Invasive pituitary adenoma is a common pituitary adenoma invading nearby structures such as the sphenoidal sinus, ethmoidal sinus,upper clivus,sellar floor dura and bone. With the development of diagnosis neuroradiology, endocrinology,pathology and microsurgery,dramatic progress has been made on the pathogenesis, pre operative diagnosis and therapy of invasive pituitary adenoma.The development of pathology,molecular biological and medication and surgical therapy of invasive pituitary adenoma in the past few years is discussed in this paper.

The medical education of China and the United States was compared by analyzing the differences about educational system, teaching mode and teaching content in this paper. Standard-ization of the Chinese medical education system, improving clinical practice, teaching students by initi-ating questions and advanced medical education technology were recommended in China. This paper will inspirit and provide experience for the innovation of Chinese medical education.

ObjectiveTo evaluate the significance of pirif orm aperture enlarge ment in transsphnoid approach microsurgery for pituitary macroadenomas.MethodsTranssphnoidal approach microsurgery through enlarged pyrifor m aperture was ca rried out in 96 patients with pituitary macroadenoma from March 1997 to October 2000.ResultsAmong the 96 patients, 65 (67 7%) underwent tot al removal of the tumor, 25 (26 0%) underwent subtotal removal (80%～90%), and 6 (6 3%) partial removal (

Objective To study the optimal time of MRI follow-up after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma. Methods MRI records of 50 patients before surgery,within 1 postoperative week (early stage),at 3 months (intermediate stage) and 1 year after surgery (late stage),respectively,were retrospectively analyzed.Dynamic changes in the sella turcica were observed and the degrees of tumor excision were studied before and after MRI T 1-weighted enhanced scans at different postoperative stages. Results In the early stage MRI images showed that the size of sellar contents decreased by 8%～32%,tumor disappeared in 22 cases,and suspected residual tumor was found in 28 cases.At 3 months after surgery,MRI scans revealed that sellar contents decreased by 11%～85% in size.On coronal position MRI scans,the size of sellar contents decreased more than 50% in 11 cases,30%～50% in 9 cases,less than 30% in 8 cases.Out of the 28 cases that were suspected of residual tumor in the early stage,confirmation of residual tumor in the sella turcica was made in 23 cases.MRI findings 1 year after surgery showed no change in the sella turcica in 46 cases and continuing to decrease in 4 cases. Conclusions Re-examination of MRI in intermediate stage after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma facilitates the detection of residual tumor and recurrence.

Objective To investigate the expression of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) in hippocampus after status convulsion (SC) and explore the influence of age and duration of SC on the expression of BDNF and NGF. Methods Animal model with the different durations of SC (30 min,3h) were established by intraperitoneal injection of 3 mEq/kg lithium chloride,18-20 h later,followed by 5 mg/kg pilocarpine in 40 adult Wistar rats aged 2-3 months and 40 20-day-old Wistar rats. The normal control and experimental control were made in ten adult rats and ten 20-day-old rats (n=5 for each control). The rats were sacrificed at 3 h,6 h,12 h,1 d,3 d,7 d after 30-minute SC,or 3 h,1 d after 3-hour SC respectively. The location and cell type expression of BDNF and NGF in the hippocampus were observed by immunohistochemistry. The levels of BDNF and NGF at different time points were quantitatively analyzed by enzyme-linked immunosorbent assay (ELISA). Results The cells expressing BDNF and NGF located mainly in the dentate granule cells and CA1-CA4 pyramidal cells of hippocampus. The most positive immunoreactivity was in cytoplasm,partly in axons. The expression of BDNF had the tendency of increase in all rats after 3-hour SC,peaked at 1 d and 3 d respectively. These increases lasted for at least 7 d. Moreover,a several-fold increase was observed at the peak levels. The patterns of NGF expression were similar to that of BDNF after SC. The elevated degree and duration of NGF expression were remarkably lower than that of BDNF,declining abruptly to below control levels by 12 h with the characteristic of biphasic increase. The expression of hippocampal BDNF had the positive correlation with the duration of SC,but that of NGF was not. No matter the duration of SC,there was more rapid and evident induction of BDNF in 20-day-old rats and adult rats. Moreover,the age-related difference was more obvious for the longer duration of SC. Conclusion SC induced the expression of BDNF chiefly in hippocampus,and had minor influence on that of NGF. The expression of BDNF was related to age and duration of SC. There was a more rapid and marked induction of BDNF in 20-day-old rats and adult rats. The age-related difference had the positive correlation with the duration of SC.

