Volume 89  ·   Issue 05  ·  2009

China is one of the countries with the highest incidence of esophageal cancer in the world. According to the data published by the Ministry of Health, there were 185 211 new cases of esophageal cancer in China in 2005. It is estimated that there are more than 200,000 new cases in China every year, accounting for about 50% of new cases in the world, and ranking the fourth cause of cancer death in China. It can be seen that the task of prevention and treatment of esophageal cancer in China is very arduous at present.

Objective To evaluate the effects of surgical treatment with cervical esophagogastrostomy by left thoracic esophagectomy on esophageal carcinoma. Methods The clinical data of 3169 patients with esophageal carcinoma, 2115 males and 1054 females, aged 60.9 (30 -82), that underwent cervical esophagogastrostomy by left thoracic esophagectomy from Jan. 1990 to Dec. 2000 were analyzed retrospectively. Results The incidence of complication was 8.6% (273). The operative mortality was 0.6% (19). The 1, 3, and 5 year survival rates were 81.5%, 51.6% , and 32. 1% respectively. Manometric examination of the digestive tract showed that the post-operative resting pressure of residual esophagus above the anastomotic stoma was ( 16±11 mm Hg), significantly higher than that of the cervical esophagus of the normal controls [(4±3) mm Hg), P <0.01]. Conclusion Reducing incidence of gastroesophageal reflux and improving the quality of life of patients, cervical anastomosis should be recommended as the first choice procedure in treatment of upper and middle segment esophageal carcinoma.

Objective To summarize the experience in surgical resection for esophageal and gastric cardiac cancers so as to put forward countermeasures to prevent the post-operative complications. Methods From September 1952 to December 2005, 20 796 patients with esophageal and gastric cardiac cancers underwent surgical operation. The category and incidence of the complications in different decades were retrospectively analyzed. Results (1) 18 772 of the 20 796 patients with esophageal and gastric cardiac cancers underwent surgical resection. Operative complications occurred in 1741 patients (9.27%), death occurred in 433 of which (24.87%). (2) The complication rate was 39.77% in 1950s, and decreased to 4, 10% in 2000s. The mortality rate of complication was 44.29% in 1950s, and decreased to 15.42% in 2000s. (3)The incidence and mortality rates of closely-surgery-related complications declined obviously over the period of study. The incidence and mortality rates of anastomotic leakage were 4.55% and 50.00% respectively in 1950s, and then decreased to 1.21% and 3.33% respectively in 2000s. The incidence and the mortality rates of empyema were 7.39% and 38.46% respectively in 1950s, and decreased to 0.36% and 5.56% respectively in 2000s. The incidence and the mortality rates of chylothorax was 0.16% and 0% recently. (4)The incidence of non-surgical-related complications declined slightly but the mortality rate was still very high over the period of study. The mortality rates of pulmonary and cardiovascular complication were 27.42% and 25.00% respectively recently. Conclusion (1) One of the advantages of surgical treatment for esophagus and gastric cardiac cancers is the obvious decline of the incidence and the mortality rates of complications. (2) In order to reduce the incidence of systemic complication, especially pulmonary complication, active and corresponding preoperative preparation should be improved along with the expansion of the scope of surgical indication. (3)The key for prevention of post-operative complications is consummate surgery techniques. Prevention and treatment of anastomotic leakage, gastric wall necrosis, and intrathoracic and intraabdominal bleeding are still the focal points.

