Objective:To evaluate the efficacy of pelvic sacral tendon regulating acupuncture combined with myofascial manipulation in the treatment of postpartum pelvic pain.Methods:A total of 86 patients with postpartum pelvic pain in our hospital from December 2019 to October 2021 who met the inclusion criteria were divided into control group ( n=44) and observation group ( n=42) by random number table method. The control group was treated with myofascial manipulation, while the observation group was treated with pelvic sacral tendon acupuncture on the basis of the control group. Both groups were treated for 4 weeks. The VAS was used to evaluate the degree of pain, Oswestry Disability Index (ODI) to evaluate the degree of lumbar dysfunction, pelvic floor dysfunction Questionnaire 7 (PFIQ-7) to evaluate the pelvic floor function, and pelvic floor dysfunction Questionnaire (PFDI20) to evaluate the quality of life. Serum levels of insulin-like growth factor-1 (IGF-1) and TGF-β1 were detected by ELISA to evaluate the clinical efficacy. Results:The total effective rate was 95.24% (40/42) in the observation group and 79.55% (35/44) in the control group, and the difference was statistically significant ( χ2=4.74, P=0.030). After treatment, the ODI, VAS, PFIQ-7 and PFIQ-20 scores of the observation group were significantly lower than those in the control group ( t=13.79, 14.05, 10.61, 10.10, all Ps<0.001). The scores of low back pain, limb pain and gait claudication were significantly lower than those in the control group ( t=11.73, 12.16 and 10.89, respectively, all Ps<0.001). The serum levels of TGF-β1 [(163.81±28.05) μg/L vs. (124.56±19.23) μg/L, t=5.76] and IGF-1 [(64.52±9.14) μg/L vs. (49.86±7.62) μg/L, t=5.06] were significantly higher than those in the control group ( P<0.01). Conclusion:The pelvic sacral tendon acupuncture combined with myofascial manipulation can improve the pelvic function of patients with postpartum pelvic pain, relieve the degree of pelvic pain, and improve the curative effect.

Objective:To evaluate the classification of petroclival meningiomas(PCM), proposed selection of microsurgical approach and therapeutic outcomes.Methods:Retrospectively analyzed clinical data of 179 cases of PCM from Department of Neurosurgery, Xiangya Hospital, Central South University between January 2011 and November 2020. There were 28 males and 151 females with an age of(49.9±10.2) years(range: 22 to 75 years) and the tumor size of(44.8±10.3)mm(range: 15 to 80 mm). The mean duration of symptom ( M( Q R)) was 18.0(40.6)months(range:1 week to 320 months) and the mean preoperative Karnofsky performance scale(KPS) was 78.6±13.3(range: 40 to 100). The PCM were classified into 5 types according to the difference in the origin of dural attachment, involvement of adjacent structures and growth patterns through preoperative MRI. The surgical approaches were selected based on the proposed classification, and the clinical characteristics, surgical record, and follow-up data of each type were reviewed. Results:The PCM were divided into clivus type(CV, 4 cases), petroclival type(PC, 60 cases), petroclivosphenoidal type(PC-S, 62 cases), sphenopetroclival type with 2 subtypes(S-PC, 50 cases) and central skull base type(CSB, 3 cases). All of 176 cases were obtained microsurgical treatment except CSB type. The gross total resection reached in 124 cases(70.5%) with 112 cases of retrosigmoid approach(RSA), 27 cases of subtemporal transtentorial transpetrosal approach, 13 cases of pretemporal trancavernous anterior transpetrosal approach(PTCA), 12 cases of extended pterional transtentorial approach(EPTA) and presigmoid combined supra-infratentorial approach, respectively. The RSA could be adopted in both of CV type and PC type and most of PC-S type(71.0%). S-PC subtype Ⅰ and subtype Ⅱ were mainly underwent EPTA(40.8%) and PTCA(52.2%), respectively. Seventy-two cases(40.9%) gained new neurological dysfunctions mainly with the cranial nerve paralysis. The postoperative morbidity and complications were recovered or improved with conservative and positive symptomatic and supportive treatment. There was no intraoperative and postoperative death case. One hundred and sixty four cases(93.2%) of operative patients were followed with the duration of 24(48)months(range:3 to 108 months). Tumor recurrence and progress were identified in 14 cases(10.4%) and 14 cases(28.6%), respectively. Compared with postoperative neurological status, 89 patients(54.3%) had improved and 38 patients(23.2%) were still suffering various degrees of neurological dysfunctions during the follow-up. The recent KPS was 84.2±11.4(range: 50 to 100) without statistical difference from preoperative KPS ( t=-1.356, P=0.125). As for each type, there were statistically significant differences in brain stem edema (χ 2=3.482, P=0.038), gross total resection (χ 2=9.127, P=0.001), surgical duration( F=8.954, P=0.013), postoperative length of stay( F=3.652, P=0.025), postoperative complications (χ 2=1.550, P=0.024), postoperative KPS( F=2.856, P=0.042) and tumor recurrence/progress (χ 2=4.824, P=0.013). Conclusion:The precise and comprehensive classification of PCM and specific individual treatment strategy are benefit to evaluate the diverse clinical prognosis, choose optimal surgical approaches, elevate gross total resection, diminish neurological dysfunctions and restraint tumor recurrence, so as to improve the quality of life for patients.

