ObjectiveTo present the experience of microsurgery for giant sellar region tumor via supraorbital pterional approach. Methods Eighteen patients with giant sellar region tumor were treated microsurgically ,There were 7 pituitary adenomas, 8 craniopharyngiomas, 1 germinoma, 1 meningioma and 1 teratoma.ResultsTumor was totally removed in 12 cases,subtotally removed in 6. The patients were followed up with a period of 4 to 23 months,good recovery was achieved in 12 cases,moderate in 3,severe deficit in 1,1 patient died 16 days after operation. ConclusionSupraorbital pterional approach offers an excellent expposure to sellar region tumor and its surrounding structures. Microsurgical techniques play a great role in tumor removing and preserving hypothalamic function during operation.

OBJECTIVE To monitor disinfection effectiveness at medical care units in Dongcheng District,Beijing,and therefore,analyze the existing problems in the process and how to solve them.METHODS Air monitoring was conducted by means of plate vessel exposure,hands and article inspection by daubing,steamed pressure disinfection by biological-bacterial piece examination and the using disinfection liquid was examined by fixed suspended liquid tests from Jan to Nov 2005.RESULTS After monitoring and inspecting 23 hospitals,103 clinics,etc,the results showed the disinfection effectiveness was of significant variety.CONCLUSIONS Medical workers should be trained about knowledge related to disinfection and medical management and disinfection control should be strengthened.

Objective To evaluate the effects of traspupillary thermotherapy (TTT) for the treatment of central exudative chorioretinopathy (CEC). Methods Twelve eyes of 12 patients who suffered from CEC were treated by using a diode laser at 810 nm. A variable spot size of 0.5 mm 2 0 mm was used depending on the size of choroidal neovascularization (CNV).The treatment was initiated in one spot for 55 to 60 seconds duration at a power range between 200 350 mW, and the treated area revealed no visible color change to a light gray appearance. Preoperative and postoperative fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed in 10 of the 12 eyes. Results The visual acuity in all eyes was improved to different degree over a period of 3 10 months. Five or more lines improvement measured by Snellen chart in visual acuity was found after the treatment in 4 eyes, three to five lines in 5 eyes and one to two lines in 3 eyes. All eyes demonstrated decreased or vanished exudation in FFA. CNV disappeared or decreaced in 8 eyes and remained nochange in 2 eyes in ICGA. Conclusion TTT is obviously effective in treating CEC.

Objective To summarize the clinical outcomes after the optimization of nutrition support in elderly patients after hepatic carcinoma surgery.Methods The clinical data of 52 elderly patients with hepatic carcinoma in Beijing Hospital were collected and analyzed from 2007 to 2009(research group).Nutritional Risk Screening(NRS)2002 was applied for the nutrition risk screening at admission.NRS 2002 score≥3 was regarded as at nutritional risk.Enteral nutrition(EN)or EN combined with parentoral nutrition(EN+PN)supports were provided during the peri-operative stage.The control group included 30 patients from 2005-2007 under the same conditions with rescareh group but only received PN supports pest-operatively.Nutritional parameters,complications,lengh of hospital stay,and healthcare expenditures were analyzed.Results Body weight and plasma albumin were no significantly different in two groups(P>0.05)by the 7th post-operative day.The incidence of infection-relatod complications and length of hospital stay were significantly lower in research group than in control group (P<0.05).Conclusions Nutrition risk screening should be performed for the elderly patients with hepatic carcinoma after admission.Optimization of peri-operative nutrition support can reduce complications and improve the clinical outcomes.