Objective To isolate and identify cancer stem cells from esophageal carcinoma cells (ECCs) using cell surface marker p75NTR. Methods ECCs cell lines were established with ECCs collected from 38 surgically resected specimens. Flow cytometry was used to identify the p75NTR positive cells therein that were isolated then using magnetic activated cell sorting (MACS) method. The growing characteristics in DMEM medium and capability of colony-forming in soft agar of the p75NTR positive cells were evaluated ex vivo with MTF method, p75NTR positive cells of different concentrations were subcutaneously injected into the backs of Balb/c nude mice and PBS was injected into the contralateral back, and then tumorigenisis was observed, 8 weeks later the mice were killed with their tumors taken out to undergo microscopy. Results Eight ECCs cell lines were established, 6 of which were found to contain 0. 32% - 3.35% of p75NTR positive cells. The purity of p75NTR positive cells isolated by MACS was up to 90%. MTr result showed that population doubling time of the p75NTR positive cells was (17±3) hours, significantly shorter than that of the p75NTR negative cells [ (37±7) hours, P<0.01 ]. The colony-forming rate in soft agar of the p75NTR positive cells was (45.9%±8.9% ), significantly higher than that of the p75NTR negative cells [ (3.7%± 2.1% ), P<0.01]. As few as 2000 p75NTR positive cells gave rise to new tumors in xenotransplantation, with a tumorigenic ability 50 times as high as that of the p75NTR negative cells. Conclusion p75NTR positive cells carry some properties of cancer stem cells, such as the ability of self-renewal, differentiation and proliferation and demonstrate higher ability of colony-forming ex vivo and tumorigenisis in vivo.

Objective To investigate the clinical value and safety of holmium: YAG laser endoureterotomy in the treatment of ureteral obstruction. Methods Holmium: YAG laser endoureterotomy, with the laser optic fiber 550 μm in diameter and the output power of 3.5 Watt, via ureteroscopy, was performed on 18 patients ureteral obstruction, 8 males and 10 females, aged 52.1 (34 -67), 11 with the stricture in the upper segment (complete obstruction in 4 cases), 5 in the middle segment, and 2 in lower segment ; and 6 cases complicated with ureteral calculus. Postoperatively, an orthopedic ureteral stent ( a 6-Fr double-J ureteral stent with a movable 5 cm length 9-Fr orthopedic cannula) was remained indwelling for 3 -6 months. Follow-up was conducted for 10.7 (2-14) months. Results The operative duration was 32 (25 -70 ) minutes. One patient underwent failed endoureterntomy and was turned to percutaneous nephroscopy. Success was achieved in 16 patients. The glomerular filtration rate (GFR) of these affected kidneys increased from 16.4 ± 6.9 ml/min ante-operatively to 24.9 ± 8.2 ml/min (P<0.01) postoperatively. One kidney was resected because of non-function, with GFR of 2 ml/min and intractable pyelitis. No recurrence of ureteral stricture was observed. Conclusion Holmium: YAG laser endoureterotomy with insertion of orthopedic ureteral stent is an efficient and safe treatment for ureteral strictures with minimal invasion, less complications and easy recovery. This operation should be performed with a thorough preparation and severely restricted indication.

Objective To analyze the characteristics of aneurysms difficult to be treated by endovascular interventional therapy and report the results of operation. Methods 27 patients with 33 intracranial aneurysms transferred from the ward of interventional therapy, 7 males and 20 females, aged 47 (27 -67), accepted microsurgical operation, The neck, volume, aspect ratio and blood vessel condition of the aneurysms were analyzed. Results The aneurysms difficult to be treated by endovascular interventional therapy included those with wide neck (>4 mm), large volume (maximal diameter≥8 mm), and failure in endovascular maneuvers (because of flexed blood vessel and severe vasospasm). The total outcome of operation was good and no death occurred. Conclusion Some aneurysms difficult to be treated by endovascular interventional therapy should be treated by microsurgical operation, which will get a better result.

