Objective To evaluate the MRI findings and clinical features of methotrexate-induced acute encephalopathy in children.Methods The clinical data and brain MRI obtained in 13 children with methotrexate-induced acute encephalopathy were retrospectively reviewed.The MRI features were analyzed , including information on the location , the signal intensity and follow-up MRI study was performed.Results Of the 13 patients , 2 patients suffered from seizure.Five patients had dysphasia , of which 4 patients had evidence of hemiparesis , 1 patient had right facial palsy.Five patients had unilateral weakness.And left hemiparesis was observed in 1 patient.DWI revealed well demarcated asymmetrical hyperintensity lesions within the centrum semiovale and/or periventricular white matter in 10 patients, corresponding to areas of hypointensity on ADC maps.One case showed hyperintensity areas in the bilateral supratentorial cortex and subcortical white matter on T 2-weighted images with subtle high-intensity on DWI.In all 10 cases there were resolution of the diffusion abnormality , 8 cases displayed residual FLAIR signal abnormalities involving areas of previously seen diffusion restriction , 5 cases showed decreased range of the lesion , 1 case was progressive, and 2 cases were stable.One case with hyperintensity areas in the supratentorial cortex and subcortical white matter showed small residual hyperintensity on T 2-weighted images and resolution of the diffusion abnormality.Conclusions MTX-induced acute encephalopathy often manifests as stoke-like symptoms.DWI is the imaging modality of choice for the detection of acute MTX neurotoxicity , and asymmetrical restricted diffusion in the deep white matter is the characteristic sign.Cytotoxic edema induced by MTX is transient and reversible .

Objective: To study the effect of Juglans Mandshuria on tumor cells. Methods : The apoptotic effect on the Hela、PC-3 of tumor cells was observed by agarose gel electrophoresis of DNA fragments. Results : It has directly cytotoxicity on tumor cells, LC 50 is about 9～15?g?mL -1 . Based on this, the inoculating trial on entity tumor in vivo administrated by hypodermic injection on mouse had the same effect as in vitro, the high-dose group (12mg?kg -1 ) can decrease the weight of tumor to 42.21%. Conclusion : Juglans Mandsshurica has the inhibition of tumor.

Bone Neoplasms ; Cartilage Diseases ; Humans ; Osteochondroma ; Soft Tissue Neoplasms

Objective To investigate the associated risk factors of postoperative complications after rad?ical resecting of colorectal cancer. Methods The clinical data of 237 patients with colorectal cancer performed radical resection in the Second Affiliated Hospital of Kunming Medical University from January 2011 to Decem?ber 2014 were analyzed retrospectively. The incidence of postoperative complications was analyzed,and the relat?ed factors were analyzed by single factor and multi factor correlation analysis. Results The postoperative com?plications occurred in 114 cases of 237 patients( 48. 1%) . Univariate analysis showed that the age more than 70 years old,preoperative comorbidity,intraoperative blood loss,surgeon’ s experience,combined evisceration or en?larged evisceration were related to postoperative complications ( P = 0. 033, 0. 014, 0. 045, 0. 028, 0. 040 ) . Compared with the patients without complications,the postoperative anal exhaust time,length of stay was longer of the patients with complications((3. 7±1. 6) d vs. (3. 2±1. 4) d,P=0. 035;(21. 3±6. 5) d vs. (12. 1 ±2. 4) d,P=0. 001). Logistic regression analysis showed that depth of tumor invasion(P=0. 001),preoperative comorbidity including NRS>3 points (χ2 =8. 903, P=0. 003 ) , anemia and hypoproteinemia (χ2 =3. 494, P=0. 048) ,hypertension complicated with type 2 diabetes mellitus(χ2=5. 418,P=0. 026) ,not complete intesti?nal obstruction(χ2=8. 376,P=0. 003),mild and severe ventilation dysfunction(χ2=6. 331,P=0. 011) and WBC<3. 9×109(χ2=4. 256,P=0. 041) were closely related to the occurrence of complications. The rate of post?operative complication of laparoscopic group and open group had no significant difference( 44. 4%( 64/144) vs. 47. 3%(44/93),P>0. 05) . Conclusion Age>70 years old,preoperative comorbidity,intraoperative blood loss,surgeon`s experience,combined evisceration or enlarged evisceration are main risk factors for patients per?formed colorectal cancer radical resection,but laparoscopy?assisted radical resection is not the risk factor.

