Objective To investigate the value of neuronavigation system in resection of pituitary adenoma through the endonasal transsphenoidal approach. Methods Twenty-one patients with pituitary adenomas underwent magnetic resonance imaging (MRI) or CT scans studies. The image datasets were transported into the neuronavigation system. The anatomic information of approach was reconstructed for three-dimensional visualization and the best approach was designed. The midline structure and internal carotid artery were displayed in real-time intraoperatively, the anterior-wall of sphenoidal sinus and the floor of sella were accurately opened and the tumor was resected guiding by neuronavigation system. Results All the operations were smoothly and accurately performed under the neuronavigation by transsphenoidal approach. No injury occurred in the internal carotid artery and cavernous sinus. After surgery, 13 patients got better vision and visual field. Postoperative transient diabetes insipidus was found in 11 cases, and CSF leak in 1 and serious hyponatremia in 2 cases. Total tumor removal was achieved in 17 patients and subtotal removal in 2 cases during operations, which were confirmed by postoperative MRI. Three-month follow-up data showed only one recurrence case (subtotal tumor removal), the recurrence rate was 4.8%. Conclusion Neuronavigation system provided real-time localization with three-dimensional anatomic information of the endonasal transsphenoidal approach during pituitary adenomas surgery. As a result, the approach proceeds more smoothly and accurately, the tumor can be resected more completely, the surgical injury and complications can also be reduced.

Objective To evaluate the clnical value of percutaneous nephrolithotomy combined with flexible cystoscope in the treatment of complicated renal calculi.Methods Data of 53 cases of complex renal calculi treated with single channel percutaneous nephrolithotomy combined with flexible cystoscope from July 2011 to September 2013 were analyzed retrospectively.There were 31 males and 22 females.Their age ranged from 26 to 74 years with a mean age of 49 years.Thirty-two cases were located on the left side,19 cases right,2 cases bilateral,21 cases of staghorn calculi and 32 cases of multiple stones.All the stones were filled in 2 or more calyces,with 7 cases in upper ureteral stones at the same time and 2 cases in solitary kidney.The longest diameter of stones was between 2.5 cm to 4.6 cm,with an average of 3.7 cm.There were 39 cases with hydronephrosis and the separation of the collection system was 2.0-5.1 cm with an average of 3.8cm.The period which patients suffered from stones was from 1 month to 6 years.Fourteen cases underwent ESWL and 6 cases underwent open operation before percutaneous nephrolithotomy.All patients underwent single channel percutaneous nephrolithotomy under the guidance of color Doppler ultrasound,and the channel of puncture was expanded to 24 F.Results Fifty-three cases (55 sides) were performed successfully in one-stage sugery and the operation time was between 85 to 170 min,with an average of 119 min.Thestone clearance rate was 89％ (49/55) and postoperative hemoglobin decreased 3.9-9.2 g/L with an average of 6.1 g/L.The hospitalization time was 8 to 12 days with an average of 9.2 days.Two cases had hemorrhage of about 500 ml after surgery and the renal hemorrhage stopped after clamping of renal fistula without blood transfusion.Two patients suffered from fever on surgery day and 1 patient on one day after surgery,and the body temperature returned to normal level after anti-infection treatment for 2 or 3 days.No renal perforation,fluid pneumothorax or damaged surrounding organs occurred.6 patients had residual stones,among which 2 were treated by two-stage operation and 4 were treated with extracorporeal shock wave lithotripsy.Conclusion Percutaneous nephrolithotomy combined with flexible cystoscope has little trauma and high stone clearance rate in the treatment of complex renal calculi with high clinical value.

ObjectiveTo discuss the role of neuronavigaition technique in localizing and facilliating microsurgical resection of intracranial ateriovenous malformations (AVM) .Methods Forty-three cases with intracranial AVM treated microneurosurgically asisting by Stryker Leibinger neuronavigation system were retrospectively analyzed.Results After reaching neuronavigation calculated technical accuracy (less than 2 mm) and continual intraoperative navigating accuracy, all of the 43 AVM lesions were completely resected.In 41 patients, syptoms were significantly improved (95.4％) at discharge, new neurofuntion defection were found in 2 patients(4.6％) , no death occured.ConclusionNeuronavigation techniques helps the surgery in planning a precise surgical approach to the targeted AVM lesion and tracing the neurovascular structures ,improves the safety of the surgery and the functional outcome of the patients, contribute to lesion resection and reduce operative complications.