Objective To investigate the effects of different doses of intrathecal magnesium on bone cancer pain (BCP) in mice.Methods Two hundred and eighty-eight male C3H/HeJ mice,aged 8-10 weeks,weighing 18-22 g,were randomly divided into 6 groups (n =48 each):control group (group C) ; sham operation group (group S) ; BCP + artificial cerebro-spinal fluid (aCSF) 5 μl group (group BCP) ; BCP + MgSO4 14.4 μg group (group M1 ) ; BCP + MgSO4 43.2 μg group (group M2 ) and BCP + MgSO4 86.4 μg group (group M3 ).BCP was produced by injecting fibrosarcoma cells of bone into the medullary cavity of right femur.Intrathecal catheter was placed in the 4 BCP groups.The aCSF 5 μl or MgSO4 14.4μg/5 μl,43.2 μg/5 μl,or 86.4μg/5 μl was injected intrathecally on 14th day after inoculation of tumor cells.The paw withdrawal threshold to mechanical stimuli (PWMT) and paw withdrawal lateney to thermal stimuli (PWTL) were measured at 0.5 h before administration (T0 ) and at 0.5,2,4 and 8 h after administration (T1-4).Eight animals chosen from each group at T0-4 were sacrificed,and L4-5 segment of the spinal cord was removed for determination of NR2B expression (by immuno-flurorescence) in the spinal cord.Results PWMT and PWTL were significantly decreased at T0-4,and NR2B expression was significantly up-regulated at T0-4 in groups BCP,M1,M2,M3 compared with groups C and S ( P ＜0.05).Compared with group BCP,PWMT and PWTL were significandy increased at T1-3,and NR2B expression was significantly down-regulated at T1-3 in groups M2 and M3 ( P ＜ 0.05).Compared with group M2,PWMT and PWTL were significantly increased at T1-3,and NR2B expression was significantly down-regulated at T1-3 in group M3 ( P ＜ 0.05).Conclusion Intrathecal magnesium can reduce BCP in a dose-dependent manner in mice.

Objective To systematically review the preventive efficacy of N-methyl-D-aspartate (NMDA) receptor antagonists on remifentanil-induced postoperative hyperalgesia.Methods Pubmed,EMBase,Springer and Cochrane Controlled Trials Register were searched to identify all randomized controlled trials(RCTs) about efficacy of NMDA receptor antagonists for preventing remifentanil-induced postoperative hyperalgesia.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.The data was extracted,including postoperative analgesic consumption,pain scores,time for first analgesic request and the incidence of adverse effects.Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software.Results Fourteen RCTs involving 623 patients were included in our Meta-analysis.NMDA receptor antagonists significantly decreased pain scores at 4 h after operation ( P ＜ 0.05),and had no effect on postoperative analgesic consumption,time for first analgesic request and the incidence of adverse effects ( P ＞ 0.05).Conclusion NMDA receptor antagonists (ketamine and magnesium)can not prevent the occurrence of postoperative hyperalgesia induced by remifentanil.

