It is hard to deal with traumatic brain injury combined with seawater insult and its high motility.Findings have been made in recent preclinical and clinical researches into the traumatic brain injury combined with seawater insult,but further studies are needed because the mechanisms associated with the injury are not completely figured out.This paper summarizes the current basic and clinical researches into the injury,intending to find clues to improve the practical treatment and to guide oncoming studies of the injury.

Objective To investigate the accuracy of volumetric measurements (Dotian formula and platform-like volume calculation formula [PLVCA]) in pituitary adenomas and their practicabilities.Methods Forty-five large and giant pituitary adenomas patients,admitted to our hospital from May 2013 to May 2014,were collected.According to the imaging finds of pituitary adenomas,the patients were divided into regular type group and irregular type group;the volume of these tumors were calculated by PLVCA method,Dotian formula and virtual reality (VR) reconstruction method,respectively.The results of VR method were used as the standards to investigate the accuracy of Dotian formula and PLVCA method on pituitary adenomas.Results In 45 pituitary adenomas,17 (37.78％) were regular;the result of tumor volume using VR method was (6.54±11.27) cm3,that using PLVCA method was (5.50±9.40) cm3 and that using Dotian formula was (4.32±9.00) cm3;significant differences were noted between the results of VR method and PLVCA method and the results of VR method and Dotian formula (P＜0.05);there was no significant difference between the results of PLVCA method and Dotian formula (P＞0.05).Another 28 (62.22％) were irregular;the result of volume using VR method was (11.65±16.60) cm3,that using PLVCA method was (11.50±16.18) cm3,there was no significant difference between the two results (P＞0.05);that using Dorian formula was (10.04±19.45) cm3,and there was significant difference between the VR method and Dotan formula (P＜0.05),which was also found between PLVCA method and Tada formula (P＜0.05).Conclusion PLVCA method has a higher accuracy in volume measurement of pituitary adenomas than Dotian formula,especially in irregular adenomas.

Objective To analyze the correlative factors of hypopituitarism in patients with intracranial non-sellar tumors.Methods Eighty-three patients with intracranial non-sellar tumors,admitted to our hospital from May 2014 to April 2015,were included in our study;their clinical data were retrospectively analyzed.The status of pituitary function was assessed according to the level of preoperative serum hormone.Univariate and multivariate Logistic regression analyses were employed to analyze the correlations of preoperative hypopituitarism with age,gender,hypertension,epilepsy history,course of disease,mass effect of tumor,tumor location,intracranial pressure (ICP),and composition of cerebrospinal fluid.Results Before surgery,30 showed hypopituitarism,accounting for 36.14％:23 had deficiency in one pituitary axe and 7 had multi-axial deficiency.Univariate analysis showed that high ICP (ICP＞200 mmH2O),acute or sub-acute course (≤ 3 months) and presence of mass effect by non-sellar brain tumor were the risk factors of hypopituitarism (P＜0.05).Multivariate Logistic regression analysis revealed that intracranial mass effect in patients with non-sellar brain tumor was an independent risk factor (OR=3.197,95％CI=1.085-9.423,P=0.035).Conclusion Hypopituitarism has high morbidity in patients with non-sellar brain tumor;intracranial mass effect is an independent risk factor for hypopituitarism.

Objective To investigate the related influence factors of the main extended direction of the pituitary macroadenoma in the vertical direction.Methods Clinical data of 184 pituitary macroadenoma patients were collected and analyzed retrospectively.The main extended direction in the vertical direction of the tumor was taken as the dependent variables.Patients were divided into two groups according to the suprasellar extension value of each tumor,(ie:suprasellar extension value＞0 and suprasellar extension value≤0).10 selected indicators (age,sex,tumor type,diameter of diaphragmatic opening,sphenoid sinus type,sella type morphology,main sphenoid sinus septum bias,maximum width of sphenoid sinus septum,tumor cyst,number of longitudinal sphenoid sinus septum) were taken as independent variables and the factors which may influence the main extended direction were analyzed and selected by logistic regression method.Results Among the 184 patients,there were 121 cases extending mainly to the suprasellar direction,while the left cases extending mainly to the opposite direction.Statistical analysis showed the tumor type (P=0.026),sphenoid sinus type (P=0.003),sella type morphology (P=0.046),diameter of diaphragmatic opening (P=0.003) and maximum width of the sphenoid sinus septum (P=0.009) were the independent predictors influencing the main expansion direction of pituitary macroadenomas in the vertical direction.Conclusions The pituitary macroadenoma is more likely to expand infrasellar in patients with sellar or sellaoccipital sphenoid sinus,sac sella turcica morphology,GH adenoma,smaller diaphragmatic opening diameter and narrower width of sphenoid sinus septum.The pituitary macroadenoma is more likely to expand suprasellar in patients with presellar sphenoid sinus,wok and cylinder sella turcica morphology,nonGH adenoma,larger diaphragmatic opening diameter and wider width of sphenoid sinus septum.

