Objective To describe the imaging findings of pancreatic and extra-pancreatic lesions of autoimmune pancreatitis (AIP),to improve the imaging diagnostic accuracy of AIP.Methods From 2011 to June 2014,38 AIP patients according to 2010 international consensus diagnostic criteria for AIP were included.Thirty-six patients underwent contrast enhanced CT scan,17 patients underwent contrast enhanced MRI,15 underwent MRCP,and the imaging data were retrospectively reviewed.Results In the 38 patients,the pancreas showed diffuse enlargement in 23,focal enlargement in 9,mixed enlargement in 6.All the patients demonstrated as progressive enhancement and gradually delayed enhancement.Fourteen cases showed diffusely irregular narrowing of the main pancreatic duct.Pseudo-capsule like structure was presented around the lesions in 24 cases.Extra pancreatic lesions included biliary duct involvement in 24 cases,renal lesions in 4 cases,peri-pancreas vessels involvement in 20 cases,8 cases with enlargement of lymph nodes.Conclusions AIP presents with characteristic imaging features in pancreas and extra pancreatic organs.Imaging tests are helpful in the early diagnosis of AIP.

Objective To investigate and determine the apparent diffusion coefficient (ADC) values in different anatomical regions of normal pancreas.Methods A total of 383 volunteers with normal pancreas were included in this study.Single-shot echo planar imaging diffusion weighted imaging (SSEP-DWI; b value =0,500 s/mm2) was employed to determine the ADCs in the head,neck,body and tail parts of the pancreas.Statistical analysis was performed by using Kruskal-Wallis and Wilcoxon signed rank tests.Results The ADCs in the head,neck,body and tail parts of the pancreas was (1.52 ± 0.29) × 10-3,( 1.64 ± 0.34) ×10-3,(1.67±0.35) × 10-3,(1.58 ±0.31) × 10-3 mm2/s,the Kruskal-Wallis test results showed a significant difference of mean ADCs among the different anatomical regions (chi square =44.8748,P ＜0.0001 ).Wilcoxon signed rank test results showed the mean ADCs differed remarkably between the head and neck ( P ＜ 0.0001 ),head and body ( P ＜ 0.0001 ),head and tail ( P =0.0008 ),neck and tail (P =0.0062 ),body and tail (P ＜0.0001),respectively.The mean ADCs between the neck and body was not significantly different (P =0.1181 ).Conclusions The mean ADC values of normal pancreas vary significantly within different anatomical regions,which can serve as a guide for DW1 and ADC in clinical application and research of pancreatic diseases.

Objective:To report a rare case of early onset epileptic encephalopathy caused by YWHAG gene mutation, and discuss the clinical and genetic characteristics as well as the diagnosis, treatment and prognosis of the disease.Methods:Clinical data of the patient with YWHAG gene deficiency from Department of Neurology, Children′s Hospital Affiliated to Zhengzhou University were collected in January 2018. The whole exome sequencing was performed on the core members of the family, and the characteristics of gene mutations were analyzed.Results:The proband is a girl, three years and 10 months old, presented to the outpatient department of neurology with a history of six-month intermittent convulsions, manifested as epilepsy seizures, mental retardation, motor delay and gait instability, ataxia. The brain magnetic resonance imaging showed myelinated dysplasia, and long-term video electroencephalogram (EEG) showed extensive 1.5-3.0 Hz slow spikes, and multiple spikes during sleep. During the monitoring, the children had clinical seizures and abnormal EEG discharges, indicating that myoclonus was accompanied by atypical absence of consciousness. Whole exome sequencing on the proband detected a de novo mutation c.169C>T (p.Arg57Cys) in YWHAG gene. According to American College of Medical Genetics guidelines (2015), the mutation was considered potentially pathogenic.Conclusion:Early epileptic encephalopathy caused by YWHAG gene mutation is very rare, and the variation of YWHAG gene c.169C>T is the possible pathogenic variation of the genetic cause of early onset epileptic encephalopathy in the proband.