Objective:To evaluate the classification of petroclival meningiomas(PCM), proposed selection of microsurgical approach and therapeutic outcomes.Methods:Retrospectively analyzed clinical data of 179 cases of PCM from Department of Neurosurgery, Xiangya Hospital, Central South University between January 2011 and November 2020. There were 28 males and 151 females with an age of(49.9±10.2) years(range: 22 to 75 years) and the tumor size of(44.8±10.3)mm(range: 15 to 80 mm). The mean duration of symptom ( M( Q R)) was 18.0(40.6)months(range:1 week to 320 months) and the mean preoperative Karnofsky performance scale(KPS) was 78.6±13.3(range: 40 to 100). The PCM were classified into 5 types according to the difference in the origin of dural attachment, involvement of adjacent structures and growth patterns through preoperative MRI. The surgical approaches were selected based on the proposed classification, and the clinical characteristics, surgical record, and follow-up data of each type were reviewed. Results:The PCM were divided into clivus type(CV, 4 cases), petroclival type(PC, 60 cases), petroclivosphenoidal type(PC-S, 62 cases), sphenopetroclival type with 2 subtypes(S-PC, 50 cases) and central skull base type(CSB, 3 cases). All of 176 cases were obtained microsurgical treatment except CSB type. The gross total resection reached in 124 cases(70.5%) with 112 cases of retrosigmoid approach(RSA), 27 cases of subtemporal transtentorial transpetrosal approach, 13 cases of pretemporal trancavernous anterior transpetrosal approach(PTCA), 12 cases of extended pterional transtentorial approach(EPTA) and presigmoid combined supra-infratentorial approach, respectively. The RSA could be adopted in both of CV type and PC type and most of PC-S type(71.0%). S-PC subtype Ⅰ and subtype Ⅱ were mainly underwent EPTA(40.8%) and PTCA(52.2%), respectively. Seventy-two cases(40.9%) gained new neurological dysfunctions mainly with the cranial nerve paralysis. The postoperative morbidity and complications were recovered or improved with conservative and positive symptomatic and supportive treatment. There was no intraoperative and postoperative death case. One hundred and sixty four cases(93.2%) of operative patients were followed with the duration of 24(48)months(range:3 to 108 months). Tumor recurrence and progress were identified in 14 cases(10.4%) and 14 cases(28.6%), respectively. Compared with postoperative neurological status, 89 patients(54.3%) had improved and 38 patients(23.2%) were still suffering various degrees of neurological dysfunctions during the follow-up. The recent KPS was 84.2±11.4(range: 50 to 100) without statistical difference from preoperative KPS ( t=-1.356, P=0.125). As for each type, there were statistically significant differences in brain stem edema (χ 2=3.482, P=0.038), gross total resection (χ 2=9.127, P=0.001), surgical duration( F=8.954, P=0.013), postoperative length of stay( F=3.652, P=0.025), postoperative complications (χ 2=1.550, P=0.024), postoperative KPS( F=2.856, P=0.042) and tumor recurrence/progress (χ 2=4.824, P=0.013). Conclusion:The precise and comprehensive classification of PCM and specific individual treatment strategy are benefit to evaluate the diverse clinical prognosis, choose optimal surgical approaches, elevate gross total resection, diminish neurological dysfunctions and restraint tumor recurrence, so as to improve the quality of life for patients.