Objective To explore the expression of endothelial cell specific molecule-1 (ESM-1) and its clinical significance in pituitary null cell adenoma (NCA).Methods Forty-six cases of NCA specimens,collected from resection of pituitary tumor via microscopic transsphenoidal approach in our hospital from January 2010 to May 2014,were chosen in our study;ESM-1 expressions in the NCA specimens was detected by immunohistochemical S-P method,and the relations of expression results with gender (male:29;female:17),age (18-45 years old:16;≥46 years old:30),maximum tumor diameter (1-3 cm:34;≥3 cm:11;＜1 cm:1),invasion state (invasive NCA:30;non-invasive NCA:16),Ki-67 labeling index (＜3％:29;≥3％:17) and pathological features were analyzed.Results ESM-1 expression was observed in endothelial cells and adenoma cells,with positive rates 100％ and 86.96％ (40/46);in the endothelial cells,high expression was noted in 32 patients;and in the adenoma cells,high expression was noted in 25 patients;no significant difference of high expression was noted between the two (P＞0.05).As compared with that ofnoninvasive NCA (7/16),the high expression of ESM-1 of invasive NCA (23/30) in endothelial cells was significantly increased (P＜0.05),while the high expression of ESM-1 in adenoma cells was not significantly increased (P＞0.05).In endothelial cells,high expression of ESM-1 was not significantly different in patients of different ages,gender,maximum tumor diameters or Ki-67 labeling indexes (P＞0.05);in adenoma cells,high expression of ESM-1 was not significantly different in patients of different ages,gender,maximum tumor diameters,Ki-67 labeling indexes or invasion states (P＞0.05).Conclusion ESM-1 in endothelial cells could be used as a marker of aggressive behavior in NCA.

Magnetic resonance diffusion tensor imaging has been developed to a kind of new imaging technology in recent years;through the nerve tissue diffusion properties of water molecules,it can quantitatively reflect the integrity of white matter fiber tracts and various kinds of pathological changes,thus achieving accurate evaluation of spinal cord injuries at the micro level.In this paper,the technology of magnetic resonance diffusion tensor imaging in the application of electroacupuncture treatment of spinal cord injuries and research progress are summarized and prospected.

Objective To explore the correlation between cervical diffusion tensor imaging (DTI) and median nerve short latency somatosensory evoked potential (MN-SLSEP) parameters in patients with cervical intraspinal tumors.Methods Twenty-two patients suffering from cervical intraspinal tumors treated with surgical resection were enrolled into study group from February 2015 to May 2016;meanwhile,22 age-matched volunteers were selected as control group.Cervical DTI and MN-SLSEP detection were performed 3 d before operation and one month after operation,respectively.The whole cervical spinal cord was divided into 3 areas,the tumor head area,the tumor area,and the tumor tail area;and the fractional anisotropy (FA) values of the 3 areas were calculated.The white matter fiber bundle was reconstructed by diffusion tensor tracking (DTT) to observe its integrity.Study group was further divided into delayed latency group (lat+ group) and normal latency group (lat group)according to the delayed latency of N9-N20 interpeak levels,and the FA values of the 3 groups at different areas were compared.Results Total removal of the tumors was achieved in 19 patients (86.4％) and subtotal in 3 patients (13.6％,two with nerve fibrolipomas and one with intramedullary neurilemmomas) of the study group.One month after the operation,the spinal function was improved in 17 patients (77.3％),and not improved in 5 patients (22.7％).The preoperative N9-N20 interpeak latency in the study group was significantly longer than that in the control group (P＜0.05).In term of preoperative fiber tract morphology of study group,the proportion of delayed N9-N20 interpeak latency in patients with interrupt type (75％) was significantly longer than that in the patients with intact type (21.4 ％,P＜0.05).FA values oflat+ and lat group in the tumor head area,tumor area,and tumor tail area were significantly lower than those in the control group (P＜0.05);and FA values of lat+ group in these three regions were significantly lower than lat group (P＜0.05).Conclusions DTI metrics correlate with MN-SLSEP measures.Through variations of quantitative parameter values and fiber tract morphology,cervical DTI can sensitively and intuitively reflect the electrophysiological changes,which could be served as a important diagnostic tool for cervical intraspinal tumors.

