Objective To study the etiology and clinics as well as CT diagnostic value of periventricular leukomalacia(PVL)in children.Methods Clinical and CT findings in 130 cases of PVL were retrospectively analyzed.Results 85 cases were premature newborn babies(65.4%) and 45 cases were fullmature newborn(34.6%) with hypoxic ischemic encephalopathy.CT showed the lateralventricle enlarge in different degrees and the white matter of periventricle decreased.Conclusion CT scan is of important value indiagnosis of PVL.

Objective To investigate the clinical effect of operation of superficial temporal artery-middle cerebral artery(STA -MCA)bypass combined with temporal muscle sticking in the treatment of adult moyamoya disease.Methods A retrospective analysis was the data of operation,including preoperative evaluation,operation method,postoperative follow -up.Results Postoperative complications occurred in 5 cases,including 3 cases of intracranial hemorrhage,2 cases of cerebral infarction.During the follow -up of 6 -35 months,no recurrent hemor-rhage cases,1 cases of cerebral infarction,TIA remission rate was 93.5%.Postoperative cerebral blood flow of 38 cases significantly improved compared with preoperative by SPET,accounted for 86.3%.Cerebral blood flow of 41 cases was well compensated by vascular bridge,accounted for 91%.Conclusion Operation of STA -MCA bypass combined with temporal muscle sticking can significantly reduce the incidence of stroke,fewer complications,which is an ideal method in the treatment of adult moyamoya disease.

Objective To analyze the CT appearances and the classification of gray matter heterotopia.Methods The clinical and CT data of 26 cases with gray matter heterotopia were retrospectively reviewed,11 were males and 15 were females,ranged in age from 2 days to 9 years with a mean of 2.6 years.Results The classification of heterotopia included:(1)Subependymal heterotopia in 14,5 cases with encephaloceles,1 case with Dandy-Walker malformation and 1 case with arachnoid cyst of cisterna megna.(2)Subcortical heterotopia in 7,4 cases with callosal agenesis were accompanied.(3)Band heterotopia in 5.Conclusion CT scan can not only reveal the appearances of the subependymal,subcortical and band types heterotopia,but also show other associated abnormalities.

Objective To explore MRI features of incontinentia pigmenti(IP) in central nervous system (CNS) in newborn infants.Methods MRI and clinical data of 17 cases of IP which confirmed by clinic,skin biopsy or NEMO gene test were analyzed retrospectively.Results There were 17 cases with IP in this study.MRI abnormalities were found in 12 cases, among which 3 cases showed high signal intensity on T2WI and a reduced signal intensity on T1WI,and 9 cases showed normal signal intensity on traditional MRI.Multiple areas of restricted diffusion were found in 12 cases which showed asymmetric high signal intensity in bilateral cerebral cortex and subcortical area, basal ganglia,centrum semiovale and periventricular area on DWI.In addition,basal ganglia was involved in 4 cases,corpus callosum was involved in 5 cases, and thalamus was involved in 2 cases.Conclusion MRI of IP in CNS shows certain specific characteristics.DWI plays an important role in the early detection and prognosis of the disease.

Objective To probe the relationship between the connectivity of premotor area detected by resting state functional MRI and stereotyped behavior of ASD.Methods 39 children patients with ASD and 42 healthy controls with matched age,sex and IQ were recruited.All the 81 subjects performed scaling with behavior scale index and underwent resting-state fMRI scans.After the fMRI data precession,the premotors in left and right sides were selected as ROI seeds to perform functional connectivity.Results Compared with healthy controls,children patients showed significant increased connectivity between the left premotor area and posterior cingulate cortex,as well as decreased functional connectivity between the left premotor area and the left insula.In addition, a negative linear correlation was showed between the connectivity of the left premotor and the insula and the behavioral scores.Con-clusion Imbalanced premotor functional connectivity may be one possible mechanism of stereotyped behavior of ASD,representing an attention deficit and/or impaired sensory perception to the external salient stimuli.

objective To investigate the differentiation of bone marrow-derived mesenchymal stem cells into neurons and transplantation of the stem ceils to repair rat hemisection spinal cord injury.Methods Adherent culture was used to isolate and culture rat bone marrow mesenchymal stem cells(MSCs).The rat spinal cord homogenate supernatant was used to induce neural differentiation of the 3rd generation ceils.The nature of ceil differentiation was identified by immunohistochemistry.The rat model of hemisection spinal cord injury was prepared and BrdU was locally injected to label the induced neurons.The distribution of living cells in the injuried spinal cord was observed at 5 weeks after cell transplantation.Results MSCs were spindle and polygonal,with 1-2 nucleoli seen under the inverted microscope.After induction with spinal cord homogenate supernatant there were a number of slender cytoplasmic projections forming interwined network and showing nestin expression,therefore,indicating the neuronal nature.MSCs at 5 weeks after transplantation into the spinal cord injury were surviving and their expression of MAP-2,NF,GFAP was significantly higher than that in the control rats(P<0.05).The rat motor function was improved than before transplantation.Conclusion MSCs induced by spinal cord homogenate supernatant can be transplanted into hemisection spinal cord injury and improve the motor function of the injuries lesions.

