Objective　To discuss the methods of treatment of sellar region tumors by microsurgery via modified transpterional approach.Methods　The clinical data of 326 patients with sellar region tumors were retrospectively analyzed. All of the patients(of them 158 patients with pituitary adenomas, 89 patients with craniopharyngiomas and 79 patients with meningiomas)were treated by microsurgery via modified transpterional in our hospital in recent 4 years. The most important part of preoperative arrangement was giving glucocorticoid and anti-epilepsy drugs. Modified transpterional craniotomy was performed, and the tumors were removed by employing microsurgical techniques via the 5 anatomy interspaces in sellar region after the subarachnoid cisterns were dissected carefully under surgical microscope. Consciousness, urine volume and serum electrolyte of the patients were observed strictly after surgery, and the complications such as diabetes insipidus, serum electrolyte disorder and epilepsy were remedied in time.Results　The rate of intact frontal branch of facial nerve was 92.18% and that of intact supraorbital nerve was 95.72%. Atrophy of temporal muscle occurred in none of the patients. Total and/or subtotal resection of tumors was achieved in 95.26% patients and the rate of intact pituitary stalk was 62.44%. The major postoperative complications included diabetes insipidus and serum electrolyte disorder. Although the incidence of complications was high to 61.42%, complete restore was achieved in 97.12% of the patients with the complications within 1 month.Conclusion　The modified transpterional approach for sellar region tumors may give a lower incidence of damage to frontal branch of facial nerve, super-orbital nerve and temporal muscle, and it can achieve higher total resection rate and a less postoperative complications by employing modified transpterional approach and the microsurgical techniques, combined with the active treatments of postoperative complications, therefore it is deserved to be spread to use in clinical works.

Objective To investigate the methods of total resection of craniopharyngioma and treatment of postoperative complications. Methods The abscission of CPG was performed in 24 patients with craniopharyngioma (CPG) which situated at sellar region after giving glucocorticoid and anti-epilepsy drug. The tumors were removed via the 4 anatomy spaces in sellar region by employing microsurgical technique. Consciousness, urine, and serum electrolyte of patients were observed strictly after surgery, and complications such as diabetes insipidus, serum electrolyte disorders and epilepsy were remedied in time. Results Total removal of tumors were achieved in 22 cases, and minor portion of tumors was left in 2 cases. All of the patients were sober after surgery. Diabetes insipidus, serum electrolyte disorder and body temperature disorder took place in 16 cases,12 cases, and 6 cases respectively. After treatment, serum electrolyte disorder and body temperature disorder were rectified in all cases, but diabetes insipidus was rectified in 13 of 16 cases. Conclusion Choosing the best operation approach according to the scope which tumor invades and being familiar with the 4 sellar anatomy spaces so as to be used correctly in operation are the keys to remove the CPG completely. Giving glucocorticoid before operation and active treatment of complications such as diabetes insipidus, serum electrolyte disorder can decrease mortality observably.

Objective To investigate the method of total resection of craniopharyngioma and prevention and treatment of post-operative complications. Methods Pterion craniotomy was performed in 24 patients with craniopharyngioma which was situated in sellar region after giving glucocorticoid and anti-epilepsy drug. The tumors were removed via the 4 anatomy spaces in sellar region by employing microsurgical technique. Consciousness, urine volume, and serum electrolyte of patients were observed strictly after surgery, and complications such as diabetes insipidus, serum electrolyte disorders and epilepsy were treated in time. Results Total removal of tumors were achieved in 22 cases, and minor portion of tumors was left in 2 cases. There was not obvious deficit of nervous system function in all of the patients after surgery. Diabetes insipidus, serum electrolyte disorder and body temperature disorder occurred in 16 cases, 12 case, and 6 cases respectively. After treatment, serum electrolyte disorder and body temperature disorder were rectified in all cases, and diabetes insipidus was rectified in 13 of 16 cases. Conclusion Choosing the best operation approach according to the scope of tumor invasion and being familiar with the 4 sellar anatomy spaces were the keys to remove craniopharyngioma completely. Giving glucocorticoid before operation and active treatment of complications such as diabetes insipidus and serum electrolyte disorder could effectively decrease mortality.