Pulmonary fluid refers to a thin and continuous liquid layer mainly consisting of airway mucus and lining liquid on the inner surface of alveoli, which is essential for maintaining a healthy lung. The clinical significance of rheological properties of pulmonary fluid in airway stability, pulmonary barrier and clearance functions, ventilator induced lung injury and surfactant replacement therapy in infant respiratory distress syndrome was introduced in this paper. Furthermore, a variety of classical methods for measuring surface tension and liquid viscosity, such as Langmuir-Wilhelmy balance, captive bubble method, glass capillary viscometer and rotational viscometer, and emerging techniques (e.g. particle tracking microrheometer and axisymmetric drop shape analysis) were reviewed, and their advantages and drawbacks were also compared, in order to provide an important reference for the assisted diagnosis and treatment of lung diseases in clinical practice.

OBJECTIVETo evaluate the clinical effects on incomplete intestinal obstruction treated with the adjuvant therapy of acupuncture and moxibustion.

METHODSUsing the retrospective analysis, 80 patients of incomplete intestinal obstruction were divided into an observation group and a control group, 40 cases in each one. In the control group, the routine treatment was given, such as fasting, gastrointestinal decompression, parenteral nutrition, infection prevention with antibiotics and enema laxative. In the observation group, on the basis of the treatment as the control group, acupuncture was applied at bilateral Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39); moxibustion was used at left Yangchi (TE 4), Zhongwan (CV 12), Qihai (CV 6) and Guanyuan (CV 4). The treatment was given once a day, 30 min each time. The average days of treatment, the surgical transfer rate, the time to first flatus, the recovery time of defecation and the time of solid food intake were observed in the patients of the two groups.

RESULTSThe average days of treatment in the observation group was obviously less than that in the control group (<0.05). The surgical transfer rate in the observation group was obviously lower than that in the control group (<0.05). The time to first flatus, the recovery time of defecation and the time of solid food intake were all obviously earlier than those in the control group (all <0.05).

CONCLUSIONThe adjuvant therapy of acupuncture and moxibustion achieves the significant therapeutic effects on incomplete intestinal obstruction, shortens the treatment duration and reduces the surgical transfer rate and the patient's economic burden.

Objective:To investigate the pro-apoptotic effect of berberine (Ber) on human lung adenocarcinoma PC-9 cell line, and to detect the role of c-Jun N-terminal kinase (JNK)/forkhead box protein O3 (FOXO3) signaling in this process. Methods:The PC-9 cells were randomly divided into the control group and the Ber group, which was treated with 30 and 60μM Ber. The survival rate, apoptot-ic rate, ROS generation, caspase-3 activity, and mitochondrial membrane potential of cells were detected. Western blot was per-formed to detect the expression of JNK/FOXO3 signaling and apoptosis-related proteins. A JNK-specific activation inhibitor, SP600125, was used to block the phosphorylation of FOXO3 in PC-9 cells, and then treated with Ber (30 and 60μM) for further detection after 24 h. Results:Ber treatment resulted in an obvious reduction in cell viability, promotion of cell apoptosis, downregulation of mitochondri-al membrane potential, and an increase of ROS and caspase-3 in a dose-dependent manner. Western blot analysis demonstrated that Ber treatment resulted in a significant upregulation of p-JNK, FOXO3, and Bax expression, and a downregulation of p-FOXO3 and Bcl2 levels. Moreover, the inhibition of JNK activation by SP600125 antagonized the anti-FOXO3 phosphorylation role and the pro-apoptotic role of Ber on PC-9 cells. Conclusion:Ber treatment effectively inhibits the viability of PC-9 cells and enhances apoptosis and oxidative stress injury, which may be related to the upregulation of p-JNK and FOXO3 and the downregulation of p-FOXO3.

