Volume 99 ·  Issue 19 ·  2019

This paper proposes that for the diagnosis and treatment of recurrent pituitary adenoma, neurosurgeons should work together with physicians from endocrinology department, imaging department, radiotherapy department and pathology department. They should attach great importance to the detailed data of previous operations, fully evaluate the advantages and disadvantages of reoperation treatment, drug treatment and radiotherapy to patients, and formulate individualized treatment plans.

Based on the diversity of clinical manifestations, complexity of diagnosis and multiple choices of treatment methods, this paper proposes that patients with refractory pituitary adenoma should go to the Center of Excellence for Pituitary Adenoma, which consists of neurosurgeons, endocrinologists, radiologists, radiotherapists, anesthesiologists and specialist nurses, so as to ensure their accurate diagnosis and most appropriate treatment.

Helicobacter pylori (H. pylori) Many gastrointestinal and parenteral diseases caused by infections bring a huge economic and health care burden to our society and families. Therefore,H. pyloriThe prevention and control of infection is an important issue in our society. At present, at home and abroad, the whole familyH. pyloriThere are few studies on the prevention and control of infection and related gastric mucosal lesions. Further strengthening family-orientedH. pyloriClinical study on prevention and treatment of infectionH. pyloriThe occurrence and development of infection, and the timely diagnosis and treatment of subsequent diseases of infection are strategies with high clinical and preventive health care value. The development of this work will be helpful to our countryH. pyloriThe prevention and control of infection and the prevention of related diseases play an active and important role.

Regarding the diagnosis of pituitary adenoma recurrence after surgery, there are currently several different criteria that have not been completely unified. Some scholars believe that as long as postoperative imaging examination finds that the tumor increases again, it can be diagnosed as recurrence; Some scholars also believe that after completely removing pituitary adenoma and reaching the level of clinical cure and remission, the tumor grows again, which is called recurrence. The residual tumor tissue continues to grow after operation, which belongs to residual tumor regrowth (regrowth) and should not be diagnosed as recurrence. In the "Chinese Expert Consensus on the Diagnosis and Treatment of Recurrent Pituitary Adenoma" (hereinafter referred to as this consensus), recurrent pituitary adenoma is defined as: the reappearance of symptoms and signs that have disappeared after pituitary adenoma resection; The endocrine index increased again after reaching the remission standard; Imaging examination showed tumor growth again. It is precisely because of the different understanding of the concept of recurrence, the different length of postoperative follow-up and the lack of bulk case reports, and the recurrence rates of various types of pituitary adenomas are quite different, so the recurrence rates of pituitary adenomas reported in the literature are quite different at present, ranging from 5.4% to 44%.

Pituitary adenoma (PA) is one of the most common intracranial tumors. Most of them show the growth characteristics of benign tumors. Most patients can be cured by surgery and/or drug treatment. However, a small number of pituitary adenomas grow aggressively in imaging, grow faster than general tumors, are resistant to conventional treatments such as surgery, drug therapy and radiotherapy, and often relapse or regrow early after surgery. Such tumors are called aggressive PA or refractory PA^[1,2]。 Pituitary adenoma with intracranial spinal canal metastasis or other systemic metastasis is pituitary adenocarcinoma (PC)^[3]。 The diagnosis and treatment of refractory pituitary adenoma and pituitary adenocarcinoma are very difficult. The tumor can seriously affect the quality of life of patients, even endanger their survival, and the prognosis of patients is poor. Standardized diagnosis and treatment measures are urgently needed. In January 2018, the European Endocrinology Society issued the Guidelines for the Diagnosis and Treatment of Refractory Pituitary Adenoma/Pituitary Adenocarcinoma^[4]The aim is to provide standardized clinical guidance for the diagnosis, treatment and follow-up of refractory pituitary adenoma and pituitary adenocarcinoma. However, there are shortcomings such as unclear diagnostic criteria, and the treatment of this disease is still a worldwide problem. Therefore, the cooperative group formulated the Expert Consensus on the Diagnosis and Treatment of Refractory Pituitary Adenoma in China (hereinafter referred to as the Consensus) to standardize the diagnosis and treatment of refractory pituitary adenoma.