Objective To explore the surgical treatment of posttraumatic epilepsy in functional cerebral area Methods After preoperative evaluation,nineteen patients with intractable posttraumatic epilepsy of functional cerebral area underwent multiple subpial transaction under the electrocorticogram monitoring during the operation, combining with anterior corpus callosotomy, anterior temporal lobectomy and selective amygdalo-hippocampectomy. Results The follow-up results showed seizures of these patients improved considerably. According to Engel' s grading,among 19 cases,10 cases were grade Ⅰ ,7 cases were grade Ⅱ ,2 cases were grade Ⅲ ,and no cases were grade Ⅳ. Conclusions The satisfactory clinical outcome of the surgical treatment of intractable posttraumatic epilepsy in functional cerebral area could be obtained with the help of careful preoperative evaluation and multiple subpial transaction under the electrocorticogram monitoring.

OBJECTIVE:To establish a method for determination of carbazochrome sodium sulfonate for injection.METH_ ODS:C 18 was used as chromatographic column;the mobile phase consisted of0.12%ammonium dihydrogen phosphate buffer solution-absolute alcohol(925∶75)with detection wavelength at363nm and flow rate at0.8ml/min.The sample size was10?l and the column temperature was25℃.RESULTS:Linear relation was achieved when the concentration of carbzochrome sodium sulfonate was within the range of0.08865mg/ml～0.4432mg/ml(r=0.9999,n=5).The mean recovery rate was99.89%(RSD=1.53%,n=9).CONCLUSION:This method is simple,rapid,accurate,precise,and which can be used as the quality control of carbzochrome sodium sulfonate for injection.

Objective To investigate antimicrobial resistance of Escherichia coli (E.coli)and Klebsiella pneumoniae (K.pneumoniae),antimicrobial use density(AUD),as well as relation between antimicrobial resistance and AUD in a ter-tiary first-class hospital.Methods Antimicrobial resistance rates of clinically-isolated E.coli and K.pneumoniae,AUD of carbapenems and quinolones,as well as relation between resistance and AUD in 2013-2015 were statistically analyzed. Results Correlation analysis of antimicrobial resistance of bacteria and AUD showed that the decrease in resistance rate of E.coli to levofloxacin was related to the decrease in the use density of quinolones(r=0.61,P=0.03);increase in resist-ance rate of K.pneumoniae to imipenem was related to the increase in the use density of carbapenems(r=0.78,P<0.01). Conclusion Antimicrobial use is one of the causes of bacterial resistance,management on antimicrobial use needs to be strengthened to reduce the threat of bacterial resistance to human health.

Abstract A chiral separation and residue determination method for cis-epoxiconazole enantiomers in apple, grape and tea samples was developed and validated by ultra performance convergence chromatography combined with quadrupole time-of-flight mass spectrometry ( UPC2-QTOF/MS) . The Chrial CCA column was used to separate cis-epoxiconazole enantiomers and the chromatography conditions ( mobile phase modifier and proportion, column temperature, automated backpressure regulator, and auxiliary solvent ) were optimized. Samples were extracted by acetonitrile, and respectively purified by Cleanert TPT or Pesti-Carb solid phase extraction ( SPE ) columns, then analyzed by UPC2-QTOF/MS. The optimum conditions were as follows:mobile phase was CO2/isopropanol (95: 5, V/V), flow-rate was 2. 0 mL/min, automated backpressure regulator (ABPR) was 13. 79 MPa, column temperature was 30℃, with a post-column mauxiliary solvent of methanol/water (1:1, V/V) containing 2 mmol/L ammonium formate. The analyte was quantified by matrix external standard method. The results showed that linear range of this method was 0. 01-1. 00 mg/L, and the correlation coefficients were above 0 . 99 . The recoveries of cis-epoxiconazole enantiomers at three spiked levels (0. 005, 0. 025 and 0. 25 mg/kg) in fruit matrix were 67. 9%-92. 8% with relative standard deviations (RSDs, n=6) less than 10%, and the limit of quantification (LOQ) of enantiomers was 0. 005 mg/kg. The recoveries of cis-epoxiconazole enantiomers at three spiked levels (0. 01, 0. 05 and 0. 5 mg/kg) in black tea were 74 . 1% -84 . 0% with RSDs ( n=6 ) less than 8%, and the LOQ for these two enantiomers was 0. 01 mg/kg. This method is rapid, convenient and reliable, and could meet the requirement of residue analysis.

