Objective To explore the related high risk factors of hyponatremia after transsphenoidal approach for pituitary adenomectomy and to direct postoperative nursing. Methods The clinical data of seventy-seven patients suffering from pituitary adenomas with the way of treatment by transsphenoidal pituitary adenomectomy from June 2014 to May 2015 were summarized retrospectively. According to the value of postoperative serum natremia, the data were divided into hyponatremia group and non-hyponatremia group. The different data between the 2 groups were compared and the high risk factors related to hyponatremia were analyzed. Results Univariate analysis showed that gender(P=0.254) and high blood pressure(P=0.742) were unrelated to postoperative hyponatremia and there was significant difference between two groups in age (P=0.038), max- diameter of tumors(P=0.004), preoperative pituitary dysfunction (P=0.013), visual deficit (P=0.000), operative procedure duration (P=0.008) and diabetes mellitus rate (P=0.023). While Logistic regression analysis showed that preoperative visual deficit (OR=0.152,P=0.004,95%CI 0.043-0.542) and preoperative pituitary dysfunction (OR=0.069, P=0.046,95%CI 0.005-0.950) were independent factors for postoperative hyponatremia. Conclusions Hyponatremia is a common complication after transsphenoidal pituitary adenomectomy. The optimal treatment can benefit the early recovery and more careful nursing should be focused on these patients who are in high risk of postoperative hyponatremia.

BACKGROUND:The repair effects of bone marrow mesenchymal stem celltransplantation on brain injury were not ideal. Combined therapy with medicine and biological engineering materials is needed. OBJECTIVE:To investigate the effects of bone marrow mesenchymal stem celltransplantation and fingolimod immunosuppressants on memory function recovery in rats with brain injury. METHODS:A total of 60 healthy Sprague-Dawley rats were subjected to hydraulic shock with peak value of 253.312 5-303.975 kPa with a hydraulic head injury instrument so as to induce a model of severe hydraulic head injury. They were randomly divided into brain injury group, bone marrow mesenchymal stem celltransplantation group and fingolimod+bone marrow mesenchymal stem celltransplantation group. The Morris water maze test was tested at 21-28 days after PKH-26-labeled bone marrow mesenchymal stem celltransplantation. The PKH-26 immunofluorescence and hematoxylin-eosin staining were conducted in brain tissues at 4 weeks after brain injury. RESULTS AND CONCLUSION:At 4 weeks after transplantation, the average escape latency was gradual y decreased in each group. The average escape latency was shorter in the fingolimod+bone marrow mesenchymal stem celltransplantation group than in the bone marrow mesenchymal stem celltransplantation group (P<0.05), and significantly shorter than in the brain injury group (P<0.01). The number of times of crossing the platform and the percentage of swimming distance to total distance were higher in the fingolimod+bone marrow mesenchymal stem celltransplantation group than in the brain injury group and bone marrow mesenchymal stem celltransplantation group (P<0.05). The number of PKH-26-positive cells was significantly higher in the fingolimod+bone marrow mesenchymal stem celltransplantation group than in the brain injury group and bone marrow mesenchymal stem celltransplantation group (P<0.05). Results confirmed that bone marrow mesenchymal stem celltransplantation could apparently improve memory function of rats with severe brain injury. The combined application of fingolimod immunosuppressants has synergistic effects.

Extracellular vesicles (EV) miRNAs are a class of small non-coding RNAs that are encapsulated in membrane-containing vesicles from a variety of cells, and which can mediate intercellular communication and transfer of functional molecules. EV miRNAs in circulation can be served as novel molecular markers for cancer diagnosis, monitoring and prognosis, and also the most promising liquid biomarkers for clinical translation and utility currently, while optimal research strategy is crucial for identifying valuable EV miRNAs in clinical study. Moreover, EV miRNAs have recently also been implicated in cancer progression as direct regulators of metabolic reprogramming, mesenchymal-to-epithelial transition, angiogenesis, anti-cancer immune response and drug resistance in the tumor microenvironment. Study on some key EV miRNAs involving in those processes may highlight their potential utility as liquid biopsies in early diagnosis, companion diagnosis, metastasis, therapeutic control, prognosis analysis as their therapeutic potential for patients with cancer.

Seven cases exhibited segmental bile duct dilation with filling defects. One case only showed dilatation of lobar bile ducts. Conclusion MRI features of IPNB are helpful for distinguishing IPNB from other hepatic lesions.

Pregnancy-associated plasma protein-A (PAPP-A),a high-molecular-weight zinc-binding metrix metalloproteinase,is expressed abundantly in the ruptured atherosclerostic plaque. PAPP-A can be used as a novel biological marker of plaque instability and cardiovascular events in patients with acute coronary syndrome. However,the role of PAPP-A in iscbemic stroke remains unclear. This article reviews the value of VAPP-A in predicting the risks of ischemic stroke events.

