Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

The Department of Radiology of West China Hospital of Sichuan University provides us a teaching model that image-reading combined with problem-based learning (PBL) for radiographer once a month. Based on the problem images and typical cases, after careful image-reading, radiographer is guided to think positively and propose specific solutions to the problems. Then designated personnel gives a detail lecture on related diseases, imaging performance, diagnostic requirements, conventional scanning schemes, operating specifications, common problems and image post-processing, etc., which aims at taking continuing education for radiographers.

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To report on 3 patients who presented with rupture of hepatic artery pseudoaneurysm after liver transplantation.Methods:From April 2010 to April 2019, 3 patients with hepatic artery pseudoaneurysm rupture after liver transplantation treated at the Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People's Hospital were studied. The possible causes, clinical manifestations, diagnosis and treatment were retrospectively analyzed.Results:Rupture of hepatic artery pseudoaneurysm occurred on the19th, 28th and 63th days after transplantation. The 3 patients all presented with hematochezia and abdominal pain, while 2 patients presented with hematemesis. Two patients had bile leakage and abdominal infection. All the 3 patients presented with fever. Patient 1 who was diagnosed by laparotomy died of liver failure. Patient 2 underwent interventional embolization of hepatic artery and died of liver failure also. Patient 3 underwent surgical resection of the pseudoaneurysm followed by hepatic artery reconstruction, but died of repeat abdominal hemorrhage.Conclusion:Hepatic artery pseudoaneurysm after liver transplantation has a long latent period and is difficult to diagnose at an early stage. Early detection of this life-threatening complication is the key to improve survival. Early treatment of biliary leakage, abdominal infection and other complications help to prevent development of pseudoaneurysms.

Objective To investigate the application value of multiple?arterial?phase imaging technique with differential sub?sampling with cartesian ordering (DISCO) in the gadoxetate acid disodium enhanced liver MRI. Methods From September 2017 to March 2018, 56 patients with suspected malignant focal liver disease diagnosed with ultrasound or CT in West China Hospital of Sichuan University were enrolled prospectively, and underwent preoperative enhanced MRI with gadoxetate acid disodium. Patients were divided into 2 groups by random?number table method. Twenty nine patients in group A underwent liver multiple?arterial?phase imaging with DISCO. Twenty seven patients in group B underwent single?arterial?phase imaging with liver acquisition with volume acceleration?flex (LAVA?Flex). The display rate of late?arterial?phase and respiratory motion artifacts of dynamic enhancement images were evaluated. The categorical variables was compared by Chi?square test. The respiratory motion artifacts between the single?arterial?phase and multiple?arterial?phases were compared by Mann?Whitney U test. The artifact scores among the various phases of the multi?arterial phase were compared by Kruskal?Wallis H. Results Compared to LAVA?Flex [74.1%(20/27)], a higher display rate of late?arterial phase [96.6%(28/29)] was found in DISCO (Group A), and the difference was statistically significant (χ2=5.770, P=0.016). In the evaluation of respiratory motion artifacts, the motion artifacts of the late?arterial images obtained by LAVA?Flex [3(3,4)] were more severe than the DISCO [2(2,3)], and the difference was statistically significant (Z=-3.250, P<0.01). Among the scores of motion artifacts in the 6 phases of DISCO, the artifact scores of phase 1, 2, 3, 4, 5, 6 were [3(3,4)], [2(2,3)], [2(2,3)], [3(2,3)], [3(3,4)] and [3(3,4)], respectively. The motion artifacts of phase 2, 3, 4 were better than phase 1, 5, 6, the differences were statistically significant (P<0.05), but there was no statistical differences among phase 2, 3 and 4 (P>0.05). Conclusion Compared with single?arterial?phase imaging, multiple?arterial?phases with DISCO using gadoxetate acid disodium can improve the capture rate of late arterial phase and reduce motion artifacts.

Objective To investigate the value of multi?arterial phase differential sub?sampling with cartesian ordering (DISCO) technique in the evaluation of hepatic vascular anatomy with gadolinium?ethoxybenzyl?diethylenetriamine pentaacetic acid (Gd?EOB?DTPA). Methods Forty?eight patients with suspected hepatic malignancy were prospectively enrolled and underwent both of Gd?EOB?DTPA enhanced DISCO MRI and CTA within two weeks. The hepatic arterial anatomy of two examination methods were evaluated by four?point scoring method. The arterial scores between DISCO and CTA images were compared by Wilcoxon test. The difference among multiple arterial scores of DISCO and CTA were compared by Kruskal?Wallis H test respectively. Results There was no difference of arterial scores in celiac artery, common hepatic artery, proper hepatic artery, left hepatic artery, right hepatic artery, first branch of right hepatic artery, splenic artery, left gastric artery and gastroduodenal artery between DISCO and CTA (P>0.05), but the arterial score of first branch of left hepatic artery [2 (2,2)] was lower than that of CTA [2 (2,3)] (Z=-3.138,P=0.002). In the multiple comparison among different arteries, there were differences between PHA and LAH (P<0.05), B?LHA and B?RHA (P<0.05) in DISCO, but no difference was found in CTA (P>0.05). Conclusion The DISCO sequence with Gd?EOB?DTPA enhancement MRI can supply comparable image quality to CTA in hepatic artery and its main branches display, which has no ionizing radiation and can also provide more diagnostic information for clinic.