BACKGROUND:Positioning of the distal locking screws of a tibial intramedulary nail is often chalenging and time consuming. The traditional free-hand technique under fluoroscopic control involves considerable radiation exposure.OBJECTIVE: To evaluate the results of a new electromagnetic navigation system (TRIGEN-SURESHOT navigation system) for distal locking of tibial intramedullary nail in tibial diaphyseal fracture and to compare the effects with the free-hand method.METHODS: Forty-five cases of tibial diaphyseal fracture in the Second Hospital of Anhui Medical University from May 2014 to August 2015 were analyzed retrospectively, and were divided into two groups. Patients in navigation group (n=23) were treated with intramedullary nail using the TRIGEN-SURESHOT navigation system for distal locking, and the remainings in free-hand group (n=22) were given the free-hand method.RESULTS AND CONCLUSION: All cases were followed up for 17-32 months. The one-time success rate of distal locking nail operation was 100％ in the navigation group, which was significantly higher than that in the free-hand group (P < 0.05). The locking nail time in the navigation group was significantly less than that in the free-hand group (P < 0.05).No significant differences were found in the incidence of adverse events and fracture healing time between two groups (P > 0.05). To conclude, the effect of the TRIGEN-SURESHOT navigation system for distal locking of tibial intramedullary nail is satisfactory, exhibiting the advantages of short operation time, high success rate, and no radiation.

Objective To investigate the neuroprotective effect and its mechanism of p38 mitogenactivated protein kinase inhibitor after subarachnoid hemorrhage (SAH).Methods Twenty-seven SPF-grade adult male SD rats were selected to induce a SAH model using the prechiasmal pool blood injection.Three dead rats were excluded.Twenty-four rats were randomly divided into four groups:sham operation group,SAH group,dimethyl sulfoxide (DMSO) group,and DMSO +p38 inhibitor group (n =6 in each group).Western blot was used to detect the expression levels of p38,phosphorylation p38,Parkinson's disease protein 7 (DJ-1),autophagy associated gene 5 (Atg5),autophagy adaptor protein p62,microtubule-associated protein Ⅰ Light Chain 3 (LC3-Ⅰ),microtubule-associated protein Ⅱ light chain 3 Ⅱ (LC3-Ⅱ),and the Garcia neurological function score was used to judge the nerve injury.PC12 cell oxygenated hemoglobin was used to induce an in vitro SAH model.They were completely randomly divided into four groups:sham operative group,SAH group,DMSO group,and DMSO + p38 inhibitor group.Fluorescent probe JC-1 was used to observe the changes of mitochondrial membrane potential.Results (1) There were significant differences in the expression of p38,phosphorylation-p38 and DJ-1 in rat brain tissue among the 4 groups (F values were 94.959,150.293 and 698.476,respectively,all P ＜ 0.01).There were significant differences in mitochondrial membrane potential in PC12 cells among the 4 groups (F value was 24.989,P ＜ 0.01).There were significant differences in the expression levels of autophagy related protein LC3-Ⅱ/LC3-Ⅰ ratio,Atg5 and p62 in rat brain tissue among the 4 groups (F values were 235.319,110.490 and 36.311,respectively,all P ＜ 0.01).There was significant difference in nerve function score among the 4 groups (F value was 25.550,P ＜ 0.01).(2) Compared with the sham operative group,the expression levels of p38,phosphorylation-p38 and DJ-1 were upregulated significantly after SAH (from 0.43 ±0.06,0.41 ±0.02 and 0.07 ±0.01 to 0.61 ± 0.08,0.79 ± 0.07 and 0.17 ± 0.03,respectively,all P ＜ 0.01),mitochondria membrane potential depolarization (from 8.29 ±0.28 to 9.23 ±0.42,P ＜0.01);upregulation of Atg5 expression and increase of LC3-Ⅱ/LC3-Ⅰratio (from 0.23 ± 0.04 and 0.25 ± 0.04 to 0.47 ± 0.04 and 0.46 ± 0.04,respectively,all P ＜ 0.01),down regulation of p62 expression (from 1.09 ± 0.14 to 0.54 ± 0.10,P ＜ 0.01);neurological score was decreased (from 17.5 ± 0.6 to 11.3 ± 2.7,P ＜ 0.01);p38 inhibitor was significantly down regulated the expression of phosphorylation-p38 after SAH (from 0.79 ± 0.07 to 0.47 ± 0.04,P ＜ 0.01),the expression of DJ-1 was up-regulated (from 0.17 ± 0.03 to 1.02 ± 0.06,P ＜ 0.01),mitochondrial membrane potential recovery (from 9.23 ±0.42 to 8.47 ±0.36,P ＜0.01),cell autophagy related protein LC3-Ⅱ/LC3-Ⅰ ratio and Atg5 were upregulated(from 0.46 ±0.04 and 0.47 ±0.04 to 0.77 ± 0.06 and 0.95 ± 0.12,all P ＜ 0.01),p62 expression returned to the levels of SAH group (from 0.57 ± 0.09,to 0.54 ± 0.10,P =0.650),and the neurological score was significantly improved (from 11.3 ± 2.7 to 15.5 ± 1.0,P ＜0.01).Conclusions After SAH,the p38 inhibitor downregulates the activity of2 phosphorylation p38.It may inhibit abnormal autophagy and maintain mitochondrial function by up-regulating the expression of DJ-1 protein,and then play a neuroprotective function.

