Objective To discuss the surgical management of von Hippel Lindau(VHL) syn drome.Methods The clinical data of four VHL patients who were clinically diagnosed from March1999 to October 2006 were reviewed.The first patient was a 56 year old man with the chief complaintof hypodynamia and low serum glucose as 2.37 mmol/L.CT scan showed three masses in the the leftkidney.He had a history of cerebral haemangioblastoma ten years before.The second case was a 57 year old woman with the chief complaint of lumbago in the left side.CT scan showed masses in theleft kidney,adrenal gland and panerease.The third case was a 39 year old woman with the chief com plaint of an accident mass in the left adrenal gland.She had the history of cerebellar hemangioblastoma9 years before,spinal hemangioblastoma resection 7 years before.The fourth case was a 41-year oldwoman,she was found brain tumors and cured by gamma radiation abalation.Bilateral renal masseswere found by B ultrasound one month later,CT scan showed four masses in the both kidneys,leftadrenal gland and pancreas.Results All 4 cases underwent surgical approach.The first case under went radical nephrectomy which pathological report was PEComa of kidney.The blood glucose wasnormal one week later.The second case underwent resection of the left adrenal gland,kidney,pancre atic body and tail and spleen.Pathological report was clear cell carcinoma,islet cell tumor and adrenal cyst.Three months later she was found spinal hemangioblastoma and refused treatment.The thirdcase underwent adrenalectomy in the left side and pathologieal report was adrenal pheoehromocytoma.There was not tumor reeurrenee during 2 years' follow up.The nephrectomy and adrenalectomy wasperformed for the last ease whose pathological report was clear celt carcinoma and pheochromoeytoma.Three weeks later,tumor enueleating of the right kidney was undertaken; the result was clear cellcancer.During the follow up for one year there was no relapse of tumor.Conclusions For VHL ac companied with multiple organ tumors,surgery resection is the proper approaeh when tumors of centralnervous system is large.Different approaches could be taken to deal with multiple tumors of VHL such aswatchful waiting,nephron sparing surgery.

Objective To investigate the clinicopathologic features of epithelioid angiomyolipoma of renal(REAML). Methods Six cases of REAML were analyzed by histopathological and clinical characteristics.Of the 6 cases,4 cases were solitary tumors and 2 cases were multiple lesions.The diameter of tumors was about 9 cm in average.One case had a family history of nodular sclerosis.Three cases were found adipose tissue in CT scan and diagnosed for RAML,the other 3 cases were diagnosed for renal cancer.All cases were undergone surgical approach,3 cases were undergone resection of tumors only and the other 3 were performed nephrectomy. Results Pathological characters:tumor was mainly composed of epithelioid cells presented with invasive hyperplasia of atypical pleomorphism,hyperchromatic nuclei with frequent mitotic figures,giant neoplasic cells and extensive hemorrhagic necrosis immunohistochemcial staining showing a positive HMB45 and negative of EMA,CK in most neoplasic cells.All cases were followed up for 10 to 44 months,5 cases did not recurrence and metastases;the other had lung metastasis after operation 18 months later,without any treatment the patient died 10 months later. Conclusions Most of REAMLs are benign and often misdiagnosed for renal cancer by CT scan.HMB45 is positive in immunohistochemcial staining available for diagnose.The minority of REMAL is malignant potentially and should be followed up closely.Operation is major method.

[Objective] Based on the resting state functional magnetic resonance imaging to investigate the abnormal features of the functional connectivity of resting brain neural network in the patients with primary insomnia,by using voxel-wise whole-brain finctional networks analysis of degree centrality (DC) for imaging evidence of neural mechanisms underlying primary insomnia.[Methods] The resting state fMRI were performed in 59 PI patients and 47 age,education,and sex-matched normal healthy subjects.Analysis of DC map changes between the two patient groups and the control group were performed by two sample t test.(threshold at P ＜ 0.05).[Results] Compared with the control group,the patients with PI showed significantly reduced DC value in bilateral medial frontal gyrus (MFG),bilateral anterior cingulate gyrus (ACG),and right insula;and increased DC value in right middle temporal gyrus (MTG),and left cuneus,(CUN),P ＜ 0.05.[Conclusion]Changes of DC value occurred in some region of brain in the P[patient groups when compared with the control group.It was indicated that DC,as a novel resting-state fMRI parameter in the voxel-wise whole-brain functional networks,might be an appealing alternative approach for further study on pathologic and neuropsychological states of PI.