Objective To investigate effect of secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) on visualization improvement of main and branch pancreatic duct and its diagnostic value of grading chronic pancreatitis (CP) .Methods The 3 .0 T magnetic resonance (MR) imaging data of 88 subjects (23 health volunteers and 65 CP patients) were prospectively analyzed .All the subjects received coronal T2-weighted sequences scan ,thick slab 2-dimensional MRCP sequences scan , routine pancreas plain scan and enhanced scan before and after 0 .1 mL/kg secretin intravenous injection . Sixty-five CP patients were grouped according to Cambridge classification and also according to normal and abnormal of duodenal filling (DF) .The images of main pancreatic duct (MPD) ,branch pancreatic duct (BPD) and DF were compared before and after secretin injection .The result was compared with that of endoscopic retrograde cholangio pancreatography (ERCP) which was the gold standard .One-way analysis of variance test was performed for comparison between healthy control group and CP group .Chi-square test was used for comparison between normal DF group and abnormal DF group .The consistence between the diagnostic results of MRCP ,S-MRCP and the results of ERCP were analyzed by Kappa test .Results Compare with MRCP ,after secretin injection the indexes of MPD ,the sensitivity ,specificity ,positive predictive value and negative predictive value of BPD were all improved ,and the rates of misdiagnosis and missed diagnosis all decreased .Using ERCP as gold standard of CP grade diagnosis ,the consistence of S-MRCP in CP grade diagnosis increased more significantly (Kappa=0 .77 ,P=0 .000 1) compared with that of MRCP (Kappa=0 .55 ,P=0 .000 1) .Among 43 normal DF cases ,the number of MPD dilatation , filling defect and branch duct in pancreatic head was 28 ,23 and 30 ,respectively ;among 22 abnormal DF cases which was 20 ,19 and 21 ,respectively ,and the differences were statistically significant (χ2=5 .01 , 3 .91 ,6 .88 and 4 .26 ,all P<0 .05) .Taking 4 min as the cutoff value of peak time ,the sensitivity and specificity of which in CP diagnosis were 86 .0% and 100 .0% , respectively . Conclusion S-MRCP improves the visualization of MPD and BPD ,and also increases the accuracy of CP grade diagnosis .

Objective:To explore the effects of NOD2 gene on the proliferation and apoptosis of tongue squamous cell carcinoma Tca8113 cells.Methods:NOD2 expression vector(NOD2-pEZ-M29)and NOD2-shRNA vector were established,then were trans-fected into Tca8113 cells respectively.Expressions of HBD-2 and NOD2 in the cells was detected by RT-PCR and Western blot.Cell proliferation was examined by MTT assay and apoptosis by flow cytometry at 48h post transfection.Results:Compared with the control group,the expression of NOD2 and HBD-2 in NOD2-pEZ-M29 transfection group was significantly higher and markedly lower in NOD2-shRNA group.The proliferation rate of Tca8113 cells was markedly lower in NOD2-pEZ-M29 transfection group and signifi-cantly higher in NOD2-shRNA group while the apoptosis rate was significantly higher in NOD2-pEZ-M29 transfection group and sig-nificantly lower in NOD2-shRNA group.Conclusion:In Tca8113 cells NOD2 expression was positively correlated with HBD-2 ex-pression.NOD2 gene may promote the apoptosis,inhibit the proliferation of Tca8113 cells.