Objective To explore the diagnostic value of endobronchial ultrasound?guided transbronchial needle aspiration ( EBUS?TBNA) in the diagnosis of enlarged mediastinal lymph nodes, and to analyze the reasons of false negative results of EBUS?TBNA. Methods A retrospective analysis of the clinical and imaging data of 389 patients who underwent EBUS?TBNA for sampling enlarged hilar and mediastinal lymph nodes from October 2009 to October 2015 in Shandong Tumor Hospital, to evaluate its significance in the diagnosis of enlarged mediastinal lymph nodes, and to analyze the reasons of false negative results. Results Among the 389 collected cases, positive biopsy results were obtained in 362 cases, and false negative results in 27 cases. The sensitivity, specificity, positive predictive value and negative predictive value were 92. 9%, 100%, 100% and 25. 0%, respectively. There was a positive correlation between the size of lymph node and biopsy positive rate (P=0.021). The subcarinal lymph nodes had the highest positive rate ( 97. 7%) , followed by the paratracheal lymph nodes ( 91. 2%) , with a statistically significant difference (P=0.006). The positive rates obtained by cytology (88.7%) and pathology (92.5%,) showed no significant difference ( P=0. 065 ) . The positive rate of EBUS?TBNA was not correlated with pathological types (P=0.932). Needle types (21G, 22G) had no significant effect on diagnosis accuracy (P=0.142). Conclusions EBUS?TBNA is a practical technology for diagnosis of enlarged mediastinal lymph nodes, with unique characteristics such as minimally invasiveness, local anesthesia, good safety and repeatability. Along with the accumulation of surgical experience, improvement of operative skills, more close cooperation between surgeons, cytologists and pathologists, false negative results will be reduced and positive rate of EBUS?TBNA examination will be further improved.

Chromosomal rearrangements involving the ROS1 receptor tyrosine kinase gene have recently been described in multiple malignancies, including non-small cell lung cancer (NSCLC). ROS1 rearrangement defines a new molecular subset of NSCLC with the prevalence of ROS1 rearrangements around 1%-2%. ROS1-positive NSCLCs arise in young never-smokers with adenocarcinoma that are similar to those observed in patients with ALK-rearranged NSCLC. Crizotinib demonstrates in vitro activity and early clinical trial shows marked antitumor activity in ROS1-rearranged patients. The overall response rate is around 56% and the disease control rate at 8 weeks is about 76%. Further understanding the ROS1 fusions in the pathogenesis of NSCLC, methods to detect ROS1 rearrangements, and targeting ROS1-rearranged NSCLC patients with specific kinase inhibitors would lead to an era of personalized medicine.

Objective To explore the diagnostic value of endobronchial ultrasound?guided transbronchial needle aspiration ( EBUS?TBNA) in the diagnosis of enlarged mediastinal lymph nodes, and to analyze the reasons of false negative results of EBUS?TBNA. Methods A retrospective analysis of the clinical and imaging data of 389 patients who underwent EBUS?TBNA for sampling enlarged hilar and mediastinal lymph nodes from October 2009 to October 2015 in Shandong Tumor Hospital, to evaluate its significance in the diagnosis of enlarged mediastinal lymph nodes, and to analyze the reasons of false negative results. Results Among the 389 collected cases, positive biopsy results were obtained in 362 cases, and false negative results in 27 cases. The sensitivity, specificity, positive predictive value and negative predictive value were 92. 9%, 100%, 100% and 25. 0%, respectively. There was a positive correlation between the size of lymph node and biopsy positive rate (P=0.021). The subcarinal lymph nodes had the highest positive rate ( 97. 7%) , followed by the paratracheal lymph nodes ( 91. 2%) , with a statistically significant difference (P=0.006). The positive rates obtained by cytology (88.7%) and pathology (92.5%,) showed no significant difference ( P=0. 065 ) . The positive rate of EBUS?TBNA was not correlated with pathological types (P=0.932). Needle types (21G, 22G) had no significant effect on diagnosis accuracy (P=0.142). Conclusions EBUS?TBNA is a practical technology for diagnosis of enlarged mediastinal lymph nodes, with unique characteristics such as minimally invasiveness, local anesthesia, good safety and repeatability. Along with the accumulation of surgical experience, improvement of operative skills, more close cooperation between surgeons, cytologists and pathologists, false negative results will be reduced and positive rate of EBUS?TBNA examination will be further improved.