【Objective】 To explore the relationship of victimization, bullying tolerance and anxiety/depression in adolescents, and to examine the moderating effect of cognitive emotion regulation strategies on the relationship between bullying tolerance and anxiety/depression, in order to provide basis for intervention. 【Methods】 From January 2019 to July 2020, 1 768 adolescents were selected into this survey, and completed Bully/Victim Questionnaire, Primary and Secondary School Bullying Tolerance Questionnaire, Cognitive Emotion Regulation Questionnaire and the 28 General Health questionnaires. 【Results】 Adolescents′ victimization was relatively common and serious, the proportion of verbal bullying, relational bullying, and physical bullying was 57.64% (1 019/1 768), 36.60% (647/1 768), and 22.40% (396/1 768), respectirely. The scores of anxiety and depression of adolescents with different gender (t=2.00), school stage (F=101.38) and academic performance (F=27.91) were statistically significant (P<0.05).Victimization and bullying tolerance had predictive effect on adolescents′ anxiety/depression (β=0.14, 0.13, P<0.01).Positive strategies, negative strategies had significant moderating effects on the relationship between bullying tolerance and anxiety/depression(β=-0.10、0.08, P<0.01).The simple slope analysis showed that at high positive strategy level, bullying tolerance had no significant predictive effect on anxiety/depression (P>0.05), while at a low positive strategy level, bullying tolerance had significant predictive effect on anxiety/depression (β=0.28, P<0.01).At a high negative strategy level, bullying tolerance had a significant predictive effect on anxiety/depression (β=0.25, P<0.01), while at a low negative strategy level, bullying tolerance had no significant predictive effect on anxiety/depression (P>0.05). 【Conclusions】 Victimization and bullying tolerance positively predict adolescent anxiety/depression.High levels of positive and low levels of negative strategies effectively inhibit the risk of anxiety/depression, while low levels of positive and high levels of negative strategies amplify the risk of anxiety/depression.

Objective The aim of this study is to understand the impairment and compensation mechanism of brain function in untreated primary insomnia (PI) patients.The approach of fractional amplitude of low frequency fluctuation (fALFF) is used to analyze raw data between the PI patients and the normal control group in resting state using functional magnetic resonance imaging (fMRI).Methods Fifty-nine PI patients,admitted to our hospital from November 2015 to November 2016,and 47 age-,education-,and gender-matched normal healthy subjects were chosen in our study.Pittsburg sleep quality index (PSQI),insomnia severity index (ISI) were employed to evaluate the sleep quality.Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to evaluate the emotion.Resting state fMRI and fALFF analyses were used to compare the functional regional activities.The correlations of fALFF data with PSQI,SAS and SDS scores were analyzed.Results In PI patients,2 had mild to moderate insomnia,41 had moderate insomnia,and 16 had serious insomnia.ISI scores in the normal healthy subjects were less than 7.The PSQI,SAS,SDS and ISI scores in the PI patients were significantly higher than those in the normal healthy subjects (P＜0.05).As compared with the control group,the PI group had significantly increased fALFF value in the right hippocampus (HIP),right parahippocampa gyms,right amygdala,and bilateral thalamus.The fALFF value was positively correlated PSQI,SASandSDSscores (r=0.582,P=0.000;r=0.617,P=0.000;r=0.653,P=0.000).Conclusion Some brain regions in the PI patients are abnormal in the resting state,which can reflex functional regional activities of PI patients.