Volume 94  ·   Issue 31  ·  2014

The world is big, divided for a long time will be united, and united for a long time will be divided. Medicine, too. At the beginning of the founding of medicine, all practitioners were general practitioners, and they were not divided into subjects. With the rise of modern medicine, people have learned about the complexity of the human body and that the body is composed of different systems. It is no longer possible for a doctor to master the diagnosis and treatment of various system diseases in the whole body and to conduct various system research. Specialization is the development trend of medicine. With the development of modern medicine, the division of specialties is becoming more and more refined, and there are many chickens and dogs who hear each other and don't interact with each other. However, in the modern society, the medical field has gradually realized that the human body as a whole, each system is organically combined, and integration has become a trend. Pituitary adenoma is to connect the "Consensus on the Diagnosis and Treatment of Pituitary Prolactin Adenoma in China (2014 Edition)"^[1](hereinafter referred to as Consensus) The link between the various disciplines in which the writing experts are involved.

Pituitary prolactin adenoma is one of the common benign intracranial tumors, and it is also a common secretory pituitary adenoma. The incidence rate in adults is about 1/10,000^[1]40% of secretory pituitary adenomas in adults^[2], belongs to the World Health Organization (WHO) Grade I tumor of the central nervous system along with other types of pituitary adenomas^[3]。 On the one hand, pituitary prolactin adenoma can cause some tumor compression symptoms, such as headache, visual field defect, etc. At the same time, due to the particularity of hyperprolactinemia, hypogonadism and its secondary symptoms are often manifested clinically, and most patients come to see a doctor with this as the first symptom. Although the diagnosis and treatment of pituitary prolactin adenoma has become more and more mature at present, there are still many problems in the diagnosis and treatment process due to the particularity of pituitary prolactin adenoma itself. Improper treatment can have catastrophic effects on patients. How to get rational and standardized treatment for patients with pituitary prolactin adenoma has become a problem that must be faced at present. Therefore, only standardized treatment is the guarantee for the best diagnosis and treatment of patients with pituitary prolactin adenoma.

Following the release of the Guidelines for the Diagnosis and Treatment of Acromegaly in China (2013 Edition) in 2013^[1]The China Pituitary Tumor Collaboration Group, together with the Neurosurgery Branch of the Chinese Medical Association and the Endocrinology Branch of the Chinese Medical Association, launched the "Consensus on the Diagnosis and Treatment of Pituitary Prolactin Adenoma in China (2014 Edition)" this year [hereinafter referred to as the Consensus (2014 Edition)]^[2]。 The consensus (2014 edition) places greater emphasis on the importance of pharmacological therapy in the treatment of pituitary prolactin adenomas. In conjunction with the consensus (2014 edition), let's talk about some ideas on the drug treatment of pituitary prolactin adenoma.

Prolactin (PRL) adenoma is the most common functional pituitary adenoma, accounting for about 40% to 45% of adult pituitary functional adenomas. It is more common in female patients aged 20 to 50 years, and the ratio of male to female in adult patients is about 1:10. Standardized diagnosis and treatment of pituitary prolactin adenoma is of great significance for restoring and maintaining normal adenopituitary function and preventing tumor recurrence.

To explore the efficacy of photodynamic antimicrobial therapy in the treatment of pressure sore with pathogen infection.

A total of 42 pressure sore patients with pathogen infection were divided randomly into experimental and control groups (n=21 each). Fufanghuangbai liquid was used for external application with control group. In the experimental group, wound was treated with Fufanghuangbai liquid wet dressing and irradiated by semiconductor laser 30 min late. The distance from semiconductor laser probe to wound site was 10-15 cm, 20 min twice daily, continuous exposure to 7 days for 1 course. The results of bacterial culture and epidermal growth factor (EGF) expression of wound granulation tissue were observed before and after treatment. And the changes of healing rate of pressure sore were measured at post-treatment in each group.

The positive rates of bacterial culture, rates of change around wound inflammation, healing rate of days 7 and 14, the high expression of EGF on healing wound granulation tissue was 9.75%, (32.2%±5.8%), (89.1%±5.6%), (12.4%±2.9%), (34.7%±3.6%), 14/21 in the treatment group versus 51.2%, (17.8%±2.0%), (57.3%±2.6%), (5.1%±1.1%), (10.5%±2.4%), 2/21 in the control group respectively. The inter-group differences were statistically significant (P<0.05).

