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【Objective】 To evaluate the efficacy and weight of sellar floor repair techniques such as different dura suture, bone reconstruction, and pedicled nasoseptal flap (PNSF) on the skull base reconstruction of medium and high flow cerebrospinal fluid leakage during endonasal endoscopic pituitary adenoma surgery. 【Methods】 We collected the data of Grade 2-3 cerebrospinal fluid leakage (Kelly grade) during endonasal endoscopic pituitary adenoma resection in our hospital from January 2015 to April 2021. Multiple reconstruction techniques such as dura suture, bone reconstruction and PNSF, and related factors such as age, sex, body mass index (BMI), diabetes, tumor size and diameter of diaphragmatic defect were recorded and introduced to multivariate regression to analyze the effects of the above factors on the duration of postoperative cerebrospinal fluid rhinorrhea and bed rest time, with a special focus on the weight priority of dura suture, bone reconstruction, and PNSF. 【Results】 A total of 281 patients were included, with the average age of (47±12.6) years, males accounting for 52.6%. There were 93 cases of PNSF, 268 cases of bone reconstruction, 109 cases of dura anchor suture, 50 cases of patch suture, and 122 cases without suture. The results of multivariate analysis indicated that the application of PNSF, bone reconstruction, and dura suture significantly reduced postoperative rhinorrhea time [reduced by 18.524, 35.876, and 16.983/19.791 (anchor suture/patch suture) hours, respectively; all PPNSF>bone reconstruction [Standard β=0.211/0.207 (anchor suture/patch suture)>0.200>0.165]. The weight of reducing bed time was bone reconstruction >dura suture > PNSF [Standard β=0.239>0.206/0.210 (anchor suture/patch suture) >0.164]. After stabilizing the learning curve in 25-30 cases, the average time for bone reconstruction was (3.9±0.4) minutes. After stabilizing learning curve in 30-40 cases, the dura suture technique took an average of (3.7±0.3) minutes per stitch, (3.7±1.0) stitches per case, and (13.6±2.7) minutes of total time consumption per case. 【Conclusion】 Dural anchoring and patching suture can both effectively shorten the duration of cerebrospinal fluid rhinorrhea and bed rest time. Bone reconstruction significantly improves the stability of reconstruction, especially in prompting patients’ early disengagement of bed rest. Moreover, the learning curves of the above two methods are economical and reasonable, and their weight is close to or even exceeds that of PNSF. Therefore, they can be an effective supplement or even substitute for PNSF.
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Objective: To explore the modified surgical method of supra- and infratentorial epidural hematoma (SIEDH) and analyze the related anatomy of the occipital bone. Methods: CT scan data of 30 adult patients with no history of craniocerebral trauma were collected in our hospital from January to August 2019. The median sagittal plane was taken to define line A (from lambdoid suture to the extraoccipital turbercle) and line B (from extraoccipital turbercle to the posterior edge of the foramen magmun). The angle θ was defined between the two lines. The mean value of θ was analyzed for comparison between genders and for exploration of the anatomical basis of single supratentorial craniotomy for SIEDH. Eight patients with SIEDH were recruited in the same period to analyze the procedure and results of the modified surgical method. Results: The average angle of the θ was (117.4±4.3)° for men and (130.0 ±4.9)° for women; the minimum was 108.3° for men and the maximum was 138.7 ° for women. The θ was smaller in men than in women (P<0.001). The smaller the angle was, the more conductive it was to detect the lesions from superior to inferior tentorial apartment. The bone flaps of the eight patients were designed above the transverse sinus. During the operation, epidural hematoma was completely removed, and no skull defects occurred like in conventional supra-inferior tentorial craniotomy. Conclusion: The supratentorial craniotomy above the tranverse sinus has reliable anatomical basis and is an effective surgical method for SIEDH.
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Objective To analyze the clinical and MR features of intracranial nonspecific inflammatory granuloma and improve the accuracy of preoperative diagnosis.Methods The clinical and MR features of 9 intracranial nonspecific inflammatory granuloma cases proved by histopathology were analyzed retrospectively.Results Nine lesions were all located in the supratentorial cerebral hemisphere with large lesion range and obvious peripheral edema.On enhancement MR imaging,the lesions were obviously and irregularly enhanced.There were simple patchy enhancement in 3 cases,patchy enhancement with multiple micronodular enhancement in 4 cases,and multiple micronodular enhancement in 2 cases.None enhancement areas were noticed in all enhancement lesions.There were superficial meningeal enhancements in 4 cases.On MR plain scanning,the MR enhancement area of lesions showed similar signal to the grey matter on T1 WI and low signal similarly to the white matter on T2 WI.On MRS scan,the significant high signal of Cho was detected in 2 cases and their Cho/Cr ratio was over 4.The Cho/Cr ratio was lower than 1.3 in 5 cases.Conclusion There are some specific MR enhancement features in the intracranial nonspecific inflammatory granuloma including multiple small nodules or patchy enhancement,in which there were no enhancement areas,and some cases have meningeal enhancement.