spinal muscular atrophy (SMA) is a neurodegenerative disease caused by the degeneration of motor neurons in the anterior horn of the spinal cord and the medulla oblongata, resulting in progressive and symmetrical muscular weakness and muscular atrophy of the proximal limbs and trunk. Although SMA can be caused by a variety of gene mutations, it generally refers to autosomal recessive diseases caused by mutations in the survival motor neuron 1 (SMN1)^[1]。 The incidence of the disease among surviving newborns in European and American populations is about 1/10 000, and the carrier frequency is 1/40 to 1/50^[2], ranking first among fatal genetic diseases in children under 2 years of age. At present, there is no definite data on the incidence rate in China, and the frequency of carriers in the Chinese population is about 1/42^[3,4]。 As the disease progresses, muscle weakness can further lead to skeletal system, respiratory system, digestive system and other system abnormalities, among which respiratory failure is the most common cause of death. Therefore, the treatment of SMA often requires multidisciplinary evaluation and integrated management. Although international colleagues have developed at least two versions of the SMA multidisciplinary diagnosis and treatment consensus^[5,6,7]However, due to the large number of patients, wide distribution and unbalanced development of economic conditions in China, a standardized opinion is needed for the diagnosis, treatment and treatment of this disease. To this end, experts in pediatric and adult neurology, genetics, respiratory medicine, orthopedics/spine surgery, rehabilitation medicine, clinical nutrition and other specialties have jointly formulated a consensus on the multidisciplinary management of SMA in China to assist clinicians, laboratory diagnosis and prenatal diagnosis related personnel to standardize the diagnosis and treatment of SMA.

To explore the changes in signal intensity (SI) ratios of globus pallidus (GP) on unenhanced T₁-weighted(T₁WI)magnetic resonance imaging (MRI) scans between the first and last MRI using the linear gadolinium-based contrast agent (GBCAs) intravenously.

Clinical and imaging data of 114 patients who underwent at least 4 consecutive enhanced MRI examinations at the Affiliated Hospital of Xuzhou Medical University between January 2016 and April 2018 were analyzed. The SI ratio of GP, thalamus and cerebrospinal fluid (CSF) were measured on unenhanced T₁WI. The GP to thalamus SI ratio was calculated by dividing the SI in the GP by that in the thalamus, and so was the GP to CSF SI ratio. The difference of SI ratio in the same patient was analyzed by nonparametric tests, linear regression analysis was used to analyze clinical factors.

The SI ratio of GP-to-thalamus and GP-to-CSF after multiple enhancement were higher than before, and the difference was statistically significant. The SI ratio of GP-to-thalamus and GP-to-CSF before and after repeated contrast-enhanced were 1.036(1.010, 1.075), 1.104(1.074, 1.168); 4.215(3.590, 5.614), 5.409(4.213, 6.502), all P<0.01. The SI ratio differences showed a significant positive correlation with the number of enhanced examination(pons:b=0.023, P<0.01,CSF:b=0.279,P=0.034), and a significant negative correlation with the interval (pons: b=-0.002,P< 0.01, CSF: b=-0.023, P=0.039). There was no correlation with other clinical factors (all P>0.05).

There is an increase in SI in the GP after serial injections of linear GBCAs, and there is a positive correlation with the times of enhanced examination, and a negative correlation with time interval.

To evaluate the efficacy and safety of cortical screw fixation in posterior lumbar spine fixation with cortical bone trajectory (CBT) fixation or pedicle screw (PS) fixation in posterior lumbar fusion.

It was a prospective study and CBT or PS for the treatment of lumbar disease from August 2015 to August 2017 in Beijing Chaoyang Hospital were analyzed. There were 53 males and 51 females, aged 56-78 years (mean age, (67±5) years). The patient′s gender, age, operative time, intraoperative blood loss, postoperative bleeding, postoperative hospital stay, and postoperative patient satisfaction were collected. The Oswestry disability index (ODI) and visual analogue scale (VAS) of back pain were used to evaluate preoperative and half-year, one-year and two-year postoperative function and quality of life. Complications such as wound infection, cage displacement, screw extraction and fixation fracture were compared between the two groups. The data of normal distribution were compared with Student t test between the two groups.

There was no significant difference in the operation time between the CBT group (n=50) and the PS group (n=54) ((223±17) min vs (221±16) min, t=0.74, P=0.46). The intraoperative blood loss and wound drainage volume were significantly lower in the CBT group than those in the PS screw group (t=-24.20, -57.62, both P<0.05). The average length of hospital stay in the CBT group was significantly shorter than that in the PS group (t=-7.65, P=0.00). Patients with CBT screws had better postoperative satisfaction than patients in PS group (91±6 vs 86±7, t=3.89, P=0.00). The ODI score in the CBT group was significantly lower than that in the PD screw group half a year after the operation (3.9±1.9 vs 5.8±3.1, t=-3.66, P=0.00). The VAS and ODI scores in the CBT group were significantly lower than those in the PS group 1 year after the surgery (t=-3.03, -4.09, both P<0.05). There was no significant differences in wound infection, cage displacement, screw extraction and fixation fracture between the two groups.