Objective To investigate the value of Fluorine-18 fluorodeoxyglucose positron emission tomography (~(18)F-FDG-PET)in staging and detecting residual disease during follow-up of non-Hodgkin's lymphoma in children. Methods The results of~(18)F-FDG-PET of 88 podiatric NHL before and after chemotherapy was analyzed respectively.The results were compared with CT scans simultaneously.Results 67 cases were performed for initial staging.Of the 1072 anatomy regions were analyzed by PET and CT with concordalice of 88.62%regions(positive in 11.10%and negative in 77.52%1.Disconcordance were found in 11.38%regions(PET positive but CT negative in 6.8 1%,PET negative but CT positive in 4.57%).PET was significantly better than CT scan in the staging of podiatric NHL.35 scans were performed in the follow-up.The true residual disease positive rate of PET and CT were 87.50%and 57.14% respectively.The false positive rate of PET and CT were 12.50%and 50.00%respectively.Conclusion ~ (18)SF-FDG-PET imaging is of great value for the staging of the pediatric patients with NHL It's a useful technique to identify the residual disease,avoid unnecessary treatment and biopsy and Can predict eady relapse.

Objective:To analyze the clinicopathological features, treatment and prognosis of Epstein -Barr virus(EBV) positive diffuse large B cell lymphoma(DLBCL) in children, so as to improve the knowledge of pediatricians on this disease.Methods:The data of 6 cases of EBV positive DLBCL who were initially diagnosed and regularly treated in Beijing Children′s Hospital from January 2016 to December 2019 were collected, including basic information (gender, age, first symptom, and course of disease), pathological results [immunohistochemistry, EBV encoded RNA(EBER), latent membrane protein(LMP), and C- MYC gene], immune function, EBV index, treatment group, treatment plan and prognosis. Results:There were 4 males and 2 females, with the average age of 6.67 years.The uric acid was 266.2 μmol/L, lactic dehydrogenase(LDH) was 346.5 U/L at early stage, and 1 patient had immunodeficiency.The immune function test before chemotherapy indicated that the proportion of auxiliary T cells decreased in 4 cases, and the humoral immune function was normal in all patients.There was no evidence of recent infection in 6 patients, and EBV-DNA increased in 3 patients.There were 2 cases of stage Ⅲ, 4 cases of stage Ⅳ, 1 case of giant tumor, 2 cases of symptom B, 6 cases of extranodal invasion, 4 cases of central invasion and 1 case of bone marrow invasion.Three patients died and three survived.Immunohistochemistry showed that: (1) CD 19, CD 20, and CD 79a were expressed in all patients, and CD 30 was expressed in 5 patients.(2) C- MYC gene was detected by immunofluorescence in situ hybridization method in all patients, and no MYC break, Bcl-2 and Bcl-6 break and amplification were found.(3) EBV: EBER and LMP-1 were expressed in all patients. Conclusions:The pathological changes of EBV positive DLBCL are similar to those adults.The origin of non-germinal center and extranodal and central invasion are more common.The prognosis of the patients with central nervous system invasion is very poor, and the recurrence and progress of the disease often occur in the treatment or in the early stage of drug withdrawal.At present, there is no effective and feasible treatment plan.It is suggested that the patients in the late stage should receive allogeneic hematopoietic stem cell transplantation as soon as possible after intensive treatment, so as to improve the survival rate.

