Objective To analysis the therapeutic effect of microsurgery through single-nostril transsphenoidal approach on pituitary adenomas and to study the surgical skill and postoperative complications about microsurgery for pituitary adenomas.Methods The clinical manifestations,pathological type, removal percentage,postoperative complications and follow-up data of 241 cases with pituitary ademoma by microsurgery through single-nostril transsphenoidal approach were analysed retrospectively.Results 171(7 1%)cases were achieved total tumor removal,28(11.6%)cases were achieved subtotal tumor removal,26(10.7%)cases were achieved most tumor removal and 16(6.6%)cases were achieved partial tumor removal.Most of patients achieved better results,however there were 38(15.8%)eases with diabetes insipidus,12(4.9%)cases with transient worse sight,4(1.6%)cases with cerebrospinal fluid leakage,2(0.8%)cases with oculomotor paralysis,and no death.The postoperative complications were cured and outcome was considered as good.The follow-up period was 1-36 months in 241 patients and the clinical symptoms were improved by different degrees.Conclusion Pituitary adenomas can be treated by microsurgery through single-nostril transsphenoidal approach due to the time of operation shorten,the postoperative complications.

Objective To discuss the reoperation method for recurrent pituitary apoplexy after the successful initial transnasal-sphenoidal surgery.Methods Twenty-one patients with pituitary apoplexy were found recurrence after previous tumor resection via transsphenoidal surgery in 9 months to 5 years.In the reoperation,transsphenoidal approach would be still used.The anterior wall of sphenoid sinus and the sellar floor were located accurately,and then the remnants of them were removed as large as possible to expand the range of bone window.Next,the intrasellar hematoma was cleared away gently,and the residual tumor was removed progressively and thoroughly to make sure the sellar diaphragm subsiding fully and finally removed the whole tumor.Results Most of recurrent tumors were found to be of soft texture with rich blood supply,and 17 cases were still apoplexy.In 18 cases of the 21 patients,total resection was achieved.However,for the other 3 cases with tumor aggressive growth,only massive resection was achieved,and underwent stereotactic radiosurgery postoperatively.Postoperative clinical symptoms were alleviated in 15 cases,whose hormones were also decreased.Temporary diabetes insipidus and hypopituitarism appeared in 5 and 3 cases respectively,but all of these postoperative complications were relieved after symptomatic treatment.Two cases of intraoperative cerebrospinal fluid leakage were resolved by packing the cavity with muscle and fat flaps.All cases were followed up for 3 months- 5 years,residual tumor enlarged in only 1 case of massive resection,which umderwent transsphenoidal surgery for the third time,no other cases recurred.Conclusion Operation via the transsphenoidal approach of recurrent pituitary apoplexy after successful initial transsphenoidal surgery could achieve high total resection rate.While the accurate locating,full expansion of the saddle bone window,and repeatedly scraping the apoplexy tumor to get a full subsidence for the sellar diaphragm,are the key points to remove tumors totally as well as to improve the symptoms.

Objective To investigate the application of neurophysiological monitoring and microsurgi-eal technique in acoustic neurinoma resection, exploring the significance of neurophysiological monitoring in facial and auditory nerve reservation of acoustic neuronma microsurgery. Methods Accompanied with EMG and BAEP nerve monitoring, 113 patients harboring acoustic neuroma were treated surgically by the subocipi-tal retrosigmoid approach for reserving facial and auditory nerve. The facial nerve was stimulated to evaluate its function during late-operation. Postoperative facial and auditory nerve function were valuated in all the postop-erative following up. Results All of them were treated microsurgically via the suboccipitai retrosigmoid ap-proach. Total tumors resection was achieved in 102 cases (90.3%), subtotal resection in 6 cases(5.3%) and partial resection in 5 case (4.4%). The facial nerve was preserved anatomically in 98 cases (86.7%), the functional valuation of facial nerve according to the House-Brakman (H-B) postoperatively: 86 cases (76.1%) in class Ⅰ -Ⅱ , 12 cases(lO.6%) in class Ⅲ-Ⅳ and 15 cases (13.3%) in class Ⅴ-Ⅵ. The acoustic nerve was preserved anatomically in 40 cases (35.4%). It denoted the good function of facial nerve responsing sensi-tively to electrostimulation ≤ 4mA at the end of operation. Conclusion Assisted with the intraoperative electrophysiological monitoring techniques, it would be greatly facilitate the preservation of facial and auditory nerve in acoustic neuroma resection. Simultaneously, it would valuate the functional convalescence by late-op-erative electrostimulation in the postoperation.