Objective To investigate the clinical, electromyographic, and magnetic resonance imaging (MRI) manifestations of the patients with cervical spondylotic myelopathy (CSM) and the correlation among them. Method 96 CSM patients, 56 males and 40 females, aged 53 2/32 - 72 ), underwent electromyography (EMG) of the deltoid muscle (C5), biceps muscle of arm (C6), common extensor muscle of fingers (C7), and short abductor muscle of thumb and abductor muscle of little finger (CB -T), and MRI of the cervical vertebrae before surgical treatment. The clinical symptoms were graded according to the Japanese Orthopaedic Association (JOA) scoring system. The correlation among the JOA score, MIR classification, and EMG manifestation was analyzed. Results EMG showed that 61 of the 96 patients (64%) with root injury at C5, 6, 7, and 8. Those positive in EMG showed higher severity in MRI (Z=2.863, P=0.004). The JOA score was not correlated with the degree of spinal cord compression demonstrated by MRI and the EMG results. Conclusion The root injury rate is high in the CSM patients. The patients positive in EMG have severe MRI results. No clear correlation is between the severity of clinical symptom and MRI of cervical vertebrae and root injury demonstrated by EMG. Hence, treatment should be considered by integration of EMG, MRI and JOA scores.

Objective To investigate the epidemiological and clinical characteristics of acute bacterial dysentery in recent years in Beijing so as to provide scientific reference for prevention and control of enteric infectious diseases. Methods The data of age, occupation, symptoms, signs, pathogen detection of 652 patients with acute bacterial dysentery diagnosed clinically from April 2007 to October 2007 were analyzed retrospectively. Results The occupations of the 652 patients included office workers and functionaries (31.4%), students (29.4%), retirees (9.8%), unemployed and housewives (7.1%), commercial attendants (6.3), workers (4. 8%), teachers (4. 1% ), and others (7. 1%). Diarrhea, stomachache, and fever were the main symptoms. Tenesmus and tenderness of left lower quadrant abdomen were infrequent. The positive rate of fecal bacterial culture was 17.7%. 8. 9% of the patients were diagnosed as with bacterial dysentery by fecal bacterial culture. Conclusion Most of the patients with bacterial dysentery in Beijing are young adults. The positive rate of fecal bacterial culture is low. It is difficult to differentiate bacterial dysentery from other diarrheal diseases.

Objective to evaluate the short- and medium-term clinical effects of 125Ⅰ seed implantation on recurrent or metastatic head and neck cancers. Methods Thirty patients with recurrent or metastatic head and neck cancers after operation, radiotherapy, or chemotherapy, totaling 421 lesions 4.2 (2-9) cm in diameter, 23 males and 12 females, aged 56 (39-71) , underwent implantation of 12 -70 125Ⅰ seeds (on average 33 per person) under the guidance of CT, uhrasonography, or endoscopy with an interval of 1 cm between any 2 seeds with the radioactive activity per seed of 29.6 MBq and matchedperipheral dose Of 90-160 Gy. Follow-up was conducted for 13 (4-40) months to observe the local control rate, overall survival rate, pain relief, and clinical complications. Results Follow-up 4 months later showed that 24 of the 42 lesions obtained complete remission, 11 obtained partial remission, 5 no change, and 2 progress of disease, with a clinical response rate of 83.3% (CR + PR). The overall 1-, 2-, and 3-year survival rates were 88.4%, 72.4%, and 45.2% respectively with a median survival time of 31 months. The pain relief rate was 73.4% (17/23). The long-term complications included hyperpigmentation at operative sites (n=4), insensible feeling on lateral cheek (n=3), dryness of oral cavity ( n = 2), andheadache combined with infection (n=1). Conclusion Relieving the pain, improving the life quality, CT guided radioactive 125Ⅰ seed implantation is a simple, safe, and effective method in treating recurrent or metastatic head and neck cancer with minimal damage and few complications.

