Objective To study the criteria and technique of transsphenoidal microsurgery on pituitary adenoma invaded cavernous sinus Methods 42 patients with pituitary adenoma underwent 45 transsphenoidal operations Sellar base was opened as large as possible under C arm X ray fluoroscopy or neuronavigation monition Dura matter was cut open under microscope Tumors were removed through the direction and tunnel they in invade Bromocriptine was administered to those with little remains Partial remains and those have no response to bromocriptine were given radiotherapy Results No modality 21 tumors were nearly totally removed, 18 tumors were subtotally resected, 3 were partially resected MRI scanned in 2～3 months after the operation showed that 19 tumors disappeared, 20 tumors had little residul, 3 tumors partially remained Conclusion Pituitary adenomas invading the cavernous sinus with enlarged sella turcica and shown soft in MRI can be submitted to transsphenoidal operation Microsurgical technique can ease tumor removal and protection of the sellar and internal carotid artery

Objective To study the inlfuence factors on detection of activity of four coagulation factors in prothrombin complex concentrates (PCC) by several factors. Methods Using Pharmacopoeia of the People’s Republic of China (2010) as reference, the activity of four coagulation factors in PCC were investigated by choosing different pre-treatments, different diluents, different salt concentration, different standard human plasma and different company reagents. Results The activity of FII, FVII, FX were decreased and FIX was increased in the condition of adding protamine sulfate, and there were no differences of four coagulation factors whether warm bath in 37 for 15 min or not. However, the differences of four coagulation factors were significant by using deficient plasma, saline, distilled water and commercial dilution buffer(P<0.05). The activity of coagulation factor II, X in 1 mol/L salt concentration of PCC were significantly lower than in 0.25 mol/L(P<0.05), while coagulation factor VII, IX were not. The activity of FII, FVII, FIX, and FX were different by using different standard human plasma to make standard curve. The activity of four coagulation factors existed significant difference(P=0.00) by using SIEMENS company reagents and domestic reagents. Conclusion Choosing different pre-treatments, different dilution buffers, salt concentration, standard human plasma and commercial kits will inlfuence the detection result of coagulation factors.

BACKGROUND:It has been recently indicated that nervous factors are able to adjust and dominate bone fracture healing. Type Ⅰ collagen is a major factor to promote the differentiation of osteoblasts and enhance the adhesion of osteoblasts; while, it is also a matrix protein for composing bone framework. Type Ⅱ collagen is derived from chondrocytes. OBJECTIVE: To study changing law of type Ⅰ and Ⅱ collagen expression during denervated bone fracture healing. DESIGN, TIME AND SETTING: Randomized controlled anima study was performed at the Animal Laboratory and Cell Biology Laboratory, the Second Military Medical University of Chinese PLA between May and December 2005. MATERIALS: Forty 3-month-year healthy male SD rats were randomly divided into fracture group (tibial fracture alone) and combination group (spinal cord injury combined with tibial fracture), with 20 rats at each group. METHODS: A φ 0.8 mm Kirschner wire was inserted into anterior border of left tibial plateau to establish tibial fracture models in the fracture group. A 0.3-cm spinal cord transection was cut at T10 segment to establish tibial fracture models with entire spinal cord injury. MAIN OUTCOME MEASRUES: Type Ⅰ and Ⅱ collagen protein expressions of callus were detected using Western blot technique in week 1, 2, 4, and 5 post-injury. RESULTS: One week after injury, type Ⅰ and Ⅱ collagen was represented in callus in the two groups, while the expressions in the combination group were significantly higher than fracture group (P<0.05); two weeks after injury, type Ⅱ collagen expression reached at the peak in the combination group, and the expression was significantly higher than the fracture group (P<0.05); four weeks after injury, type Ⅰ collagen expression reached at the peak in the fracture group, and the expression was significantly higher than the combination group (P<0.05), while type Ⅱ collagen still highly expressed in the combination group; five weeks after injury, type Ⅰ and Ⅱ collagen expressions were decreased in the two groups. CONCLUSION: Secretory law of type Ⅰ and Ⅱ collagen during denervated bone fracture healing is similar to normal bone fracture healing; however, the differences at time points, in particular expression at peak, are remarkable between them.