Objective To discuss the value of combining secretin-enhanced MR cholangiopancreatography (MRCP) and conventional MRI in the evaluation of chronic pancreatitis (CP).Methods Seventeen normal volunteers,and 36 patients with CP were enrolled in this study.Thick slab two dimension MRCP sequence,coronal T2 weighted sequence and conventional MRI were performed on all subjects.The changes of pancreatic ducts were observed before and after the injection of secretin.The exocrine function of the pancreas was evaluated using duodenal filling (DF) grades.Pancreatic parenchyma was reflected by signal intensity ratio (SIR) between the pancreas and the left psoas muscle on MR plain scan,and the ratio between the pancreatic substance phase and portal phase (A/V) of MR enhanced scan.All subjects were classified based on Cambridge classification and DF grades.The SIR and A/V were compared between all groups of Cambridge classification using the one-way ANOVA test,and between two groups of DF grades using Student's t test.Correlations between Cambridge classifications,DF grades and SIR,A/V were tested using Spearman rank correlation coefficients.Results After secretin injection,the visualization of all portions of the main pancreatic ducts and branch ducts were significantly improved in all subjects.Ten minutes after secretin injection,17 volunteers showed grade 3.Grade 3,2 and 1 were seen in 23,8,5 patients,respectively.Mild,moderate and severe CP by Cambridge classification showed in 11,12,13 patients,respectively.The mean SIR values of the volunteers and the three groups were 1.21 ± 0.19,1.07 ±0.21,0.98 ± 0.21 and 0.85 ± 0.18,respectively; the mean A/V values:1.15 ± 0.11,1.23 ± 0.34,0.97 ± 0.16 and 0.91 ± 0.12.There was statistically significant difference of SIR and A/V (F =8.72 and 7.72,P ＜0.01) between volunteers and CP.Normal and abnormal DF were seen in 40 and 13 patients.The mean SIR values of the two groups were 1.09 ± 0.20 and 0.88 ± 0.27 ; the mean A/V values:1.15 ± 0.11 and 0.94 ± 0.30.There was statistically significant difference of SIR and A/V (t =3.10 and -2.40,P ＜ 0.01) between two groups.There were correlations between Cambridge classification,DF grades and SIR (r =0.60 and 0.41,P＜0.01),A/V (r =0.60 and 0.52,P＜0.01).Conclusion Secretin-enhanced MRCP combined with conventional MRI can be used to evaluate CP regarding changes of morphology and function,which can provide a useful reference for the clinical diagnosis.

Objective To explore the best treatment strategy of pyogenic brain abscesses.Methods Clinical data of 45 patients(34 males and 11 females,ages ranged from 7 to 76 years,averaged 42.6 years) with brain abscess treated from January 1999 to March 2008 were retrospectively analyzed.Among the 45 patients,there were 40 with single brain abscess and 5 with multiple brain abscess;43 with unilocular abscess and 2 with multilocular abscess.19 patients accepted the conservative treatment with the third generation cephalosporin,16 were treated with stereotactic puncture of abscess,8 treated with stereotactic puncture and drainage,and microsurgical excision was performed in 5 patients.Results Of the 19 patients treated with conservative method,16 were cured,no recurrence was found during the follow-up period(from 6 months to 5 years) in 13 patients,and another 3 were deteriorated and accepted stereotactic operation.All the stereotactic operations were carried successfully out in 24 patients(including 3 cases after expectant treatment failure) and only one patient needed another stereotactic aspiration two weeks later because of abscess recurrence after the initial operation.Epileptic seizure was found in one patient at the end of stereotactic procedure.Total removal of brain abscess was performed by microsurgical craniotomy in 5 patients.At the time of discharge,clinical symptoms disappeared or were improved remarkably,and CT or MRI re-examination disclosed the disappearance or obviously diminution of abscess in all patients.No abscess recurred during the follow-up period(from 4 months to 3 years,average 14 months) in 22 patients.Conclusion A set of treatment strategy of pyogenic brain abscesses has been proposed and stereotactic operation seems to be the most appropriate surgical choice.