Objective To study the incidence and risk factors of intraocular pressure (IOP) elevation in patients who underwent vitreoretinal surgery. Methods Data for 422 patients (446 eyes)who underwent vitreoretinal surgery from June 2005 to June 2007 were retrospectively analyzed, lOP was measured before surgery and on day 1,2,3,7-14 after surgery with Goldmann applanation tonometer. Ocular hypertension was defined as IOP 25mmHg or more. All factors were analyzed for association with Ocular hypertension. Results 232 of the 422 patients were female. 190 were male. The IOP was elevated significandy in 185 eyes(41% )after surgery within 2 weeks. Among them the lOP occurred mostly in day 1 ( 152 eyes , 82% ). The rate of lOP elevation with intraocular tamponade of C3F8 or silicone oil was 53 % or 55% , the difference being not statistically significant (P>0.05) . The incidence of high IOP in C3F8 injection group and silicone oil injection group were statistically higher than simple pars plana vitrectomy group( P<0.01). The risk factors of ocular hypertension include C3F8 injection (X2=37.82, P<0.01),silicone oil injection (X2= 27.84, P<0.01 ), lentectomy ( X2 = 8.98, P<0.01 ), scatter endolaser (X2 = 7.41 ,P <0.01), diabetes( X2 = 12.12, P<0.01 ) and increasing patient age (X2 = 7.07, P <0.01 ). Conclusion IOP elevation was a common complication of vitreoretinal surgery. The risk factors of ocular hypertension include C3F8 injection, silicone oil injection, lentectomy, scatter endolaser, diabetes and increasing patient age.

Objective To evaluate the effects of patient-controlled analgesia (PCA) with small dose ketamine combined with morphine on analgesia and influence thereof on the plasma β-endorphin (EP) level in the patients after radical operation for esophageal carcinoma. Methods Thirty ASA Ⅰ-Ⅱ patients, aged 35 -65, weighing 42 -75 kg, with visual analogue score ≥3, undergoing elective radical operation for esophageal carcinoma under general anesthesia received intravenous morphine 2 -3 mg were randomly course of treatment the patients received intravenous injection of morphine 2 -3 mg when the VAS was ≥3. VAS was recorded 4, 8, 20, 24, and 48 h after operation. The amount of morphine used after operation, PCA button pressing times (effective/active), side effects, and vital signs including pulse, saturation of blood oxygen, respiratory rate, heart rate, and average arterial pressure were recorded. Central venous blood samples were collected when entering the operation room ( T0 ), by the end of operation ( T1 ), and 6 h (T2), 24 h (T3), and 48 h ( T4 ) after operation respectively to examine the β-endorphin level. Results During the period 4 - 48 h after operation the VAS scores of the group mk were significantly lower than those of the group m in activity state (all P<0.05 ) and were not significantly different those of the group m at resting state ( all P>0.05). The total amount of morphine consumed and the actual PCA button pressing times were significantly less in the group mk than in the group m ( both P <0.05 ). The incidence rates of nausea, vomiting, and pruritus of the group mk were all significantly lower than those of the group m ( all P <0.05 ). There were not significant differences in the incidence rates of dreaming and pseudoesthesia between these 2 groups. All the vital signs were stable in the 2 groups. The plasma β-EP levels at the time point T1 of these 2 groups were both significantly higher than those at T0 ( both P <0.05 ). The plasma β-endorphin levels at T2-4 of the group mk decreased gradually from the level at T1 to the level at T0, and the plasma β-endorphin levels of the group m rapidly decreased from the level at T0 to the T0 level and remained at this level to the 48 h after operation. Conclusion The combination of small dose of ketamine with morphine provides optimal analgesia with low side-effect rate and little effect on the plasma β-EP level.

Objective To establish a model of three-dimensional numerical simulation of intracranial longitypical aneurism and analyze the hemodynamic features thereof. Methods Ten patients with intracranial longitypical aneurism underwent surgical treatment. Iutracranial vascular ultrasonography was conducted before operation. Intra-operatively three-dimensional angiography of the aneurysm was conducted and multifunctional physiological monitor was used to record the dynamic pressure and pressure wave form of the main branch parent artery. Matlab, Ansys, and Fluent softwares were used to simulate the blood flow of the longitypical aneurisms. Results The hemodynamic parameter levels were the highest at the inflow tract, followed by those at the outflow tract, and were the lowest at the top of aneurysm, for example, the blood flow velocity was (1.07 ±0.23) m/s, the dynamic pressure was (574±186) Pa, and the wall shear stress was (7.7±2.0) Pa at the inflow tract, all significantly higher than those at the top [ (0.15± 0.07) m/s, ( 37±13 ) Pa, and (0.40±0.13 ) Pa respectively, all P<0.05 ]. No eddy or just simple eddy occurred in the aneurysm. Conclusion The dynamic pressure, velocity, and wall shear stress are the lowest at the top of longitypical aneurysm which may contribute to the rupture of aneurysm.

