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.

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.

0.05). The NAA/Cr and NAA/Cho in the Group A were significantly higher than those in the Group B (t=4.235, P=0.011; t=2.832, P=0.031), and the Cho/Cr in the Group A was significantly lower than that in the Group B (t=-2.323, P=0.042). Conclusions ~1H magnetic resonance spectroscopy can improve the diagnostic accuracy of glioma.

Objective To study the method of measuring air kerma strength of afterloading units with 192Ir source by using well type ionization chamber.MethodsThe air kerma strength of 30 afterloading units with 192Ir source was measured using 2000A electrometer and 1000 plus well type ionization chamber,and apparent activity of the source was calculated with the air kerma strength and apparent activity conversion factor.The measured activity of the source was compared with the original value of the source provided by the manufacturer,and the relevant deviation should be within ± 5%.Results Theair kerma strength of afterloding units with 192Ir sources was tested.The relevant deviation of the measured activity and the original value was within -0.1%-4.4%.Conclusions The measurement method with a well type ionization chamber is convenient and highly accurate which can be used for the test of quality control in hospitals.

Objective To explore the method for measuring and calculating both absorbed dose and effective dose received in organ and tissues of occupational workers by using TLDs for the implantation of 125Ⅰ seed sources.Methods The experiments with 60Co γ-rays were carried out for the stability.A group of TLD chips was exposed to 125Ⅰ seed sources to establish standard dose curve for air kerma.During the 125Ⅰ seed implantation, the TLD chips were pasted to 13 locations like thyroid inside and outside the lead aprons worn by occupational workers to measure average absorbed dose and calculate the absorbed doses and effectives to organs and tissues.Results For 3 cases of prostate cancers with implantation of 125Ⅰ seeds, the worker's organs and tissues received the absorbed dose 0.02 -3.80 μ Gy and effective dose 0.06- 1.81 μSv outside lead aprons and the highest absorbed dose 2.35 μ Gy and effective 0.02 μSv inside lead aprons, respectively, with more than 65.9% of rays shielded.For 3 cases of brain cancers with implantation of 125Ⅰ seeds, the workers received the absorbed dose 0.23 - 11.31 μGy and effective dose 0.88 - 4.07 μSv outside lead aprons and the highest absorbed dose 2.22 μ Gy and effective dose 0.09 μSv inside lead aprons, respectively, with more than 54.5% of rays shielded.For 3 cases of lung cancers with implantation of 125Ⅰ seeds, the workers received the absorbed dose 0.03 - 14.78 μGy and effective dose 0.35 -7.59 μSv outside lead aprons and the highest absorbed dose 4.09 μGy and effective 0.22 μSv inside lead aprons, respectively, with more than 58.4% of rays shielded.For 2 cases of mediastinum cancers with implantation of 125Ⅰseeds, the workers received the absorbed dose 0.06 - 74.91 μGy and effective dose 0.83 - 17.96 μSv outside lead aprons and the highest absorbed dose 10.29 μGy and effective 0.5 μSv inside lead aprons, respectively, with more than 85% of rays shielded.For one case of ovary cancer with implantation of 125Ⅰ seeds, the worker received the absorbed dose 0.09 - 14.29 μGy and effective dose 2.40 - 4.50 μSv outside lead aprons and the highest absorbed dose 7.77 μGy and effective 0.12 μSv inside lead aprons, respectively, with more than 34% of rays shielded.For one case of eye cancer with implantation of 125Ⅰ seeds, the workers received the absorbed dose 2.2 -39.84 μGy and effective dose 4.48 - 10.06 μSv outside aprons and the highest absorbed dose 5.19 μGy and effective 0.16 μSv inside aprons, respectively, with more than 54.6 % of rays shielded.Conclusions The method of using TLDs to measure the doses to the occupational workers in the course of the implantation of 125Ⅰ seed sources is simple and easy to operate.It would be an effective approach to protecting medical workers in the case of brachytherapy.

Objective To evaluate nasal carriage and antimicrobial resistance of bacteria in health care workers (HCWs)in an intensive care unit (ICU),and provide basis for making prevention and control measures of health-care-associated infection(HAI).Methods From April 2014 to March 2015,nasal swabs from HCWs in ICU were collected,carriage and antimicrobial resistance of bacteria were detected.Results A total of 450 nasal swab speci-mens were taken,137 strains were isolated,isolation rate was 30.44%.There were no significant difference in na-sal carriage rates of bacteria in HCWs with different genders,ages,types of work,length of service,and education-al level (P >0.05);nasal carriage rates in HCWs at different seasons were significantly different (P <0.05 ).82 strains (59.85%)were gram-negative bacteria,the major were Klebsiella pneumoniae (21 .16%)and Enterobacter aerogenes (18.98%);55 strains (40.15% )were gram-positive bacteria,the major were Staphylococcus aureus (18.98%)and Staphylococcus epidermidis (15.33%).38 (27.74% )strains were multidrug-resistant strains. 7.69% (2/26)of Staphylococcus aureus were methicillin-resistant strains,3.45%(1/29)of Klebsiella pneumoniae and 3.85%(1/26)of Enterobacter aerogenes were imipenem-resistant strains.Conclusion Nasal carriage rate of bac-teria and detection rate of multidrug-resistant organisms in HCWs in ICU is high.