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Objective To explore the ultrasonographic features of the gallbladder with malaria in stage of attack (MSA) at Sudan.Methods A total of 67 cases of MSA patients were divided into common type of malaria (CM) and sever malaria (SM).All patients underwent routine abdominal ultrasound examination and the ultrasonographic features of the gallbladder were divided into type Ⅰ,Ⅱ and Ⅲ according to the volume of gallbladder,thickness of the gallbladder wall and chole stasis.The relationship between clinical types and the ultrasonic types were analyzed.Then the differences of liver function among normal,Ⅰ,Ⅱ and Ⅲ types were compared statistically.Results In all of the 67 MSA patients,52 cases were CM and 15 cases were SM.The gallbladder ultrasonography showed that normal gallbladder were in 14 cases,type Ⅰ in 28 ca ses,type Ⅱ in 19 cases,type Ⅲ in 6 cases.The ultrasonic types of the gallbladder had significant difference in SM patients (type Ⅰ 3 cases,type Ⅱ 7 cases,type lⅢ 5 cases) and CM patients (normal 14 cases,type Ⅰ 25 cases,type Ⅱ 12 cases,type Ⅲ 1 case;P＜0.001).Ultrasonic types of the gallbladder had no difference between Chinese and Sudanese (P＞ 0.05).There were statistical significant differences of liver function among normal,Ⅰ,Ⅱ and Ⅲ types of the gallbladder (P＜0.001).Conclusion Most of the MSA patients have ultrasonic changes of gallbladder.And there are more serious pathological changes of gallbladder in SM than that in CM.
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<p><b>OBJECTIVE</b>Since 1986, the reference of birth weight for gestational age has not been updated. The aim of this study was to set up Chinese neonatal network to investigate the current situation of birth weight in China, especially preterm birth weight, to develop the new reference for birth weight for gestational age and birth weight curve.</p><p><b>METHOD</b>A nationwide neonatology network was established in China. This survey was carried out in 63 hospitals of 23 provinces, municipalities and autonomous regions. We continuously collected the information of live births in participating hospitals during the study period of 2011-2014. Data describing birth weight and gestational age were collected prospectively. Newborn's birth weight was measured by electronic scale within 2 hours after birth when baby was undressed. The evaluation of gestational age was based on the combination of mother's last menstrual period, ultrasound in first trimester and gestational age estimation by gestational age scoring system.</p><p><b>STATISTICAL ANALYSIS</b>the growth curve was drawn by using LMSP method, which was conducted in GAMLSS 1.9-4 software package in R software 2.11.1.</p><p><b>RESULT</b>A total of 159 334 newborn infants were enrolled in this study. There were 84 447 male and 74 907 female. The mean birth weight was (3 232 ± 555) g, the mean birth weight of male newborn was (3 271 ± 576) g, the mean weight of female newborn was (3 188 ± 528) g. The test of the variables' distribution suggested that the distribution of gestational age and birth weight did not fit the normal distribution, the optimal distribution for them was BCT distribution. The Q-Q plot test and worm plot test suggested that this curve fitted the distribution optimally. The male and female neonatal birth weight curve was developed using the same method.</p><p><b>CONCLUSION</b>Using GAMLSS method to establish nationwide neonatal birth weight curve, and the first time to update the birth weight reference in recent 28 years.</p>
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Female , Humans , Infant, Newborn , Male , Birth Weight , China , Gestational Age , Infant, Low Birth WeightABSTRACT
<p><b>OBJECTIVE</b>To investigate the glycolytic phenotype of SHG44 human glioma cells under hypoxic conditions and the association between cell proliferation and apoptosis and the metabolic status.</p><p><b>METHODS</b>An in vitro hypoxic cell model was established in SHG44 cells using CoCl2. Real-time PCR and Western blotting were used to assess the expressions of hypoxia-inducible factor-1α (HIF-1α) and the enzymes involved in glycolysis including PDK1, PKM2, and LDHA. Intracellular ATP levels were measured by bioluminescence assay to assess the energy metabolic status of SHG44 cells. The viability and apoptosis of the cells were examined using MTT assay and flow cytometry, respectively.</p><p><b>RESULTS</b>The cells in hypoxic culture showed obviously increased expressions of HIF-1α, LDHA, PDK1, and PKM2 at both the mRNA and protein levels as compared to those in normal cell culture. Hypoxia of the cells also resulted in a lowered cell proliferative activity and an increased apoptosis rate with lowered intracellular ATP concentrations and elevated mitochondrial membrane potential.</p><p><b>CONCLUSION</b>Hypoxia can induce a glycolytic phenotype of tumor cells. The sensitivity of tumor cells to hypoxia-induced cell death is directly correlated with their metabolic status.</p>