Objective To study the characteristics of MR imaging and proton MR spectrscopy(~1H MRS)of stroke-like lesions in MELAS.Methods Clinical,MR imaging and proton spectroscopic findings of stroke-like lesions in 7 patients with confirmed MELAS were analyzed retrospectively.Results A total of 12 MR investigations had been performed in 7 patients.Stroke-like lesions showed by MR imaging included superacute in 12,acute in 12,subacute in 10 and chronic stage in 6.Early stroke-like lesions were demonstrated as focal edematous foci mainly involved cortex/subcotical areas of occipital,temporal and parietal lobes.At MR diffusion imaging,stroke-like lesions in the superacute(＜3 days)stage were showed as well-circumscribed lesions with high signal intensities for cytotoxic edema.During the acute(4～7 days),sub-acute(2～4 weeks)and chronic(＞4 weeks)stages,the lesions gradually expanded,and became blur,and presented with vasogenic edema mainly.Proton spectroscopy showed a prominently elevated lactate,varied decrease of NAA concentration and other brain motabolites in the stroke-like lesions early after onset,and depicted gradual decrease of lactate level and partial recovery of NAA concentration subsequently.Conclusion Stroke-like lesions in MELAS mainly involve the cerebral cortex and subcortical areas,in which cytotoxic edema appears early but for a short period.In ~1H MRS,the lesions are characterized by a double lactate peak with decrease of NAA concentration.

Objective To explore differences in phototest and photopatch test results, and in skin color?related parameters between healthy subjects and patients with chronic actinic dermatitis (CAD), and to examine their relationship with the melanocortin?1 receptor gene(MC1R)Arg163Gln variant. Methods Phototests were performed by using a sun simulator SUN1000, and skin color was analyzed by using Hexameter MX18 in 25 patients with CAD and 25 healthy subjects. The MC1R genotype at position?163 was determined by PCR. Photopatch tests were performed on 25 patients with CAD and 5 healthy subjects using a standard series of photoallergens(RuiMin)and an ultraviolet (UV)phototherapy equipment, SS?03A. Results Regarding phototest results, both UVA?minimal persistent pigment darkening dose(MPPD)and UVB?minimal erythema dose(MED)were significantly lower in CAD patients compared with healthy controls (both P < 0.05), with the reduction in UVB?MED being particularly notable. Sixteen patients (64%)in the CAD group had positive photopatch reactions, including 13(52%)cases of photoallergy. Skin color?related parameters were measured at four sites. Skin hemoglobin levels on the cheek, forehead, back of hands, inner upper arms were all significantly higher in CAD patients than in healthy controls(all P<0.05). However, skin melanin levels on the cheek, forehead and inner upper arms were similar between the two groups, and only those on the back of hands were significantly higher in CAD patients than in controls(P<0.01). Skin melanin and hemoglobin levels were significantly higher in exposed than in unexposed (inner upper arms) areas in CAD patients (all P < 0.05). The frequency of the CGA genotype at position?163 in the MC1R gene was similar between CAD patients and controls(P>0.05), but that of the CAA genotype differed significantly between the two groups(P<0.01). UVA?MPPD and UVB?MED were both significantly lower in CAD patients with the CAA genotype at position?163 in the MC1R gene than in those without the genotype(P=0.055, 0.325, respectively). Conclusions Skin photobiological testing plays a critical role in the diagnosis of CAD. Further studies are needed to clarify the role of the CAA genotype at position?163 in the MC1R gene in the diagnosis, prevention and treatment of CAD.

Objective To study the usefulness of combined flow cytometry (FCM) and polymerasechain reaction examination for clonal TCR gene rearrangements in the diagnosis of T-cell lymphoma (T-NHL). Methods Histopathologic features, immunohistochemistry, flow cytometric immunophenotyping, cytomorphologic evaluation and TCR gene rearrangements of 32 T-NHL were reviewed retrospectively. The control cases were 18 reactive lesions and 1 histiocytic necrotizing lymphaderitis. Results Out of 32 T-NHL,23 were diagnosed as T-NHL by FCM / TCR gene rearrangements. Of 19 control group, 17 were diagnosed as reactive lesions by FCM / TCR gene rearrangements. The sensitivity, specificity and accuracy were 71.9%, 89.5% and 78.4%, respectively. Conclusions FCM / TCR gene rearrangement is a very important technique in diagnosing T-NHL. Thus, patients with fine needle aspiration cytology can be saved from having an invasive surgery.

