Objective To study imageology anatomy concerned of sellar turica and explore its potential role on growth of pituitary adenomas. Methods According to classification of sinus sphenoidalis,103 normal imageology data of sellar turica region were analyzed, including 83 cases with entire saddle type sinus sphenoidalis and 20 cases anti-saddle type sinus sphenoidalis. Furthermore, the clinical data of 45 cases of pituitary adenomas with extension into sinus sphenoidalis were retrospectively studied. Results The relationship between sellar floor's shapes and sinus sphenoidals'types was that the larger the sinus sphenoidalis was, the deeper the floor was(98.8%). The relationship between sellar floor's shapes and the superior surface of hypophysis was that most of depressed sellar floors were companied with depressed superior surfaces of hypophysises(93.8%). The anteroposterior shapes of sellar turica in midsagittal can be divided into 4 types such as bag-type, kettle-type, tube-type, and sifter-type. 45 patients suffering from pituitary adenoms with extension into sinus sphenoidalis all had entire saddle type sinus sphenoidalis. Conclusions The imageology anatomy concerned of sellar turica could explain the phenomena of pituitary adenomas with extension toward sellar floor and sinus sphenoidalis. Referring to the literatures concerned, it indicated that the imageology anatomy was the key factor of affecting the growth of pituitary adenomas.

Objective:To analyze long-term therapeutic effect and safety of warfarin anticoagulant therapy of differ- ent intensity on aged patients with nonvalvular atrial fibrillation (NVAF). Methods:According to age,a total of 197 NVAF patients followed up for five years were divided into advanced aged group [n=65,≥80 (85.00±2.09) years],aged group [n=75,65-79 (76.50±2.27)years]and middle-aged group [n=57,<65 (57.40±2.18) years].All enrolled patients received long-term warfarin anticoagulant therapy,advanced aged group and aged group received low intensity anticoagulation,international normalized ratio (INR)was 1.6~2.5,while middle-aged group received standard intensity anticoagulation and the INR was 2.0~3.0. Thrombus events and incidence rates of hemorrhage etc.over five years were compared among three groups,and the safe dose range of warfarin was ex- plored.Results:During five-year follow-up,no acute cerebral infarction occurred in three groups.The bleeding and other adverse reaction among three groups were no significant difference (P>0.05).Compared with middle- aged group,there were significant reductions in warfarin dose [(3.29±0.49)mg/d vs.(2.95±0.38)mg/d,(2.85 ±0.49)mg/d],INR [(2.54±0.43)vs.(2.20±0.29),(2.16±0.32)]and CHA2DS2-VASc [(3.02±0.89) scores vs.(2.64±0.77)scores vs.(2.33±0.48)scores]in aged group and advanced aged group,P<0.01 all;but there were no significant difference between aged group and advanced aged group (P>0.05).There were no signif- icant difference in incidence rates of mild hemorrhage (21.1% vs.14.7% vs.24.6%)and severe hemorrhage (1.8% vs.1.3% vs.1.5%)among middle-aged group,aged group and advanced aged group,P>0.05 all.Conclu-sion:When INR is closely monitored,INR controlled within 1.6-2.5 warfarin anticoagulation is safe and effective for in aged patients with nonvalvular atrial fibrillation.

Objective To systematically evaluate the study of animal surgery course among medical students with different majors and languages so as to provide evidences for further improve-ment education quality. Methods Ten majors and two kinds of international medical students (in total of 1 105 students;2009 grade)of Southern Medical University were subdivided into five groups ac-cording to the relationship with clinical operative manipulation. Quality of experimental animal surgery education was tested respectively. Then SPSS 13.0 was used to statistically evaluate and analyze the data. Measurement data between two groups were compared by t-test,multi-group analysis of variance between groups was conducted using one-way ANOVA. Ranked data between groups were compared using non-parametric Mann-Whitney U rank sum test. Merits and demerits of the curriculum were dis-cussed by combing statistical results with in-class condition to provide evidences for further improve-ment. Results There was no significant difference between clinical group and clinical professional group in aseptic technique and operation skills (P=0.739),but scores of the two groups were signifi-cant higher than that of associate group (P=0.004). Moreover,scores of international students who passed Chinese TOEFL were significant higher than the others (P=0.001). Differences between groups existed predominantly in the animal surgical practice rather than in basic theory or knot and sterilized methods. Conclusions For students with different majors and languages,different teaching key points should be paid attention to. Basic surgery techniques might be emphasized on for students with associ-ate clinical major and foreign students with poor Chinese language.

