Primary immune thrombocytopenia(ITP)is an acquired autoimmune hemorrhagic disease characterized by reduced isolated peripheral blood platelet counts for which pathogenesis and etiology are not well defined.Present diagnosis of ITP is to be excluding other diseases,whose pathogenesis generally involves multiple aspects of immunology,biology,epigenetics and environ-mental factors.Recognition of epigenetic alterations in dysregulation of immune tolerance and autoimmune diseases has been deepened in recent years with progress by molecular biology.DNA methylation,an important epigenetic modification,has been shown to play a role in pathogenesis of ITP.Abnormal DNA methylation leads to cellular abnormalities in proliferation,differentiation,apoptosis and immune response in body,induces immune intolerance to autologous platelet antigens in patients,resulting in abnormal activation of immune cells which makes excessive platelet destruction or insufficient platelet production.Therefore,this article reviews latest research progress of DNA methylation genes in ITP to provide a reference for further recovery of immune tolerance of patients.

Primary immune thrombocytopenia(ITP)is an acquired autoimmune hemorrhagic disease characterized by reduced isolated peripheral blood platelet counts for which pathogenesis and etiology are not well defined.Present diagnosis of ITP is to be excluding other diseases,whose pathogenesis generally involves multiple aspects of immunology,biology,epigenetics and environ-mental factors.Recognition of epigenetic alterations in dysregulation of immune tolerance and autoimmune diseases has been deepened in recent years with progress by molecular biology.DNA methylation,an important epigenetic modification,has been shown to play a role in pathogenesis of ITP.Abnormal DNA methylation leads to cellular abnormalities in proliferation,differentiation,apoptosis and immune response in body,induces immune intolerance to autologous platelet antigens in patients,resulting in abnormal activation of immune cells which makes excessive platelet destruction or insufficient platelet production.Therefore,this article reviews latest research progress of DNA methylation genes in ITP to provide a reference for further recovery of immune tolerance of patients.

Objective To investigate the value of ADC and T2WI in differentiating of skull base chordoma and invasive pituitary adenomas(IPA).Methods 15 patients with skull base chordoma and 19 patients with IPA which involve paranasal sinus were reviewed retrospectively.All diagnosis were demonstrated by pathology.Quantitative analysis of minimum ADC, normal ADC and rT2WI values were performed.Differences in minimum ADC, normal ADC and rT2WI values between skull base chordoma and IPA were evaluated using the independent samples t test and receiver operating curves(ROC).Results Statistical analysis revealed a significant difference among normal ADC, minimum ADC and rT2WI values (P<0.01),and the area under the ROC curves decreased in turn.Conclusion Both ADC values and rT2WI SI are effective parameter for differentiating diagnosis of skull base chordoma and IPA.

Objective To explore the feasibility and safety of carotid artery stenting (CAS) via right transradial approach (TRA).Methods A retrospective analysis was made on 46 cases undergoing the CAS via right TRA.Patients were divided into the right carotid artery group (RCA),bovine left carotid artery group (B-LCA),nonbovine carotid artery group (NB-LCA) according to the lesion location.Low TRA or high TRA were selected to overcome the difficulties of insufficient supporting power,using techniques such as catheter looping and retrograde engagement technique(CLRET).Results CAS were successful in all cases (100％),the differences of the operation time and fluoroscopy time among RCA group,B-LCA group and NB-LCA group were not significant.In NB-LCA group,CLRET were applied in 10 cases (55.56％,10/18),includeing 8 cases with type Ⅲ aortic arch(100％,8/8)and 2 cases with type Ⅱ aortic arch (33.33％,2/6).The CLRET prolonged the operation time and fluoroscopy time [(39.45 ±7.27) min vs.(30.80±4.66) min;(11.84 ± 2.05) min vs.(9.91 ± 1.45) min,P ＜0.05).There was no cerebrovascular events and puncture point complications in perioperative period.Conclusion Right transradial approach for carotid artery stenting is safe and technically feasible,especially in RCA stenosis and LCA stenosis with type Ⅰ or Ⅱ aortic arch.

Objective To assess the value of diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) in differential diagnosis of neuroendocrine carcinoma of the uterine cervix (NECUC) from other tumors.Methods A total of 12 NECUCs,39 cervical squamous cell carcinomas (SCC) and 21 cervical adenocarcinomas (CA) confirmed by pathology were analyzed retrospectively.All the patients underwent conventional MRI and DWI.The ADC values were measured and compared among NECUC,SCC and CA.Diagnostic performance of ADC was compared using receiver operating characteristic curves (ROC).Results The mean ADC values of NECUC,SCC and CA were (0.66 ± 0.11) ×10-3 mm2/s,(0.86 ± 0.11) × 10-3 mm2/s and (1.04 ± 0.17) × 10-3 mm2 / s,with statistical differences between any two groups (P ＜0.001).The optimal cutoff values of ADC for differentiating NECUC and SCC was 0.681 ×10-3mm2/s with a sensitivity of 94.9％,specificity of 75.0％ and accuracy of 90.2％.The optimal cutoff values of ADC for differentiating NECUC and CA was 0.824× 10-3mm2/s with a sensitivity of 95.2％,specificity of 91.7％ and accuracy of 98.9％.Conclusion The differences of the mean ADC value are helpful for the differential diagnosis of NECUC,SCC and CA.