Objective:To explore the effect of Rain Classroom combined with situational teaching in clinical clerkship of internal medicine.Methods:A total of 72 undergraduate students with clinical majors of Batch 2015 were selected and randomly divided into a control group and an experimental group using computer scrolling pause method, with 36 students in each group. The control group adopted traditional teaching methods, and the research group adopted Rain Classroom combined with situational teaching. The teaching effect evaluation was carried out through a 10-point questionnaire based on the internal medicine theory examination, clinical skill assessment and learning interest, knowledge mastery and application, and clinical thinking and practical ability. SPSS 20.0 was used to conduct t-test. Results:The average scores of the students in the experimental group including the theoretical test (87.94±5.68) and the skill test scores (88.08±5.73) were significantly higher than those in the control group (83.00±5.89) and (83.86±4.80)( P<0.01). The results of the questionnaire showed that students' interest in learning improvement, self-learning ability, new knowledge acquisition, application of knowledge, clinical thinking, clinical practice, problem solving, self-expression, teamwork, doctor-patient communication ability in the study group were better than those in the control group ( P < 0.01). Conclusion:The Rain Classroom combined with situational teaching method is helpful to improve students' knowledge mastery and application, improve clinical thinking and practical ability, improve learning interest and clinical clerkship teaching effect.

Methylmalonic acidemia (MMA) is a series of rare inherited organic acid metabolic disorders with variable and nonspecific clinical manifestations, in particular neurological symptoms such as vomiting, lethargy, etc. Even with timely treatment, patients may still have various degrees of neurological complications and can even die. The prognosis is mainly related to the type of genetic variants, level of metabolites, newborn screening, onset of disease and early initiation of treatment. This article has reviewed the prognosis of patients with various types of MMA and factors that may affect it.
Infant, Newborn ; Humans ; Amino Acid Metabolism, Inborn Errors/complications* ; Prognosis ; Mutation ; Neonatal Screening ; Propionic Acidemia

Objective To explore the efficacy of moderate dose bromocriptine by one-off oral administration in treatment of patients with non-acute prolactin (PRL) type pituitary adenoma.Methods Forty-three patients with definite diagnosis of non-acute prolactin type pituitary adenoma,admitted to our hospital from January 2016 to December 2017,were chosen in our study.All patients were administrated with 5 mg bromocriptine at 18 pm;the serum PRL levels were examined at 2,3 and 12 h after bromocriptine administration.The curative effects of these patients were judged by decline rate of PRL,and the curative effects of patients with different genders,different initial PRL levels and different ages were compared.Results In these 43 patients,bromocriptine showed excellent effect in 20 patients,obvious effect in 18 and invalid effect in 5.There were statistically significant differences in the efficacy of bromocriptine between different genders (P＜0.05).There were statistically significant differences in efficacy of patients with different genders after taking bromocriptine (P＜0.05).The female patients had obviously higher rate of obvious effect than the male patients.Patients with different initial PRL values had statistically significant differences in efficacy after taking bromocriptine (P＜0.05).Patients with PRL initial value of 40-200 ng/mL had significantly higher rate of obvious effect than patients with PRL initial value of ＞200 ng/mL.There was no significant difference in efficacy between patients ＜ 45 years old and patients＞45 years old (P＞0.05).Conclusion The treatment ofhyperprolactin caused by prolactin type pituitary adenoma with moderate dose bromocriptine by one-off oral administration is effective;female patients have obviously better effect than male patients;and for patients with initial prolactin＞200 ng/mL,the effect is better.

Objective:To apply the best evidence of perioperative enhanced recovery nursing for lung cancer patients to clinical practice, and to evaluate the effect of practice.Methods:Following the 5 steps of the Stetler model of research utilization, an evidence-based protocol was formed through literature search, quality assessment, evidence synthesis and revision by expert group meetings. From January to July 2021, convenience sampling was used to select 160 lung cancer patients admitted to the Thoracic Surgery of Shanghai Chest Hospital as the research object. Patients admitted from January to April 2021 were set as the control group ( n=80) for baseline review. Patients admitted from May to July 2021 were set as the intervention group ( n=80) , and an evidence-based protocol was applied. Results:Finally, one guideline and 7 consensus articles were included. The evidence-based protocol covered 10 modules of preoperative nursing assessment, nutritional management, dietary preparation, health education, postoperative dietary management, functional exercise, pipeline management, pain management, venous thrombosis management and symptom management, with a total of 22 recommendations. There were significant differences in the time of first ambulation, the completion of ambulation on the day of operation, the pain score of first ambulation, the time for the first eating, and the time for the first exhausting between the two groups ( P<0.05) . There were no complications and venous thrombosis in the two groups during hospitalization. Conclusions:The development of the evidence-based practice project is beneficial to accelerate the postoperative recovery of lung cancer patients, and is conducive to standardizing the nursing path, thereby promoting the improvement of nursing quality.