Objective To investigate the characteristics of gene structure in facioscapulohumeral muscular dystrophy (FSHD) -related 4q35 subtelomere, to analyze the distribution of 2 alleles (4qA and 4qB) distal to D4Z4 of this locus, and to further elucidate the genotype-phenotype correlation in Chinese Han FSHD patients. Methods Peripheral blood samples were collected from 52 unrelated families including 62 FSHD-affected and 57 unaffected members. Genomic DNA was extracted from the lymphocytes according to the specific procedure designed to minimize DNA shearing, then digested with EcoR Ⅰ or Hind Ⅲ, or double digested with EeoR Ⅰ and Bin Ⅰ. The cleaved DNA was separated by pulsed field electrophoresis (PFGE) and Southern blotting with the probes p13E-11,4qA, and 4qB. The size of FSHD-causing 4qA allele and its distribution was analyzed by " curve fitting". Then the characteristics of translocation and mosaicism, the frequencies of two allelic variants of chromosome 4q and their genotypes were calculated to analyze the genotype-phenotype correlation. Results It was found that 69 patients carried a short chromosome 4-type allele of 4qA origin with the length 10 - 38 kb. The mean length of these pathogenic EcoR Ⅰ/4qA arrays was 20 kb±7 kb, without significant difference between the sporadic cases and familial cases (t=1.413, P>0.05). Three different translocation types were observed with a translocation rate of 14.49%. The rate of 4q→10q translocation was 13.04%, significantly higher than that of 10q→4q translocation (1.45%, X2 = 6.900, P<0.05). Somatic mosaicism was detected in a male sporadic case and a female asymptomatic familial case. In 57 cases with standard configuration distribution, the frequency of 4qA/4qB beterozygote was 61.40%, significantly higher than that of 4qA/4qA homozygote (38.60%, (X2 = 5. 930, P<0.05 ). There were not significant differences in the repeat size distributions and assessment of clinical severity between the sporadic and familial cases (t=-0.039, P>0.05 ; H = 0.693,P>0.05). Conclusion About 95% of Chinese FSHD patients carry a pathogenic 4-type allele of 4qA origin less than 30 kb long. The frequent translocations between chromosome 4q and 10q may play an essential rote for FSHD mechanism. The frequency of 4qA/4qB heterozygote is significantly higher than that of 4qA/4qA homozygote, while the allelic variant genotypes do not contribute to modify FSHD manifestations.

Objective To explore the effect of long-chain polyunsaturated fatty acids (LPFA) on the survival and process growth of the brain hippocampal Oligndendrocyte precursor cells (OPC). Method Two kinds of cultured neural progenitor cells isolated from adult rat hippocampus were used. After arachidonic acid (AA), eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) treatment respectively, the activity of cells were determined by Lactate dehydrogenase (LDH) assay, and the quantitative measurements of the cell processes were done after the fluorescent immune cells staining. Results EPA, DHA and AA showed similar trends to increase the cell numbers when the concentrations were high (50 μmol/L, P <0.05 ), but only EPA and DHA elongated the process of OPC significantly (P < 0.05). Conclusion ω-3 LPFA ( EPA and DHA) could enhance the survival and process growth of OPC.