CBT screw technique is minimally invasive, with short operation time, less intraoperative blood loss, rapid postoperative recovery and low complications. It can be effectively used in posterior lumbar cone fusion.

To preliminarily study on the possible mechanism of cerebral cortical dysfunction pattern after anterior cruciate ligament (ACL) preservation reconstruction with autologous tendon through resting-state functional magnetic resonance imaging (fMRI).

From June 2015 to February 2019, 18 patients (10 males and 8 females with an average age of (36±10) years) with left anterior cruciate ligament rupture and treated with arthroscopic preservation reconstruction with autologous tendon were enrolled in this study, and 17 comparable healthy controls were included in Tongji Hospital of Tongji University. fMRI was performed after the postoperative period (2 to 12 weeks). The fMRI data were preprocessed by SPM8 software package and RESTplus software. The amplitude of low-frequency fluctuation (ALFF) and the fractional amplitude of low-frequency fluctuation (fALFF) in those two groups were calculated. Two-sample t-test was performed on ALFF and fALFF of the two groups, and multiple test corrections were performed by using AlphaSim. These methods were used for contrast studies on the characteristic activities of the brain dysfunction.

Compared with those in the control, ALFF in the central cingulate gyrus (cingulum_mid_bilateral), involving the auxiliary movement zone (supp_motor_ area) were significantly higher in the patients (P<0.01 before correction, P<0.05 after AlphaSim correction). The fALFF in activation cluster 1 was significantly higher in the right central gyrus (postcentral_R), the right lower lobule (parietal_inf_R), and the right upper margin (supramarginal_R) in the patients than that in the normal control group, respectively (P<0.01 before correction, P<0.05 after AlphaSim correction); the fALFF in activation cluster 2 in the right central cingulate gyrus (cingulum_mid_R), involving the right auxiliary movement zone (supp_motor_area_R) was significantly higher in the patients than that in the normal control group, respectively (P<0.01 before correction, P<0.05 after AlphaSim correction).

The patients′ cerebrum cortical function associated with the kinesthesis and their regulations are abnormally changed after anterior cruciate ligament preservation reconstruction with autologous tendon.

To investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM DWI) in evaluating microstructure changes in elderly white matter hyperintensities (WMH) patients and to analyze the correlation between IVIM parameters and severity grading and cognitive scores.

Sixty-two WMH patients in Zhejiang Hospital were collected from December 2014 to March 2018 and underwent conventional magnetic resonance (MR) plain scan and diffusion weighted imaging with different b values. The age was 60-92(74±10) years with 37 males, 25 females. The severity of WMH was assessed by T₂ fluid attenuated inversion recovery (FLAIR) sequence and Fazekas score,which were divided into two subgroups. Slow diffusion coefficient (D), fast diffusion coefficient (D^*) and perfusion fraction (f) from IVIM parameters of double exponential model were compared between regions of WMH (deep WMH (DWMH) and periventricular WMH (PWMH)) and surrounding normal white matter (NWM).The Shapiro-Wilk test was used for normality tests, Kruskal-Wallis tests and Dwass-Steel-Critchlow-Fligner (DSCF) procedure were used for the comparison among these parameters. Furthermore, Wilcoxon two-sample test was used for the comparisons between different severity. Pearson correlation analysis was performed to determine whether these D, D^*, f values were correlated with the mini mental state examination (MMSE) scores.

D_DWMH (0.83(0.72,0.99)×10^-3 mm²/s), D_PWMH((1.13±0.25)×10^-3 mm²/s) were significantly higher than D_NWM ((0.71±0.05)×10^-3 mm²/s)(P<0.01). f _DWMH ((8.94%(7.46%,11.67%)), f _PWMH(8.34%(6.73%,9.96%)) were significantly higher than f _NWM(6.71%±1.72%)(P<0.01).D in DWMH were significantly lower than that in PWMH(P<0.01), there′s no statistically difference between other groups. D in severe WMH (both DWMH and PWMH) were significantly higher than that in mild WMH (P=0.000 1, P=0.04). Only f in PWMH were positively associated with the MMSE scores (r=0.326 5,P<0.05).