Photodynamic antimicrobial therapy is an effective method for pressure sore with pathogen infection. Wound healing is promoted through an up-regulation of EGF.

To evaluate the effects of rosuvastatin on arterial stiffness in hyperlipidemia patient without hypertension.

A total of 60 patients without hypertension received rosuvastatin (10 mg, n=60) daily for 12 weeks while another 60 subjects used no statins. Brachial-ankle pulse wave velocity (ba-PWV), radial artery augmentation index of reflected wave (rAI) and metabolic index were measured before and after treatment.

There were no significant change before and after non-statin treatment.Total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) levels decreased dramatically after resuvastin treatment [TC: (4.0±1.0)vs(5.8±1.1) mmol/L; LDL-C: (2.1±0.7)vs(3.8±0.7) mmol/L, both P<0.01]. In rosuvastatin group, ba-PWV and rAI decreased significantly [ba-PWV: (1 340±177) vs (1 477±159) cm/s; rAI: (44±13)% vs(57±15)%,P<0.01 andP<0.05).

Atherosclerosis may be improved by rosuvastatin treatment in hyerlipidemia patient without hypertension.

To explore the value of combining T₂-weighted imaging (T₂WI), diffusion weighted imaging (DWI) and dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) for qualitatively diagnosing central gland prostate cancer (CGPCa) as a gold standard with pathologic findings.

A total of 42 cases with CGPCa and 42 cases with benign prostate hyperplasia (BPH) proved by pathology were followed up with T₂WI, DWI and DCE-MRI examinations retrospectively. The diagnosis sensitivity and specificity by T₂WI, DWI, DCE-MRI alone and combination were calculated respectively. And the consistency of MRI diagnosis and pathological results was judged by Kappa value and the diagnostic value of each method evaluated by A_z of receiver operating characteristic curve.

While using T₂WI alone, the diagnostic sensitivity, specificity, A_z and Kappa value was 66.7%, 76.2%, 0.714 and 0.429; DWI 78.6%, 81.0%, 0.798 and 0.595; DCE-MRI 83.3%, 61.9%, 0.726 and 0.452, A_z between DWI and T₂WI was statistically significant (P<0.05) while DCE-MRI insignificant (P>0.05). When combining T₂WI+ DWI+ DCE-MRI, the diagnostic sensitivity, specificity, A_z and Kappa value was 90.5%, 88.1%, 0.893 and 0.786, A_z between T₂WI+ DWI+ DCE-MRI and T₂WI, DWI and DCE-MRI was statistically significant respectively (all P<0.05).

DWI is better than T₂WI for diagnosing CGPCa. Combining T₂WI+ DWI+ DCE-MRI can obviously improve the diagnostic accuracy of CGPCa. And it has excellent consistency with pathological analysis.

To explore the diagnostic value of dual source computed tomography (CT) in the diagnosing acute pulmonary embolism (PE).

A total of 20 cases with suspected PE were scanned by dual source CT and the data were analyzed with the software packages of conventional 3D, pulmonary embolism detection (PED), lung vessels and lung PBV. The examination with the highest detection rate was used to screen for pulmonary segment of PE and verify the diagnostic consistency with dual-energy perfusion imaging (DEPI) on pulmonary segment of PE.

The detection rates for PE in pulmonary artery branches were all 30% for CTPA, lung vessels and PED.There were no statistical difference. The detection rates for PE in pulmonary lobar arteries were 47.0%, 49% and 50% for CTPA, lung vessels and PED. There were no statistical difference. The detection rates for PE in pulmonary segment arteries were 14.2%, 19.7% and 26.1% for CTPA, lung vessels and PED. Statistical differences existed among CTPA, lung vessels and PED. The detection rates for PE in pulmonary subsegment arteries were 3.7%, 4.5% and 7.0% for CTPA, lung vessels and PED. Statistical differences existed between PED, CTPA and lung vessels. No statistical difference existed between CTPA and lung vessels. PED had the higher clinical value on the diagnosis of PE of pulmonary segmental artery and inferior segmental artery. The sensitivity of DEPI for PE was 85.7%, specificity 94.1% and kappa 0.789. The diagnosis on PE of DEPI and PED image had a higher consistency.