OBJECTIVE: To improve the surgical outcome of pituitary adenomas by identifying and preserving the pituitary stalk and the gland during surgery. METHODS: From October 2010 to September 2012, the author from the Department of Neurosurgery of Xiangya Hospital, Central South University operated on 51 patients with pituitary adenoma. During the operations, we carefully identified the normal adenohypophysis, pituitary stalk, neurohypophysis and the abnormal tissues either by direct observation or by medical images, aiming to excise the tumor thoroughly, protect the pituitary function and reduce the postoperative complications. RESULTS: Totally 37 patients (72.5%, 37/51) had total resection of the tumor, 12 (23.5%, 12/51) had subtotal tumor resection and the other 2 had major removal. The gland and the pituitary stalk were well identified and reserved. Detection of hormone content proved that the operation had little effect on the free triiodothyronine (FT3) and adrenocorticotropic hormone (ACTH), while for free tetraiodothyronine (FT4) and thyroid stimulating hormone (TSH) and postoperative followup significant alleviation was found. There was no significant fluctuation for the testosterone in the men preoperatively and postoperatively (all the above results were obtained without hormone replacement therapy). The main postoperative complications were as follows: temporary diabetes insipidus in 5 patients (9.8%, 5/51); electrolyte disorder (the appearance of hyponatremia) in 17 (33.3%, 17/51); and cerebrospinal fluid rhinorrhea and postoperative intracranial infection in 1 (2%, 1/51). No one died during the perioperation period. CONCLUSION Microscopic transsphenoidal surgery is effective for pituitary adenomas including tumors violating the cavernous sinus. Accurate identification of the pituitary stalk, the gland and the abnormal tissue during the microscopic transsphenoidal operation plays a critical role in preserving the pituitary function and promoting postoperative rehabilitation.
Adenoma ; surgery ; Humans ; Male ; Microsurgery ; Neurosurgical Procedures ; methods ; Pituitary Gland ; surgery ; Pituitary Hormones ; blood ; Pituitary Neoplasms ; surgery ; Postoperative Complications ; Treatment Outcome

Objective To explore the impact of 2009 International Federation of Gynecology and Obstetrics(FIGO)staging system alteration for stage Ⅰ endometrioid adenocarcinoma on its' prognosis assessing.Methods A retrospective study was carried out on 244 cases with endometrial carcinoma admitted in Peking University People's Hospital from Jan.1995 to Feb.2008.Results(1)All 244 patients were divided into FIGO 2009 Ⅰ a group(n =200)and FIGO 2009 Ⅰ b group(n =44)according to FIGO 2009 staging system,while they were divided into FIGO 1988 Ⅰ a group(n =34),FIGO 1988 Ⅰ b group(n =156)and FIGO 1988 Ⅰ c group(n =29).The others 25 cases were stage Ⅱ a(n =16)and stage Ⅲa with merely positive abdominal cytology(n =9)according to FIGO 1988 staging system.(2)The higher percentage of low-grade in FIGO 1988 Ⅰ a group than that in FIGO 2009 Ⅰ a group(P =0.003).Compared with FIGO 2009 Ⅰ a group,the age of the patients,surgery extent,the percentage of lymph node excision and received chemotherapy and radiotherapy,there were no difference in FIGO 1988 Ⅰ a and Ⅰ b group,respectively(P ＞ 0.05).There were 5.9％(2/34)and 6.7％(10/150)found relapse among FIGO 1988 Ⅰ a group and FIGO 1988 Ⅰ b group,and there were 2.9％(1/34)and 2.7％(4/150)for the two groups died of carcinoma.Compared with FIGO 2009 Ⅰ a group,there were not significant difference[7.5％(13/200)vs.3.0％(6/200);P ＞0.05].The 5 years and 10 years progression-free survival(PFS)of FIGO 1988 Ⅰ a group and Ⅰ b group were(97.0 ±3.0)％,(90.9 ±6.5)％ and(95.3 ±2.1)％,(90.2 ± 3.6)％,respectively,in which there were not significant difference compared with that in FIGO 2009 Ⅰ a group[(96.1 ±1.6)％,(89.6±3.2)％ ; P＞0.05].The 5 years and 10 years overall survival(OS)in FIGO 1988 Ⅰ a group and Ⅰ b group were 100％,(93.8 ±6.0)％ and(96.9 ± 1.8)％,(95.2 ±2.5)％,respectively,in which there were did not significant difference with that in FIGO 2009 Ⅰ a group [(97.9 ± 1.2)％,(93.4 ± 2.8)％ ; P ＞ 0.05].(3)There were not significant difference between FIGO 1988 Ⅰ c group and FIGO 2009 Ⅰ b group(P ＞0.05)for the age of the patients,grade,surgery extent,lymph node excision,the percentage of received chemotherapy and radiotherapy.Between FIGO 1988 Ⅰ c group and FIGO 2009 Ⅰ b group,there were 3.4％(1/29)and 6.8％(3/44)cases found relapse,respectively.And there were 0 and 2.3％(1/44)cases died of carcinoma in the two groups,in which there were not differ much either(P ＞ O.05).The 5 years and 10 years PFS in FIGO 1988 Ⅰ c group were all 100％,while they were 100％ and(90.9 ±6.2)％ in FIGO 2009 Ⅰ b group.The 5 years and 10 years OS in FIGO 1988 Ⅰ c group were all 100％,but were 100％ and(95.0 ±4.9)％ in FIGO 2009 Ⅰ b group,in which they all did not significantly differ much(P ＞ 0.05).(4)The patients in FIGO 2009 Ⅰ a group were younger than those in FIGO 2009 Ⅰ b group(P ＜ 0.01).The percentage of low grade in FIGO 2009 Ⅰ a group were higher than that in FIGO 2009 Ⅰ b group(P =0.029).The percentages of received chemotherapy and radiotherapy in FIGO 2009 Ⅰ a group were lower than that in FIGO 2009 Ⅰ b group remarkably(P ＜ 0.01).But there were not significant difference in the uterine excision extent and the percentage of lymph node excision between the two groups(P ＞ 0.05).There were not significantly differ in the relapse rates and the death rates between the FIGO 2009 Ⅰ a group and FIGO 2009 Ⅰ b group(P ＞0.05).There were also not significant difference in PFS and OS between the two groups(P ＞0.05).Conclusions There were not significant difference in the prognosis between FIGO 2009 stage Ⅰ a and FIGO 1988 stage Ⅰ a and Ⅰ b.There were also not significant difference in the prognosis between FIGO 2009 stage Ⅰ a and FIGO 2009 stage Ⅰ b,which may be due to received more chemotherapy and radiotherapy in FIGO 2009 stage Ⅰ b patients.