Objective To investigate the diagnostic value of ADC in the evaluation of small round cell malignant tumors(SRCMT) of nasal and paranasal sinus.Methods This study included 143 patients with surgically confirmed SRCMT and Non-SRCMT of nasal and paranasal sinus between 2008 and 2015, all patients underwent diffusion weighted MRI at 3.0 T with a b factor of 0 and 1 000 s/mm2.Quantitative analysis of ADC values was performed.Difference in ADC values between SRCMT and Non-SRCMT was evaluated using the independent samples t test.One-way analysis of variance(ANOVA) test was performed to compare the ADC values of SRCMT.Receiver operating curves (ROC) were developed to determine the cutoff points to differentiate SRCMT from Non-SRCMT.Results There were 98 SRCMT, of which 20 lesions were rhabdomyosarcoma(RMS), 19 lesions were non-Hodgkin's lymphoma(NHL), 4 lesions were malignant melanoma(MM), 14 lesions were neuroendocrine carcinoma(NEC), 12 lesions were Ewing sarcoma or primitive neuroectodermal tumor(EWS or PNET), 11 lesions were extramedullary plasmacytoma(EMP), and 8 lesions were olfactory neuroblastoma(ON).There were 45 Non-SRCMT, of which 28 lesions were squamous cell carcinoma(SCC) and 17 lesions were adenoid cystic carcinoma(ACC).The mean ADC value of SRCMT[(0.66 ± 0.12) × 10-3mm2/s] was significantly different (t=14.97, P＜0.01) from Non-SRCMT [(1.02± 0.16)× 10-3mm2/s].All of 7 kinds of SRCMT were divided into 3 groups according to ADC values: NHL,MM, NEC,EMP;RMS,EWS,PNET;ON.There was statistically significant difference among all 3 groups(F=39.743, P＜0.01), and the differences between any 2 groups were still statistically significant.The area under the ROC of ADC values diagnosing SRCMT was 0.975.Compared with pathological results, an ADC value of 0.82 × 10-3mm2/s was used as the threshold for diagnosing SRCMT with a sensitivity of 97.8％ (44/45),specificity of 89.8％(88/98), and accuracy of 92.3％ (132/143).ADC value had high correlations compared with pathological results (Kappa value was 0.831).Conclusion The ADC value is a non-invasive imaging parameter that can be used to effectively assess SRCMT of nasal and paranasal sinus.

Objective To discuss the feasibility, safety and validity of the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral traumatic pseudoaneurysm (TPA). Methods During the period from June 2012 to April 2014, a total of 8 patients with peripheral TPA were admitted to the Department of Vascular and Endovascular Surgery of Shanghai Changzheng Hospital . The clinical data were retrospective analyzed. The lesions were located at the common carotid artery (n=4), vertebral artery (n=1), subclavian artery (n=1) and superficial femoral artery (n=2). On the basis of acute and chronic TPA classification and different therapeutic principles, endovascular repair with ViabahnTM self-expanding covered stent was employed in 8 patients. Intraoperative angiographic findings, the size and number of the implanted stent, and the immediate angiographic results after stent implantation were recorded. All the patients were followed up to evaluate the improvement of the symptoms, the effectiveness of the repair of TPA cavity, and the occurrence of endoleak or restenosis. Results Successful implantation of ViabahnTM self-expanding covered stent was accomplished in all 8 patients, with a technical success rate of 100%. Angiography performed immediately after stent implantation showed that complete repair of TPA cavity was obtained in all patients, the distal segment of the parent artery was patent, and no endoleak was observed. The sizes of the stent used in the patients were 8×50 mm (n=2) and 9×50 mm (n=2) in common carotid artery, 6×50 mm (n=1) in vertebral artery, 11×100 mm (n=1) in subclavian artery, and 8×100 mm (n=2) in superficial femoral artery. The patients were followed up for 6-30 months (mean of 14.3 months), and the clinical symptoms disappeared in all patients. CT angiography indicated that there was no endoleak or restenosis. Conclusion Based on the different therapeutic principles, the use of ViabahnTM self-expanding covered stent in endovascular repair of peripheral TPA is technically simple and micro-invasive, and clinically feasible with reliable effect and safety. Therefore, this technique can be employed as a first-line therapy option for peripheral TPA.