Objective To investigate and analyze the postoperative progression of ossification of the patients with ossification of the posterior longitudinal ligament (OPLL) on cervical spine. Methods From Jaunary 2001 to December 2007, 95 postoperative patients with cervical OPLL were followed and analyzed retrospectively. There are 72 males, 23 females, with the average age of 56.3 years (range, 40-73years). The follow-up time was from 1 to 6 years, average 3.1 years. Among them 36 patients were performed with anterior cervical corpectomy, fusion with titanium mesh and fixed with cervical plates, others treated with posterior cervical laminectomy and fixation. 2 of the 95 cases were performed anterior and posterior combined operation. Clinical data, X-rays, CT and MR images and progression of ossification, were measured and analyzed in details .The relationships between the progression of ossification and relative factors, as gender, age, C3 ossified involved, T-OPLL, OPLL-type, time of follow-up, surgical approach, Japanese Orthopaedic Association (JOA) scores and improvement rate of JOA scores, were analyzed. Results Progression of ossification in 39 cases among the 95 followed postoperative OPLL patients, 28 men and 11 women, average age 55.9 years, range 41-71 years. The age of progressed patients included 12 cases of ≤49 years, 12of 50-59 years, 12 of 60-69 years and 3 of ≥70 years. 35 patients were operated by posterior approach and only 4 treated with anterior operation. According to the standard of the progression of ossification that 2 mm in the length or/and thickness, there are 4 cases progressed only in length, 2 only in thickness, other 33 patients both the length and thickness. Progression of length is from 2mm to 20mm (average 7.74±4.71). But thickness is progressed from 2 mm to 6 mm (average 2.67±1.51). From 1 to 3 years follow-up time it appeard as a downtrend about the progression of ossification. But it may appear an uptrend from the 4th year. JOA score and improvement rate of the JOA score were almost improved to the high-point in three years. And according to the statistic data there are obvious relationship between progression of ossification with age, surgical approach and C3 ossified involved. Conclusion There is a high rate of postoperative ossification progression in cervical OPLL patients. Cervical OPLL patients with C3 ossification involved, performed with posterior laminectomy and those young at surgery may have higher rate of progression of the ossification. The JOA score and improvement rate of the JOA score were little influenced by the progression of the OPLL during the short and intermediate-term follow-up.

ObjectiveTo study the treatment and prognosis of the breast phyllodes tumors.MethodsKG1Clinical data, and the results of follow-up in 203 cases of breast phyllodes tumors were analyzed using Logistic analysis and Cox regression in SPSS statistic software.ResultWT5”BZLocal recurrence and tumor mortality were in direct proportion to the pathologic grade of the tumor. There was a direct proportion between local recurrence and tumor infiltration; and between tumor caused-mortality and tumor mitosis and necrosis.Mitotic activity and tumor necrosis were the independent prognostic factors. After surgical resection 21 1% of patients with benign tumor, 45 2% of patients with borderline tumor, 64 3% of patients with malignant tumor suffered recurrence. The 5-year survival rate was 100% in patients with benign phyllodes tumor, 92 0% with borderline tumor, and 33 3% with malignance.KG2Conclusion Local excision is not the appropriate treatment for phyllodes tumor. Patients with benign or borderline phyllodes tumor should undergo wide local excision including a margin of uninvolved tissue, and that with local recurrent borderline and malignant phyllodes tumor receive mastectomy.

