Objective To investigate the effect of inversion time (TI) on flow-sensitive alternating inversion recovery (FAIR) perfusion imaging of spinal bone marrow (SBM),and evaluate the reproducibility of blood flow (BF) measurements using this technique.Methods Twenty four healthy volunteers without lumbar and other disease with clinical and MR studies were prospectively included.The first 14 healthy volunteers were included to study the effect of TI on ASL perfusion imaging of SBM to get the optimized TI,the remaining 10 volunteers were included to investigate the reproducibility of the SBM arterial spin labeling (ASL) scan protocol.The optimized TI of FAIR spinal bone marrow perfusion experiment was carried out on 14 healthy volunteers on 3.0 T magnet,two adjacent vertebral bodies were orderly selected from each volunteer to measure the △M and the SNR of FAIR perfusion MRI with 5 different TIs (800,1 000,1 200,1 400,1 600 ms),and the vertebral bodies selected order were determined by the order of the subjects enrolled.In addition,FAIR perfusion spinal vertebral BF measurements were repeated in last l0 healthy subjects on L4 or L5 by reposition immediately,paired t test and reproducibility statistics (included within-patient standard deviation (wSD) and within-patient coefficient of variation (WCV)) were used to analyze the test-retest experiment reproducibility.Result TI optimization experiments total included 28 vertebral bodies,when TI (ms) was chose as 800,1 000,1 200,1 400,1 600,ms respectively,the mean △M of spinal bone marrow were 20.8±9.0,29.0± 10.9,36.4± 12.5,26.2± 10.2 and 23.8± 11.5,and the mean SNR were 2.0± 1.0,2.3±0.8,2.4± 1.0,2.3±0.8 and 2.0±0.7.With TI increasing,AM and SNR increased first and then decrcascd,the maximum values of both were achieved when the TI near 1 200 ms.Test-retestexperimcnt were carried on 10 vertebral bodies eventually,and two measurements of spinal vertebral BF perfusion before and after were (108.9±4.6)and (109.2 ±4.6)ml · 100g-1· min 1,respectively,and no significant difference was found (t=-0.157,P=0.879),wCV of the measurements was 3.28％ (3.57/109.06).Conclusion The optimal TI was 1 200 ms for spinal bone marrow ASL perfusion image,at which the maximum AM,higher SNR,and good reproducibility for the FAIR spinal bone marrow perfusion imaging can be achieved.

Objective To investigate the effect of FK506 on the in vitro ostengenic potential of rat bone marrow-derived mesenchymal stem cells(MSCs)and the dose-response effect of FK506(5-5000 nmol/ L)on the ostengenic potential of MSCs in vitro.Methods MSCs derived from primary culture were sub- cultured for 16 days under four conditions:(1)?-MEM containing L-ascorbicacid-2-phosphate(AsAP)and?-glycemphosphate(?-GP)(basic culture medium)as a control;(2) AsAP and?-GP(basic culture medi- um) plus dexamethasone;(3)AsAP and?-GP(basic culture medium)plus FK506,(4)AsAP and?-GP (basic culture medium)plus FK506 and dexamethasone.Osteogenie potential was determined by testing os- teoblastic morphology,cell proliferation,alkaline phosphatase(APase)activity,bone nodule formation and the expression of osteocalcin mRNA.Results FK506 promoted the proliferation of MSCs,induced mineral- izing bone-like nodule formation,and increased APase activity and the expression of osteocalcin mRNA.The data also showed that the efficacy of FK506 was greater when used in combination with dexamethasone.Opti- mal ostengenesis was achieved with?-MEM containing 0.25mmol/L AsAP,10mmol/L?-GP,10nmol/L dexa- methasone and 50nmol/L FK506.Conclusion FK506 has powerful ostengenic ablility.It can be consid- ered as an osteogenic agent to repair bone defects.