The birth rate of very low birth weight(VLBW)is rising year by year,and its survival rate increases with developing of modern methods of neonatal intensive care.The outcomes of VLBW have become a social concern.VLBW have different brain structure compared with term children,mainly in the reduction of brain volume.including the reduction of gray matter volume and white matter vollame.Because of these pathologic changes in brain.some VLBW show severe neurodevelopmental disorders in childhood,including cognitive problems.behavioral and psychological problems,motor clumsiness and so on.

Biliary stricture after cholecystectomy poses difficult management problems to surgeons because of high and stable incidence.In contrast to malignant stricture,benign stricture requires durable repair.Repeated operations may not only increase the suffering of the patient,but also reduce the likelihood of a better outcome. A 56-year-old woman with biliary stricture after cholecystectomy who had undergone several operations in other hospitals was admitted to Chinese PLA General Hospital.Computed tomography (CT) scan showed a dilated biliary tree and localized the level of ductal obstruction in the hepatic hilar stricture.In addition,CT identified fluid collections in the left upper quadrant and no artery injury was detected. Ultrasound-guided percutaneous abdominal drainage was performed to control the abdominal infection. Magnetic resonance cholangiopancreatography classified the injury as Bismuth Ⅲ.The patient with bile leakage and severe abdominal infection was treated with antibiotics before the final operation.On June 1,2012,the patient received Roux-en-Y hepaticojejunostomy.After operation,the patient recovered smoothly without severe complications,such as bile leakage,cholangitis and recurrent stricture.Liver function of the patient was back to normal and T tube drainage was pulled out at the end of 3 months of follow up.

Autonomic nervous system(ANS) activity plays an important role in the pathogenesis of cardiovascular disease,including organic cardiovascular disease(such as hypertension,coronary artery disease,etc) and functional cardiovascular disease (such as vasovagal syncope,postural orthostatic tachycardia syndrome,etc).Many methods was used to evaluate ANS function.Heart rate variability is a widely accepted method to assess cardiac autonomic nerve function.Autonomic nervous affected cardiac action potential and let electrocardiogram changes.Through the sympathetic and parasympathetic neurotransmitters which acting on the corresponding receptors.Electrocardiogram changes reflects autonomic nervous function.Present researches suggest that electrocardiogram has an important significance in the evaluation of autonomic nerve function in functional cardiovascular disease.

Objective To observe the clinical efficacy of bone-setting manipulation combined with TCM internal and external treatment for lumbar disc herniation.Methods Totally 240 cases with lumbar disc herniation were selected, and were divided into treatment group and control group according to the random number table method, with 120 cases in each group. Both groups were in bed for rest and did functional exercise. At the same time, modified Mahuang Fuzi XixinDecoction combined withDuhuo JishengDecoction were given, 1 dose per day, three times a day, orally, and were wrapped with a cloth bag dregs, adding 200 mL of vinegar, placed in lumbosacral region afer heating, 2 times a day, external treatment. The treatment group was given bone-setting manipulation combined with TCM internal and external treatment, and the control group was given traction therapy, 1 time for Monday, Wednesday and Friday, 4 weeks as a course of treatment, for continuous 2 courses. The clinical efficacy, visual analogue scale (VAS), Oswestry disability index (ODI), and serum NO content were observed.Results Compared with before the treatment, VAS and ODI score decreased significantly after the first and second courses (P<0.05); The treatment group was significantly lower than the control group at the same time after treatment (P<0.05). The total effective rate was 91.67% (110/120) in treatment group, and 83.33% (100/120) in control group, with statistical significance (Z=-2.103,P=0.036). Compared with before treatment, the NO level of the two groups significantly decreased after treatment, with statistical significance (P<0.05). The NO level in the treatment group was lower than that in the control group after treatment (t=7.843,P=0.041).Conclusion Bone-setting manipulation combined with TCM internal and external treatment have obvious efficacy for lumbar disc herniation, which may be related to down-regulating serum NO level.

Asian-pacific area,especially China,is Hepatitis B high epidemic area.Since 2011,the first generation of oral direct anti-HCV agents (DAAs) came to clinical use,the treatment of chronic hepatitis C has switched from interferon-based regimen era to DAA era.There is an increased awareness of hepatitis B (HBV) reactivation in chronic hepatitis C (CHC) patients coinfected with HBV treated with pan-oral direct-acting antivirals(DAAs).Compared with interferon-based regimen,HBV reactivation occurred earlier and more severe among patients received DAA regimen,and even fetal cases or case end up with liver transplantation was reported.Thus,association of liver diseases called to alert the occurrence of HBV reactivation among CHC patients who received DAAs regimen.It is hence important to have HBV serology screened in all CHC patients before initiation of pan-oral DAAs therapy and the usefulness of preemptive administration of effective anti-HBV nucleos(t) ide analogues in coinfected patients need to be further studied.