Objective To investigate the prognostic factors for chronic heart failure and the prognostic ability of copeptin,big endothelin-1(Big ET-1)and N-terminal pro-brain natriuretic peptide (NT-proBNP)in patients with chronic heart failure. Methods To study 1 5 9 consecutive patients hospitalized for chronic heart failure.Serum concentration of copeptin,NT-proBNP,cTnI,CKMB and plasma Big ET-1 as well as left ventricular ejection fraction (LVEF)and NYHA classⅠtoⅣ on admission were measured.Cardiac events were found by patients to discharge after 360~490 days,prospectively.Results During a median follow-up period of 385 days,the endpoint of recurrence for cardiac events was reached in 65 patients with 159 heart failure.Multivarlate canonical correlation analysis shows the older and the higher NYHA classification as well as the lower LVEF in patients with heart failure.There were higher concentration of copeptin,Big ET-1 and NT-proBNP.On a Cox proportional hazards regression models analyses,age,copeptin,Big ET-1 and NT-proBNP were found to be the inde-pendent predictors of cardiac events.Risk ratio (RR)were 1.215,1.236,4.031 and 13.052,respectively.Logistic regression models analyses,copeptin,Big ET-1 and NT-proBNP were found independent predictors of death.Odd ratio (OR)were 4.003,2.477 and 1.235,respectively.Conclusion Measurement of copeptin,Big ET-1 and NT-proBNP in patients with chronic heart failure can help to identify patients at higher risk for cardiac events and patients for prognosis.

Objective To observe the therapeutic effect of anti-inflammatory combined with cedilanid and diuretic therapy for treatment of patients with senile pneumonia and lung cancer accompanied by pleural effusion and to investigate the changes of concentrations in plasma levels of B-type natriuretic peptide(BNP)and C-reactive protein(CRP),procalcitonin(PCT)before and after treatment. Methods From July 2012 to January 2013, a prospective study was carried out to investigate 57 emergently hospitalized patients with pleural effusion,and according to the etiology,they were divided into two groups:a senile pneumonia group(30 cases)and a lung cancer group(27 cases). The same therapeutic measures were taken in the two groups,such as anti-infection,enhancement of cardiac function,diuresis,and limitation of the amount of liquid intake. Respectively,all the patients took the CT scan of the chest before treatment and on the 7th day after treatment,and at the same time,plasma concentrations of BNP,CRP and PCT were detected. Results ①According to the gradation of the New York Heart Association (NYHA),before treatment most of the cardiac function of patients in pneumonia group was at the Ⅲ grade,while that in the lung cancer group was at theⅠgrade,and the incidence of congestive heart failure(CHF)in pneumonia group was significantly higher than that in lung cancer group(86.7% vs. 14.8%,P<0.01). Before treatment,the plasma BNP level in pneumonia group was obviously higher than that in lung cancer group(ng/L:582.67±126.53 vs. 146.27±43.77,P<0.01);compared with that before treatment,BNP was significantly decreased in the pneumonia group(ng/L:225.59±131.33,P<0.05)after treatment,but no such obvious change in the lung cancer group(ng/L:149.34±51.05)was seen. The therapeutic effect of pleural effusion in the pneumonia group was markedly better than that in lung cancer group〔cure:70.0%(21 cases)vs. 0(0),P<0.01〕. ②Before treatment,the plasma levels of CRP and PCT in pneumonia group were remarkably lower than those in lung cancer group(both P<0.05);after treatment,CRP and PCT levels were decreased or decreased to close to the normal physiological range in patients of the two groups,but the comparisons between the two groups there were no statistically significant differences〔CRP(mg/L):20.21±16.32 vs. 22.76±18.53,PCT(ng/L):0.46±0.13 vs. 0.55±0.17,both P>0.05〕. Anti-inflammatory effect in pneumonia group was much superior to that in lung cancer group〔basically cured:86.7%(26 cases)vs. 0(0),P<0.05〕. In pneumonia group,the decrease of the above two indexes after treatment was consistent with the pneumonia shadow dissipation,while in the lung cancer group,no such consistency was found,apparently,the latter phenomenon was associated with the tumor invasive occupation. Conclusion To detect the concentration changes of plasma BNP, CRP and PCT has important clinical significance in screening the cardiac insufficiency and evaluating the curative effect of anti-inflammatory combined with cedilanid and diuretic therapy in patients of lung diseases complicated by pleural effusion.