Objective To determine the usefulness of real time three-dimensional transesophageal echocardiography(RT-3D TEE) in the preoperative assessment of mitral valve (MV) pathology by comparing images with surgical findings and to evaluate the function of MV postoperatively. Methods Nineteen consecutive adult patients with established diagnosis of mitral regurgitation(MR) scheduled for surgical correction were enrolled. Intraoperative 2D and 3D transesophageal echocardiography(TEE) were performed. All the 3D images were compared with findings obtained from direct surgical inspection. Postoperative RT-3D TEE was performed immediately to evaluate outcomes of mitral annuloplasty. Results Superb 3D-TEE en face views of the MV were obtained in all patients. Correct diagnoses of MV pathology in agreement with the surgical findings were made in 16 of 19 patients (84. 2%), however in the remaining 3 patients, the diagnoses were incorrect despite good image quality. In one, RT-3D TEE diagnosed prolapse of A2 segment and P2 scallop,which was not confirmed at surgery, but MV degeneration and annular dilatation were observed. In another one, RT-3D TEE revealed prolapse of P3 scallop, while at surgery prolapse involved P2 and P3 with ruptured chordae. In the rest one,surgically detected prolapse of P2 was missed by RT-3D TEE. On the other hand with 2D TEE,the diagnoses correlated poorly with surgical findings,only 10 patients were accurately diagnosed (52.6%). In some patients,2D TEE was able to identify the MVP, but it had difficulty in defining the exact location of the prolapsed segment or scallop. The severity of MR decreased significantly after surgery. MV repair was successful in all patients except one(5.1%), in whom moderate to severe MR was still present and MV replacement was conducted subsequently as an alternative.Conclusions RT-3D TEE provides excellent imaging of MV components, including the anterior and posterior leaflets, as well as annulus and subvalvular structures, which can be especially helpful in planning the most appropriate surgery strategy. RT-3D TEE offers exact anatomic characteristics of mitral annuloplasty rings and bands, providing additional information for the evaluation of surgical outcomes.

Objective: The purpose of this study was to explore the relationship between maternal tea consumption and birth outcomes. Methods: From January 2005 to December 2010, pregnant women were recruited from Nanjing Maternity and Child Health Hospital. The basic information and the situation of tea consumption during pregnancy were investigated using questionnaire and the birth outcomes of newborns were followed up. Finally, 500 pairs of mothers and infants with complete and standard-compliant data were included in the analysis. The differences of birth outcomes between the tea consumption group and the non tea consumption group were compared and the associations between tea consumption and birth outcomes were analyzed using multivariate logistic regression. Results: Mother's tea consumption rate was 32.8% (164 cases) during pregnancy. The rate of low birth weight in the tea consumption group was (5.5%, 9 cases) and higher than that in the non-tea consumption group (2.1%, 7 cases) (P=0.042). There was no significant difference in the rate of premature birth, small for gestational age, fetal distress, and macrosomia between the two groups After the adjustment of maternal age, education level, family income, weight gain during pregnancy, pre-pregnancy BMI, parity, gestational hypertension, gestational diabetes, neonatal gender and gestational age, compared with non-tea consumption group, there was a positive effect on low birth weight, OR(95%CI) was 4.76 (1.06-21.48). The OR (95%CI) value of the low birth weight risk of the tea group was 5.30 (1.04-26.92) compared with the non-tea consumption group after the adjustment of additional factors such as passive smoking, coffee consumption, folic acid supplement, mineral supplement, carbonated beverage consumption. Simultaneously, compared with non-tea consumption group, there was no statistically significant association between tea consumption during pregnancy and premature birth, small for gestational age, fetal distress and macrosomia (P>0.05). Conclusion Tea consumption during pregnancy was a risk factor for low birth weight in offspring.

