Objective To provide the anatomical data for single-nostril transsphenoidal microsurgery for pituitary adenoma.Methods Microanatomic structures were observed and measured in 20 cadaveric a- dults heads.Results(1)The diaphragmal opering was 5 mm or greater broad in 90%.The mean thick- ness of the diaphragma sellae was (0.18?0.08)mm.(2) A sphenoid sinus with complete pneumatization was named as all-sellae type,its percentage in all specimens was 85%,85% sphenoid sinus had middle sep- tum of which only 18.8% located in the medial sagital section.(3)The meant thickness of the sellar floor was (0.81?0.34) mm,70% of which were not more than 1 mm.Of the sellar floors,that the shape was flatness reach 15%.(4) The relationship between ICA and sphenoid sinus had two aspects,one was to be mutually apart (55%),the other was to communicate (45%),which formers carinae on the lateral wall of the sphe- noid sinus,espeially in the superior surface of posterior part.The relationship between optic nerve and sphe- noid sinus,one was to be mutually apart (27.5%),the other was to communicate (72.5% ),which formers carinae on the lateral wall of the sphenoid sinus,especially in the superior surface of anterior part.(5) Three main types of the intercavernous sinus were the anterior intercavernous sinus,present in 80%,the inferior in- tercavenous sinus (25%),and the posterior intercavenous sinus (15%).Conclusion The knowledge of the anatomy of the sellar region and sphenoid sinus is helpful to safe operation in the single-nostril transsphe- noidal approach for pituitary,adenoma microsurgery.

OBJECTIVETo explore the relation between the expressions of PD-ECGF and VEGF and the evolution of capillary hemangioma, so as to provide theoretical basis for treatment.

METHODSFourty cases with capillary hemangioma, proved by pathologic method, were randomly selected and divided into proliferative (n=22) and involuted groups (n=18), according to the Mulliken standard. 8 specimens from 8 children with prepuce operation were used as control group. All the specimens were fixed, embedded and underwent HE staining. The expression of PD-ECGF, VEGF and CD34 in endothelial cells were detected by immunohistochemistry. The microvessel-density (MVD) was also calculated. The results were analyzed by SPSS12.0.

RESULTSThe positive expression rates of PD-ECGF and VEGF were 95.45% (21/22) and 86.36% (19/22) in proliferative hemangioma, 77.78% (14/18) and 66.67% (12/ 18) in involuted hemangioma, 37.50% (3/8) and 37.50% (3/8) in normal skin. MVD in proliferative and involuted hemangioma and normal skin was 93.68 +/- 20.56, 51.94 +/- 20.73 and 17.50 +/- 5.30, respectively. There was a significant difference in PD-ECGF expression and MVD between the proliferative and involuted groups, or between the hemangioma and control groups (P < 0.05). The VEGF was significantly different between the proliferative and involuted groups, or between the proliferative and control groups (P < 0.05), but not between the involuted and control groups (P > 0.05). The expression of VEGF, PD-ECGD and MVD showed a positive relationship.

CONCLUSIONSPD-ECGF and VEGF have a synergetic effect in the proliferation of micro-vessels. PD-ECGF may enhance the activity of thymidine phosphorylase. They play an important role in the proliferation and involution of hemangioma.

Child, Preschool ; Female ; Hemangioma, Capillary ; metabolism ; pathology ; Humans ; Infant ; Male ; Neoplastic Syndromes, Hereditary ; metabolism ; pathology ; Thymidine Phosphorylase ; metabolism ; Vascular Endothelial Growth Factor A ; metabolism

