Objective To assess the changes in normal-appearing white matter fiber tracts of the brainstem in patients with relapsing-remitting multiple sclerosis (RRMS) quantitatively with diffusion tensor imaging (DTI). Methods Fifty patients with RRMS were recruited, and twenty five healthy volunteers with the same gender and age were selected as controls. Conventional magnetic resonance imaging and DTI was performed. Quantitative indexes as fractional anisotropy (FA) and mean diffusivity (MD) values in the brainstem fiber tracts, including corticopontine tract/corticospinal tract (cpt/cst), superior cerebellar peduncle (scp), middle cerebellar peduncle (mcp), inferior cerebellar peduncle (icp), and medial lemniscus (ml) were measured and analyzed. Results In comparison with controls, decreasing FA values in cpt/cst (L:P=0.030; R:P=0.020), icp (L:P=0.030; R:P=0.037), scp (L:P=0.036; R:P=0.041) and ml (L:P=0.014; R:P=0.035), as well as increasing MD values in cpt/cst (L:P=0.004; R:P=0.046), icp (L:P=0.047; R:P=0.011), scp (L:P=0.021; R:P=0.011) and ml (L:P=0.002; R:P=0.044) were found in patients with RRMS. No significant difference of FA and MD values was found in mcp between patients with RRMS and controls (P＞0.05). None of the MD or FA values in fiber tracts of the brainstem in patients with RRMS was correlated with brain parenchymal fraction (BPF) or T2 lesion volume. Conclusion The relevant abnormalities which were found in normal-appearing white matter fiber tracts of the brainstem in RRMS patients by DTI scanning suggested pathological changes. It is presumed that the changes may be due to demyelination caused by hiding lesions.

Objective To investigate CT and MRI features of abdominal huge liposarcoma,and improve the preoperative diagnostic accuracy. Methods The CT and MRI findings of 1 7 cases with abdominal huge liposarcoma proved by operation and pathology were analyzed and correlated with pathologic subtypes retrospectively.Results In 17 cases,16 cases were located in retroperitoneal,1 case was located in the abdominal cavity.The average maximal diameter of the lesions was 17 cm.In all cases,main components of well differentiated liposarcomata (n=7) were fat density on CT and MRI,and enhanced slightly,3 cases were multiple lesions,1 case of sclerosing liposarcoma contained massive patchy calcification,1 case was fatless.Myxoid liposarcoma (n=5)were similar to cystic on CT and MRI features,enhanced with latticed or cloudy components slightly to moderately .Dedifferentiated liposarcoma (n=2)has both fat and soft tissue inside and the dividing line was clear.The soft tissue mass unevenly obviously enhanced.Mixed liposarcoma (n=3)had the imaging characteristics above different types,2 cases contained no fat composition.Conclusion Liposarcoma pathological subtype has diversity,and various subtypes have certain characteristic on CT and MRI imaging features.

Objective To investigate CT and MRI features of extragonadal primary seminoma and improve its diagnostic accuracy.Methods The clinical and imaging features of 8 patients with extragonadal primary seminoma proved by histopathology were analyzed retrospectively.Results In 8 cases,4 cases were located in intracranial regions,4 cases in the abdominal and pelvic cavity.Detailedly,roundlike solid and cystic tumors were seen in the basal ganglia and thalamus in 2 cases.The mass density and signal were inhomogeneous in the necrotic area with slight peritumoral edema and heterogeneous enhancement,and hemorrhage and metastasis of the third ventricle were occurred inone case.Shallow lobulated tumor was occurred in the pineal region forone case,which MRI features included slightly low signal on T1 WI,equal or higher signal on T2 WI,with obvious enhancement and peripheral cystic change.There was one case in the sella area with slight high density on CT routine scan,and on MRI,slight equal signal on T1 WI,equal or higher signal on T2 WI.The pituitary stalk was involved with thickening.Tumor in suprasellar region was obviously enhanced,with a small uniformity enhancement nodule in the mouth of corpus callosum.4 cases were occurred in the abdominal and pelvic cavity,shallow lobulated tumors with varying degrees of necrosis were found on CT with infiltrating growth and slight to moderate enhancement,and swollen lymph nodes were found in retroperitoneal and mesenteric root areas.Conclusion Extragonadal primary seminoma is rare,there are some characteristic imaging findings,which contributes to improve diagnosis accuracy when combining with clinical data.