Objective To explore the lymph nodes (LN) metastasis characters of the endometrial carcinoma and its relation with the patients' prognosis. Methods A retrospective study was carried out on 227 cases of endometrial carcinoma who admitted to our department and underwent LN excision from Jul. 2000 to Feb. 2008. Results Among 227 cases who underwent pelvic LN excision, there were 22 cases (9.7%) presented LN metastasis. There were 12 cases with positive external iliac LN from 20 cases of patients with data in LN grouping. Para-aortic LN excision was carried out on 138 patients. There were 6 cases with positive para-aortic LN, 5 cases of them together with pelvic LN metastasis. Those patients with cervix involvement, annex metastasis, deep myometrium infiltration, grade 2-3 and negative estrogen receptor occurred pelvic LN metastasis more frequently than the others ( P ＜ 0. 05 ). Among the 6 cases with positive para-aortic LN, there were 3 cases ( 3/6) with deep myometrium infiltration. For those whose paraaortic LN was negative, it was only 16. 7% (22 cases). But there were no difference statistically between them ( P＞ 0. 05 ). There were significant difference in 3 years disease-free survival rate between patients with positive pelvic LN or negative pelvic LN [(81. 8 ± 8. 2)% vs ( 97. 4 ± 1. 2 ) % , P = 0. 004]. While there were not significant difference in 3 years disease-free survival rate between patients with positive para-aortic LN or negative para-aortic LN [100% vs ( 96. 7 ± 1. 6) % , P ＞ 0. 05]. Single factor analysis showed that the age more than 50 years, annex metastasis and pelvic LN metastasis related with the recurrence (P ＜0. 01). But cervix involvement, deep myometrium infiltration, para-aortic LN metastasis, pathology type, tumor grade and estrogen receptor did not relate with the recurrence ( P ＞ 0. 05 ). Cox regression analysis showed that annex metastasis and the age of patients were independent risk factors affecting the recurrence ( P = 0. 011, P = 0. 025 ). Conclusions The most common site of pelvic LN metastasis is the external iliac LN for endometrial carcinoma patients. The patients with positive para-aortic LN always accompanied pelvic LN metastasis. Those patients with cervical involvement, annex metastasis, deep myometrium infiltration, poor differentiation and negative estrogen receptor be more likely exist pelvic LN metastasis. Pelvic LN metastasis may affect the prognosis of endometrial carcinoma patients.

ObjectiveTo explore the effects of hyperbaric oxygen (HBO) on severe brain injury. Methods60 patients with severe brain injury were divided into control group and treatment group. They were treated with neurosurgical conventional therapy, and HBO for treatment group in addition. They were assessed with Glasgow Coma Scale (GCS) before and after treatment, and Glasgow Outcome Scale (GOS) 3 and 6 months after treatment. ResultsCompared with control group, there is significant improvement in GCS (P<0.05) and GOS (P<0.05) in treatment group. ConclusionHBO has immediate and long-term efficiency on severe brain injury.