Objective To observe the pathologically regressive changes of rat models of Parkinson's disease (PD) induced by Lactacystin (Lac), and to investigate the pathogenesis of PD.Methods Totally 32 SD rats were randomly divided into 2 groups: test group and control group. Lac, a selective proteasome inhibitor, was unilaterally injected stereotaxically into the left substantia nigral pars compacta (SNc) of rats. Equal volume of saline was injected in control group. On day 1, 3, 5, 7, 9, 11, 14 and 21 post-in jection, we observed the behavioral changes of the rats and pathological changes in substantial nigra and striatum, and detected the expressions of tyrosine hydroxylase (TH) and α-synuclein by immunohistochemistry (IHC) and HE staining and the expressions of their mRNA by RT-PCR. Results Behavioral changes were found in the rats of test group. By HE staining, after Lac-treatment, microglia was increased on the 1st day (3501.92±57.32), 4895.50±52.67 on day 7, 5340.18±52.87 on day 21 (P<0.05 vs control group 3271.23±63.76). By IHC, after Lac-treatment, the test group manifested retrograde dopaminergic neuron degeneration in nigra; the number of neurons was 568.57±36.39 on day7 and 119.67±21.06 on day 21 (P<0.05 vs control group 679.76±30.24). By IHC, after Lac-treatment,expression of TH-positive nerve fiber in left striatum was decreased on day 7, being 0.1953±0.0076 (P>0.05 vs control group 0.2412±0.0067); it was 0.0781±0.0013 on day 21, significantly different from control group 0.2412±0.0067 (P<0.05). Meanwhile, in the test group, the detection of mRNA expression displayed that TH neurons were reduced, while α-synuclein mRNA was accumulating in survival TH neurons. Conclusion Pathological changes in PD models induced by lactacystin are retrograde along with time going on, and consistent with the characters of delitescence and slow progressions in PD.

Objective To investigate the effect ofplatelet-derived growth factor (PDGF) and conditional medium of U87 glioma cells on the migration ability of human mesenchymal stem cells (hMSCs) to understand the possible role of PDGF in the directional migration of hMSCs toward gliomas. Methods hMSCs were isolated from the whole bone marrow by adherent culture, and the expression of PDGF receptor (PDGFR-α, β) in the cells was examined by RT-PCR. In vitro migration assay was performed using transwell inserts to observe the effect of PDGF (0, 5, 50, and 125 ng/mL) and the conditional medium on the directional migration ability ofhMSCs. The changes in the migration ability of hMSCs in response to addition of anti-PDGF antibody in the conditional medium were investigated. Results RT-PCR detected the expression of PDGFR- αand PDGFR-β mRNA in the isolated hMSCs. In the cell migration assay, both PDGF and the conditional medium induced directional migration of hMSCs (P<0.05), which was significantly suppressed by anti-PDGF antibody P<0.05). Conclusion With chemokine-like activities, PDGF concentration-dependently enhances the directional migration of hMSCs toward gliomas in vitro.

Objective To construct and identify a recombinant baculovirus transfer vector of mouse conserved dopamine neurotrophic factor (mCDNF): pFastBacHTb-mCDNF. Methods Mouse total RNA was isolated by using Trizol reagent, and then, first-strand cDNAs were synthesized by reverse transcriptase. Overall length of CDNF (564 bp) was amplified by two rounds of PCR introducing appropriate restriction sites (BamH Ⅰ, Xho Ⅰ). The PCR products were cloned into pGEM-T vector and sequenced to confirm PCR fidelity. The mCDNF was sub-cloned into pFastBacHTb vector to create pFastBacHTb-mCDNF vector, then the vector was transferred into the E. coli DH5α competent cells. The clone was selected using amicillin resistance and then this vector was sequenced and identified by double digests. Results Agarose gel electrophoresis after RT-PCR showed a 564 bp band being consistent with the anticipation size. Positive clone of pGEM-T-CDNF was screened by blue/white and antibiotic resistance selection. Recombinant plasmid pGEM-T-mCDNF was identified by PCR and sequence.Recombinant plsmid pGEM-T-mCDNF and pFastBacHTb vector were cut by BamH Ⅰ and XhoⅠ restriction enzyme, and then, recombinant plasmid pFastBacHTb-mCDNF was constructed and successfully identified by double digestion of Xho Ⅰ and BamH Ⅰ restriction enzyme or single digestion of BamH Ⅰ, PCR and sequence. Conclusion We successfully constructe the recombinant baculovirus transfer vector pFastBacHTb-mCDNF, laying the foundation for further research of this neurotrophic factor.

