Overview of the 2022 WHO Classification of Pituitary Adenomas/Pituitary Neuroendocrine Tumors:Clinical Practices,Controversies,and Perspectives

The latest edition of the WHO classification of the central nervous system was published in 2021.This review summarizes the major revisions to the classification of anterior pituitary tumors.The most important revision involves preferring the terminology of pituitary neuroendocrine tumor(PitNET),even though the terminology of pituitary adenoma(PA)still can be used according to this WHO classification compared to the previous one.Moreover,immunohistochemistry(IHC)examination of pituitary-specific transcription factors(TFs),including PIT1,TPIT,SF-1,GATA2/3,and ERα,is endorsed to determine the tumor cell lineage and to facilitate the classification of PitNET/PA subgroups.However,TF-negative IHC staining indicates PitNET/PA with no distinct cell lineages,which includes unclassified plurihormonal(PH)tumors and null cell(NC)tumors in this edition.The new WHO classification of PitNET/PA has incorporated tremendous advances in the understanding of the cytogenesis and pathogenesis of pituitary tumors.However,due to the shortcomings of the technology used in the diagnosis of PitNET/PA and the limited understanding of the tumorigenesis of PitNET/PA,the application of this new classification system in practice should be further evaluated and validated.Besides providing information for deciding the follow-up plans and adjunctive treatment after surgery,this classification system offers no additional help for neurosurgeons in clinical practice,especially in determining the treatment strategies.Therefore,it is necessary for neurosurgeons to establish a comprehensive pituitary classification system for PitNET/PA that incorporates neuroimaging grading data or direct observation of invasiveness during operation or the predictor of prognosis,as well as pathological diagnosis,thereby distinguishing the invasiveness of the tumor and facilitating neurosurgeons to decide on the treatment strategies and follow-up plans as well as adjunctive treatment after surgery.

多焦视网膜电图在视网膜疾病中的应用进展

多焦视网膜电图(mfERG)是视网膜电图(ERG)中的一种常见类型,它能够客观、准确、定量地检测视网膜各个细小部位的功能,在临床上被广泛应用,尤其是在视网膜疾病中,它不仅在视网膜疾病的诊断与疗效评价中有着重要作用,而且最近的研究发现它在疾病的随访和预后评估中也具有重要价值,甚至其应用范围可向基础研究推广。因此本文对mfERG在视网膜疾病中的应用进展作一综述。

Clinical Characteristics, Imaging Findings and Surgical Outcomes of Chiari Malformation Type I in Pediatric and Adult Patients

A growing number of children and adolescents are being diagnosed as Chiari malformation type I （CM- I ） for behavioral disorders, developmental delay, seizures, or abnormal orpharyngeal function. The aim of this study was to compare the clinical characteristics, imaging findings and surgical outcomes of CM- I in pediatric and adult patients. Between January 2014 and June 2017, 84 patients with CM- I underwent surgical treatment in our department. We divided the patients into two groups： pediatric group （n=l 1, age 〈18 years） and adult group （n=73, age 〉18 years）. Data on clinical characteristics, imaging findings, surgical outcomes, and prognosis were retrospectively reviewed and compared between these two groups. For clinical presentation, scoliosis （36.4%） and developmental delay （36.4%） were more common in pediatric patients, whereas, sensory disturbance （58.9%） and motor weakness （41. 1%） were more common in adult patients. Imaging findings showed that the incidence of hydrocephalus and craniovertebral junctional abnormalities was significantly higher in pediatric group than in adult group （P〈0.05）. Compared to adult group, pediatric group showed a better improvement or resolution of syrinx and tonsillar herniation after surgical treatments （P〈0.05）. The total Chicago Chiari Outcome Scale （CCOS） score in pediatric patients at the last follow- up was significantly higher than that in adult patients （P=0.002）. In conclusion, the clinical characteristics and imaging findings appeared to be different in pediatric and adult patients with CM- I. The surgical outcomes of pediatric patients were shown to be significantly better than those of adult patients.

Preliminary Recommendations for Surgical Practice of Neurosurgery Department in the Central Epidemic Area of 2019 Coronavirus Infection

Since December 2019,an outbreak of coronavirus disease 2019(COVID-19)has.posed significant threats to the public health and life in China.Unlike the other 6 identified coronaviruscs,the SARS-Cov-2 has a high infectious rate,a long incubation period and a variety of manifestations.In the absence of effective treatments for the virus,it becomes extremely urgent to develop scientific and standardized proposals for prevention and control of virus transmission.Hereby we focused on the surgical practice in Neurosurgery Department,Tongji Hospital,Wuhan,and drafted several recommendations based on the latest relevant guidelines and our experience.These recommendations have helped us until now to achieve'zero infection'of doctors and nurses in our department,we would like to share them with other medical staff of neurosurgery to fight 2019-nCoV infection.