Objective To explore the effect and mechanism of sodium hydrosulfide(NaHS)on cerebral cortical injury in rats with cerebral ischemia-reperfusion.Methods A total of 80 male SD rats were divided into a sham operation group,an NaHS group,an ischemia-reperfusion group,and an ischemia-reperfusion+NaHS group using a random number table method,with 20 rats in each group.The rats in the ischemia-reperfusion group and ischemia-reperfusion+NaHS group were used to prepare ischemia-reperfusion models.The rats in the ischemia-reperfusion+NaHS group were given 50 μmol·kg-1 NaHS intraperitoneally after cerebral ischemia,while the rats in the ischemia-reperfusion group were given an equal volume of physiological saline intraperitoneally after cerebral ischemia.The rats in the sham operation group and NaHS group only had vessels isolated but not occluded with threads.The rats in the NaHS group were given 50 μmol·kg-1 NaHS intraperitoneally after vascular detachment,while the rats in the sham operation group were given an equal volume of physiological saline intraperitoneally after vascular detachment.Twenty-four hours after modeling,the neurological deficits of rats in the four groups were evaluated by using the modified neurological severity score(mNSS),the cerebral infarction of rats in the four groups was observed aftertriphenyltetrazolium chloride staining,the levels of pro-inflammatory cytokines interleukin-1β(IL-1β)and interleukin-18(IL-18)in theischemiccerebralcortical tissues of rats in the four groups were detected by using enzyme-linked immunosorbent assay,the expression of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)in the ischemic cerebral cortical tissues of rats in the four groups was detected by using Western blot,and the activity of microglia in the ischemic cerebral cortical tissues of rats in the four groups was detected by using immunofluorescence.Results The brain tissues of rats in the sham operation group and the NaHS group showed uniform orange red color,while the rats in the ischemia-reperfusion group and the ischemia-reperfusion+NaHS group had pale infarcted areas in the ischemic cerebral cortex and striatum.The cerebral infarction area of rats in the ischemia-reperfusion group and the ischemia-reperfusion+NaHS group were significantly larger than that in the sham operation group and the NaHS group,while the cerebral infarction area of rats in the ischemia-reperfusion+NaHS group was significantly smaller than that in the ischemia-reperfusion group(P＜0.05).The mNSS scores of rats in the ischemia-reperfusion group and the ischemia-reperfusion+NaHS group were significantly higher than those in the sham operation group and the NaHS group,while the mNSS score of rats in the ischemia-reperfusion+NaHS group was significantly lower than that in the ischemia-reperfusion group(P＜0.05).The relative expression levels of NLRP3 protein in the ischemic cerebral cortex of rats in the ischemia-reperfusion group and the ischemia-reperfusion+NaHS group were significantly higher than those in the sham operation group and the NaHS group,while the relative expression level of NLRP3 protein in the ischemic cerebral cortex of rats in the ischemia-reperfusion+NaHS group was significantly lower than that in the ischemia-reperfusion group(P＜0.05).The levels of IL-1β and IL-18 in the ischemic cerebral cortex of rats in the ischemia-reperfusion group and the ischemia-reperfusion+NaHS group were significantly higher than those in the sham operation group and the NaHS group,while the levels of IL-1β and IL-18 in the ischemic cerebral cortex of rats in the ischemia-reperfusion+NaHS group were significantly lower than those in the ischemia-reperfusion group(P＜0.05).The rats in both sham operation group and NaHS group showed normal morphology of microglia in the ischemic cerebral cortical area.Compared with the sham operation group and the NaHS group,the rats in the ischemia-reperfusion group showed a significant reduction in the protrusion of microglia in the ischemic cerebral cortical area and a significant increase in the brightness of microglial cell bodies,and the cells appeared as clumps,losing their normal morphology,with a higher proportion of activated microglia.Compared with the ischemia-reperfusion group,the rats in the ischemia-reperfusion+NaHS group showed an increase in the number of microglial processes in the ischemic cerebral cortex,with fewer activated microglia and significantly improved morphology.The total numbers of microglia in the ischemic cerebral cortex of rats in the ischemia-reperfusion group and theischemia-reperfusion+NaHS group were significantly lower than those in the sham operation group and the NaHS group,while the total number of microglia in the ischemic cerebral cortex of rats in the ischemia-reperfusion+NaHS group was significantly higher than that in the ischemia-reperfusion group(P＜0.05).Conclusion NaHS can significantly improve brain injury in ischemia-reperfusion rats by inhibiting the inflammatory response and microglial activation induced by NLRP3 and reducing the levels of pro-inflammatory cytokines IL-1β and IL-18.

Birth cohort is an effective method to explore the relationship between various prepregnant and pregnant exposures and the health of fetuses, infants and young children. It is a long construction period to build a birth cohort and the quality of research may be affected by many factors. This paper reviews the quality assurance and quality control measures in the process of China National Birth Cohort (CNBC), and summarizes the construction experience. We aim to provide experience for related cohort studies, which could improve the quality of cohort studies through removing the impact of related factors. CNBC adopted a series of measures to ensure the quality of research in the top-level design of quality assurance, including screening research center, developing member management system, formulating standard operating procedures and training staff by it. In terms of quality control, it includes real-time, timely and timing quality control for the process of data generation, full-cycle quality control for biological sample collection, processing, storage and comprehensive three-dimensional quality control for staff training, supervision and quantitative assessment.