A new minimally invasive gallbladder-preserving operation has emerged for the treatment of gallbladder stones,but fundamentally it is a replica of the previous gallbladder preservation method.The gallbladder aids in digestion but is not essential for life.Its function should not be exaggerated and should not instigate trivial reasons for its preservation.Most patients undergoing cholecystectomy maintain a good quality of life.The causes,mechanisms,and prevention of gallstone formation remains mysterious,so a high recurrence rate after gallbladder-preserving operation is difficult to avoid.A full cholecystectomy can avoid recurrence complications and the benefits outweigh the risks.A discussion of the benefits and complications must be initiated to evaluate both treatment modalities for gallstones.

Objective To describe the CT features of giant lymph node hyperplasia in abdomen.Methods A retrospective study of CT features of giant lymph node hyperplasia in abdomen confirmed by surgery or biopsy pathology was performed.CT findings of all lesions were assessed by two radiologists including size,location,pattern of enhancement and density characteristics.Results 1 2 patients with giant lymph node hyperplasia in abdomen were confirmed including 7 women and 5 men with age range from 11 to 75 years (median age 3 9 years).All patients underwent pre-and post-contrast enhanced CT.CT showed a single mass in 9 patients lo-cated at retroperitoneum in 5,porta hepatic in 2,and mesentery in 2.Multiple masses were located at chest,abdomen and neck in 3.The lesions ranged in size from 1.2 to 11.9 cm in maximum diameter with an average size of 3.7cm.CT showed all lesions with well-defined margin and regular shape.The lesions less than 5 cm in diameter usually showed homogeneous enhancement,and how-ever those more than 5 cm showed heterogeneous enhancement.The calcification was seen in two patients.Conclusion CT features of giant lymph node hyperplasia in abdomen are characteristic.

Objective To discuss the clinical value of Mutislice CT angiography (MSCTA)in cervical vascular diseases. Methods 60 patients highly suspected suffering cervical vascular diseases,were implemented 16-slices spiral CT angiography of cervical vascular,and blood vessel reconstruction and analysis were done subsequently. Results 43 cases with cervical vascular abnormality were presented in the 60 patients,who were implemented MSCTA. Positive ratio was 71.7%. 171 pieces vessel stenosis were detected among 240 pieces carotid artery and vertebra artery, and 4 cases carotid artery aneurysm and 1 case AVM were found also. Conclusion MSCTA is a convenient and shortcut modality to inspect cervical vascular diseases, and the blood vessel can be observed 3-dimensionally and in any direction in high quality reconstruction images.

Objective: To explore the characteristics of clinical pathology, diagnosis, and prognosis of primary renal lymphoma (PRL).Methods: The clinical features, pathological features, immune phenotypes, treatment, and prognosis of 22 patients were retrospectively analyzed. Results: The PRL patients' ages ranged from 2 to 72 years (mean, 54.3 years), of which 13 patients were older than 50 years (59.1%). All of the 22 patients were diagnosed with non-Hodgkin's lymphoma (NHL), including 20 cases of B-cell lymphoma and 2 cases of T-cell lymphoma. Seven patients were still alive and survived for 6-50 months, but the other 15 were dead and survived for only 5-35 months. Conclusion: PRL is uncommon. Clinical manifestations and imaging performance specificity are not obvious. and easily misdiagnosed. Histopathology is still the golden standard for the final diagnosis of this entity. The kidney is most easily involved followed by the bladder. B-cell NHL is the common subtype, and the most common type is the diffuse large B-cell lymphoma. Up to now,no standard regime could be performed for PRL patients. At present, comprehensive therapy, including surgery and chemotherapy, is recommended. For patients with locally advanced or highly aggressive status, therapeutic effect with chemotherapy alone is usually satisfied.