Objective To retrospectively evaluate the clinical efficacy and safety of brentuximab vedotin(BV) combined with chemotherapy in the treatment of malignant lymphoma. Methods We collected the data of 32 lymphoma patients with CD30-positive status, including 14 cases of Hodgkin's lymphomas, 2 cases of diffuse large B-cell lymphomas, and 16 cases of mature T/NK cell lymphomas. Chemotherapy combined with BV was administered to all patients for a minimum of two cycles. The efficacy of the treatment was evaluated according to Lugano criteria every two cycles. Results Complete response rate and overall response rate after four cycles of treatment were 22% and 50%, respectively. Sixteen cases (50.0%) had grades 1 and 2 toxicity, and 16 cases (50.0%) had grade 3 toxicity or higher. The most common adverse events were neutropenia (50.0%), pneumonia (46.9%), and anemia (43.8%). The most common grade 3 or higher adverse events were pneumonia (18.8%) and febrile neutropenia (12.5%). Four patients discontinued brentuximab vedotin because of severe adverse events. Conclusion BV is effective in treating relapsed and refractory CD30- positive Hodgkin's lymphoma and peripheral T-cell lymphoma, and its overall safety is acceptable.

Objective:To investigate the changes of glymphatic system function at relapse and remission phases in patients with relapsing remitting multiple sclerosis (RRMS) and their relations with clinical parameters.Methods:Sixteen patients with RRMS at relapsing phase and 25 patients with RRMS at remitting phase, admitted to Department of Neurology, First Affiliated Hospital of Nanchang University from September 2012 to December 2020, were enrolled; and 29 normal controls were recruited at the same period in Physical Examination Center the same hospital. The diffusion tensor imaging data were analyzed retrospectively, and the along perivascular space (ALPS) index was calculated. The differences in clinical data and ALPS index among the 3 groups were compared, and the correlations between ALPS index and clinical parameters in RRMS patients were analyzed.Results:The scores of expanded disability status scale (EDSS) and modified fatigue impact scale (MFIS) in patients at relapsing phase were significantly higher than those in patients at remitting phase ( P<0.05). The ALPS index in bilateral cerebral hemispheres in the control group was significantly higher than that in RRMS patients at relapse and remission phases ( P<0.05). In patients with RRMS at relapse phase, the ALPS index in the left cerebral hemisphere was negatively correlated with disease duration and EDSS scores ( r=-0.536, P=0.032; r=-0.573, P=0.020). Conclusion:Patients with RRMS have glymphatic system dysfunction; this dysfunction may be the potential pathological basis of clinical dysfunction in patients with RRMS at relapsing phase.

OBJECTIVE： To investigate anti-tumor effects of Periplaneta americana polypeptide PAP-2 on H22 tumor-bearing mice. METHODS： The mice tumor-bearing model was established by subcutaneous injection of ascites of H22 hepatocellular carcinoma mice via axilla. 70 mice were randomly divided into model group （normal saline）， 5-FU group （positive drug control， 20 mg/kg）， P. americana extract skimmed cream group （200 mg/kg， calculated by extract）， CⅡ-3 group （polypeptide isolated from skimmed cream as main active ingredient， 200 mg/kg， calculated by extract） and polypeptide PAP-2 high-dose， medium-dose and low-dose groups （isolated from CⅡ-3， 200， 100， 50 mg/kg， calculated by monomer）， with 10 mice in each group. The mice in the 5-FU group were given intraperitoneal injection once every other day， while the mice in the other groups were given intragastric administration once a day， the administration cycle was 10 d. After medication， the changes of tumor were observed and the organs （spleen， thymus and liver） index were measured. Histopathological changes of tumor tissue were observed after HE staining. The contents of VEGF， IL-1β and IL-4 in serum were determined by ELISA. RESULTS： Skimmed cream， CⅡ-3 and different doses of PAP-2 could inhibit the growth of tumor in tumor-bearing mice to different extent and increase organ index， and PAP-2 showed a dose-effect relationship. The tumor inhibition rate （38.95％） of PAP-2 high dose group was significantly higher than those of skimmed cream group and CⅡ-3 group （P＜0.05）， which was close to that （40.87％） of 5-FU group （P＞0.05）. Spleen index， thymus index and liver index of mice in PAP-2 high dose group were significantly those of model group and CⅡ-3 group （P＜0.05）； and the liver index of mice in PAP-2 high dose group was significantly higher than that of skimmed cream group （P＜0.05）. In addition， PAP-2 could decrease the serum contents of VEGF and IL-4， and increased serum content of IL-1β， with high dose group showed significant difference compared with model group （P＜0.05）； the serum content of IL-1β of mice in PAP-2 high dose group was significantly higher the that of skimmed cream group and CⅡ-3 group （P＜0.05）， serum contnet of IL-4 in PAP-2 high dose group was significantly lower the  that of skimmed cream group and CⅡ-3 group （P＜0.05）， but the serum content in which was significantly lower than that of skimmed cream group and CⅡ-3 group（P＜0.05）. CONCLU- SIONS： P. americana polypeptide PAP-2 it has a certern anti-tumor effects on H22 tumor-bearing mice， and its can increase the index of organs of H22 tumor-bearing mice， decrease the contents of VEGF and IL-4 in serum， increase the content of IL-1β in serum.