Objective To discuss the imaging features of skeletal changes in children with Gaucher disease on X-ray and MRI images.Methods One hundred and nine children with Gaucher disease were enrolled in this study.They all received routine X-ray for spine with anterior-posterior(A-P)and lateral view and bilateral femurs with A-P view.Among them.18 patients received X-ray for pelvic with A-P view.14 patients received X-ray for left wrist with A-P view.and 14 patients received MRI scan for femur.The MRI scan included T1-weighted imaging,T2-weighted imaging and fat-suppressed T2-weighted imaging with short tau inversion recovery(STIR)sequence.The imaging features of the X-ray and MRI images were analyzed retrospectively.Results The most common feature is osteoporosis,which presented in 91 cases (83.5%).Besides this,decreased density of metaphysis occurred in 86 cases(78.9%).erlenmeyer flask deformity of metaphysis occurred in 89 patients(81.7%),thinner cortex occurred in 69 cases(63.3%),osteolytic destruction occurred in 31 cases(28.4%).pathological fractures occurred in 26 cases (23.9%),osteosclerosis occurred in 12 cases(11.0%).cystic degeneration of bone occurred in 16 cases (14.7%),and dislocation of the hip occurred in 4 cases.All 14 patients received MRI presented abnormal signals.Among them,4 patients presented low signal intensity both on T1-weighted and T2-weighted images in bone marrow;the other ten presented high signal intensity mixed in low signal intensity areas on T2-weighted and fat-suppressed T2-weighted images.Conclusions The imaging features of skeletal changes in children with Gaucher disease are of some characteristics,which could provide useful information for the clinical treatment.

Objective: To review the clinical-pathology characteristics of 19 relapsed pediatric mature B cell lymphoma and to find the risk factors for recurrence and the feasible treatment after relapse. Method: Data of 212 pediatric B cell lymphomas cases in Beijing Children′s Hospital from January 2006 to June 2015 were collected retrospectively. All the patients were treated according to the B cell lymphoma regimen of Beijing Children′s Hospital. During the study period, 19 of 212 cases were relapsed; the clinio-pathological characteristics of relapsed patients before treatment and after relapse were analyzed retrospectively, the treatment outcomes after relapse were summarized and the patients were followed-up. Result: Nineteen of 212 cases had relapsed disease, for these relapsed patients: the median age at initial diagnosis was 5.5 years old, the median level of uric acid was 384(range, 121-713)μmol/L, the median level of lactate dehydrogenase(LDH) was 1 323(range, 146-6 370)U/L. Among 19 relapsed patients, 10 had local relapse and 9 had multiple relapses; 17 were Burkitt′s lymphoma and 2 were diffuse large B cell lymphoma. Staging: 2 cases were stageⅡ, 3 cases were stage Ⅲ and 14 cases were stage Ⅳ. Risk group: 6 cases were group B and 13 cases were group C. Nine cases had bone marrow involvement and 10 cases had central nervous system(CNS) involvement. Acute tumor lysis syndrome was seen in 6 cases during the early treatment and 13 cases had delayed treatment. Treatment after relapse: 10 cases received further treatment after relapse (rituximab + 1-4 courses high intensity second-line chemotherapy), 3 cases received autologous stem cell transplantation. There was no chemotherapy or infection related death, 3 cases achieved complete remission (CR). For all the 212 patients, the median follow-up time was 47 (range, 1-131)months and the 5-year event free survival(EFS)rate was (89.4±0.2)%. For the 19 relapse cases, the 5-year overall survival (OS) rate was (21.1±0.1)%, CR rate after relapse was 30%, patients died of the progression of the primary disease, no treatment related death occurred. Univariate analyses showed that bulky disease, stage Ⅳ, maxillofacial and CNS involvement, LDH>1 000 U/L, delay treatment, day 7 evaluation shrink <25%, residual diseases after 3 months treatment are relapse risk factors (all P<0.01). Conclusion Patients relapse during the treatment or at the early stage after the end of all chemotherapy have poor prognosis. So far there is no effective method for early relapse patients; the late relapse patients had the possibility of CR if they are sensitive to salvage treatment. In conclusion, to improve the outcome, the key point is to reduce the relapse.

