Objective To provide anatomical basis for endoscopic endonasal transsphenoidal surgery for excision of sellar tumors. Methods The relationship between ostia of sphenoidal sinus and sellar areas of 25 heads of adult cadavers, and the structure of pituitary fossa and the relationship of the anterior-posterior clinoid processes of 21 heads of adult cadavers were observed and measured. At the same time, structure of 9 fresh heads of adult cadavers were observed with the operating endoscope. Results The distance between the ostia of the sphenoidal sinus to the tuberculum sellae, internal carotid artery, optic nerve and dorsum sellae were 14.6?3.0mm, 13.7?2.2mm, 11.6?1.8mm, and 22.6?3.2mm, respectively. The sagittal diameter of the pituitary fossa was 10.2?1.5mm. The transverse diameter of the pituitary fossa was 1.4?2.4mm. The distance between two anterior clinoid processes was 25.0?3.0mm. The distance between two posterior clinoid processes was 15.8?3.3mm. The distance between anterior clinoid process and ipsilateral posterior clinoid process was 7.8?1.7mm. The distance between anterior clinoid process to contralateral posterior clinoid process was 21.8?2.4mm. Conclusion These results would provide the surgeons a stereoscopic image about sellar areas, so that the operative field could be accurately defined in endoscopic endonasal transsphenoidal surgery for the excision of sellar tumors.

Objective To systematically the efficacy of transcatheter arterial chemoembolization (TACE) conbined with percutaneous microwave coagulation therapy (PMCT) in treatment of advanced liver cancer.Methods A search was performed by retrieving the domestic and foreign literature database,including WanFang Data,VIP,CNKI,PubMed,Cochrane Library,CBM,EMBASE,Medline,between January 2005 and May 2015.These documents were about the analysis of the efficacy of TACE combined with PMCT in treatment of advanced liver cancer,including complete response(CR),partial response(PR),total effective rate,the levels of AFP declining,1,2,and 3 year survival rate and all the trials must be randomized controlled trials.Meta-analyses were conducted using the Cochrane Collaboration's RevMan 5.2 software.Results Fourteen documents were retrieved,including 989 patients,conbined treatment group 470 patients,simple treatment group 519 patients.The results of Mete-analysis shows that the total effective rate of TACE combined with PMCT is higher than TACE alone in treatment of advanced liver cancer.AFP declining ＞ 50％ of TACE combined with PMCT more obvious than TACE alone.1,2,and 3 year survival rate of TACE combincd with PMCT higher than TACE alone.These differences were statistically significant.Conclusion TACE combined with PMCT might be more effective than TACE alone in treatment of advanced liver cancer.

Objective To investigate the preoperative biliary drainage on the effect of surgical treatment for hilar cholangiocarcinoma patients.Methods A total of 52 hilar cholangiocarcinoma patients who underwent resection operation in Renmin Hospital of Wuhan University from January 2005 to December 2015 were divided into preoperative biliary drainage group (24 cases) and non-preoperative biliary drainage group (28 cases).To compare the operation time,intraoperative blood loss,hospital stay,perioperative changes in liver function,and incidence of postoperative complications,tumor recurrence rate,1-,3-,and 5-year survival rate and some other indicators.The data was analyzed using SPSS 19.0 software.The patients of two groups were followed up by telephone,out-patient review and hospital examination.Patients were followed up for 8-60 monthes.Results The hospital stay for biliary drainage group was longer than that in non-preoperative biliary drainage group and the difference was statistically significant (P ＜ 0.05).The differences of operation time,intraoperative blood loss,postoperative tumor recurrence rate,postoperative complications (including bile leakage,blooding,fever,pleural effusion,abdominal infection,wound infection,pulmonary infection,liver failure and some others) and 1-,3-,and 5-year survival rate were not statistically significant (P ＞ 0.05).Alanine aminotransferase,aspartate aminotransferase,total bilirubin and direct bilirubin in preoperative biliary drainage group before biliary drainage were(98.0 ± 51.7) U/L,(94.2 ± 44.2) U/L,(177.5 ± 64.1) μmol/L and (160.2 ± 61.9) μmol/L,respectively,and after biliary drainage were (71.2 ± 13.8) μmol/L,(60.0 ± 12.1) μmol/L,(93.5 ± 20.7) μmol/L and (76.3 ± 18.1) μmol/L,respectively.The differences of the above parameters before and after biliary drainage were statistically significant (P ＜ 0.05).However,the changes of albumin before and after biliary drainage were not significant (P ＞ 0.05).The follow-up patients of biliary drainage group were 21 cases and the follow-up patients of non-preoperative biliary drainage group were 25 cases.The differences of 1-,3-,and 5-year survival rate between the two groups were not statistically significant (P ＞ 0.05).Conclusions Preoperative biliary drainage for hilar cholangiocarcinoma patients may improve the liver function to a certain extent.However,preoperative biliary drainage cannot improve the prognosis of the hilar cholangiocarcinoma patients.Therefore preoperative biliary drainage is not suggested for patients with good general conditions.