Objective To explore whether the prognostic efficiency of international prognostic index (IPI) can be further improved by interim 18F-fluorodeoxyglucose (FDG) PET/CT.Methods A total of 185 patients (116 males,69 females;average age 49 years) with pathologically confirmed diffuse large Bcell lymphoma (DLBCL) from January 2004 to January 2014 were enrolled in this retrospective study.The risk was classified by IPI (0-2 was considered as low risk,3-5 was considered as high risk) and all patients underwent 18F-FDG PET/CT scan before and after 4 cycles of immunochemotherapy.Based on interim 18 F-FDG PET/CT imaging,5-point Deauville score was used to reclassify DLBCL patient into negative group and positive group,and the interpretations were evaluated for 2-year progression-free survival (PFS) and overall survival (OS) rates.Kaplan-Meier analysis,log-rank test and Cox regression were used for data analysis.Results With a median follow-up of 27 (2-146) months,the 2-year PFS and OS rates were 60％(111/185) and 81％(150/185),respectively.A total of 114 patients were included in the low-risk group and 71 patients were in the high-risk group.Both 2-year PFS rates and OS rates between the 2 groups were statistically different:72％(82/114) vs 37％(26/71),x2=20.86,P＜0.01;90％(103/114) vs 63％(45/71),x2=13.39,P＜0.01.The interim PET/CT showed 113 patients with negative results and 72 patients with positive results,whose 2-year PFS rates and OS rates were also statistically different:82％ (93/113) vs 24％(17/72),x2 =66.66,P＜0.01;90％(102/113) vs 51％(37/72),x2 =33.11,P＜0.01.In the low-risk group,85 patients were PET-negative and 29 patients were PET-positive.The 2-year PFS rates were 88％ (75/85) and 31％(9/29),respectively (x2 =35.52,P＜0.01).The 2-year OS rates were 96％ (82/85) and 66％(19/29),respectively (x2 =11.88,P＜0.01).In the high-risk group,28 patients were PET-negative and 43 patients were PET-positive.The 2-year PFS and OS rates were 64％(18/28) vs 19％(8/43;x2 =17.33,P＜0.01) and 86％(24/28) vs 49％(21/43;x2=9.95,P＜0.01),respectively.Conclusions Both IPI and interim 18F-FDG PET/CT have the prognostic value for patients with DLBCL.Interim 18F-FDG PET/CT can improve the prognostic efficiency of IPI.