Objective: To explore the turnover and treament of postoperative remainder of giant nonfunctioning pituitary adenoma with suprasellar extension(SSE). Methods: The clinical data of 68 cases suffering from giant nonfunctioning pituitary adenoma with suprasellar extension(SSE)admitted into our department were retrospectively analyzed.These patients underwent primary transsphenoidal surgery. Results: Twenty cases had SSE adenomas totally removed(20.6%).In other 48 cases(79.34%)，SSE residues were shown in MRI recheck at one day after surgery.After 3 months，the 3rd MRI scanning was performed only to find that tumor residues descended to sellar floor in 21 cases,into intrasella in 8 cases，and down to the level of stalk hypophysial and the entrance to the sella in 3 cases.All of Patients with residual tumors received retranssphenoidal resection(the total removal rate of desending SSE residues was 96.9%).There were 2 cases with adenoma residues with slight descending.Obvious SSE adenomas were treated with transtranial approach.The twelve cases with small SSE residues were consecutively observed and two of them received gamma knife treatment because of unobvious postoperative visual improvement.The surgical mortality was 0%.There was no death during follow up in all of these patients.There were no cases with rhinorrhea.meningitis or visual deterioration.Two patients had supradiaphragmatic bleeding detected by routine postoperative CT. Conclusion: Staged surgery with two or multiple transsphenoidal resections is an appropriate treatment for giant nonfunctioning pituitary adenoma with supresellar extension(SSE)，with few complications.Futher study is warranted to investigate the growth pattern of pituitary adenoma.

Objective To investigate the correlation of short-term systolic blood pressure variability (SBPV) with esti?mated glomeruar filtration rate (eGFR) in the elderly. Methods In physical examination for the third time of kailuan group, the method of cluster sampling was used to collect randomly retired employees, age≥60 in kailuan group. The 24-hour am?bulatory blood pressure monitoring was given to these objects. Finally, 1 405 participants with integral data were recruited in?to the survey. SBPV indices were standard deviation of systolic blood pressure (SD), variability independent of the mean (VIM), maximum-minimum difference (MMD), and average real variability (ARV). Multivariate stepwise linear regression models were used to analyze the influence of short-term SBPV on eGFR. Results (1) Among 1 405 participants (67.16 ± 5.82) years, 933 individuals (66.4%) were male and 472 (33.6%) were female. (2) Study population were divided into four groups based on the 24-hour mean SBP, daytime mean SBP, night time mean SBP (group 1:mean SBP<120 mmHg, group 2:120≤mean SBP<140 mmHg, group 3:140≤mean SBP<160 mmHg, group 4:mean SBP≥160 mmHg), respectively. Values of SD, MMD and ARV, but not VIM were increased with increased mean SBP. (3) The participants were grouped according to the median SBPV with between-group comparison of the eGFR. The average eGFR levels were lower in the high 24-hour SB?PV group (SD, VIM, MMD and ARV), day-time SBPV group (SD, VIM, MMD and ARV) and night-time SBPV group (SD, MMD and ARV) than those in the low SBPV groups (P<0.05). (4) Multivariate stepwise linear regression showed that eGFR increased with 3 indices of 24-hour SBPV (SD, MMD and ARV) and 2 indices of day-time SBPV (MMD and ARV) but not for night-time SBPV (β=-0.07,-0.11,-0.07,-0.12 and-0.07, respectively). Conclusion There is a certain degree of asso?ciation between short-term SBPV indices and eGFR.

Objective: To analyze long-term therapeutic effect and safety of warfarin anticoagulant therapy of different intensity on aged patients with nonvalvular atrial fibrillation (NVAF). Methods: According to age, a total of 197 NVAF patients followed up for five years were divided into advanced aged group [n=65，≥80(85±2.09)years], aged group [n=75, 65-79(76.5±2.27) years] and middle-aged group [n=57, ＜65(57.4±2.18)]. All enrolled patients received long-term warfarin anticoagulant therapy, advanced aged group and aged group received low intensity anticoagulation, international normalized ratio (INR) was 1.6~2.5, while middle-aged group received standard intensity anticoagulation and the INR was 2.0~3.0. Thrombus events and incidence rates of hemorrhage etc. over five years were compared among three groups, and the safe dose range of warfarin was explored. Results: During five-year follow-up, no acute cerebral infarction occurred in three groups. The bleeding and other adverse reaction among three groups were no significant difference（P＞0.05). Compared with middle-aged group, there were significant reductions in warfarin dose [(3.29±0.49) mg/d vs. (2.95±0.38) mg/d, (2.85±0.49) mg/d],INR [(2.54±0.43) vs. (2.20±0.29), (2.16±0.32)] and CHA2DS2-VASc [(3.02±0.89) score vs.( 2.64±0.77) score vs.( 2.33±0.48) score]in aged group and advanced aged group, P＜0.01 all; but there were no significant difference between aged group and advanced aged group (P>0.05). There were no significant difference in incidence rates of mild hemorrhage (21.1% vs. 14.7% vs. 24.6%) and severe hemorrhage (1.8% vs. 1.3% vs. 1.5%) among middle-aged group, aged group and advanced aged group, P>0.05 all. Conclusion: When INR is closely monitored, INR controlled within 1.6~2.5, warfarin anticoagulation is safe and effective in aged patients with nonvalvular atrial fibrillation.