Objective To explore the regulation of Bub1 mRNA expression in endometrial carcinoma cells by estrogen and paclitaxel. Methods The high differentiated endometrial adenocarcinoma cells ( Ishikawa cell line) were cultured in DMED/F12 supplemented with 10% fetal bovine serum(FBS) or phenol red-free DMED/F12 supplemented with 5% dextran-charcoal FBS (dcFBS). Firstly, the cells were stimulated by 10 nmol/L estradiol (17β-E2 ) or no hormonal stimulation as control group, and the cell proliferation was quantified at 24, 48 and 72 hours using cell counting kit-8 (CCK-8) method. Then the cells were stimulated with different concentrations of 17β-E2 (0.1, 10, 1000 nmol/L) at different periods (5,15,30 minites and 2,4,8,12,16,24,30 hours), the expression of Bub1 mRNA was detected by real-time quantitative PCR. Ishikawa cells were cultured with non-serum DMEM/F12 to be synchronized, and then were treated with different concentrations of paclitaxel( 10,100 nmol/L) for 8 and 24 hours. While, nonsynchronized Ishikawa cells were exposed to 100 nmoL/L paclitaxel for different periods(4, 8, 16, 24,48 hours), and real-time quantitative PCR was also used to detect the expression levels of Bub1 mRNA.Data were presented as folds change relative to control group, in which values ＜ 1 were down-regulated, and those ＞ 1 were up regulated. Results The proliferation rate of cells in the presence of 17β-E2 was significantly highter than that of the control group after treated 24 hours (A value: 0. 70 ±0. 08 vs. 0. 86 ±0.10, P = 0.049). Time-dependent experiments revealed that addition of 17β-E2 could increase cell numbers during 72 hours period, while the expression level of Bub1 mRNA was decreased in Ishikawa cell.Dose-dependent experiments revealed maximal estradiol stimulation effects at 10 nmol/L( P = 0. 020). After being treated with serum-free culture, Ishikawa cells were exposed to 10 nmol/L paclitaxel for 8 and 24 hours, and the expression of Bubl mRNA decreased (0. 403 ± 0. 008 vs. 0. 775 ± 0. 144, P = 0. 251 ).Compared to the control cells, the mRNA expression levels of Bub1 in cells treated by paclitaxel for 8 hours was significantly decreased ( P = 0. 009 ), while there was not significantly decreased at 24 hours ( P =0. 396). When exposed to 100 nmol/L paclitaxel for 8 and 24 hours, the expression of Bubl mRNA was also decreased(0. 697 ±0. 017 vs. 0. 850 ±0. 004, P =0. 061 ). Compared to the control cells, Bub1 mRNA expression was also significantly decreased (P = 0. 038 and P= 0. 019, respectively). While with serum freetreatment culture, when Ishikawa cells exposed to 100 nmoL/L paclitxel for 4, 8, 16, 24 or 48 hours, the expression of Bub1 mRNA significantly increased ( 1. 127 ± 0. 105 vs. 1. 614 ± 0. 154 vs. 2. 092 ± 0. 179vs. 1. 381 ± 0. 061 vs. 1. 519 ± 0. 182, P = 0. 002 ), of which was signicantaly increased at 16 hours treatment. Conclusion Bub1 exrpession could be regulated by estradiol and paclitaxel, in which deregulated Bubl expression may contribute to chemotherapeutic efficacy of paclitaxel.

Objective To analyze the effects of minimally invasive intenvention on acute suppurative cholangitis(ASC).Methods The clinical data of 28 patients with ASC and performed with endoscopic therapy were analyzed.Results 5 patients with a single stone incarcerated in the duodenal nipple were performed with ERCP and needle electrode fenestration to removed the stone.6 patients with a single stone were performed with endoscopic sphineterotomy(EST).15 patients are successfully performed with ERCP+EST after cholangitis and general situation turned better.2 patients failed with endoscopic therapy,and they were recovered treated with conventional surgery.Conclusion Minimally invasive intenvention on ASC has characteristics of quick,minimally invasive surgery,high success rate,rapid recover,and fewer complications.

Objective To explore the influences of age and duration of status convulsion (SC) on hippocampal neuron apoptosis by observing the dynamic change of neuron apoptosis in rats with different age when SC terminates. Methods Seizures were induced in infant rats (IRs) and adult rats (ARs) injected with lithium and pilocarpine intraperitoneally. Rats were sacrificed at 6 time points (3, 6, 12 hours and 1, 3, 7 days) after 30 minutes of SC, or 2 time points (3 hours and 1 day ) after 3 hours of SC respectively. The location and type of apoptotic cells were assessed by using terminal deoxynucleotidyl dUTP nick end-labeling (TUNEL) of brain sections in situ. The proportion of apoptotic cells was quantified by Annexin-Ⅴ-FITC apoptosis detecting method and analysed by flow cytometer. Results (1) SC induced neuronal apoptosis and necrosis mainly in the CA_1 and CA_3 regions of hippocampus. (2) As compared to the time point before SC, the proportion of apoptotic cells in IRs and ARs hippocampus was increased obviously at 3 hours point after 30 minutes of SC (IRs 0.55%?0.21%, ARs 0.53%?0.06%), and with a maximal induction at 12 hours in IRs (0.67%?0.18%) and 1 day in ARs (0.98%?0.38%). The apoptotic process continued at least for 3—7 days. (3) In IRs, the proportion of apoptotic cells was lower than in ARs at different time points after 30 minutes of SC, except 3 hours point. There was a significant difference between the two age groups at 1 day and 7 days after SC respectively. The age-related difference was more obvious after 3 hours SC. Conclusions (1) Severe seizure induces neuronal apoptosis in hippocampus. (2) Age and duration of SC might be the important factors in influencing the neuronal apoptosis. The neuronal apoptosis in hippocampus after SC would have a positive correlation with age and duration of SC.