Objective To investigate the safety and efficacy of structured triglycerides in parenteral nutrition in elderly patients with acute biliary tract infection.Methods 62 elderly patients with acute biliary tract infection under conservative therapy were randomly divided into structured triglycerides (ST) group and medium-chain triglycerides plus long-chain triglycerides (MCT/LCT) group.Patients underwent parenteral nutrition for 5 days.Levels of hepatic enzymes,blood triglycerides,nitrogen balance,fasting blood insulin and glucose were compared between the two groups after 5 days of parenteral nutrition.Results There were no significant differences in levels of hepatic enzymes,blood triglycerides and fasting blood glucose between ST group and MCT/LCT group.Plasma total bilirubin (T-Bill) levels were increased in the two groups,and T-Bill level dropped faster in the ST group than in the MCT/LCT group after 7 days of parenteral nutrition(P＜ 0.05).The difference in total cholesterol level dropping was significant between ST group and MCT/ LCT group (P＜0.05).The cumulative nitrogen balance for 5 days had significant difference between ST and MCT/LCT groups [(4.7-±-2.2) g vs.(2.8±0.7) g,P＜0.05].STG group versus MCT/LCT group had less fluctuation of fasting blood insulin level after 1,4 and 7 days of parenteral nutrition.Conclusions In the acute phase of biliary tract infection in elderly patients,ST-based parenteral nutrition can provide energy and help maintain nitrogen balance,with a little fluctuation of fasting blood insulin level.Short-term nutritional support may have better tolerance in the liver and has little effect on the change of hepatic enzymes.

Objective:To assess the nutritional status of obese patients prior to bariatric surgery, and to explore the related factors of nutrient deficiency.Methods:Clinical data of 43 patients with obesity who underwent bariatric surgery at Beijing Hospital from Jan. 2011 to Dec. 2017 were retrospectively analyzed. Gender, age, BMI, body composition analysis data, blood test data of nutrients were collected. The software of SPSS 20.0 was used to conduct data analysis.Results:Nutrients deficiencies were found for vitamin D (100.0%), iron (26.1%), prealbumin (15.4%) and hemoglobin (7.0%). Hemoglobin, prealbumin, and serum iron levels were significantly higher in male patients than in female patients ( P=0.001, 0.000 and 0.001, respectively). Body fat percentage was negatively correlated with 25 hydroxyvitamin D ( r=-0.983, P=0.017), and positively correlated with serum sodium ( r=0.568, P<0.001). Conclusions:Obesity patients were presented with a variety of nutritional deficiencies before bariatric surgery. A comprehensive nutrients test should be performed before bariatric surgery, to detect and correct nutrient deficiencies preoperatively.

Objective To systematically evaluate the clinical efficacy of bariatric surgery for elderly (age ≥ 60 years) or nonelderly (age ＜60 years) obese patients.Methods Literatures were researched using PubMed,Embase,Cochrane Library from January 2006 to June 2016 with the key words including bariatric surgery,metabolic surgery,gastric bypass,gastric band,sleeve gastrectomy,biliopancreatic diversion,elderly,aged,over 60 years.The cohort study about clinical efficacy of bariatric surgery for elderly or nonelderly obese patients were received and enrolled,and surgical procedures were unrestricted.Patients with age ≥ 60 years and with age ＜60 years were respectively allocated into the elderly group and nonelderly group.Two reviewers independently screened literatures,extracted data and assessed the risk of bias.Count data were described as odds ratio (OR) and 95％ confidence interval (CI).The heterogeneity of the studies was analyzed using the I2 test.Results Eleven retrospective studies were enrolled in the Meta analysis,and the total sample size was 9 913 patients,including 792 in the elderly group and 9121 in the nonelderly group.The results of Meta analysis showed that there were no statistically significant differences in the early mortality,incidence of postoperative early complication,remission rates of postoperative diabetes,postoperative hypertension,dyslipidemia and obstructive sleep apnea syndrome between elderly group and nonelderly group (OR =3.31,1.94,1.00,0.61,0.99,1.40,95 ％ CI:0.86-12.77,1.01-3.74,0.66-1.50,0.34-1.10,0.42-2.29,0.72-2.72,P＞0.05).Conclusion The safety and clinical efficacy of bariatric surgery in the elderly obese patients are equivalent to that of nonelderly patients.