Objective To investigate the correlation of the supine hypertension (SP) with carotid intima-media thickness (IMT) in the elderly. Methods Kailuan study is a functional community-based cardiovascular risk factor study. From June 2006, there was a physical examination every two years. In the examination, demographic data, smoking, drinking, physical exercise situation and medication situation were recorded. Levels of triglyceride, high sensitivity C-reactive protein, low density lipoprotein and other biochemical indexes were observed. Using cluster random sampling, 3 064 retired employees of 60 years of age or older were selected. A total of 2 464 subjects took part in an additional examination, including the 24-hour ambulatory blood pressure monitoring, brachial-ankle pulse wave velocity, blood pressure of different positions and urine albumin. Multiple linear regression was used to analyze the correlation between supine systolic blood pressure (SBP) and IMT. Multivariate Logistic regression was used to analyze the effect of SP on IMT. Results (1) Among 2 220 participants (67.29±6.09) years, 1 463 (65.9%) individuals were male and 757 (34.1%) were females, and the average IMT was (0.92 ± 0.18) mm. (2) There was a positive correlation between supine SBP and IMT (r=0.175, P<0.01). (3) After adjusting the confounds, supine SBP was significantly associated with IMT, with an increase of 1 SD (+20.42 mmHg, 1 mmHg=0.133 kPa) in SBP corresponding to an increase of IMT by 0.01 mm (P<0.01). (4) Multiple Logistic regression analysis showed that after adjusting for sitting SBP, age, gender and other factors, SP was still a risk factor of increased IMT (OR=1.37, 95%CI:1.03-1.80), and independent of sitting SBP. Conclusion The supine hypertension is a risk factor of increased IMT, and independent of sitting SBP.

Objective To provide applied anatomic data for relevant operations of blood vessels of perisacral promontory(BVPSP). Methods The composition of BVPSP including origin, course, diameter of the middle sacral vessels, the distance between the sacral promontory and the sacral 1 transverse trunk were observed on 37 adult cadavers. Result The BVPSP is composed of the common and internal iliac vessels, the superior segment of the middle sacral vessels and the sacral 1 transverse trunk. Middle sacral artery comes from abdominal aorta. Middle sacral veins are thin walled without valves. The average diameter of middle sacral artery and vein is 1.02 mm and 2.53 mm respectively. The distance between the sacral 1 transverse trunk and the sacral promontory is 5.75 mm. Conclusion The composition of BVPSP, especially middle sacral veins, plentiful vascular anastomosis are the anatomical basis leading to massive hemorrhage in the relevant operations.

Objective To explore the distribution characteristics of plasma renin concentration in patients with hypertension and the possibly methodological problems.Methods The subjects including 361 patients with hypertension[male: 184 cases, average age: (45.16±13.74)years old;female: 177 cases, average age: (51.04±12.68) years old]and 187 apparent healthy individuals[male: 92 cases, average age: (46.74±13.17)years old;female: 95 cases, average age: (47.33±13.18) years old]were recruited from Departments of Healthy Check-up and outpatients for hypertension in Tangshan Gongren Hospital. The plasma renin concentration was detected by chemiluminescence-Immunoassay.Results The plasma renin concentration shows log-transformed normal distribution both in healthy group and hypertension group. The range of plasma renin concentration in hypertension group is from 0.05 to 574.07 pg/ml, while that in apparent healthy group is from 3.24 to 120.40 pg/ml. The plasma renin concentration in both groups is higher in male than female (Hypertension t=2.19,P=0.029;Healthy people t=2.85,P=0.005). The average concentration of plasma renin in hypertension group is slightly higher, and the width of density distribution is larger in comparison with healthy group although there is no significant difference between them. However, the percentage of plasma renin abnormality was 26.59% (96/361) in hypertension group with 13.85%(50/361)of low renin subtype and 12.74%(46/361)of high renin subtype ConclusionsThe plasma renin concentration measured by Chemiluminescence-Immunoassay can be used as an effective tool for hypertension screening.

Objective:To investigate the associations between the hormone receptors,Ki67 expression and response to neoadjuvant anthracycline-based chemotherapy in breast cancer patients.Methods:One hundred sixty-eight primary breast cancer patients received anthracycline-based neoadjuvant chemotherapy.The expression of estrogen receptor(ER),progesterone receptor(PR),and Ki67 were determined by immunohistochemistry assay in core-needle biopsy specimens prior to the chemotherapy,and pathologic response was assessed by Miller & Payne grade(G1 to G5).Results:40%(67/168)of the patients had a good pathologic response,defined as complete pathologic response(pCR or G5)and minimal residual disease(G4).Among the patients,20%(33/168)had a complete pathologic response(G5).ER or PR status was significantly associated with pathological response.Patients with PR-negative tumors had a higher pathological response rate or pCR than those with PR-positive tumors(17/67 vs 45/90,P=0.002;6/67 vs 25/90,P=0.003,respectively),whereas patients with ER-negative tumors had a higher pathological response rate than those with ER-positive tumors.Moreover,Patients with both ER-and PR-negative tumors exhibited a remarkable pathological response as compared with those with any single factor(36/17 vs 26/86,P=0.009).No association between Ki67 expression and pathological was found in this cohort of patients.There was a linear correlation between the expression of Ki-67,ER or PR status and pathologic response.Conclusion:There is a significant association between the hormone receptors and pathological response to neoadjvant anthracycline-based chemotherapy in breast cancer patients,and patients with PR-negative tumors are more likely to respond to chemotherapy.