Objective:To construct a combined diet and exercise program for puerperal women with Yin-deficiency constitution based on traditional Chinese medicine (TCM) constitution identification, and evaluate the effect of this program.Methods:This study was guided by the complex intervention development framework of the UK Research Council, and based on the TCM constitution identification, and determined the combined diet and exercise program for puerperal women with Yin-deficiency constitution based on TCM constitution identification through literature review, case analysis, group discussion, and Delphi method. From October to December 2022, convenience sampling was used to select 76 delivery women with Yin-deficiency constitution who delivered at Shenzhen Hospital of Southern Medical University as the research subject. According to the delivery time, the delivery women were divided into a control group ( n=37) and an experimental group ( n=39). The control group adopted routine postpartum nursing. On this basis, the experimental group implemented the combined diet and exercise program for puerperal women with Yin-deficiency constitution based on TCM constitution identification. We compared the Yin-deficiency constitution score, duration of lochia, and incidence of puerperium complications between two groups of delivery women before and after intervention. Results:The final constructed program included 6 primary indicators, 20 secondary indicators, and 50 tertiary indicators. In the two rounds of consultation, the positivity coefficients of experts were all 100%, the authority coefficients of experts were 0.827 and 0.843, and the Kendall harmony coefficients were 0.419 and 0.502, respectively with a statistical difference ( P<0.01). After intervention, the score of Yin-deficiency constitution, duration of lochia, and incidence of puerperium complications in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The combined diet and exercise program for puerperal women with Yin-deficiency constitution based on TCM constitution identification is scientific, comprehensive, and feasible, which can provide reference for future development of TCM constitution management during the puerperium.

Objective:To explore the clinical characteristics, genotypes and long-term outcomes of individuals with 3-methylglutaconic aciduria.Methods:The clinical features, biochemical data, genetic test results and treatment outcomes of six children with 3-methylglutaconic aciduria admitted to the Department of Endocrinology, Genetics and Metabolism, Xinhua Hospital from February 2017 to February 2019 were retrospectively analyzed and the Gesell developmental diagnosis schedule was performed to evaluate the development of four patients.Results:Among 6 children with 3-methylglutaconic aciduria 2 were males and 4 were females.Four cases had 3-methylglutaconic aciduria type Ⅰ and 2 cases had 3-methylglutaconic aciduria with deafness,encephalopathy, and Leigh-like syndrome. Five of 6 patients were detected by newborn screening among whom 4 remained asymptomatic, and only one had a postmortem diagnosis. Among them, 4 patients remained asymptomatic, while two presented with clinical symptoms such as jaundice and dyspnea and the age of disease onset was 1 and 2 days respectively. The concentration of 3-methylglutaconic acid in urine of all affected individuals was between 22.38 and 77.09 mmol/molCr, which was above the normal value. Genetic tests were performed for all patients. Eleven variants were identified in 2 genes, of which 10 variants were novel and only c.442C>T p.(R148X) has been previously reported; Seven variants (c.656-2delA, EX5-EX6 Del, c.942+3A>G, c.373C>T p.(R125W), c.895-3C>G, c.667C>T p.(R223X) and c.894+5G>A) were in AUH gene. The others (c.548G>A p.(R138Q), c.442C>T p.(R148X), c.1339C>T p.(R447X) and c.973dupA p.(M325Nfs*5) were in SERAC1 gene. After being treated with leucine diet restriction and L-carnitine, 4 patients with AUH gene variation who were from asymptomatic phase developed normally, whereas those 2 patients with SERAC1 gene variation had a poor prognosis. During the follow-up, 2 patients exhibited varying degrees of psychomotor retardation, the rest had normal course of development.Conclusions:There are significant clinical heterogeneities among individuals with 3-methylglutaconic aciduria. The most common pathogenic variants are splicing variations, followed by nonsense, missense and frameshift mutations. Leucine-free diet and oral L-carnitine therapy are effective for some patients. Newborn screening is essential for early diagnosis and improvement of prognosis.

Objective To conclude the application experience of intraoperative ultrasound added with neuronavigation in resection of intracranial gliomas.Methods A retrospective analysis was performed on the clinical data of 60 patients with intracranial gliomas,performed resection in our hospital from January 2010 to June 2013 by intraoperative ultrasound added with neuronavigation; 32 of them had high-grade gliomas and 28 low-grade ones.Ultrasonoscopy of different grade gliomas was studied.Results The accuracy of localization was 100％ in 60 patients with intracranial gliomas.Ultrasonic image of high-grade gliomas enjoyed obvious hyperechogenicity and the boundaries were clear usually; ultrasonic image of low-grade ones were slightly hyperechogenic or isoechogenic and the boundaries were indistinct usually.Inhomogeneous hyperechogenic of the ultrasonoscopy of intracranial gliomas before resection and hypoechogenic of residual cavity after resection were noted,respectively.Total removal was achieved in 50 patients,subtotal resection in 6 and partial resection in 4.Brain swelling happened postoperatively in 1 and was remitted by decompressive craniectomy.Hemiplegia happened in 2,and no death occurred postoperatively.Conclusions Intraoperative ultrasound is important to the correct of brain shift,and has clear and important value to the choice of operation approach and incising cortex.Ultrasonic image of high-grade gliomas and calcified lesions enjoys the best view.Intraoperative ultrasound added with neuronavigation can raise resection rate of intracranial gliomas.