Objective To review the clinical characteristics of prostate mucinous adenocarcinoma cases and update literatures,and recommend the corresponding clinical treatment strategy.Methods From October 2010 to March 2018,36 cases of prostate mucinous adenocarcinoma were involved from 5 urinary centers in China,including 9 cases from Shanghai Changhai Hospital,4 cases from Wuhan Tongji Hospital,13 cases from Shanghai Renji Hospitals,8 cases from the First Affiliated Hospital of Nanjing Medical University,and 2 cases from Sichuan West China Hospitals.The patients' age were (66.8 ±7.2) years (53-83 years) and the median PSA was 22.89 ng/ ml (2.67-1786 ng/ ml).Prostate biopsy confirmed Gleason score 3 + 3 points in 6 cases,3 + 4 points in 9 cases,4 + 3 points in 5 cases,8 points in 11 cases,and 9 to 10 points in 5 cases.According to D'Amico risk stratification,2 patients were in the low-risk group,9 in the intermediate-risk group,and 25 in the high-risk group.Eight cases underwent radical retroperitoneal prostatectomy,13 cases underwent laparoscopic radical prostatectomy,and 12 cases underwent robotic laparoscopic radical prostatectomy.Twenty-three cases underwent pelvic lymphadenectomy,including 12 cases of bilateral obturator lymph node dissection,and 11 cases of bilateral obturator + intraorbital + para-vascular para-aortic lymphadenectomy.Results All 36 operations were completed successfully.Twenty-three cases underwent pelvic lymphadenectomy,including 12 of bilateral obturator lymph node dissection,and 11 of bilateral obturator,intraorbital,and para-aortic lymphadenectomy.Pathological examination showed 9 cases of prostate mucinous adenocarcinoma,26 cases of mucinous adenocarcinoma with acinar adenocarcinoma,and 1 case of mucinous adenocarcinoma with neuroendocrine and immunohistochemical positive of MUC2 (+).Among 33 cases undergoing radical surgery,the pathological stage of ≤T2b in 12 cases (36.3％),T2c in 7 cases (21.2％),T3a in 7 cases (21.2％),T3b in 6 cases (18.2％),and T4 in 1 case (3.0％).Four cases had positive pelvic lymph nodes and 9 cases had positive margin.The median follow-up period was 26 months (6-48 months).The biochemical recurrence occurred in 6 patients one year after surgery,including 3 cases in the intermediaterisk group and 3 cases in the high-risk group.Six cases with postoperative biochemical recurrence and 19 cases with PSA ＞ 0.2 ng/ml after radical or palliative resection underwent adjuvant androgen deprivation therapy(ADT),no postoperative adjuvant radiotherapy or chemotherapy was administered,and 4 cases progressed to castration-resistant prostate cancer.Four cases with CRPC were in the high-risk group and had underwent radical surgery,and the median period progressed to CRPC was 26 months(3-37months)with 2 cases of death.However,there was no significant difference in the rate of biochemical recurrence and the incidence of CRPC in the low-risk group,the intermediate-risk group and the high-risk group.In addition,2 cases had metastases,with pelvic MRI presenting pelvic multiple nodular mass in one case which was consistent with recurrence and metastasis at the 5th month after radical surgery,and pathological examination presenting the mucinous adenocarcinoma being neurosecretory in another case and mestastasis being detected on glans at the 3rd months after radical surgery.The recovery rate of urinary continience at 6 and 12 months after radical surgery was 86.2％ (31/36) and 89.7％ (32/36) respectively.Conclusions Prostate mucinous adenocarcinoma is a variant of acinar adenocarcinoma.This study clarifies prostate mucinous adenocarcinoma of Chinese patients with high Gleason scores,advanced pathological stage,variant in prognosis,and prone to recurrence and metastasis.For treatment strategy,the low-risk and intermediate-risk mucinous adenocarcinoma is recommended undergoing radical surgery,and the prognosis maybe good.High-risk mucinous adenocarcinoma could treated with radical surgery or palliative surgery with adjuvant ADT,and most high-risk patients can benefite,with a small number of poor prognosis.