Surgical Technique and Efficacy Analysis of Extra-pseudocapsular Transnasal Transsphenoidal Surgery for Pituitary Microprolactinoma

Objective To elucidate the role of transsphenoidal surgery in the treatment of pituitary microprolactinoma.Methods The clinical data of 107 prolactinoma cases treated by extra-pseudocapsular transnasal transsphenoidal surgery(ETTS)for different indications in our department since 2011 was retrospectively analyzed.Results The most common indication was the ineffectiveness of oral medication(41.1%),followed by the personal willingness of the patient(35.5%),and 20.6%of the patients were young women with clear tumor boundaries.The pseudocapsule was not observed in 63 cases(58.9%),incomplete pseudocapsule was observed in 26 cases(24.3%),and complete pseudocapsule in 18 cases(16.8%).A total of 97 patients(90.7%)obtained 1-year post-operation remission.According to the relative location of the adenoma and pituitary gland on the MRI scan,46 patients were classified into a central type,59 a lateral type,and 2 a supra-pituitary type.Two patients developed hypogonadism,one patient developed hypocortisolism,and one patient developed post-operative hypothyroidism.Two patients were administrated with hormone replacement treatment,and the treatment was stopped within one week.There was no permanent hypopituitarism.Further investigation demonstrated that the adenoma types could affect the remission rates of hyperprolactinemia and gross total resection rate in microprolactinoma.Conclusion ETTS was an effective treatment for pituitary microprolactinomas.This could be the first choice for patients who presented enclosed adenoma on the MRI and were potentially curable in a preoperative evaluation.Maximal safe removal of the adenoma by ETTS with the aim to increase the sensitivity of the drugs was also recommended for patients with invasive dopamine agonist resistant prolactinomas and patients with difficulty in childbirth.

Artificial Intelligence to Diagnose Tibial Plateau Fractures: An Intelligent Assistant for Orthopedic Physicians

Objective:To explore a new artificial intelligence(AI)-aided method to assist the clinical diagnosis of tibial plateau fractures(TPFs)and further measure its validity and feasibility.Methods:A total of 542 X-rays of TPFs were collected as a reference database.An AI algorithm(RetinaNet)was trained to analyze and detect TPF on the X-rays.The ability of the AI algorithm was determined by indexes such as detection accuracy and time taken for analysis.The algorithm performance was also compared with orthopedic physicians.Results:The AI algorithm showed a detection accuracy of 0.91 for the identification of TPF,which was similar to the performance of orthopedic physicians(0.92±0.03).The average time spent for analysis of the AI was 0.56 s,which was 16 times faster than human performance(8.44±3.26 s).Conclusion:The AI algorithm is a valid and efficient method for the clinical diagnosis of TPF.It can be a useful assistant for orthopedic physicians,which largely promotes clinical workflow and further guarantees the health and security of patients.

Extra-pseudocapsular Transnasal Transsphenoidal Resection of Pituitary Macroadenoma:Technique Note and Evaluation of Endocrine Function

Objective In this study,we investigated the surgical technique and endocrine assessment of pituitary function of patients with macroadenoma treated by extra-pseudocapsular transnasal transsphenoidal surgery(ETTS).Methods Clinical data of 144 patients with pituitary macroadenomas in the same surgical group at the Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed from January 2019 to June 2021.Based on the results of the endocrinological evaluation and MRI examinations before and after surgery,the fluctuation of pituitary function and the extent of resection were analyzed.Multiple Logistic regression analysis was used to determine the predictors affecting postoperative tumor residual.Results Among the 144 patients with pituitary macroadenomas,72(50.0%)were female and 72(50.0%)were male,the median age was 50 years,26(18.1%)had invasiveness grade 0,46(31.9%)had grade I,57(39.6%)had grade II,and 15(10.4%)had grade III according to Lu’s classification method.Based on observation during surgery,37 cases(25.7%)had no pseudocapsule,54 cases(37.5%)had incomplete pseudocapsule,and 53 cases(36.8%)had intact pseudocapsule.In addition,91(63.2%)patients had total resection,39(27.1%)had subtotal resection,and 14(9.7%)had partial resection.As for anterior pituitary function,13 of 19 hypothyroid patients had recovery after surgery,with a remission rate of 68.4%.Eighteen of the 26 decreased cortisol patients got back to normal,with a remission rate of 69.2%.A total of 27 of 51 patients with hypogonadism improved,with a remission rate of 52.9%.Univariate and multivariate analyses indicated that gender,tumor size,and invasiveness were predictors of postoperative residual in patients(P<0.05).Conclusion The results showed that ETTS is an effective treatment modality for restoring the function of pituitary gland of the patients with macroadenomas.Tumor size and invasiveness are predictors of the extent of surgical resection and postoperative residual of macroadenomas.