Objective To evaluate the efficacy of different methods of biliary stenting for intractable choledocholithiasis.Methods A total of 137 patients with intractable choledocholithiasis were randomly divided into 4 groups to receive different managements.The treatments included single biliary stent placement in group A (n=32),single stent placement plus oral medication in group B (n=35),double stents placement in group C (n=33) and double stents placements plus oral medication in group D (n=37).All biliary stents were placed via endoscopic retrograde cholangiopancreatography (ERCP).Oral medication included ursodeoxycholic acid and/or anethol trithione after the procedure.All patients were closely followed up.Results The size of stones in common bile duct (CBD) decreased in all cases at 3 months after stent placement,with most significant changes in groups C and D than in groups A and B (P＜0.05).The stents kept unobstructed for a mean time of 7.6 months (3.5-20 months),with a significant difference between every 2 groups (P＜0.05) and a longest duration time in group D.A second procedure of ERCP was performed in 72 patients (52.6%),with achievement of total choledocholithiasis clearance in 51 (84.7%).Hyperamylasemia (HA) occurred in 41 cases (29.9%),which were mainly observed in the groups C and D (P ＜0.05).Conclusion Biliary stent placement is a safe and effective palliative therapy for intractable choledocholithiasis,while double stents placements combined with pharmacotherapy is most effective.

AIM: To observe the levels of triglyceridemia(TG),uricemia(UA),glycemia(GLU),the activity of 3-glyceraldehyde phosphate dehydrogenase(GAPDH) in blood and the gene expression in the liver in the animal model of hypertriglyceridemia,hyperuricemia and hyperglycemia.METHODS: SD rats were randomly divided into three groups,control group,fructose group,fructose and fenofibrate treated group.Rats in control group were fed with standard chow.Rats in fructose group were fed with high fructose diet.Rats in fructose and fenofibrate group were fed with high fructose diet,and treated with fenofibrate 100 mg?kg-1?d-1 by intragastric administration at the same time.Rats in control group and fructose group were given distilled water by intragastric administration.The levels of TG,UA and GLU were detected.Improved method was used to measure the activity of GAPDH.Quanti Gene technology was applied to determine the transcriptional level of GAPDH mRNA.RESULTS: During 7-28 d,the level of TG in fructose group was significantly and persistently high.During 14-28 d,the level of UA was higher.The level of GLU higher than that in control group was only observed at 28th day.The GAPDH activity change in blood and the expression in liver were significantly lower than that in norma1 during 7-28 d.Fenofibrate had the effect on reducing TG only at 7th day and reduced the level of GLU significantly at 28th day.Fenofibrate also increased the GAPDH activity in blood and the expression in liver at 7th day.CONCLUSION: ① The level of TG is significantly and persistently high in the early days by feeding with excessive fructose.The levels of UA and GLU are higher with the time cause of the model development.② The significantly higher level of TG,UA and GLU may be correlated with the reduction of the GAPDH activity in blood and the expression in liver.③ Fenofibrate has the effect of reducing the TG level only in the condition of hypertriglyceridemia,but not in the condition of accompanying hyperuricemia and hyperglycemia.④ The mechanism of reducing the TG level by fenofibrate may be correlated with the increase in GAPDH activity in blood and the expression in liver.

Objective To investigate the features and clinical value of endoscopic ultrasonography and colonoscopy for appendix mucocele. Methods The patients with mucocele of appendix who were diagnosed by endoscopic ultrasonography and colonoscopy in three hospitals all underwent surgery from January 2008 to March 2015. Appendix mucocele in these patients was confirmed by postoperative pathology and clinical data were retrospectively analyzed. Results A total of 22 patients with appendix mucocele were analyzed retrospectively. The average size of intralumen mucocele was 1. 84±1. 42 cm (0. 6-4. 5 cm) . The colonscopic finding of appendiceal mucocele showed submucosal protuberance at the appendiceal orifice with smooth surface. The appendiceal orifice was found at the edge of appendiceal mucocele. Endoscopic ultrasonogrphy showed low echo with smooth cyst wall in 8 patients, mixed equal echo and low echo in 14 cases. Appendicectomy was performed in 11 patients and resection of ileocecum in 11 others. Conclusion Endoscopic ultrasonography and colonoscopy are valuable for diagnosis and treatment in appendiceal mucocele.