Objective To provide the anatomical data for single-nostril transsphenoidal microsurgery for pituitary adenoma.Methods Microanatomic structures were observed and measured in 20 cadaveric a- dults heads.Results(1)The diaphragmal opering was 5 mm or greater broad in 90%.The mean thick- ness of the diaphragma sellae was (0.18?0.08)mm.(2) A sphenoid sinus with complete pneumatization was named as all-sellae type,its percentage in all specimens was 85%,85% sphenoid sinus had middle sep- tum of which only 18.8% located in the medial sagital section.(3)The meant thickness of the sellar floor was (0.81?0.34) mm,70% of which were not more than 1 mm.Of the sellar floors,that the shape was flatness reach 15%.(4) The relationship between ICA and sphenoid sinus had two aspects,one was to be mutually apart (55%),the other was to communicate (45%),which formers carinae on the lateral wall of the sphe- noid sinus,espeially in the superior surface of posterior part.The relationship between optic nerve and sphe- noid sinus,one was to be mutually apart (27.5%),the other was to communicate (72.5% ),which formers carinae on the lateral wall of the sphenoid sinus,especially in the superior surface of anterior part.(5) Three main types of the intercavernous sinus were the anterior intercavernous sinus,present in 80%,the inferior in- tercavenous sinus (25%),and the posterior intercavenous sinus (15%).Conclusion The knowledge of the anatomy of the sellar region and sphenoid sinus is helpful to safe operation in the single-nostril transsphe- noidal approach for pituitary,adenoma microsurgery.

OBJECTIVETo evaluate the effect of importing triamcinolone acetonide into hypertrophic scars with skin roller needles.

METHODSThirty-two cases with burn hypertrophic scar were treated. The skin roller needles were moved back and forth on the hypertrophic scars with triamcinolone acetonide dropping on the scar surface at the same time. So the triamcinolone acetonide could be imported into the scar through needles and needle holes. The effect was evaluated as cured, effective, and no effect. The Vancouver scaring criteria and visual analogue scale was used to assess the scar color, thickness, texture and feeling before and after treatment, as well as at the untreated scar area (control).

RESULTSThirty-two cases were treated 1-3 times, including 28 cases with cured result and 4 cases with effective result. The total effective rate was 100%. The scar color, thickness, texture and feeling was significantly different between the scar before and after treatment, or between the treated and untreated scar (P < 0.05).

CONCLUSIONSImporting triamcinolone acetonide into hypertrophic scars with skin roller needles is effective. It is a new method for the treatment of large hypertrophic scar with medicine.

Burns ; complications ; Cicatrix, Hypertrophic ; drug therapy ; etiology ; Humans ; Injections, Intralesional ; instrumentation ; Needles ; Treatment Outcome ; Triamcinolone Acetonide ; administration & dosage

Objective: To observe the midterm outcomes of“2-staged”hybrid coronary revascularization (HCR) for treating the patients with multi-vessel coronary artery disease (CAD) and to evaluate the feasibility, safety and effcacy of“2-staged”HCR.
Methods: A total of 73 relevant patients received elective “2-staged” HCR in our hospital from 2012-01 to 2014-06 were studied. There were 50 (68.5%) male and 23 (31.5%) female at the age of (61.1±10.7) years and all patients had multi coronary artery lesions including left anterior descending (LAD) artery. The key points of“2-staged”HCR were as follows:double-chamber intubation with general anesthesia, small incision between 4-5 ribs of left front thorax, take left internal mammary artery (LIMA) by direct view and make anastomosis of LIMA and LAD with heartbeat. At (3-5) days post-minimally invasive direct coronary artery bypass (MIDCAB), coronary angiography (CAG) was conducted to confirm that LIMA-LAD bypass vessel was unobstructed; then percutaneous coronary intervention (PCI) was performed in non-LAD coronary artery for stent implantation. Post-operative echocardiography, chest X-ray and ECG were examined in each year;coronary CTA or CAG would be taken if the patients with myocardial ischemia.
Results: All patients finished“2-staged”HCR smoothly and no operative death occurred. The average surgical time was (152.9±43.8) min and (2.6±0.5) coronary branches were treated, total post-operative drainage volume was (558.6±441.3) ml, red blood cell transfusion was (0.8±1.9) U, mechanical ventilation time was (10.5±13.0) h. The interval between MIDCAB and PCI was (5.3±2) days and (1.6±0.7) stents was implanted. During post-operative follow-up period, there 1 (1.4%) patient died, 3 (4.1%) with recurrent myocardial ischemia, 1 (1.4%) with in-stent restenosis and received PCI again, 4 (5.5%) with MACCE.
Conclusion: “2-staged”HCR is a safe and feasible operation with satisfactory peri-operative and mid-term outcomes;it is suitable for the patients with multi-vessel CAD including severe LAD lesions.