IVIM DWI can noninvasively assess the variation of microstructure diffusion and perfusion in WMH in one sequence,which may objectively reflect the severity of these lesions. This method has important clinical significance for better assessment and management of this disease.

To investigate the relationship between Lipoprotein (LP) (a) level and the characteristics of tissue components of left main coronary artery (LMCA) plaque.

A total of 102 patients with stable angina pectoris who underwent percutaneous coronary intervention (PCI) in the People’s Hospital of Henan Province from June 2010 to October 2016 were included. We performed intravascular ultrasound-virtual histology (IVUS-VH) to their LMCAs and evaluated the tissue characteristics, and the blood level of total cholesterol (TC), triacylglycerol (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), ApoB, ApoA1, LP(a) were measured. According to the value of their LP(a) level they were divided into 2 groups (high LP(a) group (>300 mg/L) (n=35) and low LP(a) group (≤300 mg/L) (n=67)), then the relationship between the above lipid values and the tissue characteristics of the LMCA plaque in the patients were evaluated.

Patients with a high LP(a) had a larger percentage of fibrolipid volume and a smaller percentage fibrous volume compared to patients with a normal LP(a) (25%±5% vs 13%±6%, P<0.01 and 50%±8% vs 61%±9%,P<0.01). Using multivariate linear regression analysis after adjustment for the above-mentioned confounding factors, LP(a) had a significantly positive correlation with fibrolipid volume percentage (r=0.645, β=0.29, P<0.01), and had a negative correlation with fibrous volume percentage (r=-0.467, β=-0.32,P<0.01), suggesting that the LP(a) was associated with the vulnerability of the LMCA plaque.

For the patients with stable angina pectoris, the LP(a) has a significantly positive correlation with the percentage of fibrolipid volume and a negative correlation with the percentage of fibrous volume, suggesting that the LP(a) could predict the vulnerability of the LMCA plaque.

To investigate the efficacy and safety of mechanical thrombectory with a tri-axial system of the solitaire AB stent through a Navien delivery catheter to treatment acute vertebrobasilar artery occlusion.

The clinical data of 16 consecutive patients with acute ischemic stroke of vertebrobasilar artery occlusion treated with the Solitaire AB device from March 2016 to March 2018 in Department of Neurosurgery, the First Affiliated Hospital, Medical College of Shihezi University, were extracted and then retrospectively analyzed.Recanalization rate as well as complications after treatment were analysized. Also, neurological functions of the patients before and after operation 1 weeks, measured by National Institute of Health stroke scale (NIHSS) score were compared via t test and the clinical outcomes were assessed by modified Rankin score (mRS) at 90 days after operation.

There were 10 male and 6 female patients with a median age of 59 years (ranging from 45 to 78 years).Fourteen patients resulted in successfully recanalization, and 2 cases failed both of whose onset to sheath mean time were 8.5 hours.The NIHSS score at 7 days was 13±7, which was significantly decreased compared to the admission NIHSS score 24±4 (P=0.000).No symptomatic intracranial hemorrhage case was found after operation.At 90 days, 8 patients achieved good outcome (mRS 0 to 2), one patient died (mRS 6),two patients moderately seriously disabled (mRS 4).Three patients resulted in moderate outcome (mRS 3).In 3 cases of death,2 patients died due to failure in recanalization,another patient died of severe pulmonary infection.

The results suggest that this technique of a tri-axial system used of the Solitaire AB stent through a Navien delivery catheter can effectively retrieve clots from the occlusive artery and improves functional outcome in patients with acute ischemic stroke of vertebrobasilar artery.

To analyze the indication and the outcome of trans-sphenoidal surgery (TSS) in Cushing′s disease (CD) with negative high dose dexamethasone suppression tests (HDDST) results.

Eighteen cases of ACTH-dependent Cushing′s syndrome (CS) with negative HDDST results in the Department of Neurosurgery in Shanghai Ruijin Hospital from January 2015 to December 2017 were retrospectively reviewed. All patients underwent TSS. There were 5 males and 13 females, with an average age of (41±14) years.

All patients underwent bilateral inferior petrosal sinus sampling (BIPSS) before the surgery and got evidence of pituitary origin of ACTH secretion. They were thus indicated for TSS. Immediate post-operative remission was achieved in ratio 17/18. There were no recurrences within a flow-up of 1 to 3 years. Pituitary ACTH secreting adenomas were pathologically confirmed in 15 cases, including the one who did not achieve post-operative remission. Thus, all 18 patients with negative HDDST results can finally be confirmed as CD.