The dual-energy scanning of dual source CT has higher practical values in the diagnosis of PE. And PED can visualize the pulmonary artery segment and a downstream segment of PE. Pulmonary perfusion imaging may show the perfusion abnormalities due to pulmonary blood flow changes. A combination of both increases the diagnostic rate of PE.

To analyze the clinical effect on chronic tuberculosis empyema in treatment of surgical operation.

One hundred and eighty three cases treated with surgical operation were chose in our hospital from Jan. 2003 to Jan. 2013. The clinical effect of chronic tuberculosis empyema treated with different treatments was analyzed.

Eighty nine cases with pleural fibrotic plastictomy, 17 cases with thoracostomy combined pleural fibrotic plastictomy, 47 cases with tboracoplasty, 24 cases with thoracostomy combined tboracoplasty, and 6 cases with pleurolobectomy. 16 patients occurred complications, and the rate was 8.7%. The curative rate among 5 groups of different surgical style were 94.4%, 100.0%, 93.6%, 100.0%, 83.3%.

The surgical operation is best way in treatment of chronic tuberculosis empyema. It's necessary to choose the best surgical approach by actual clinical condition of patients to improve clinical effect.

To explore the feasibility and methods of transnasal endoscope for removing foreign bodies at orbital-skull base.

Retrospective analyses were performed for 8 cases of foreign body injuries at orbital-skull base at our department from January 2009 to January 2014. The foreign bodies were metallic (n=4) and wooden (n=4). Six cases were only within orbit while the remainder had nasal-orbital foreign bodies. The symptoms included preoperative visual loss (n=6), visual deterioration (n=2) and eye movement disorder (n=5). All underwent transnasal endoscopic removal.

Foreign bodies were totally removed. During a follow-up period of 3 months to 4 years, there was no recovery of preoperative visual loss (n=6). Two patients with reduced vision recovered to normal after 3 months. Eye movement disorder fully recovered in 4 cases and 1 case of eye movement disorder had partial recovery.

Endoscopic removal of foreign body at orbital-skull base has the advantage of mini-invasiveness and non-facial surgical scar.

To explore the correlation between the Indian hedgehog and severity of knee osteoarthritis cartilage damage.

A total of 215 patients with osteoarthritis [97 males and 118 females with an average age of 65.2±7.8 (49-78) years and 34 healthy persons [28 males and 6 females with an average age of 58.4±8.7 (45-62) years were selected randomly and their cartilages in knee joints collected. The damage degree of osteoarthritis was evaluated by revised Markin scale. The Ihh mRNA was assessed by real-time polymerase chain reaction (PCR) and the Ihh protein expression examined by Western blot.

According to the revised Mankin scale, the osteoarthritis samples were divided into 3 stages of severe, moderate and mild. Comparing with normal control group, the Ihh mRNA and protein expressions increased obviously in cartilage. With worsening cartilage damage, Ihh mRNA and protein expression increased accordingly. Statistical differences existed among the groups (normal: 1.00±0.01; mild: 1.37±0.02; moderate: 1.90±0.02; severe: 2.13±0.03; P<0.01). And the damage degree of osteoarthritis was determined by injury extent of soft tissue in knee joint (Mankin scale). And the damage degree of cartilage was positively correlated with Ihh expression (r=0.581, P<0.01).

Ihh expression is correlated with the damage degree of knee joint osteoarthritis.

To assess the survival and prognostic significance of various demographic and radiographic parameters for conversion into total hip arthroplasty after treatment with a modified porous tantalum implant technology for early and intermediate stages of osteonecrosis of the femoral head (ONFH).

This study included 45 patients (59 hips) with Steinberg Stage Ⅰ-ⅣA ONFH undergoing progressively core decompression, impaction bone grafting of 5 mm-composite bone filling material and inserting of a porous tantalum implant. Weight-bearing was forbidden within the first 3 months after implants.

A total of 57 hips (44 patients) were available during a mean follow-up period of 44.8 (11-62) months. Their mean age was 43 (21-70) years. The mean Harris hip score significantly improved from 59.93±2.80 preoperative to 77.84±2.95 at the last follow-up (P<0.001). Overall, 11 hips (19.30%) were converted into total hip arthroplasty. The overall survival rate was 72.49% at 60 months postoperatively. The Cox proportional hazard model revealed that bone marrow edema was an independent prognostic factor related with a conversion into total hip arthroplasty.