Objective To investigate the feasibility of the arterial wall imaging technology of high-resolution magnetic resonance imaging ( HR-MRI) in the risk assessment of intracranial aneurysm rupture. Methods Fifty-four patients with 66 intracranial aneurysms underwent 3. 0 T HR-MRI multiple sequences arterial wall imaging from November 2013 to March 2015 were analyzed retrospectively. Five patients with ruptured aneurysm were used as a control group. The characteristic differences of aneurysm lesions between an unruptured intracranial aneurysm ( UIA) wall enhancement group and a non-enhancement group were compared. The risk factors for rupture were analyzed according to the size,location, and basic clinical characteristics of aneurysm. Results (1) HR-MRI revealed that whether the aneurysm walls enhanced or not,there were no significant differences in the location size,wide-necked aneurysm or not,and ratios of aneurysm height and neck width (all P >0. 05). (2) The enhancement rates of the aneurysm volume <2 group and ≥2 group were 20%(8/40) and 61. 9%(13/21) respectively,the incidence of the ruptured aneurysm asci was higher than that of UIA,and there was significant difference ( all P<0. 05). There were no significant differences in neck width,rate of aneurysm volume,ratios of aneurysm height and neck width,and enhancement rates among the groups. Conclusion The preliminary results of this study have showed that there is a related trend between the HR-MRI aneurysm wall enhancement and the risk of rupture,but a further large sample follow-up study is needed.

Objective To study the potential and value of ultrasmall superparamagnetic iron oxide (USPIO) conjugated by mesothelin antibody as MRI targeting contrast agent for diagnosis of implanted human pancreatic carcinomas in nude mouse.Methods Nude mouse tumor models bearing multiple human pancreatic carcinomas at different time points was established and they were randomized into two groups,and USPIO or MSLN-USPIO were used as contrast enhanced agents in the 3.0T MRI scan,respectively,then the positive detection rates for smallest tumors,and the signal intensity of tumors in T2 mapping images of both unenhanced and contrast enhanced scanning and the negative enhancement rate were measured,then Prussian blue staining was performed in alI the tumor specimens to observe the difference of Fe3 + ion deposition.Results There was no statistical significance between USPIO group and MSLN-USPIO group in the positive detection rates for smallest tumors.In USPIO group,the negative enhancement rate of left or right axilla tumors was (12.29 ±7.45)％ and (11.06 ±5.91)％,and they were (33.88 ±6.09)％ and (43.29 ± 11.64)％ in MSLN-USPIO group.There was statistical significance in the difference of signal intensity between unenhanced and contrast enhanced in left or right axilla tumors (P ＜ 0.05),and the negative enhancement rate in MSLN-USPIO group was significantly higher than that in USPIO group (P ＜0.05).The Fe3+ ion deposition in tumors' tissue in MSLN-USPIO group was significantly more than that in USPIO group.Conclusions The enhanced effect of MSLN-USPIO is superior to USOPIO,and it can be a tumor targeted MR contrast enhanced agent for the diagnosis of pancreatic carcinoma in nude mouse.

Objective To investigate the post-traumatic stress disorder (PTSD) and its influence factors among people living with HIV /AIDS (PLWHA) ,and provide evidence for developing relevant interventions and treatment methods .Methods Anony-mously completed questionnaires ,including self-designed questionnaire and the post-traumatic checklist civilian version (PCL-C) , were received from PLWHA in Suizhou from December 2014 to March 2015 .Descriptive analysis and multivariate logistic regres-sion analysis were used to examine factors associated with PTSD .Results Among 243 qualified PLWHA ,106 of them were positive with PTSD (43 .62% ) ,and the prevalence of PTSD among male and female were 37 .88% and 50 .45% ,respectively .Among the three characteristic symptoms ,repeated flashback was the highest (78 .60% ) ,then hyper-vigilance (64 .20% ) ,and the positive rate of avoidance/numbness was the lowest (57 .20% ) .Multivariate logistic regression analysis showed that female was more suscepti-ble to PTSD than male (OR = 1 .960 ,95% CI :1 .025 - 3 .747) ,discrimination or unfair treatment would increase the risk of PTSD (OR= 2 .967 ,95% CI :1 .498 - 5 .876) ,and the frequency of fear/tension was positive correlated with PTSD (occasionally OR =2 .074 ,95% CI :1 .008 - 4 .265 ;always OR = 6 .690 ,95% CI :2 .708 - 16 .531) .Conclusion PLWHA had a high level of PTSD ,and fe-male PLWHA and those who felt fear/tension or experienced discrimination/unfair treatment were more likely to suffer from PTSD .