Birth cohort is an important observational study which can continuously and dynamically collect the exposure changes and health outcomes from gametophyte development to adolescence and even old age. However, because of its complex design and difficult implementation, how to construct birth cohort with high quality and high efficiency is the main difficulty faced by epidemiologists at home and abroad. In 2016, China National Birth Cohort was officially launched. The network and information technology were used to explore, and a set of "cloud-based information platform" was established to support this queue construction, containing 16 units in China. After four years of development, the platform has formed a complete set of programs about the construction of cohort information platform, which including recruitment and follow-up management of participants, real-time data interaction, queue quality control, multi-level authority management and function division. The relevant design framework and functional elements provide the references to the future information construction of large-scale birth cohort and even population-based research in China.

Objective:To investigate the role of microRNA-338-3p (miR-338-3p) in regulating the generation and function of interphotoreceptor retinoid-binding protein (IRBP) 1-20-specific T helper 17 (Th17) cells in experimental autoimmune uveitis (EAU). Methods:Bone marrow cells were flushed from the femurs and tibiae of wild-type C57BL/6 mice and cultured in the presence of granulocyte macrophage-colony stimulating factor (GM-CSF) and interleukin-4 (IL-4)to differentiate into bone marrow-derived dendritic cells (BMDCs). On day 5 after induction, immature BMDCs were collected and divided into miR-338-3p mimics transfection group and mimics negative control transfection group, then transfected with miR-338-3p mimics or negative mimics according to grouping.Twenty-four hours after transfection, the BMDCs were stimulated with 100 ng/ml of lipopolysaccharide to mature.Relative expression levels of miR-338-3p, IL-6, IL-23 and IL-1β mRNA in BMDCs of the two groups were detected by quantitative real-time polymerase chain reaction (qRT-PCR). The EAU model was established with IRBP 1-20, incomplete Freund adjuvant and mycobacterium tuberculosis (H37Ra) in mice.On day 13 after modeling, T cells were isolated from the mice spleen or draining lymph nodes and co-cultured with miR-338-3p mimics or negative control mimics-transfected BMDCs under Th17-polarizing conditions.Concentration of IL-17 in the supernatant was detected by ELISA.Relative expression levels of retinoic acid receptor-related orphan nuclear receptor γt (RORγt) and IL-17 mRNA were analyzed by qRT-PCR.The proportion of IL-17 + cells among T cells co-cultured with BMDCs was assessed by flow cytometry.To further verify the role of miR-338-3p in dendritic cells on Th17 cells, BMDCs transfected with miR-338-3p inhibitor or control inhibitor were co-cultured with T cells isolated from spleen or draining lymph nodes of EAU mice.Concentration of IL-17 in the supernatant was detected by ELISA.The use and care of the animals complied with Regulations for the Administration of Affairs Concerning Experiment Animals by State Science and Technology Commission.The study protocol was approved by the Institutional Animal Care and Use Committee of Tianjin Medical University (No.TJYY2019110117). Results:Relative expression level of miR-338-3p in BMDCs was significantly increased in the miR-338-3p mimics transfection group than the mimics negative control group ( t=6.861, P=0.002). In T cells co-cultured with miR-338-3p mimics-transfected BMDCs, the relative expression levels of RORγt and IL-17 mRNA were 1.34±0.16 and 1.33±0.16, which were significantly higher than 1.00±0.01 and 1.00±0.01 in the mimics negative control group ( t=3.632, P=0.022; t=3.681, P=0.021). ELISA showed that the concentration of IL-17 in the supernatant was (5 941.00±452.40)pg/ml in the miR-338-3p mimics transfection group, which was significantly higher than (4 299.00±348.30)pg/ml in the mimics negative control group ( t=4.979, P=0.008), and IL-17 concentration in the supernatant was (3 092.00±200.90)pg/ml in the miR-338-3p inhibitor transfection group, which was lower than (4 063.00±131.50)pg/ml in the inhibitor negative control group ( t=7.005, P=0.002). The proportion of IL-17 + cells among T cells was (8.03±1.35)% in the miR-338-3p mimics transfection group, which was significantly higher than (4.52±0.73)% in the mimics negative control group ( t=3.968, P=0.017). The relative expression levels of IL-6, IL-23, and IL-1β mRNA were 2.23±0.21, 2.21±0.56, 2.32±0.43, respectively in the miR-338-3p mimics transfection group, which were significantly higher than 1.00±0.06, 1.00±0.07, 1.01±0.15 in the mimics negative control group ( t=10.290, P=0.001; t=3.747, P=0.020; t=5.280, P=0.006). Conclusions:Overexpression of miR-338-3p in BMDCs can promote the IRBP 1-20-specific Th17 cell response by increasing the expression of Th17-polarizing cytokines including IL-6, IL-1β and IL-23.