Objective To investigate the clinical and pathological features of the sporadic Burkitt's lymphoma(BL),as well as its immunohistochemical and molecular characteristics.Methods 20 cases of sporadic BL were retrospectively studied by analyzing their light microscopy features,immunohistochemical expression,EBV infection detected by in stiu hybridization,chromosomal breakage of c-myc and/or lgH genes by interphase fluorescence in stiu hybridization (FISH),and their clinical manifestation.Results All the 20 cases of sporadic BL occurred in children(3-14 y)including 16 males and 4 females.Microscopically,the medium-sized tumor cells were monomorphic and proliferated in a diffuse pattern showingstarry-skywith numerous karyorrhectic debris.Mitotic figures were frequently seen.Immunohistochemically,the tumor cells were positive for CD20 and CD10,over 95%positive for Ki-67 and negative for TdT,CD99,MPO. No EBV infection wag found by in situ hybridization in 18 cases.Interphase FISH analysis detected c-myc gene breakage or amplification and/or IgH/c-myc gene breakage in all detected 15 cases.Conclusion Sporadic BL is a high-grade malignant B cell lymphoma.The tumor cell proliferation index is very high.Molecular and immunohistochemical analysis could reduce the incidence of misdiagnosis and thus phys a vital role on its correct diagnosis and appropriate therapy.

Objective To explore the diagnosis,treatment options and outcomes of patients with ureteropelvic junction obstruction(UPJO)and ureterovesical junction obstruction(UVJO). Methods Clinical records of 12 children with UPJO and UVJO who received treatment in Children′s Hospital of Nanjing Medical University from April 2008 to December 2015 were reviewed. Presentations included prenatal hydronephrosis and symptoms caused by urinary tract in-fections. Ultrasonography,intravenous pyelography,magnetic resonance imaging and renography were performed before surgery. Results Four patients underwent nephrostomy,followed by pyeloplasty and eventually,ureteroneocystostomy. Five patients underwent heterochronic pyeloplasty plus ureteroneocystostomy. Two patients received pyeloplasty only. And another patient underwent heterochronic nephrostomy plus ureteroneocystostomy. The 12 patients received a 2. 0 months to 2. 5 years′ follow - up. Recurrent urinary tract infection and abdominal pain were relieved after the treatment. Ultrasonography showed hydronephrosis reduced obviously after the surgery. Conclusions UVJO patients with unparallel hydronephrosis should be considered with the coexistence of UPJO. Retrograde pyelography(RPG)is recommended for the diagnosis. And the treatment includes both pyeloplasty and ureteroneocystostomy. The patients diagnosed with UPJO should be first managed with pyeloplasty or nephrostomy instead of RPG. Subsequently anterograde pyelography can be performed to decide if the patients need additional ureteroneocystostomy.

Objective To study the expressions of anaplastic lymphoma kinase (ALK-1) and cytotoxic proteins in primary systemic anaplastic large cell lymphoma (S-ALCL) and their relationship with clinical outcome. Methods 51 S-ALCL cases were collected from Lymphoma Lab of Peking University Health Science Centre & Peking Children's Hospital. The morphologic characteristics were studied under routine microscope, and essential immunohistochemical stainings were performed and reviewed to confirm the diagnosis of S-ALCL. Immunohistochemical stainings for ALK-1 and cytotoxic proteins (TIA-1 & granzyme B) were performed using standard SP method. Patients related clinical data including follow-up materials were collected. Results Survival time of 44 cases with completely clinical follow up materials ranged from 0.5～66months. 36 out of 51 cases(37 %) was positive for ALK-1 protein. While 20 cases out of 47 S-ALCL cases ( 42.55 % ) positive for granzyme B and 22 out of 28 cases (81.48 %) were positive for TIA-1. The prognosis of patients with ALK-1 protein positive and granzyme B negative expression was better, but TIA-1 expression might have nothing to do with clinical outcome (P＞0.05). In addition, multivariate analysis confirmed that ALK-1 protein expression, granzyme B protein expression and Ann-Arbor stage system were possible for prognosis(P＜0.05), Conclusion Expression of ALK-1 and granzyme B protein expression may serve as two independent prognostic predictors in S-ALCL patients.

Objective: To explore the application of penile base staggered flap in the operation of severe hypospadias with penoscrotal transposition. Methods: Twenty-three cases with severe hypospadias with penoscrotal transposition were corrected by urethroplasty and staggered flap plasty in our department from May 2013 to June 2016. After urethroplasty, the skin at the junction of the penile base and scrotum was transversely cut by 1.5-2.0 cm, and then sutured with Z-plasty to reconstruct the angle of the penis and scrotum. Results: After the operation, infection and cracking at the suture of the staggered flap occurred in one child and was cured after dressing change and symptomatic treatment. Two cases suffered from urine leakage at the suture of the staggered flap. One of the cases realized self-healing and the other received a repair operation for urinary fistula. Three children suffered coronary sulcus fistula and was cured by urethroplasty. All the patients were followed up from 10 to 30 months with normal penis scrotal position and satisfactory appearance. Conclusions The application of penile base staggered flap can be used for severe hypospadias in one stage with penoscrotal transposition surgery. It is a simple and satisfactory method for the treatment of hypospadias with penoscrotal transposition.