Establishment of quality management system (QMS) plays a critical role in the clinical data management (CDM). The objectives of CDM are to ensure the quality and integrity of the trial data. Thus, every stage or element that may impact the quality outcomes of clinical studies should be in the controlled manner, which is referred to the full life cycle of CDM associated with the data collection, handling and statistical analysis of trial data. Based on the QMS, this paper provides consensus on how to develop a compliant clinical data management plan (CDMP). According to the essential requirements of the CDM, the CDMP should encompass each process of data collection, data capture and cleaning, medical coding, data verification and reconciliation, database monitoring and management, external data transmission and integration, data documentation and data quality assurance and so on. Creating and following up data management plan in each designed data management steps, dynamically record systems used, actions taken, parties involved will build and confirm regulated data management processes, standard operational procedures and effective quality metrics in all data management activities. CDMP is one of most important data management documents that is the solid foundation for clinical data quality.

Objective To study the process conditions for new gel Capto DEAE ion exchange chromatography to purify prothrombin complexes concentrates.Methods After removal of cryoprecipitate by centrifugation, healthy human plasma was mixed with DEAE-Sephadex A-50 gel.After that, the gel were washed and eluted to obtain eluate; then, the eluate, after being ultrafiltered, was loaded on a column packed with Capto DEAE-gel for chromatography to prepare PCC which was later determined for activities of coagulation factors Ⅱ,Ⅶ,Ⅸ,Ⅹ and anticoagulation protein C, with their yield calculated.Besides, the protein concentration of PCC was determined using the Bradford method, based on which the specific activity of the four coagulation factors and protein C were calculated. According to the results, purification effect of Capto DEAE-gel on the PCC was analyzed. Results Under different experimental conditions, the yield and purity of the coagulation factors FⅡ,FⅨ and FⅩ were high, and the equilibrum degree of the three factors was good;however, the yield and purity of coagulation factor FⅦwere very low.When the three variables ( sodium citrate, NaCl and pH) in balanced solution, washing solution and elution were 0.020-0.028 mol/L, 0.10-0.15 mol/L and 6.9-7.2;0.012-0.020 mol/L, 0.10-0.15 mol/L and 6.9-7.2;0.005-0.012 mol/L, 2.4 mol/L and 7.2-7.5 , respectively,the yield and purity of PCC prepared from Capto DEAE-gel were good. Under this condition, yield of factor Ⅸ was ( 74.40 ±10.89 )% and purity of factor Ⅸ was ( 3.31 ±0.31 ) IU/mL.Under different experimental conditions, yield and specific activity of anticoagulant protein C were higher.Conclusion The purity of four coagulation factors and anticoagulation protein C of PCC prepared by the new method that combined the batch adsorption with DEAE-sephadex A-50 was combined with column chromatography packed with Capto DEAE-gel are higher than those prepared by the routine procedure.Furthermore, the PCC are better than these products obtained by traditional process, whose purity are 2.17-3.31IU/mg.Therefore, these studies will lay the groundwork for exploring novel preparation process of producing PCC.

Objective To evaluate the effect of robot-assisted gait training on the walking ability of hemiplegic patients.Methods Sixty hemiplegic patients were randomly divided into a control group and a treatment group,each of 30.Both groups were given traditional rehabilitation and drug therapy.The control group was additionally provided with the traditional gait training,while the treatment group additionally received robot-assisted gait training.The gait training lasted 30 minutes a day,5 days per week.Before and after 8 weeks of training,the time parameters,phase parameters,the joint angles of the lower limbs,and the peak ground reaction forces of both groups were evaluated using a three-dimensional gait analysis system.Results After the intervention,the walking velocity,stride frequency and stride length had increased in the treatment group,while stride width had decreased.Significant improvement was observed in the treatment group in terms of the percentage of swing phase on the paretic side,the percentage of stance phase on the paretic side,the single support time ratio,the percentage of double support phase,the range of motion of the hip and knee joints,and the peak vertical and forward ground reaction force as a percentage of body weight.The improvements were significantly greater than those observed in the control group.Conclusions Compared with traditional walking training,robot-assisted gait training can be more effective in improving the walking ability of hemiplegic patients.