Objective Summing up and analyzing outcome and influencing factors following thymectomy in patients with ocular myasthenia gravis tries to provide clinical evidence for an option of the treatment modalities.Methods From May 2007 to November 2014,thymectomy was performed in 129 patients with ocular myasthenia gravis consisting of 110 patients by Video-assisted thoracoscopic surgery(VATS) and 19 by partial sternotomy.Follow-up information was obtained by outpatient visit and telephone contact.The outcome evaluation after thymectomy was classified into full remission,partial remission,unchanged and deteriorated.Statistical analysis was done using x2 test and Cox regression model.Results There was no perioperative death.Seven(5.4％) postoperative complications occurred and cured after treatment.Follow-up was complete in 123 patients(95.3％) and the mean duration of follow-up was 49(range 21-99) months.Surgical outcome revealed full remission in 40 patients,partial remission in 68,unchanged in 9 and deteriorated in 6 patients.Response(full remission and partial remission) rate was 87.8％ and no benefit(unchanged and deteriorated) rate was 12.2％.Four of 6 patients in deteriorated condition progressed into generalized myasthenia gravis(3.3％).The significant difference was noted in 24 months or less of preoperative clinical duration (P =0.004) and thymic hyperplasia (P =0.001) in postoperative pathology among the full remission,partial remission and no benefit group.On the other hand,there was no statistical difference in sex,age,symptoms,comorbidities,preoperative taking acetylcholinase inhibitor,corticosteroid,surgical approach,and associated thymona among the three groups.Multivariate Cox regression analysis also demonstrated that a preoperative duration of symptoms 24 months or less and postoperative histology being thymic hyperplasia favourably influenced the outcome.Conclusion The role of thymectomy in patients with ocular myasthenia gravis can relieve symptoms effectively and avert or decrease the potential development of generalized symptoms.Thymectomy,which has a low postoperative mortality and morbidity,may be a first-line option of the therapeutic armamentarium to treat ocular myasthenia gravis.Thymectomy via VATS has clinical advantages of minimal trauma,less pain,fast recovery,and the comparable clinical results over via the traditional sternotomy.Therefore,this procedure deserves to be advocated for ocular myasthenia gravis.

Objective To compare the clinical effects of lobectomy by single utility port video-assisted thoracoscopic surgery (SP-VATS) and video-assisted mini-thoracotomy(VAMT) for treating early-stage non-small cell lung cancer(NSCLC) .Methods 286 patients with early-stage NSCLC in our hospital from October 2010 to October 2012 were randomly divided into the SP-VATS group(n=150) and the VAMT group(n=136) ,and received lobectomy and lymph node dissection by SP-VATS and VAMT re-spectively .The operative time ,intraoperative blood loss ,chest drainage duration ,postoperative total drainage volume ,lymph node dissection number ,postoperative complications and postoperative pain were compared between the two groups .Results The two groups were smoothly performed the operation .There was no perioperative death .The operative time ,lymph node dissection num-ber and postoperative complications showed no statistically significant difference between the two groups (P>0 .05) .However ,intr-aoperative blood loss ,postoperative total drainage volume ,chest drainage duration and postoperative pain scores (postoperative 1 -3 d) in the SP-VATS group were less than those in the VAMT group ,the differences showed statistical significance (P<0 .05) . The incidence of complications in the two groups showed no statistically significant difference (P>0 .05) .Conclusion SP-VATS lo-bectomy for treating NSCLC is safe and reliable with less injury and rapid postoperative recovery compared with VAMT .SP-VATS lobectomy may be as a preferred surgical mode for early-stage NSCLC .

OBJECTIVETo find a sensitive index of early injury of the nervous system in lead-exposed workers and to provide a scientific basis for establishing an efficient occupational health surveillance route.

METHODSA total of 317 lead-exposed workers (blood lead levels: 26.90∼ 912.80 µg/L, determined with the atomic absorption spectrum) were divided into four groups according to the normal blood lead level (201 µg/L), acceptable upper limit of blood lead (400 µg/L), and diagnostic value (600 µg/L). The motor nerve conduction function was examined and analyzed by one-way ANOVA.

RESULTSThe distal latency and amplitude of the median nerve were significantly different between groups. The median distal latency of the highest blood lead group (>600 µg/L) was 3.63 ms, which was significantly longer than the average level (3.30 ms), and the median nerve amplitude of the highest blood lead group was 5.63 µV, significantly lower than the average level (7.27 µV). No significant difference was found between different groups in motor conduction velocity. Significant difference was found in ulnar nerve amplitude between groups. The ulnar nerve amplitude of the highest blood lead group was 4.31 µV, significantly lower than the average level (4.87 µV). No significant differences were observed in other parameters between groups.

CONCLUSIONThe distal latency and amplitude of the median nerve can be used as a sensitive index for the diagnosis of early subclinical motor nerve injury in lead?exposed workers.

Adult ; Humans ; Lead ; blood ; Lead Poisoning ; blood ; physiopathology ; Neural Conduction ; drug effects ; Occupational Exposure