Objective To study the inhibitive effects of transfection of siRNA expressing plasmids targeting S gene, one of the 4 open reading frames of hepatitis B virus (HBV) , on the rephcation and expression of HBV. Methods Two plasmids expressing 2 siRNAs targeting S gene, one of the 4 open reading frames of HBV (S1 and S2) and one nonspecific plasmid (siRNA-S3), as negative control, with the length of 21 m heterologous to the HBV/U95551 genome were constructed, and then transfected into the hepatic cancer cells of the line HepG2. 2.15. 48 hours later, real-time PCR was used to evaluate the gene silencing efficiency and ELISA was used to detect the expression of HBsAg and hepatitis B e antigen (HBeAg), protein markers of HBV, in the supernatants. Results The inhibition rates of HBsAg and HBeAg expression of the HepG2.2.15 cells transfected with S1 were 60% and 56% respectively, those of the HepG2.2.15 cells transfected with S2 were 73% and 70% respectively, those of the HepG2.2.15 cells transfected with S1 + S2 were 82% and 78% respectively, and those of the HepG2.2.15 cells transfected with S3 were not significantly different from those of the blank control group. RT-PCR showed that the mRNA expression rates of HBsAg and HBeAg in the HepG2.2.15 cells transfected with S1, S2, and S1+S2 were inhibited by 64%-88% t respectively. Conclusion Transfection of the vector plasmids expressing the siRNAs targeting S gene inhibits the expression of HBsAg and HBeAg in hepatic cancer cells. RNAi may provide a viable strategy against viruses for the prevention and treatment of HBV infection.

Objective To investigate the effect of low dose irradiation (LDI) on callus formation and mineralization. Methods 80 SD rats were subjected to standard closed fracture on right femur so as to establish animal models and then were randomly divided into 2 equal groups : LDI group undergoing low dose whole body X-ray irradiation of 1Gy right after fracture induction and control group without irradiation. 1,2, 3,4, and 8 weeks later blood samples were collected from the heart to examine the amounts of white blood cells and platelets and alkaline phosphatase (ALP) level. Conventional X-ray films were taken and MicroCT was conducted to evaluate the callus bridging. Then the rats were killed to take out the femurs to undergo histological examination. Peripheral quantitative computed tomography (pQCT) was conducted to quantify the bone mineral content (BMC). Four-point bending test was used to examine the mechanical properties of the callus. Results The maximum load value and histological score 2 weeks later of the LDI group were both lower than those of the control group, however, the serum ALP, BMC, maximum load level, callus bridging score, and histological score 3 weeks later of the LDI group were all significantly higher than those of the control groups ( all P<0.05 ). 4 and 8 weeks later there were not significant differences in all these parameters between the 2 groups. The WBC amount in the first 2 weeks of experiment of the LDI group was remarkably lower in these 2 groups, however, in the third week, the WBC value of the LDI group was higher than thin of the control group (P<0.05 ). Conclusion LDI promotes the mineralization at the stage of hard callus formation which is probably associated with progenitor cell mobilization.

Objective To observe the therapeutic effect of core decompression and autograft of mesenchymal stem cells (MSCs) cultured in vitro under arthroscopy in treatment of early osteonecrosis of femoral head. Methods Thirty-six rabbits were made into models of early osteoneerosis of femoral head of the fight leg, and then randomly divided into 3 equal groups: Group A group as control group, Group B group undergoing simple core decompression under arthroseopy by clearing out of necrotic bone, and Group C undergoing core decompression and implantation of MSCs . Four and 8 weeks later 6 rabbits from each group underwent roentgenography and then were killed with their femoral heads taken pout to undergo histological examination. Results Four weeks later new bone was evident in the implantation field of Group C while fibrous tissues were evident in the femoral head of Group B. Pathological examination showed regular shape and normal density of femoral head in Group C and irregular shape and low density of femoral head in Group B. X- ray photograph 8 weeks after treatment showed that the femoral head articular surface of Group A collapsed, uneven density and defect of spongy bone were seen in Group B, and the shape of femoral head of Group C was regular without collapse and the original defect had been repaired. Conclusion With strong osteogenic function, MSCs improve the repair of iscbemic necrosis of femoral head and can be used in treatment of early osteonecrosis of femoral head via core decompression and autograft of MSCs cultured in vitro under arthroscopy.