Objective: To investigate the application value of multiple-arterial-phase imaging technique with differential sub-sampling with cartesian ordering (DISCO) in the gadoxetate acid disodium enhanced liver MRI. Methods: From September 2017 to March 2018, 56 patients with suspected malignant focal liver disease diagnosed with ultrasound or CT in West China Hospital of Sichuan University were enrolled prospectively, and underwent preoperative enhanced MRI with gadoxetate acid disodium. Patients were divided into 2 groups by random-number table method. Twenty nine patients in group A underwent liver multiple-arterial-phase imaging with DISCO. Twenty seven patients in group B underwent single-arterial-phase imaging with liver acquisition with volume acceleration-flex (LAVA-Flex). The display rate of late-arterial-phase and respiratory motion artifacts of dynamic enhancement images were evaluated. The categorical variables was compared by Chi-square test. The respiratory motion artifacts between the single-arterial-phase and multiple-arterial-phases were compared by Mann-Whitney U test. The artifact scores among the various phases of the multi-arterial phase were compared by Kruskal-Wallis H. Results: Compared to LAVA-Flex [74.1%(20/27)], a higher display rate of late-arterial phase [96.6%(28/29)] was found in DISCO (Group A), and the difference was statistically significant (χ²=5.770, P=0.016). In the evaluation of respiratory motion artifacts, the motion artifacts of the late-arterial images obtained by LAVA-Flex [3(3,4)] were more severe than the DISCO [2(2,3)], and the difference was statistically significant (Z=-3.250, P<0.01). Among the scores of motion artifacts in the 6 phases of DISCO, the artifact scores of phase 1, 2, 3, 4, 5, 6 were [3(3,4)], [2(2,3)], [2(2,3)], [3(2,3)], [3(3,4)] and [3(3,4)], respectively. The motion artifacts of phase 2, 3, 4 were better than phase 1, 5, 6, the differences were statistically significant (P<0.05), but there was no statistical differences among phase 2, 3 and 4 (P>0.05). Conclusion Compared with single-arterial-phase imaging, multiple-arterial-phases with DISCO using gadoxetate acid disodium can improve the capture rate of late arterial phase and reduce motion artifacts.

Objective: To investigate the value of multi-arterial phase differential sub-sampling with cartesian ordering (DISCO) technique in the evaluation of hepatic vascular anatomy with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA). Methods: Forty-eight patients with suspected hepatic malignancy were prospectively enrolled and underwent both of Gd-EOB-DTPA enhanced DISCO MRI and CTA within two weeks. The hepatic arterial anatomy of two examination methods were evaluated by four-point scoring method. The arterial scores between DISCO and CTA images were compared by Wilcoxon test. The difference among multiple arterial scores of DISCO and CTA were compared by Kruskal-Wallis H test respectively. Results: There was no difference of arterial scores in celiac artery, common hepatic artery, proper hepatic artery, left hepatic artery, right hepatic artery, first branch of right hepatic artery, splenic artery, left gastric artery and gastroduodenal artery between DISCO and CTA (P>0.05), but the arterial score of first branch of left hepatic artery [2 (2,2)] was lower than that of CTA [2 (2,3)] (Z=-3.138,P=0.002). In the multiple comparison among different arteries, there were differences between PHA and LAH (P<0.05), B-LHA and B-RHA (P<0.05) in DISCO, but no difference was found in CTA (P>0.05). Conclusion The DISCO sequence with Gd-EOB-DTPA enhancement MRI can supply comparable image quality to CTA in hepatic artery and its main branches display, which has no ionizing radiation and can also provide more diagnostic information for clinic.

Qi arrival is the meridian qi response to acupuncture stimulation. Through analyzing the relevant concepts of qi arrival and summarizing the general understanding of it in clinic and on the basis of the collection of the relevant literature at home and abroad on the determination of qi arrival and its strength, the characteristics are analyzed on the present method and the method for the determination of qi arrival and its strength is discussed in terms of the results in the needling sensation scale. It is believed that the needling sensation and its strength can be used to determine whether the qi is arrived or not and its strength. The components of different types of needling sensation are much better applicable for the analysis on the characteristics and rules on the influence on qi arrival. This method is in compliance not only with the theoretic connotation of qi arrival, but also with the clinical general understanding, which lays the foundation for the analysis on the scale results.
Acupuncture Therapy ; instrumentation ; methods ; Humans ; Meridians ; Qi ; Sensation