Higher survival rates may be obtained from modified tantalum implant technology for early and intermediate stages of ONFH. And prognosis was poor for patients of ONFH with bone marrow edema.

To discuss the relationship between shorter incision and less radiation time in mini-invasive transforaminal lumbar interbodyfusion (TLIF).

Retrospective analyses were performed for the data of 17 cases of single-level lumbar vertebral disc herniation with mini-invasive TLIF. And 10 of them had instability. According to incision length, they were divided into 2 groups of routine mini-invasive TLIF (3 cm incision) and longer incision mini-invasive TLIF (4 cm incision). The relevant data included operative duration, blood loss volume, postoperative ambulation time, intraoperative radiological exposure time and complications. Visual analog scales (for pain) were also administered preoperatively and postoperatively.

The follow-up period was 6-24 months. The mean operative duration was 212 min in routine mini-invasive TLIF group; the mean operative duration 150 min in longer incision mini-invasive TLIF group; mean blood loss volume 100 ml in routine group versus 200 ml in longer group. The radiation time was 27-38 seconds in routine mini-invasive TLIF group versus 8-11 seconds in longer incision mini-invasive TLIF group. No significant inter-group differences existed in ambulation time and VAS score. One case with pedical screw planted into spine canal complained of muscle weakness of low extremity in routine mini-invasive TLIF group. And muscle weakness disappeared upon a replacement of pedical screw.

Both shorter and percutaneous incisions may achieve mini-invasiveness during TLIF. And extended incision offers equivalent clinical efficacies and minimizes radiation time.

To explore the feasibility of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in proposing selection criteria for patients with hepatocellular carcinoma (HCC) in liver transplantation.

We respectively analyzed 31 cases of HCC patients from our hospital and those accepting no anti-tumor therapy or orthotopic liver transplantation before ¹⁸F-FDG PET/CT examination. The T/B value was set as a semi-quantitative parameter reflecting the metabolic activities of tumors. And receiver operating characteristic (ROC) curve was plotted to determine the optimal cutoff value of T/B affecting HCC recurrence after transplantation. Their clinicopathological features were analyzed by univariate and multivariate analyses to determine the risk factors for HCC recurrence after transplantation.

During the follow-up period, the total incidence of tumor recurrence or metastasis was 51.6%. And the disease-free survival rates of 6 months, 1 year and 2 years post-transplantation were 93.5%, 67.7% and 46.8% respectively. The univariate analysis revealed 4 variables of affecting the recurrence or metastasis of HCC after transplantation, namely T/B value, tumor size, tumor number and preoperative alpha fetoprotein (AFP) level. While multivariate analyses indicated that T/B value and tumor size were independent factors.

T/B value, tumor number and preoperative AFP level were independent risk factors for tumor recurrence. As a prognostic indicator of tumor biological behavior, ¹⁸F-FDG PET/CT can identify the eligible transplant HCC candidates.

To explore the expression and significance of Wnt/β-catenin signaling pathway in the natural degeneration of endplate chondrocytes in rats.

Endplate chondrocytes extracted from lumbar vertebrae were divided into control (P2 cell), naturally passaged (P5 cell) and wnt signaling pathway inhibition groups. The morphology of endplate chondrocytes was observed by inverted microscope. Hematoxylin and eosin (HE) and toluidine blue stains were used to identify their phenotypes. Type Ⅱ collagen marker, SOX-9 and aggrecan genes were detected by reverse transcription-polymerase chain reaction (RT-PCR) to verify the degeneration model. Based on this model, the changes of β-catenin were detected by RT-PCR and Western blot. Laser confocal microscopy was used to detect the expression and localization of β-catenin within endplate chondrocytes.