Objective To evaluate the efficacy and safety of acute ureteroscopy for the treatment of ureterie stones during middle and late pregnancy.Methods From June 1998 to March 2005,17 pregnant women(mean age,27 years;age range,21-35 years)with ureteric stones were treated by ureteroscopy when the fetus was at 20-36 weeks of gestation(mean,29 weeks).All the cases presented with urgent symptoms such as recurrent renal colic(11 cases),fever(4)or acute obstructive anuria(2).Among 17 cases,the stones(between 6 mm?7 mm and 13 mm?21 mm)were located in the upper(8 cases),middle(5)or lower ureter(4);and on the left side(5 eases),on the right(10)and on both(2)of the lower ureter. Mild hydronephrosis were observed in 6 cases and moderate hydronephrosis in 11,Of the 17 cases,14 under- went ureteroscopic pneumatic lithotripsy;in 1 case the calculi were pushed to the renal pelvis;and 2 cases were treated by Double-J catheter drainage.Results All the urgent symptoms in 17 cases were relieved after treatment.The stone-free rate of initial treatment was 82.4%(14 of 17).Three cases with residual stones were treated by Douhle-J catheters,which were replaced every 3 months until the calculi were re- moved.No abortion,premature delivery or complications such as ureter perforation occurred.Mild renal colic occurred in 1 case after insertion of Douhle-J catheter,and it was relieved 3d later;gross hematuria occurred in l case and disappeared 6 d later without treatment.All 17 patients had normal delivery and gave birth to healthy children.Conclusions Ureteroscopy is a safe and reliable method for the treatment of ureteric calculi during middle and late pregnancy.

Objective To investigate the efficacy and safety of staged bilateral thalamus and globus pallidus stereotactic lesioning in patients with idiopathic Parkinson's disease (PD). Methods Nineteen PD patients,admitted to our hospital from February 1998 to May 2008 and received staged bilateral thalamus and globus pallidus stereotactic lesioning under the stereotactic microelectrode-guidance,were chosen in our study; 16 of them had a primary operation with ventral intermediate (Vim) stereotactic lesioning,and other 3 had globus pallidus-intemal segment (Gpi)stereotactic lesioning; second-staged operation with contralateral Gpi and small focal of Vim nucleus stereotactic lesioning was performed on all patients.The unified Parkinson disease rating scale (UPDRS)was used to estimate the "switch-on" and "switch-off" states of each patient before operation and 1 week after operation.The improvement of symptoms and the happening of complications after the operation were analyzed. Results Improvements were observed in all the 19 patients postoperatively in terms of stiffness and tremor.Stiffness was significantly alleviated after lesioning of Gpi,and tremor was markedly relieved after the Vim nucleus small focal lesioning.Two patients had dysarthria postoperatively,and 1 of them had dysphagia; the symptoms were alleviated 3 months after the operation. Conclusion Staged bilateral thalamus and globus pallidus stereotactic lesioning is a safe and effective surgical treatment for PD patients with bilateral severe symptoms.Controlling the indications and the size of lesioning strictly,and selecting the targets appropriately are of vital importance to the operation.

Objective To investigate the expressions of the putative brain tumor stem cell (BTSC) marker CD133, nestin and proliferating cell nuclear antigen (PCNA) in formalin-fixed and paraffin-embedded gliomas, and discuss the BTSC microenvironment: the composition, morphology and distribution of the niche. Methods The samples of 74 patients performed resection of the glioma in our hospital from January 2007 and October 2008 were chosen. According to WHO 2008 classification of nervous system tumors, they were assigned into low-grade glioma group (grade Ⅱ, 22) and high-grade glioma group(grade Ⅲ, 27 and grade Ⅳ,25). Immunohistochemistry was used to detect the expression of CD 133 in 74 cases of brain gliomas. Double immunofluorescence staining was employed to detect the co-expressions of CD133/nestin or CD133/PCNA. The percentages of the CD133+cells, CD133+ blood vessels and CD 133+ niches were calculated, and correlation analysis was also performed on their percentage and the pathological grading of the tumor. Results Accumulated CD 133+ cells grew in the niches. CD 133+ niches could be observed in all grade gliomas; low-grade group showed lower level expression of the CD 133+ niches, fewer proliferating cells, clearer boundary between the 2 neighboring niches and fewer surrounding blood vessels as compared with high-grade group. Besides CD113+/nestin+ BTSCs, some subsets as CD133+/nestin-cells and CD133-/PCNA+ cells were noted in the niches in the high-grade group. The percentages of CD 133+ cells, CD 133+ blood vessels and CD 133+ niches were different in different grades of gliomas and the higher the grade of gliomas was, the higher their expressions were. Positive correlation was observed between the percentage of CD 133+ niches and the percentage of CD133+ blood vessels (r=0.425, P=0.000). The expression of CD133+ niches in high-grade glioma were higher than that in low-grade tumors (F=5.324, P=0.002). Conclusion Glioma tissues have niche structures, which composed of CD133+/nestin+ BTSCs and some subsets. CD133+ blood vessels were playing a key role in maintaining the niche structure, and the expression of CD133+ niches is statistically different in different pathological grading tumors.