Objective To study the co-expressions of human glioma transcription factor (Nanog gene) with brain tumor stem cell marker (CD133) and glioma differentiation marker (GFAP), and demonstrate the significance of Nanog gene in the development of glioma. Methods The double-labeled of Nanog/CD133 and Nanog/GFAP were detected by immunohistochemical double staining in 60 cases of human gliomas (19 with grade Ⅱ, 23 with grade Ⅲ and 18 with grade Ⅳ according to WHO 2000 classification of nervous system tumors). The percentages of Nanog+ cells, CD133+ cells,GFAP+ cells, Nanog+/CD133+ cells and Nanog+/GFAP+ cells in glioma tissues of different grades were calculated and compared. Results The percentages of Nanog+, CD133+, and Nanog+/CD133+ cells in different pathological levels of gliomas were significantly different (P＜0.05), and the expressions of Nanog+, CD133+, and Nanog+/CD133+ in gliomas of grade Ⅲ and Ⅳ were significantly higher than those in glioma of grade Ⅱ (P＜0.05). The Nanog+ expression and CD133+ expression were positively correlated (r=0.904, P=0.000), and the Nanog+/CD133+ expression and CD133+ expression were positively related too (r=0.823, P=0.000). The percentages of GFAP+ cells in different pathological levels of gliomas were significantly different (P＜0.05), and the expression of GFAP+ in gliomas of grade Ⅲ and Ⅳ were significantly higher than that in glioma of grade Ⅱ (P＜0.05). No statistical significance of percentage of Nanog+/GFAP+ cells was noted in different pathological levels of gliomas (P＞0.05).Conclusion The Nanog gene and stem cell marker CD 133 has a significant correlation, and they enjoy significant co-expressions in cellular level. Nanog gene may be a marker of glioma stem cells, and plays a vital role in maintaining the cancer stem cells under the undifferentiated state.

Objective To investigate the efficacy and safety of staged bilateral thalamus and globus pallidus stereotactic lesioning in patients with idiopathic Parkinson's disease (PD). Methods Nineteen PD patients,admitted to our hospital from February 1998 to May 2008 and received staged bilateral thalamus and globus pallidus stereotactic lesioning under the stereotactic microelectrode-guidance,were chosen in our study; 16 of them had a primary operation with ventral intermediate (Vim) stereotactic lesioning,and other 3 had globus pallidus-intemal segment (Gpi)stereotactic lesioning; second-staged operation with contralateral Gpi and small focal of Vim nucleus stereotactic lesioning was performed on all patients.The unified Parkinson disease rating scale (UPDRS)was used to estimate the "switch-on" and "switch-off" states of each patient before operation and 1 week after operation.The improvement of symptoms and the happening of complications after the operation were analyzed. Results Improvements were observed in all the 19 patients postoperatively in terms of stiffness and tremor.Stiffness was significantly alleviated after lesioning of Gpi,and tremor was markedly relieved after the Vim nucleus small focal lesioning.Two patients had dysarthria postoperatively,and 1 of them had dysphagia; the symptoms were alleviated 3 months after the operation. Conclusion Staged bilateral thalamus and globus pallidus stereotactic lesioning is a safe and effective surgical treatment for PD patients with bilateral severe symptoms.Controlling the indications and the size of lesioning strictly,and selecting the targets appropriately are of vital importance to the operation.

Objective To discuss the common complications of single-nostril transsphenoidal surgery for pituitary adenomas, and the prevention ofpostsurgical complications. Methods Clinical and follow-up (1-36 months) data of 241 patients with pituitary adenomas treated with single-nostril transsphenoidal surgery were collected and analyzed retrospectively by EXCEL software with regard to the patients' sex, age, tumor dimension and quality, postsurgical complications, and so on. Results Total removal of tumors was achieved in 171 (71%) cases, subtotal removal in 28 (11.6%), most removal in 26 (10.7%), and partial removal in 16 (6.6%). After the operation, 38 (15.8%) cases were found with transient diabetes insipidus, 12 (4.9%) cases with worse sight, 4 (1.6%) with cerebrospinal fluid rhinorrhea, 2 (0.8%) with unilateral oculomotor paralysis, and 2 (0.8%) with anterior pituitary insufficiency; during the operation, there were 2 (0.8%) cases with severe cavernous sinus hemorrhage, 2(0.8%) with nasoseptal perforation, no internal carotid artery injuries or death. Conclusions Though the damage of single-nostril transsphenoidal surgery for pituitary adenomas was small, there were a few complications. In order to prevent the complications and reduce the mortality, we should be familiar with the regional anatomy and better master the surgical skills, meanwhile, clinical experience is also very important in improving the therapeutic efficacy.