HDDST alone is not sufficient to eliminate CD. For patients with ACTH-dependent CS with negative HDDST results, BIPSS should be further performed. The fact of post-operative remission and the pathological confirm of ACTH secreting pituitary adenoma may add final evidence to the diagnosis of CD.

To explore the mechanism of androgen in improving erectile dysfunction in castrated rats.

Forty 8-week-old male Sprague-Dawley (SD) rats were randomly divided into 4 groups:normal control group (Group A); castration group (Group B, in which rats were castrated); intervention groups (group C and D), in which rats were treated with different concentrations of testosterone undecanoate orally every day at 10 mg/kg (low dose) and 20 mg/kg (high dose), respectively after being castrated. Animals in group A and B were given 0.9% NS instead. After 8-week treatment, the level of serum testosterone, intra cavernous pressure (ICP) and mean arterial pressure (MAP) were detected, and the expression of androgen receptor (AR)and vascular endothelial growth factor (VEGF) were detected in the penis by Immunohistochemistry and Western blot.

The level of serum testosterone was significantly lower in group B [(1.3±0.6) nmol/L] than in group A [(17.1±1.5) nmol/L] (P<0.05).After testosterone supplementation, serum testosterone levels in group C [(8.7±1.2) nmol/L] and group D [(15.5±1.6) nmol/L] were higher than that in group B (allP<0.05). Max ICP/MAP of group C and D were higher than that in group B (all P<0.05). Immunohistochemistry and Western blot showed that the expression levels of AR and VEGF in group B were significantly lower than those in group A, C and D, and group D > group C (all P<0.05).

Androgen replacement therapy with testosterone undecanoate can improve the erectile function of castrated rats by protecting the integrity of endothelial cells through AR/VEGF pathway.

A middle-aged male patient was admitted to hospital due to chronic diarrhea and multiple jejunal ulcers. He was diagnosed with gelatin enteropathy by gastroscopy and serological antibody examination. At the same time, the patient also suffered from selective IgA deficiency and hereditary deafness, which increased the diagnosis and treatment of the disease. Difficulty. The analysis of this case will help to increase the understanding of rare diseases such as gelatin enteropathy, selective IgA deficiency and hereditary deafness, and also help to cultivate the clinical thinking of difficult diseases in internal medicine.

Lymphoepithelioma-like carcinoma (LELC) is an undifferentiated or poorly differentiated malignancy that is similar to lymphoepithelioma that occurs in the nasopharynx, but occurs outside the nasopharynx. LELC can occur in many organs of the whole body, including thyroid, esophagus, stomach, lung, breast, uterus and bladder. Among them, LECE of primary thymus is extremely rare and rarely reported in China. Now review the clinical, pathological and imaging data and diagnosis of a child with thymic lymphoepithelioma-like carcinoma in our hospital, and analyze the difficulties, doubts and breakthroughs in the process of diagnosing this disease, so as to enrich clinicians' diagnostic experience and provide new ideas and references for the follow-up diagnosis and treatment of this disease.

Laparoscopic surgery, which has the advantages of minimally invasive and quick postoperative recovery, has been widely used, and some uncommon complications such as puncture hernia have also appeared. The incidence of puncture hernia is low, and incarcerated intestinal obstruction caused by puncture hernia in the early stage after laparoscopic surgery is even rarer. If such intestinal obstruction is not relieved in time, it is easy to lead to serious complications and even death. This article reports a case of pockhole hernia in a woman, and discusses its classification, clinical characteristics, risk factors, diagnosis and treatment methods and preventive measures.

Primary seminal vesicle adenocarcinoma is extremely rare in clinical practice. Because it lacks specific clinical manifestations and is difficult to distinguish from primary tumors of adjacent organs such as malignant tumors of prostate, bladder and rectum, its clinical diagnosis is difficult and easy to be misdiagnosed and missed. A patient with primary bilateral seminal vesicle adenocarcinoma was admitted to our hospital in November 2017. The disease is analyzed and summarized based on the clinical data of the patient and related literature.

Granulosa cell tumor is a rare tumor. At present, most scholars believe that it originates from Schwann cells, and granulosa cell tumor occurring in the spinal canal is extremely rare. This paper reports a case of multiple granulosa cell tumor in the spinal canal with paravertebral involvement.

Mycoplasma pneumoniae (MP) is a common pathogen of respiratory tract infections. The infection rate of MP in young adults is higher. Some patients may have multi-system and multi-organ damage, and even only extrapulmonary manifestations are the main clinical feature, which is easy to be misdiagnosed at the initial stage.