Objective To investigate the immunomodulatory effect of mesenchymal stem cells (MSCs) and their role in prolonging allograft survival in rat heart transplantation. Methods Inbred Wistar rats were used as donors, and Fisher 344 as recipients. MSC were isolated from femur and tibia bone marrow of donors and cultured in vitro. Mixed lymphocyte reaction assays were performed to assess the immunosuppressive effects of different concentrations of MSC on allogeneic T cell proliferation. Cardiac allograft model was established and according to different intervention measures recipients were divided into two groups (MSC treatment group and control group) (n=8 in each group). In MSC treatment group, recipients were infused with 2×106 MSC via the tail vein at designated intervals (one week before operation, during operation and consecutive three days postoperation), while in control group, the recipients were treated with Ringer's solution at the same interval& At day 5 posttransplantation real-time PCR was used to detect the changes in the expression of Thl and Th2 cytokine genes in transplanted hearts. Results In vitro allogeneic T cell response was greatly suppressed by MSC in a dose-dependent manner. Real-time PCR revealed that IL-1β,IFN-γ, IL-4 and IL-10 were expressed in MSC treatment group, while IL-4 and IL-10 were not expressed in control group but with significantly higher expression of IL-1β and IFN-γ. As compared with control group, survival of MSC-treated allografts was markedly prolonged as compared with control group (mean survivaldays: 12.4±5.3 vs 6.4±2.0, P＜0.05). Conclusion Intravenous adrninistmtion of MSC can prolong the survival of transplanted heart possibly by induction of allograft tolerance through changing Th1/Th2 balance.

Objective To explore protective effects of curcumin on lung injury in the early hepatic ischemia/reperfsion (reperfusion for 1 and 3 hour) inrats. Methods Wistarratswererandom]y divided into the fo]]owinggroups: GroupA (shamoperation), group B (control group) and group C (cureumin applied). Contents of superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), myeloperoxidase (MPO) in lung tissues were determined to evaluate the protective effect of eurcumin on lung injury in the injury of isehemia/ reperfusion. Results Curcumin relieved edema of diaphragmatic wall and exudation of blood cell and white cell in pulmonary alveoli. Curcumin increased the contents of SOD, CAT and decreased contents of MDA, MPO in lung tissue. Conclusion By repressing the generation of oxygen free radical and infiltration of polymorphonuclear leukocyte in lung tissue, curcumin can relieve lung injury in the early hepatic ischemia/repeffusion.