Objective To investigate the efficacy and safety of preoperative systemic chemotherapy combined with regional intraarterial chemoembolization in the treatment of locally advanced gastric cancer.Methods Clinical data of 158 patients of locally advanced gastric receiving neoadjuvant chemotherapy cancer from January 2008 to July 2012 were retrospectively analyzed.Patients were divided into two groups:those who received preoperative systemic chemotherapy plus regional intraarterial chemoembolization (group A,n =78) and those who received preoperative systemic chemotherapy (group B,n =80).Radical resection was perfomed after 3 to 4 weeks.Results The overall satisfactory rate was significantly higher (60％) in group A compared with 42％ in group B (x2 =6.136,P ＜0.05).The incidence rate of toxicity reaction (except nausea) and postoperative conplications such as anastomotic leakage,intestinal obstruction,poor wound healing,abdominal infection and pulmonary infection were all lower in group A than in group B (all P ＜ 0.05),while the incidence rate of nausea was higher in group A than in Group B (x2 =16.458,P ＜ 0.01).There was no perioperative mortality related to neoadjuvant therapy in two groups.Conclusions Preoperative systemic chemotherapy combined with regional intraarterial chemoembolization was associated with better efficacy,and fewer toxicity reactions and postoperative complications in the treatment of locally advanced gastric cancer.

This study is to investigate the anti-angiogenetic effect of arenobufagin in vitro and in vivo. The anti-proliferation effect of arenobufagin on CNE-2, Hep2, SH-SY5Y, LOVO, PC-3 and DU145 cells as well as human umbilical vein endothelial cells (HUVECs) was determined by MTT assay. Cell morphological changes of LOVO and HUVECs after arenobufagin treatment were observed by microscopy. Arenobufagin inhibited the proliferation of CNE-2, Hep2, SH-SY5Y, LOVO, PC-3, DU145 and HUVECs in a dose-dependent manner. Furthermore, it was obviously observed that the subcytotoxic concentration of arenobufagin in human carcinoma cells induced a marked decrease in the viability of HUVECs. Chick embryo chorioallantoic membrane (CAM) model was used to detect the anti-angiogenetic effect of arenobufagin in vivo. Arenobufagin significantly suppressed the angiogenesis of CAM. Cell cycle analysis demonstrated that G2/M phase was arrested and the sub-G1 peak appeared with the increase of arenobufagin concentration. PI/Annexin V double staining assay further demonstrated that arenobufagin could induce apoptosis in a dose- and time-dependent manner. Mitochondrial potential collapse detected by flow cytometric analysis was increased after arenobufagin treatment. It also observed that PARP was cleaved to p85 active form by Western blotting. Taken together, arenobufagin has significant anti-angiogenetic effect in vitro and in vivo, and the action mechanisms behind its anti-angiogenesis may be associated with cell cycle arrest and apoptosis of vein endothelial cells.

Objective: To investigate the clinicopathological features of gangliocytic paraganglioma(GP). Methods: Clinical data and pathological diagnosis of the 4 cases of GP were obtained through the medical record inquiry from January 2011 to December 2017 at the First Affiliated Hospital of Zhengzhou University. Routine HE staining and immunohistochemistry of CKpan, Syn, CgA, CD56, NSE and NF were performed. Clinical follow-up of the patients was obtained through telephone communication. Results: All 4 patients, including 2 male and 2 female patients, presented with intermittent abdominal pain and distention. The median age was 56 years. Preoperative CT showed local thickening of the duodenum wall with slight enhancement in all four cases. Endoscopic ultrasonography showed low level echo in the mucous layer and submucosa involved by the tumor in 3 of 4 cases. The maximal diameter of the tumor ranged from 0.6 to 1.8 cm with an average of 1.2 cm. Microscopically, the tumors consisted of epithelioid, spindle and ganglion-like cells, and the proportion of the three cell types was different among cases. Epithelioid cells expressed CKpan, Syn, CgA and CD56. Spindle cells expressed S-100 protein and SOX-10 and ganglion-like cells expressed NF, Syn, CgA and CD56.All tumour cells expressed NSE. All 4 patients had no recurrence a post-surgery follow-up period of 3 to 30 months. Conclusions GP of the duodenum is a benign tumor with excellent prognosis after endoscopic excision. Although its incidence is very low, its diagnosis should be considered for any mass lesion of the duodenum, especially involving mucosa and submucosa of the second dudenal segment.