signal), enhancement characteristics, surrounding invasion, and metastasis of the lesion were analyzed.Results:Among the 17 cases there were 7 males and 10 females, aged 32 to 78 years. All patients had single tumors, the maximum diameter of the mass was 3.8 to 19.0 cm, and in 12 cases it was consistent with the inferior venacava.There were 11 cases of "petal-like" necrosis cystic lesion, and 6 cases of "fissure" necrosis cystic lesion. Collateral circulation was found around the mass in 15 cases. There were 3 cases of intraluminal type, 2 cases of extraluminal type, and 12 cases of junctional type. The tumors of intraluminal type presented as "worm-like" appearance, while the extraluminal and junctional type tumors presented as lobulated shape, with local "umbilical depression sign". The margins were clear in 3 cases and unclear in 14 cases. Vascular invasion by the mass was observed in 7 cases. On CT plain scan, the solid component of PLV presented as isodense or slightly hypodense. On MRI T1-weighted images, the solid component presented as isodense or slightly hypodense, and on fat-suppressed T2-weighted images, it presented as isodense or slightly hyperdense. On MRI diffusion-weighted imaging, 12 cases showed high signal intensity, and the corresponding apparent diffusion coefficient map showed low signal intensity. On CT enhanced scan, 8 cases showed mild to moderate enhancement of the solid part of PLV in the arterial phase and 9 cases showed obvious enhancement. In the venous phase and delayed phase, 10 cases showed continuous enhancement and 7 cases showed progressive enhancement. On MRI enhanced scan, 8 cases showed moderate enhancement and 6 cases showed obvious enhancement of the solid part of PLV in the arterial phase. In the venous phase and delayed phase, continuous progressive enhancement was observed; no enhancement was seen in the necrotic and cystic areas.Conclusion:The imaging characteristics of PLV show that the maximum diameter of the masses are consistent with the direction of inferior vena cava, most masses exhibit a "petal-like" necrotic cyst morphology with collateral circulation, and a localized "umbilical concave sign", and some cases possess hemophilic tube features.

Objective To investigate the protective effect and mechanism of nicorandil on lipopolysac-charide(LPS)-induced human microvascular endothelial cells(HPMVECs)injury based on BMP9/BMPR2/SMAD pathway and its mechanism.Methods The HPMVECs injury model induced by LPS(100 ng/mL)was established.The normal cultured HPMVECs were set as the NC group,and other model cells were set as the model group(LPS group),low,medium and high concentrations nicorandil groups(nicorandil 50,100,200μmol/L),si-NC+high nicorandil group,and si-BMP9+high nicorandil group.MTT assay was used to detect the cell proliferation activity;the apoptosis and intracellular ROS level were detected by flow cytometry;the levels of MDA,SOD and CAT in cells were detected by the micro assay;the levels of TNF-α,IL-6 and IL-1β in cells were detected by ELISA;the mRNA levels of BMP9,BMPR2 and SMAD1 were detected by RT-qPCR;and the expression of BMP9,BMPR2,SMAD1,Bcl-2,Bax proteins in cells was detected by Western blot.Re-sults Compared with the NC group,the proliferation activity of HPMVECs,SOD,CAT levels,Bcl-2 protein,BMP9,BMPR2,SMAD1 mRNA and protein expression levels in the LPS group were decreased(P＜0.05),the apoptosis rate and the Bax protein expression level,ROS,MDA,TNF-α,IL-6 and IL-1β levels were in-creased(P＜0.05).Compared with the LPS group,the proliferation activity of HPMVECs,SOD,CAT levels,Bcl-2 protein level,BMP9,BMPR2,SMAD1 mRNA and protein expression levels in the low,middle and high concentrations nicorandil groups were increased,the apoptosis rate and the Bax protein level,ROS,MDA,TNF-α,IL-6 and IL-1β levels were decreased obviously(P＜0.05);compared with the high concentration nic-orandil group,the si-BMP9+high nicorandil group and LPS group showed the same trend,si-BMP9 was able to reverse the protective effect of high nicorandil group on LPS induced HPMVECs injury to some extent.Conclusion Nicorandil could reduce the oxidative stress,inflammatory reaction and cell apoptosis induced by LPS in HPMVECs and inhibit LPS induced HPMVECs injury by up-regulating the expression of BMP9/BM-PR2/SMAD pathway.