Purpose To investigate the reproducibility and risk factors of aortic distensibility quantification in patients with abdominal aortic aneurysm using multi-slice spiral CT.Materials and Methods The abdominal aortic computed tomography angiography data of 54 patients with infrarenal abdominal aortic aneurysm were prospectively studied.64-muti detector spiral CT,retrospective ECG-gating and segment data collecting scanning were all carried out.The aortic distensibility,D value,and pulse wave velocity at renal artery level and infrarenal artery level were calculated using semiautomatic segmentation software.The difference of aortic distensibility at different levels was compared,and consistency test was performed.Results The D value at renal artery level and infrarenal artery level of abdominal aortic aneurysm was (1.05 ±0.22)×10-5/Pa and (0.49± 0.18)× 10-5/Pa,respectively;and the corresponding pulse wave velocity was (9.68± 1.09) m/s and (14.96 ±4.01) m/s,respectively.The intraclass correlation coefficient of intra-and interobserver at renal level was 0.92 and 0.79,while it was 0.85 and 0.79 at inffa level.The Bland-Altman graph showed that the vast majority of points were within the 95％ CI,the difference of intraobserver between the two positions was 0.017×105/pa and 0.010×10-5/Pa,and the difference of interobserver was 0.013×105/Pa and 0.018×10-5/Pa.Multivariate analysis of all these variables showed aortic distensibility to be independently correlated to body mass index,pulse pressure,diastolic pressure and abdominal aortic aneurysm diameter (R2=0.68).Conclusion The quantification of aortic distensibility using multi-slice spiral in patients with abdominal aortic aneurysm shows high stability.Taking into consideration of the relationship between different risk factors and the incidence of abdominal aortic aneurysm can lead to a better clinical approach.

Objective: To summarize the diagnosis and prognosis of adrenocortical carcinoma in children. Methods: Medical records of 10 pediatric patients with adrenocortical cancer treated in Children's Hospital of Nanjing Medical University from September 2010 to March 2018 were retrospectively reviewed, and their clinical manifestation, laboratory, auxiliary, and pathological examination results, and prognosis were analyzed. Results: The average age of all patients (5 male and 5 female pediatric patients) was (53.3+48.4) months. Clinical mani-festations included abdominal mass, hypertension, cortisol level, and peripheral precocious puberty. Laboratory tests showed that lactate dehydrogenase, neuroenolase, and cortisol levels were high in some patients, and sex hormones were abnormal. Auxiliary examination using the abdominal computed tomography enhancement showed irregular an adrenal gland, uneven density, necrosis, mass calcification, and some infiltration into the surrounding tissue. Pathological examination suggests tumor cell pleomorphism, more frequent pathological division, high mitotic index, abundant interstitial sinusoid, necrosis, tumor infiltration, vascular invasion, and Weiss score of≥3 points. Lactate acid dehydrogenase and cortisol levels; Weiss score; and tumor size, staging, and resection rate were not statistically different among prognostic factors. Conclusions: For pediatric patients with adrenal masses, the survival rate should be improved by combining the clinical manifestation, laboratory examination, and auxiliary examination for the early diagnosis of adrenocortical carcinoma and to select the appropriate treatment. Combined with pathological results, adrenocortical carcinoma can be well differentiated from other adrenal masses.