OBJECTIVE：To study the mechanism of Periplaneta americana extract degreasing cream and CⅡ-3（shorted for “degreasing cream ”and“CⅡ-3”）reversing the multi-drug resistance of human HepG 2/ADM cells. METHODS ：MTT assay was used to investigate the toxicity effects of different concentrations of sorafenib （positive control ），degreasing cream and C Ⅱ-3 on HepG2/ADM cells ，then IC 20 was calculated. The experiment was divided into sensitivity drug ，drug-resistance group ，sorafenib group，degreasing cream group and C Ⅱ-3 group. HepG 2 cells were included in sensitivity group ，and HepG 2/ADM cells were included in the latter 4 groups. Sensitivity group and drug-resistance group were treated with routine medium ，and other 3 groups were treated with relevant medicine （IC20 as drug concentration ）. The content of ADM in HepG 2/ADM cells was determined by Laser scanning confocal microscopy. The expression of apoptosis-related protein as Bcl- 2 and Cleaved-Caspase- 9 p37 were detected by Western blotting assay. RT-qPCR and immunocytochemistry were adopted to detect mRNA and protein expressions that related to multidrug resistance [P-gp （expression produce of MDR1 gene），LRP，BCRP] and that related to enzyme-mediated multidrug resistance pathway （GST-π and Topo Ⅱ）. RESULTS ：The IC 20 of degreasing cream ，CⅡ-3 and sorafenib were （2.40±0.16）， （200.44±27.52），（18.00±1.82）μg/mL，respectively. Compared with sensitivity group ，the protein expressions of Bcl- 2，P-gp， LRP，BCRP and Topo Ⅱ，the mRNA expressions of MDR 1， LRP，BCRP and GST-π were increased significantly in drug resistance group （P＜0.05 or P＜0.01）. Compared with @qq.com drug-resistance group ，the mRNA and protein expression of MDR1 mRNA and LRP ，BCRP，GST-π were significantly decreased in degreasing cream group and C Ⅱ-3 group（P＜ 0.05 or P＜0.01）；the protein expression of Bcl- 2 and the mRNA expression of Topo Ⅱ were significantly decreased （P＜0.01）， while the protein expression level of Cleaved-Caspase- 9 p37 was significantly increased in C Ⅱ -3 group （P＜0.05）. CONCLUSIONS：Degreasing cream and C Ⅱ-3 can reverse multidrug resistance of HepG 2/ADM cells by reducing drug efflux ， promoting cell apoptosis ，reducing the mRNA and protein expression of multi-drug resistance gene as well as gene in enzyme-mediated multi-drug resistance pathway. The effect of C Ⅱ-3 is better than that of degreasing cream.

【Objective】 To explore the surgical characteristics and clinical efficacy of percutaneous endoscopic visualization trephine for thoracic spinal stenosis. 【Methods】 We made a retrospective analysis of 37 patients with single-segment thoracic spinal stenosis treated with percutaneous endoscopic visualization trephine from January 2019 to June 2020. Among them， there were 14 males and 23 females； their age ranged from 31 to 82 years old， with an average of （57.6±11.8） years old. Their posture， length of hospital stay， length of operation and blood loss were recorded. The visual analogue scale （VAS）， Oswestry disability index （ODI） and the modified Japanese Orthopaedic Association （JOA） score were used to evaluate the preoperative and final conditions of patients and calculate the improvement rate. 【Results】 The operation was successfully completed in all the patients， and no patients developed epidural hematoma， incision infection or postoperative paralysis. Among the 37 patients， 24 ones with ossification of ligamentum flavum （OLF） were in the prone position， and 13 patients had lateral surgery. Among them， thoracic disc herniation （TDH） occurred in 3 cases， OPLL in 5 cases and OLF+OPLL in 5 cases. The hospital stay was （7.2±1.6） days， the operation time was （96.5±20.0） min， and the blood loss was （41.9±10.8） mL. VAS score decreased from （7.0±0.9） to （1.9±0.8）； ODI improved from （41.7±2.1） to （16.1±1.7）； and JOA score increased from （5.8±1.4） to （8.6±1.4）. The preoperative and postoperative differences were statistically significant （P<0.05）. 【Conclusion】 Percutaneous endoscopic visualization of thoracic spinal stenosis is treated by choosing different positions according to the type of compression. The spinal canal is fully decompressed. The surgical method is safe and minimally invasive， and the postoperative effect is satisfactory.