Objective:To analyze the imaging features of primary leiomyosarcoma of the inferior vena cava (PLV).Methods:This study was a case series analysis. The clinical and imaging data of 17 patients with PLV confirmed by pathology who underwent CT, MRI and/or PET-CT examinations in the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2012 to September 2022 were retrospectively collected. The CT or MRI findings, including the number, location, size, shape, margin, density (signal), enhancement characteristics, surrounding invasion, and metastasis of the lesion were analyzed.Results:Among the 17 cases there were 7 males and 10 females, aged 32 to 78 years. All patients had single tumors, the maximum diameter of the mass was 3.8 to 19.0 cm, and in 12 cases it was consistent with the inferior venacava.There were 11 cases of "petal-like" necrosis cystic lesion, and 6 cases of "fissure" necrosis cystic lesion. Collateral circulation was found around the mass in 15 cases. There were 3 cases of intraluminal type, 2 cases of extraluminal type, and 12 cases of junctional type. The tumors of intraluminal type presented as "worm-like" appearance, while the extraluminal and junctional type tumors presented as lobulated shape, with local "umbilical depression sign". The margins were clear in 3 cases and unclear in 14 cases. Vascular invasion by the mass was observed in 7 cases. On CT plain scan, the solid component of PLV presented as isodense or slightly hypodense. On MRI T1-weighted images, the solid component presented as isodense or slightly hypodense, and on fat-suppressed T2-weighted images, it presented as isodense or slightly hyperdense. On MRI diffusion-weighted imaging, 12 cases showed high signal intensity, and the corresponding apparent diffusion coefficient map showed low signal intensity. On CT enhanced scan, 8 cases showed mild to moderate enhancement of the solid part of PLV in the arterial phase and 9 cases showed obvious enhancement. In the venous phase and delayed phase, 10 cases showed continuous enhancement and 7 cases showed progressive enhancement. On MRI enhanced scan, 8 cases showed moderate enhancement and 6 cases showed obvious enhancement of the solid part of PLV in the arterial phase. In the venous phase and delayed phase, continuous progressive enhancement was observed; no enhancement was seen in the necrotic and cystic areas.Conclusion:The imaging characteristics of PLV show that the maximum diameter of the masses are consistent with the direction of inferior vena cava, most masses exhibit a "petal-like" necrotic cyst morphology with collateral circulation, and a localized "umbilical concave sign", and some cases possess hemophilic tube features.

Objective To understand the effectiveness of peroral endoscopic myotomy(POEM)for achalasia and secondary severe malnutrition in children and the effectiveness of nutrition support before and after POEM.Method Treatment of POEM,nutrition support(tube feeding by percutaneous endoscopic gastrostomy three months before operation)in one case were recorded and analyzed.Results POEM was successful without any complication such as perforation,bleeding,and pneumoderm.The child suffered from fever after surgery,which was dissolved after symptomatic treatment three days later.Chest pain was relieved after changing position.The diet was changed from liquid to semifluid,and then to normal diet.The child did not have dysphagia.During the 6-month follow-up,the patient had normal diets by oral route.The weight was 32 kg before achalasia and decreased to 18 kg after 9 months(at admission);it then increased to 29 kg after short-time(12 days)parenteral nutrition and long-time(3 months)enteral nutrition by percutaneous endoscopic gastrostomy,and then the patient received POEM.His weight was 30,31,31,29,and 31 kg 1,4,6,9,and 13 months,respectively,after POEM.Conclusion POEM can effectively cure achalasia in pediatric patients and improve the quality of life.Rational enteral nutrition can improve nutrition status and facilitate a successful POEM.

Objective Due to the superior performance,Carbon-Carbon composites,although still at their early stage of development,have gained more and more attention and showed great application potential.Methods According to the National Standard,the biological safety evaluation of carbon-carbon composites were done in the following aspects:cytotoxicity test,acute systemic toxicity test,haemolysis test,pyrogen test,intramuscular implantation test.Results test results showed the biological safety evaluation of carbon-carbon composites well meet the requirement of the national standard with fine biological compatibility.Conclusion The experiment results demonstrate that carbon-carbon composites can be put in clinical application