Objective To study the variational features of the brainstem auditory evoked potential (BAEP) and the preservation of the facial and auditory nerves during the microsurgery in patients with acoustic neuromas (AN). Methods We retrospectively analyzed the data of 76 patients with AN, admitted to our hospital fi'om May 2006 to May 2009: preoperative BAEP were examined; the peak latency (PL) of Ⅰ, Ⅲ and Ⅴ waves and their interpeak latency (IPL) were noted and compared. The tumors were microsurgically removed under intraoperative electrophysiologic monitoring to preserve the facial and auditory nerves. The relationships between the preservation of facial and auditory nerves and both the tumor size and the utilization of intraoperative monitoring were discussed. Results Before the operation, the 100% abnormal rate of BAEP was showed on the diseased side with the disappearance of Ⅲ and Ⅴ waves as its main features, while 82.9% (63/76) of that was noted on the contralateral side with the IPL ratio of Ⅲ-Ⅴ / Ⅰ-Ⅲ greater than or equal to 1 as its main features; the BAEP features between the 2 sides had statistical significance (P<0.05). Seventy patients (92.1%) were found abnormal of BAEP on the contralateral side during the operation; the BAEP features of the contralateral side had statistical significance between preoperation and intraoperation (P<0.05). The tumors were totally removed in 69 (90.8%), subtotally removed in 6 (7.9%) and partially removed in 2 (1.3%). The preservation of facial and auditory nerves increased obviously through monitoring the response of BAEP during the surgery and a positive correlation was observed between the preservation of facial and auditory nerves and the response of BAEP in the contralateral side(r=0.912, P=0.000; r=0.613, P=0.000). However, an inverse correlation was observed between the preservation of facial and auditory nerves and the size of AN (r=-0.869, P=0.000; r=-0.738, P=0.000). Conclusion Preoperative BAEP can help to make an exact diagnosis on patients with AN and the preservation of facial and auditory nerves can increase obviously through monitoring the normal response of BAEP during the surgery. The anatomy preservation of facial and auditory nerves depends on the size of AN.

Objective To discuss the common complications of large acoustic neuromas performed surgery via suboccipital retrosigmoid approach under neurophysiological monitoring, and the prevention of postsurgical complications. Methods One hundred and sixteen patients with large acoustic neuromas, admitted to our hospital from May 2006 to April 2010, were performed surgery via suboccipital retrosigmoid approach under neurophysiological monitoring; clinical data and follow-up data (3-12 months) of these patients were collected and analyzed retrospectively; the influence of tumor dimension on short- and long-term postoperative complications after the surgery were compared.Results Total tumor resection was achieved in 107 patients, subtotal resection in 7 patients, and partial resection in 2 patients. After the operation, the facial nerve was preserved anatomically in 101 patients (87.07%); and the functional valuation of facial nerve according to postoperative House-Brackman showed 89 patients (76.72%) in grade Ⅰ-Ⅱ, 13 patients (11.21%) in gradeⅢ-Ⅳ and 14 patients (12.07%) in grade Ⅴ-Ⅵ. Short-term postoperative complications included hoarse voice in 16 patients and herpes catarrhalis of injured side in 20 patients. Long-term postoperative complications included loss of hearing (n=83) and permanent facial paralysis (n=23). Patients with tumor dimension larger than 5 cm had a significantly higher incidence of short-term postoperative complications than those within 3-5 cm (P< 0.05). No patient died. Conclusion The keys to avoiding the complications are to master the clinical anatomy of the approach, accumulate surgical experiences, preoperatively study the individual imaging and clinical data, and use intraoperative nerve monitoring.