Objective To assess the value of real-time intraoperative neuronavigation integrated with ultrasound in the resection of deep-seated brain tumor. Methods Thirty patients with deep-seated brain tumor were treated with microneurosurgery guided with real-time ultrasound integrated with the Brain Lab IGSonic navigation. During the ultrasound based operation, the degree of brain shift and the tumor border was timely observed, and then the tumor was resected totally. Results Guiding with navigation integrated ultrasound, we noticed the brain shift with various degrees happening in 30 patients,and the border of tumor was exposed and the tumor was resected totally without serious complications.Conclusions Intraoperative ultrasound integrated with navigation is a reliable guidance which can accurately re-localize the border of deep-seated brain tumor even when the tumor is shifting, timely delineate the reformatted images from ultrasound and totally resectcd the tumor, thus decrease the surgical time and increase the safety of surgical procedure.

Objective To explore the reaction patterns of impulsiveness and risk-taking decision-making in heroin addicts and their significance.Methods Seventeen heroin addicts(HA group)admitted to Detoxification and Rehabilitation Center of Anhui Province from July 2010 to December 2010 and 18 healthy controls(HC group)recruited at the same period were performed Iowa gambling task(IGT)and Risky-Gains task(RGT),respectively; the different capacities of impulsiveness control and risk-taking decision-making between HA group and HC group were compared.Results As for IGT,decision-making course affected the net scores remarkably in HC group,whereas contrary result was observed in HA group(P＜0.05); no statistical difference between the numbers of low-frequency punishment cards and high-frequency punishment cards which subjects selected was noted in HA group,while statistical difference was observed in HC group(P＜0.05).Furthermore,the difference between the number of low-frequency punishment cards and high-frequency punishment cards in HC group was higher than that in HA group(P＜0.05).In RGT,as compared with risky response rate before punishment,risky response rate after punishment declined notably in HC group,while no significant changes were seen in HA group; risky response rate after reward and after punishment in HA group were significantly higher than those in HC group(P＜0.05).Conclusion As evidence of chronic heroin addicts' behavior,heroin addict exsits impulsiveness and deficit in risk-taking decision-making,which may be one of the causes of generation and maintenance of heroin addiction.

Objective To detect the neuronal network activity of specific brain areas in heroin addicts under craving state induced by heroin related cues with independent component analysis (ICA) of functional MRI (fMRI) data. Methods Fifteen heroin addicts,admitted to our hospital from February 2010 to December 2010, and 15 healthy controls were recruited in the case-control study; they were performed whole brain scan with 3.0Tesla MR scanner when being presented with heroin related cues.ICA was performed on these data and their neuronal network activities were compared. Results As compared with those in the controls,the bilateral prefrontal cortex,the left anterior cingulated cortex,the bilateral posterior cingulated cortex, the left inferior temporal gyrus and the left parietal lobe enjoyed obviously decreased activity, while bilateral nucleus accumbens, the right hippocampus, part of the temporal lobe and the occipital lobe enjoyed significantly increased activity (P＜0.05). Conclusion ICA is an advanced approach to identify fMRI data induced by related cues; the specific neuroanatomy mediated to cue-elicited heroin craving mostly locates in the learn-memory system and reward system,which involves the frontal cortex,the parietal lobe,the anterior eingulate,the posterior cingulate,the hippocampus and the nucleus accumbens.

Objective To evaluate the effect of surgical excision of the anterior temporal lobe and hippocampus on the cognitive function of patients with refractory temporal lobe epilepsy. Methods Nineteen patients with refractory temporal epilepsy received surgical excision of the anterior temporal lobe and hippocampus, and cognitive neuropsychologieal assessments were conducted, 3 and 6 months after the surgery, to evaluate the changes in the patinets' cognitive functions. Results Satisfactory effects were achieved in these patients after the operations. One patient showed temporary speech disorder, and two exhibited temporary euphoria. Patients with refractory temporal lobe epilepsy had severe cognitive dysfunctions involving especially in the intelligence, attention and memory, which were not aggravated after the operation, Conversely, the operation resulted in gradual improvement of some of the cognitive functions in these patients. Conclusion Patients with refractory temporal lobe epilepsy have cognitive dysfunction, and surgical excision of the anterior temporal lobe and hippocampus can cure or reduce seizure of temporal lobe epilepsy and improve the cognitive dysfunctions to some extent.