Objective To compare patellar ring,Kirschner wire tension band and patellar ring plus Kirschner wire in fixation for treatment of patella fractures.Methods A retrospective analysis was conducted on the 285 patients with patellar fracture who had been treated between September 2009 and January 2016.They were 155 men and 130 women,with an average age of 45.5 years (from 18 to 70 years).Their fractures included 176 transverse,28 longitudinal split and 81 comminuted ones.They were divided into 3 groups according to their different internal fixation methods:patellar ring fixation (98 cases),Kirschner wire tension band (92 cases),patellar ring plus Kirschner wire fixation (95 cases).The 3 groups were compared in terms of operative time,intraoperative bleeding,fracture healing time,knee function by B(o)stman score at the last follow-up and postoperative complications.Results The operative time in the patellar ring group(58.9 ±6.4 min) was significantly shorter than in the Kirschner wire group (71.8 ± 7.8 min) and in the patellar ring plus Kirschner wire group (74.4 ± 8.0 min) (P ＜ 0.05).There were no statistical significant differences between the 3 groups in fracture healing time and intraoperative bleeding (P ＞ 0.05).The good to excellent rate of knee function at the last follow-up in the Kirschner wire tension band group was 100.0％ (92/92),significantly higher than in the patellar ring group (90.8％,89/98) and in the patellar ring plus Kirschner wire group (91.6％,87/95) (P ＜ 0.017).There was no significant difference in postoperative complication rate between the patellar ring fixation group (2.0％,2/98),Kirschner wire tension band fixation group (1.1％,1/92) and the patellar ring plus Kirschner wire group (2.1％,2/95) (P ＞ 0.05).Conclusion Internal fixation with Kirschner wire tension band has definite curative effect on patellar fractures,showing the advantages of less operative invasion,fewer postoperative complications,better functional recovery of the affected knee joint,and lower price over the other 2 internal fixation methods.

Objective To investigate the curative effect between liver resection combined with microwave ablation during operation and simple liver resection in the treatment of primary liver cancer.Methods From January 2005 to December 2013,a total of 84 patients diagnosed as primary liver cancer in our hospital were collected and divided into combination group(42 cases) and simple group(42 cases) according to the surgical method.Combination group were treated by combining liver resection with microwave ablation during operation,simple group by simple liver resection.Results The intraoperative blood loss for combination group was (323.9 ± 93.1) ml and simple group was (524.5 ± 119.2) ml,P ＜ 0.05.postoperative tumor recurrence rate for combination group was 14.2％ and simple group was 33.3％,P =0.040.1-,3-,and 5-year survival rate for combination group was 96.5％,67％ and 51％,and simple group was 84％,49.5％ and 36.5％,P =0.036.The differences of the above parameters between the two groups were statistically significant.The operation time for combination group was (177.7 ± 30.7) min and simple group was (165.1 ± 29.5) min,P =0.058.The postoperative hospital stay for combination group was (15.5 ± 3.7) d and simple group was (14.0 ± 4.0) d,P =0.068.The changes of ALT,AST,ALB,TBIL on the first postoperative day and the incidence of postoperative complications (including bile leakage,fever,pleural effusion,blooding,abdominal infection and some others) between the two groups had no statistical significances (P ＞ 0.05).Conclusion The curative effects of liver resection combined with microwave ablation during operation are superior to pure liver resection in the treatment of primary liver cancer.

To evaluate the application of blood salvage techmque in spine orthopaedic operation. 26 cases of spine orthopaedic operations were divided into two groups. Group A received homologous blood transfusion. Group B received intraoperative blood salvage by cell saver in spine orthopaedic operations. No complications of transfusion and dysfunciton were found in all pateints. The results showed that blood salvage technique can decrease effectively the need of homologous blood transfusion in spine orthopaedic operation and can be used safely in clinical practice.
Adolescent ; Adult ; Blood Transfusion, Autologous ; methods ; Child ; Child, Preschool ; Female ; Humans ; Male ; Orthopedic Procedures ; Scoliosis ; surgery