miRNA is a kind of widespread non-coding RNA small molecule that fine-tunes genes. It accounts for about 3% of human genome and controls about 1/3 of human mRNA expression. By base pairing with target gene mRNA, it guides the silencing complex (RISC) to degrade mRNA or inhibit mRNA translation, thereby regulating protein expression at the posttranscriptional level, and participates in a series of important processes in life process, including early embryonic development, cell proliferation, differentiation, apoptosis, adipose metabolism and its role in gene expression regulation [1]. In 1993, Lee et al. [2] first discovered that the gene Lin-4 regulates the development process of nematodes through RNA generated by transcription. In 2000, Reinhart et al. [3] discovered another similar small molecule RNA with post-transcriptional regulation function: let-7. Subsequent research found that such small RNA is ubiquitous in various organisms, and miRNA is a new research entry point, It has opened up a new way for the research of functional genomics, transcriptional regulation mechanism and gene therapy. The biological characteristics, production, mechanism of action and correlation of miRNA with gynecological tumors are reviewed as follows.

Objective To determine medical reference values for tumor markers in cerebrospinal fluid. Methods Concentrations of CEA, CA125, CA15-3, CA19-9, CA72-4, CYFRA21-1, AFP, NSE, SCC and HCG were determined by means of double-antibody sandwich ELISA in 110 patients excluding primary tumors and meningeal carcinomatosis using Roche E170 modular immunoassay analyzer. Results The determined medical reference values for tumor biomarkers in cerebrospinal fluid were as follows: CEA < O. 573 μg/L ,CA125 <2. 591 U/mI,CA15-3 <2. 045 U/mI,CA19-9 <2. 272 U/ml,CA72-4<1.252 U/ml, CYFRA21-1 < 1.44 ng/ml,AFP <0. 968 μg/L,NSE <57. 666 ng/ml,SCC <0.5 μg/L,HCG <0.769 U/L There was no correlation between any tumor marker and age (P>0.05 ). Concentrations of tumor markers were not affected by gender (P>0.05). Conclusion Medical reference values for CEA, CA125, CA15-3, CA19-9, CA72-4, CYFRA21-1, AFP, NSE, SCC and HCG in cerebrospinal fluid were first determined.

There were 5 cases of sellar germ cell tumor in this group, including 4 males and 1 female; The age ranged from 13 to 34 years old, with an average of 13.7 years old; The course of the disease was 0.5~6 months, with an average of 2.4 months. Clinical manifestations: 3 cases with diabetes insipidus as the first symptom, urine volume 3200~6500 ml/24 h, 3 cases with visual impairment, 4 cases with growth retardation, 3 cases with endocrine disorders, and 3 cases with increased intracranial pressure. Laboratory examination: 3 cases with urine specific gravity 1.003~1.008, 3 cases with hypothyroidism, and 4 cases with low growth hormone. Imaging examination: All cases were examined by CT and MRI of the head. The tumor volume was ≤3 cm in 3 cases,>3 cm in 2 cases, compression of compartment III in 1 case (Figure 1), and invasion of cavernous sinus in 1 case. CT plain scan mainly showed round or quasi-round high-density or isodensity foci, which showed obvious enhancement effect after drug injection, but none of them had calcification. MRI T1WI showed isosignal in 3 cases, low signal in 1 case, high signal in 1 case, isosignal in 3 cases, high signal in 1 case, and uneven signal in 1 case. All 5 cases underwent T1Wl enhancement scan, all showed obvious enhancement of tumor, and 3 cases showed uniform enhancement, without cystic degeneration, hemorrhage and necrosis.