Objective To explore the risk factors of hemorrhagic transformation and prognosis of acute ischemic stroke (AIS) after intravenous thrombolysis. Methods From June 2017 to June 2019,211 patients with AIS undergoing intravenous thrombolysis were selected as the research object. Among them,34 patients with hemorrhagic tromsformation (HT) were recorded as HT group,and 177 patients without hemorrhagic transformation The patient was recorded as a non-HT group,with a bleeding conversion rate of 16.11%. The relationship between intensive blood pressure reduction and bleeding conversion and prognosis in patients with AIS intravenous thrombolysis was analyzed during intravenous thrombolysis. Results Univariate analysis revealed gender,age,time interval between onset to start of treatment (OTT),blood glucose at admission,baseline blood pressure,and baseline from the onset to start of treatment (reombinant tissue plasminogen activator,rt-PA) The National Institute of Health stroke scale (NIHSS) score,type 2 diabetes,atrial fibrillation,and venous thrombolysis have statistically significant differences (P<0.05 or P<0.01),which is a vein Risk factors related to HT after thrombolysis;binary logistic analysis showed that the baseline NIHSS score of 17.5 was divided into independent risk factors for the transformation of venous thrombolysis hemorrhage in AIS patients (OR=1.639,P=0.013). Atrial fibrillation (OR=9.129,P<0.01) is an independent risk factor for the prognosis of patients with intravenous thrombolysis. Conclusion The baseline NIHSS score of 17.5 is divided into independent risk factors for HT after intravenous thrombolysis in AIS patients,and intensive blood pressure reduction during intravenous thrombolysis is a related risk factor for HT;atrial fibrillation is an independent risk factor for the prognosis of patients with intravenous thrombolysis.

Objective: To analyze the clinical features and prognostic factors of childhood Burkitt's lymphoma and to summarize the therapeutic effect of the mature B-cell lymphoma regimen of Beijing Children's Hospital. Methods: It was a retrospective study. From January 2007 to December 2015, 186 patients below 18 years of age with newly diagnosed, untreated Burkitt's lymphoma were enrolled. Three cases were eliminated because of the abandonment of the treatment and 183 cases were stratified and treated according to the mature B-cell lymphoma regimen of Beijing Children's Hospital, groups were as follows: A, n=1; B, n=59; C, n=123 and 97 patients in group C received combined rituximab therapy during the treatment. The clinical features and therapeutic effects of patients were analyzed, overall survival (OS) and event-free survival (EFS) were estimated by the Kaplan-Meier method. COX regression was used to identify the prognostic factors. Results: The median age at diagnosis was 5 (1-14) years. There were 159 males (85.5%) and 27 females (14.5%) , the male-to-female ratio was 5.9∶1. A total of 174 cases (93.5%) evolved to stage Ⅲ and Ⅳ. Eight cases did not achieve remission and progressed to death, 9 cases relapsed. Only 5 patients (2.7%) died of treatment-related complications. With a median follow-up time of 48.0 (0.5-128.0) months, the 5-year OS rate and EFS rate were (89.1±2.3) % and (87.8±2.5) %. There was significant difference in the 5-year EFS rate between group B and C ( (94.9±2.9) % vs. (84.0±3.4) %, χ²=4.258, P=0.039). The 5-year EFS rate was (73.1±8.7) % and (86.7±3.7) % for patients in the group C treated with chemotherapy only and those treated with chemotherapy combined rituximab, but no statistical difference was found between them (χ²=3.360, P=0.067) . Central nervous system (CNS) involvement, insensitivity to early phase chemotherapy, residual diseases in mid-term evaluation were independent unfavorable prognostic factors (HR=6.167, 9.102, 3.104, 95%CI: 2.293-16.592, 1.837-45.107, 1.182-8.153) . Conclusions The large dose, short course treatment of mature B-cell lymphoma regimen of Beijing Children's Hospital is effective for pediatric Burkitt's Lymphoma. Combined treatment with rituximab can improve the efficacy. CNS involvement, insensitivity to early phase chemotherapy, residual diseases in mid-term evaluation are associated with increased risk of poor prognosis.