Objective:To investigate the efficacy of new-type stereotaxic apparatus-assisted transfrontal puncture and drainage in the treatment of hypertensive intracerebral hemorrhage in the basal ganglia.Methods:A retrospective analysis was performed on the clinical data of 60 patients with hypertensive intracerebral hemorrhage in the basal ganglia who received disposable new-type stereotaxic apparatus-assisted transfrontal insertion with soft tunnels for hematoma aspiration drainage in our hospital from August 2017 to September 2019. The treatment efficacy was analyzed.Results:All patients were successfully punctured at one time; the puncture surface was 5-6.5 cm on the basement plane, where the hematoma surface was the largest; the puncture angle was 10-14°, and the puncture depth was 9-11.5 cm. Fifteen patients were operated within 6 h of hemorrhage, and the intraoperative hematoma clearance rate was about 25%; 40 patients were operated 6-24 h after hemorrhage, and the hematoma clearance rate was about 20%; 5 patients were operated one-3 d after hemorrhage, and the hematoma clearance rate was as high as 30%. The first postoperative re-check CT showed that 51 patients had ideal position of the drainage tube, 2 were too deep, one was too shallow, 2 were below the position, 2 were above the position, one was inside the position, and one was outside the position. The Glasgow Coma Scale (GOS) scores of the patients on 3 rd d of operation (9.88±3.998) were significantly higher than those of the patients before operation (6.24±3.159, P<0.05). One month after the operation, GOS showed that 20 patients (33.3%) had good recovery, 28 (46.7%) had mild disability, 7 (11.7%) had severe disability, 3 (5.0%) had plant survival, and 2 (3.3%) died. Conclusion:The disposable new-type stereotaxic apparatus-assisted transfrontal puncture drainage is easy to be conducted and practicable with a reasonable design, accurate positioning, minimal surgical traumas and satisfactory curative effect.

Objective: To observe the clinical characteristics, treatment responses and prognosis of patients with myelodysplastic syndrome (MDS) -del (5q) syndrome who met WHO (2016) diagnostic typing criteria. Methods: A total of 77 patients with del (5q) syndrome, according to WHO (2016) classification, were retrospectively analyzed between January 2008 and April 2018 in the Blood Diseases Hospital, Chinese Academy of Medical Sciences. Clinical characteristics, lenalidomide (LEN) efficacy and survivals were compared between the patients with del (5q) alone and those with one additional cytogenetic abnormality (ACA) with the exception of monosomy 7 or del (7q) . Treatment response and overall survival (OS) were compared between patients who were treated with LEN and traditional non-LEN drugs. Results: Of 77 patients, 64 were isolated del (5q) and 13 were del (5q) with ACA. There were significant differences of the median age and percentage of patients who had small megakaryocytes in bone marrow smear by immunohistochemistry (CD41) between the patients with isolated del (5q) and the patients with del (5q) + ACA[58 (29-64) years old vs 63 (31-82) years old, z=2.164, P=0.030; and 91.7%vs 60.0%, P=0.046, respectively]. The overall hematological response rate (78.9%vs 80.0%) , complete hematological remission (CR) rate (57.9% vs 60.0%) , cytogenetic response (CyR) rate[69.2% (9/13) vs 66.7% (4/6) ] and complete cytogenetic response (CCyR) rate [61.5% (8/13) vs 33.3% (2/6) ] of LEN were similar between the patients with isolated del (5q) (n=19) and with del (5q) + ACA (n=10) , as well as the median Overall survival (OS) between these two groups of patients (62 months vs 78 months, P=0.388) . The hematological response rate (79.3% vs 36.0%) , CR rate (58.6% vs 8.0%) , CyR rate [68.4% (13/19) vs 11.1% (1/9) ] and CCyR rate [52.6% (10/19) vs 0 (0/9) ] were higher among patients treated with LEN (n=29) than those treated with non-LEN therapy (n=25) . There was no statistically significant difference in OS between the patients with LEN or non-LEN therapy (78 months vs 62 months, P=0.297) . Conclusion Comparing del (5q) syndrome patients with isolated del (5q) or with del (5q) + ACA, two groups of patients had similar clinical characteristics, median OS and LEN efficacy. LEN showed better treatment response than traditional drugs in patients with del (5q) syndrome.