Objective To investigate the risk factors,mechanism and treatment strategies of expanding regional brain injury (traumatic intracerebral contusion or hematoma) in patients with acute traumatic epidural hematoma (ATEDH) after surgical evacuation.Methods Fifty-nine patients with ATEDH,admired to and accepted surgical evacuation in our hospital from February 2013 to September 2018,were chosen in this study;their clinical data and CT imaging data were retrospectively analyzed.The volume ofintracranial hematoma was measured by 3D Slicer software.According to the progress of local brain injury revealed by first CT examination after surgical evacuation,patients with ATEDH were divided into progressive group and non-progressive group.Risk factors of patients with expanding regional brain injury after surgery were analyzed by univariate and multivariate Logistic regression analyses.Results After surgery,22 showed expanding regional brain injury,accounting for 37.29％:9 occurred expanding intracerebral hematoma,and 2 of them died after conservative treatment;two had both expanding intracerebral contusion and hematoma;11 expanding intracerebral contusion patients developed into hematoma,and three of them occurred delayed intracerebral hematoma adjacent to the area of ATEDH,and two underwent secondary craniotomy with good recovery.As compared with patients from the non-progressive group,progressive group had significantly higher percentages of patients with preoperative hyperglycemia (＞9.1 mmol/L),patients with preoperative abnormal coagulation and patients accepted decompressive craniectomy (P＜0.05).Multivariate Logistic regression analysis revealed that preoperative abnormal coagulation was an independent risk factor for expanding intracerebral contusion or hematoma after surgery (OR=6.498,95％CI:1.076-39.253,P=0.041).Conclusion Expanding regional brain injury has high morbidity in patients with ATEDH after surgery evacuation;preoperative abnormal coagulation is an independent risk factor for its occurrence.

Objective:To observe the effect of hyperbaric oxygen (HBO) therapy on the pituitary function of patients with subacute traumatic brain injury.Methods:Sixty-six patients with subacute traumatic brain injury and hypopituitarism were randomly divided into a control group ( n=33) and an HBO group ( n=33). Patients in both groups were given conventional treatment including dehydration to reduce intracranial pressure, anti-infection medication, epilepsy and bed sores prevention measures, neurotrophic treatment, fluid replacement and rehabilitation. The HBO group was additionally given HBO at 0.2MPa (2.0ATA), once a day, 6 times a week for a total of 20 administrations. Before and after the treatment, serum adrenocorticotropic hormone (ACTH), growth hormone (GH), thyroid stimulating hormone (TSH), prolactin (PRL), luteinizing hormone (LH), follicle stimulating hormone (FSH), cortisol, insulin-like growth factor 1, free tetraiodothyronine, testosterone, and estradiol levels were detected using chemical immunoluminescence. The ACTH, GH, TSH, PRL, LH and FSH values were used to calculate general pituitary hormone scores. Results:After the treatment, the average PRL, LH and testosterone levels and the general pituitary hormone score in the HBO group were significantly higher than among the controls.Conclusions:HBO treatment can increase the levels of various hormones in patients with subacute traumatic brain injury and promote the recovery of pituitary function.

Objective To analyze the occurrence and location of posterior pituitary bright spot (PPBS) and its influence factors by analyzing the magnetic resonance T1-weighted imaging (T1WI) in patients with pituitary adenoma.Methods One hundred and twenty-three patients with pituitary adenoma,admitted to our hospital from September 2012 to September 2014,were collected in our study.All patients were performed T1WI and T2WI sagittal,coronal and axial scan and enhanced scan at SE sequence before operation.The occurrence and location of PPBS of the pituitary gland were observed;the clinical data of these patients from PPBS-visible group and PPBS-non-visible group were analyzed and compared.Re.sults Of the 123 patients,the PPBS-visible group included 98 patients (79.7％) and the PPBS-non-visible group included 25 patients (20.3％).The adenoma shapes were classified into hourglass-type (n=43),barrel-type (n=63) and wedge-type (n=17).The occurrencerateofPPBSin barrel-type patients was significantly lower than hourglass-type patients (P＜0.05);the signal intensity ratio of PPBS and pons in barrel-type patients and wedge-type patients was significantly higher than that in the hourglass-type patients (P＜0.05).Adenoma volume and height of the PPBS-visible group was significantly smaller than those in the PPBS-non-visible group (P＜0.05).The distribution of different adenoma types was significantly different between patients from PPBS-visible group and PPBS-non-visible group (P＜0.05).Conclusion The posterior lobe of pituitary could be displayed satisfactorily at T1WI,and appearance of PPBS is related to the morphology,volume and height of pituitary adenoma.