With natural passaging, endplate cartilage cells appeared spindle-shaped and gradually lost chondrocytic phenotypes. The levels of type Ⅱ collagen (P5/P2=0.11, P=0.003 9), SOX-9 (P5/P2=0.58, P=0.016 8) and aggrecan (P5/P2=0.32, P=0.004 6) significantly reduced; β-catenin (P5/P2=1.62, P=0.008 2) significantly increased. β-catenin was down-regulated (XAV-939/P5=0.23, P=0.001 7) in inhibition group. And type Ⅱ collagen (XAV-939/P5=2.60, P=0.018 0), SOX-9 (XAV-939/P5=1.47, P=0.038 2) and aggrecan (XAV-939/P5=2.56, P=0.004 1) significantly increased. β-catenin had a higher expression and obviously entered into nuclear transcription in P5 generation and decreased in inhibition group.

β-catenin plays an important role in the in vitro degeneration of endplate chondrocytes. There are great potentials for protecting endplate cartilage degeneration by regulating the Wnt/β-catenin signaling pathway.

To generate the gene recombinant protein of brain-derived neurotrophic factor precursor (proBDNF) in prokaryotic cells and investigate its biological activity.

Rat-derived cDNA of proBDNF with point mutation was amplified by polymerase chain reaction (PCR) and cloned into plasmid pET-28a for expression in E. coli BL21. Western blot was used to identify the product and DAPI performed to test its effect on apoptosis of PC12 cells.

PCR product of recombinant gene was successfully expressed in E. coli. And the product agreed with the target protein in molecular weight and showed reactivity with its specific antibody. Apoptosis of PC12 cells was induced by a certain concentration of recombinant proBDNF.

The prokaryotic expression vector has been successfully constructed for recombinant gene of proBDNF. And the product has biological toxicity and it may induce the apoptosis of PC12 cells.

Dopamine receptor agonist (DA) therapy of choice for pituitary prolactin adenomas, including bromocriptine and cabergoline^[1]。 At present, bromocriptine remains the treatment of choice in mainland China^[2,3]。 However, bromocriptine resistance occurs in 10% ~25% of patients, especially for invasive giant prolactin adenomas. The control of some tumors of cavernous sinus has always been a difficult problem in clinical practice^[4,5]。 Cabergoline has the advantages of convenient administration, good tolerance and good curative effect, and is also effective for bromocriptine-resistant patients^[6,7]。 Through the clinical analysis of a case of invasive giant prolactin adenoma drug therapy, this paper discusses its effect, hoping to have guiding significance for future clinical practice.

After the pathogen infects the human body, the occurrence of immune activation is a necessary step for the immune system to activate the immune defense mechanism, and it is a normal process of immune response. However, in the immune response against human immunodeficiency virus (HIV) infection, immune activation not only plays an immune defense role, but also causes damage to the body. Therefore, immune activation in the field of HIV research generally refers to "abnormal" immune activation that produces a negative effect. Virus and host immune response are the two most important factors in the pathogenesis of acquired immunodeficiency syndrome (AIDS) caused by HIV infection. In recent years, on the basis of exploring treatment strategies to inhibit HIV replication, researchers have paid more and more attention to abnormal immune activation, and new evidence continues to suggest that abnormal immune activation is probably a pathogenic mechanism independent of viral replication. Abnormal immune activation has become a potential therapeutic target. Researchers have tried to use immunosuppressants or modulators to reduce the activation level to achieve the purpose of reducing immune damage^[1]。 To explore the influence of abnormal immune activation associated with HIV infection on disease progression and the efficacy of antiviral therapy is of great significance for understanding the pathogenesis of HIV/AIDS and formulating treatment strategies. This article reviews the research progress in related fields.

amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease that selectively affects the anterior horn cells of the spinal cord, the motor nucleus of the brainstem, the cortical pyramidal cells and the pyramidal tract. Clinically, there can be symptoms of muscle weakness, muscle atrophy and pyramidal tract signs involved at the same time. The disease is a progressive course, and there is still a lack of specific treatment, and the prognosis is poor. Most patients die of respiratory failure, and the median survival time is only 3~5 years. More and more studies have shown that ALS can not only involve the motor system, but also damage other functions such as cognition. With the abundance of research methods such as neuropsychology, imaging, pathology and molecular biology, people have a deeper understanding of ALS combined with cognitive impairment. This paper summarizes the research status and progress in this area.

The incidence of ovarian Brenner tumor is extremely low. There were only 3 cases of ovarian Brenner tumor confirmed by pathology in Weihai Maternal and Child Health Hospital from 2008 to 2013. The ultrasound characteristics of these 3 cases are summarized as follows.