Objective:To analyze the correlation between left and right atrial diameters and fetal biological growth parameters of normal fetuses in middle and late trimester, and to establish normal reference and Z-score model for left and right atria.Methods:Three hundred and ninety-two fetuses in middle and late trimester were prospectively selected from July 2022 to October 2022 in Sir Run Run Shaw Hospital.Non-cardiac biometric parameters included biparietal diameter (BPD), femoral length (FL), and gestational age (GA) based on menstrual age were assessed.Left and right atrial widths (LAW, RAW) and atrial lengths (LAL, RAL) at end-systole, left and right atrial areas (LAA, RAA) at end-systole and the heart area (HA) at end-diastole were measured in standard apical four-chamber or basal four-chamber view. The ratio of RA and LA transverse diameters (RAW/LAW), the ratio of RA and LA length diameters (RAL/LAL), ratio of RA and LA area (RAA/LAA), spherical index of the ratio of RA and LA length to transverse diameter (RASI, LASI), ratio of LA and RA area to heart area (LAA/HA, RAA/HA) were calculated. The best regression equation was established using GA, BPD and FL as independent variables and LAL, LAW, LAA, RAL, RAW, RAA as dependent variable. The correlation between the standard deviation (SD) and the independent variables GA, BPD and FL was analyzed, and then the above statistics were used to calculate the corresponding Z-score for each variable of RA and LA using the regression equation.Results:①Significant positive correlations were found between LAW, RAW, LAL, RAL, LAA and RAA with the increase of GA, BPD and FL, and the highest degree of correlation between RAA, LAA and GA was denoted ( r=0.927, 0.920, all P<0.001). ②Taking GA as an example, there was no significant correlation between RAL/LAL, RAW/LAW and GA ( r=-0.064, 0.077; all P>0.05). RAA/LAA showed a very weak positive correlation with GA ( r=0.106, P=0.037), with normal reference values of 1.002±0.091, 1.091±0.093, 1.059±0.090, respectively. Interestingly RAL/LAL was found close to 1, while RAW/LAW and RAA/LAA were always >1. No significant correlations were found between LAA/HA, RAA/HA and GA ( r=0.003, 0.056; all P>0.05), with normal reference values of 0.155±0.026, 0.163±0.026, respectively, and RAA/HA was found larger than LAA/HA. LASI showed a very weak positive correlation with GA ( r=0.112, P=0.027), while there was no significant correlation between RASI and GA ( r=0.003, P>0.05), the normal reference values were 1.068±0.113, 0.980±0.105, respectively. ③The SD of LAL, LAW, etc.showed a simple linear relationship with the independent variables. Taking RAA and GA as examples, the linear regression equation for RAA was Y=-1.690+ 0.107 0GA ( r=0.927, P<0.001) and the linear regression equation for RAA-SD was Y=-0.107+ 0.010 4GA ( r=0.320, P<0.001). The Z-scores for LAL, LAW, LAA, RAL, RAW and RAA were relatively constant with the growth of GA, BPD and FL, with the corresponding Z-scores for GA were -1.817~3.631( r=0.000 3), -1.605~2.995( r<-0.000 1), -1.700~3.107( r<0.000 1), -1.617~3.466( r=0.000 1), -1.491~3.025( r<-0.000 1), -1.566~3.104( r=0.000 2), respectively. Conclusions:This study preliminarily establish the reference value ranges and Z-score of atrial diameters in normal fetuses during middle and late trimester, providing a reference basis for accurate quantitative evaluation of fetal atrial development and analysis of fetal congenital heart abnormalities, and contributing to the early detection of pathological conditions leading to abnormal atrial size.