Objective:To explore the clinical value of single-hole laparoscopic percutaneous extraperitoneal closure operation using a Kirschner wire assisted double-hook water-injection hernia needle in treating complicated pediatric oblique inguinal hernia.Methods:The clinical data of 366 children with oblique inguinal hernia treated in the Department of Urology Surgery, Children′s Hospital of Nanjing Medical University from December 2020 to October 2021 were retrospectively analyzed.According to the surgical methods, the children were divided into the ordinary crochet needle group and the Kirschner wire assisted group.Children treated by a single-port laparoscopic double hook water-injection hernia crochet needle (309 cases) were classified into the ordinary crochet needle group.Children treated by a single-port laparoscopic Kirschner wire assisted double hook water-injection hernia crochet needle (57 cases) were included in the Kirschner wire assisted group.The independent sample t-test and rank sum test was used to compare the relevant clinical indicators between the two groups. Results:Compared with the ordinary crochet needle group, children in the Kirschner wire assisted group were younger at surgery[(2.87±1.88) years vs.(4.91±2.39) years] and had larger hernia sacs [17 303.89(8 622.49, 37 295.42) mm 3vs.9 650.97(3 849.24, 17 539.51) mm 3]. The differences in the age at surgery and hernia sac volume were statistically significant ( t=-5.407, Z=-4.218; all P<0.001). There was no significant difference in body mass index between the 2 groups ( P>0.05). Taking hernias with sac volume >10 000 mm 3 as huge hernias, there were 70.18%(40/57 cases) and 47.25%(146/309 cases) of huge hernias in the Kirschner wire assisted group and the ordinary crochet needle group, respectively.The overall operation time of the Kirschner wire assisted group was significantly longer than that of the ordinary crochet needle group[(20(15, 20) min vs.15(15, 20) min] ( Z=-2.842, P<0.05). However, the operation time for huge oblique hernias with sac volume >10 000 mm 3 was not statistically significant between the 2 groups ( P>0.05). No recurrence in both groups was found during 6-16 months of follow-up. Conclusions:For complicated oblique inguinal hernia in children with a huge hernia or obvious retroperitoneal folds at the internal ring and heavy scar adhesion between the hernia sac and abdominal wall, the insertion of a Kirschner wire can help the hernia crochet needle to traverse the vas de-ferens and spermatic cord vessels smoothly.As a single port laparoscopic operation, the Kirschner wire assisted hernia crochet needle requires no addition of trocar holes and leaves only a small surgical scar.With good feasibility and safety, it is applicable for clinical popularization.

Objective:To explore the clinical characteristics and treatment regimens of adrenal incidentaloma (AI) in children.Methods:Clinical data of 38 children with AI treated in the Department of Urology, Children′s Hospital of Nanjing Medical University from December 2016 to October 2021 were retrospectively analyzed.A total of 38 children were divided into neonatal group and non-neonatal group according to their age at first diagnosis.The neonatal group had 7 males and 9 females patients, of whom 7 cases were detected with AI during prenatal examinations, 9 cases were diagnosed postnatally.Four children in neonatal group had AI in the left adrenal gland and 12 cases in the right, with the maximum diameter of tumor (MDT) ranging from 16-48 mm.In the non-neonatal group, there were 14 males and 8 females patients aged 7 months and 1 day to 12 years and 1 month, and the MDT was 29-131 mm.Paired t test was used to compare the age and MDT of benign and malignant tumors. Results:In the neonatal group, 3 patients were surgically treated, with 2 cases and 1 case of neuroblastoma and teratoma confirmed by postoperative histology, respectively.The remaining 13 patients in the neonatal group were followed up for 1-31 months, with 8 cases and 5 cases of complete remission and significantly decreased tumor volume, respectively.In the non-neonatal group, there were 3, 9 and 10 patients received open biopsy, laparoscopic adrenalectomy, and open adrenalectomy, respectively.Of these 22 surgically treated cases, 8 cases had a benign lesion, including ganglioneuroma ( n=4), adrenocortical adenoma ( n=1), adrenal cyst ( n=1), teratoma ( n=1), and pheochromocytoma ( n=1); while 14 cases had a malignant lesion, including neuroblastoma ( n=8), ganglioneuroblastoma ( n=5), and adrenocortical carcinoma ( n=1). The mean age of patients with malignant tumors was significantly younger than those with benign tumors[(38.94±35.44) months vs.(95.89±41.43) months, t=3.63, P=0.001]. The mean MDT in malignant tumors was significantly longer than that of benign tumors[(64.43±25.20) mm vs.(41.44±15.66) mm, t=2.45, P=0.023]. Conclusions:AI in children has a high risk of malignancy.Therefore, more detailed examinations are needed to detect tumor markers and endocrinological parameters, and imaging tests such as non-contrast and CT examination should be performed as early as possible.AI in children is predominantly neuroblastic tumors.For non-neonatal patients, surgery should be performed as early as possible.For AI found in the neonatal period and prenatal examination, expectant management is feasible if the tumor is relatively small and limited to the adrenal gland without distant metastases.