Primary yields of protons measured using CR-39 in laser-induceddeuteron–deuteron fusion reactions

Investigating deuteron–deuteron(DD)fusion reactions in a plasma environment similar to the early stages of the Big Bang is an important topic in nuclear astrophysics.In this study,we experimentally investigated such reactions,using eight laser beams with the third harmonic impacting on a deuterated polyethylene target at the ShenGuang-II Upgrade laser facility.This work focused on the application of range-filter(RF)spectrometers,assembled from a 70 lm aluminum filter and two CR-39 nuclear track detectors,to measure the yields of primary DD-protons.Based on the track diameter calibration results of 3 MeV protons used to diagnose the tracks on the RF spectrometers,an approximate primary DD-proton yield of(8.5±1.7)×10^6 was obtained,consistent with the yields from similar laser facilities worldwide.This indicates that the RF spectrometer is an effective way to measure primary DD-protons.However,due to the low yields of D^3He-protons and its small track diameter,CR-39 detectors were unable to distinguish it from the background spots.Using other accurate detectors may help to measure these rare events.

MicroRNA-149 Regulates Proliferation,Migration,and Invasion of Pituitary Adenoma Cells by Targeting ADAM12 and MMP14

Objective Pituitary adenomas(PAs)can adapt an aggressive phenotype by invading adjacent brain structures with rapid cellular proliferation.Previous studies demonstrated that excessive expression of metalloproteases ADAM12 and MMP-14 is instrumental for the active proliferation and invasiveness of PA cells in vitro and of tumors in vivo.However,the mechanisms regulating ADAM12 and MMP-14 expression in PAs remain unclear.Methods Target gene prediction and transcriptomic profiling of invasive vs.noninvasive human PA samples were performed to identify miRNA species potentially involved in the regulation of ADAM12 and MMP14.For cellular analyses of miRNA functions,two mouse PA cell lines(AtT20 and TtT/GF)were transfected with miR-149-3p and miR-149-5p,respectively.The effects of miR-149(3p and 5p)on expression levels of ADAM12 and MMP14 were determined by Western blotting followed by an analysis of proliferation and colony formation assays,scratch migration assays,and invasion assays.Results A significant downregulation of miRNA-149 was observed in invasive vs.noninvasive PA(0.32 vs.0.09,P<0.0001).In AtT-20 and TtT/GF mouse PAs cells,transfection of mimic miRNA-149(3p and 5p)caused a significantly reduced cell proliferation and matrigel invasion,whilst the effect on cell migration was less pronounced.Both strands of miRNA-149(3p and 5p)markedly reduced protein levels of ADAM12 and MMP-14 by at least 40%in both cell lines.Conclusion This study proved that the invasiveness of PA cells is,at least partly,regulated by miRNA-149-dependent expression of ADAM12 and MMP-14.

A novel thiazole-based luminescent porous organic polymer as recyclable and selective turn-off fluorescent sensor for ultrasensitive detection of Pd^(2+)

1.Introduction Due to the potential harm of even low doses of Pd^(2+),to develop efficient approaches towards selective recognition of trace Pd^(2+)in environment is of great significance[1].Up to now,a wide variety of analytical methods and instruments for detecting palladium ions have been developed,including atomic absorption spectrometry(AAS),inductively coupled plasma atomic emission spectroscopy(ICP-AES),total reflection X-ray fluorescence(TXRF),HPLC,capillary zone elec-trophoresis(CZE),colorimetric sensing,and inductively coupled plasma mass spectrometry(ICP-MS).Most of these methods suffer from various drawbacks like complicated sample pretreatment processes,expensive apparatus and high detection costs[2,3].

Expert consensus on management principles of orthopedic emergency in the epidemic of coronavirus disease 2019

Since December 2019,many patients in Wuhan sustained pneumonia with unknown causes.[1,2]A part of severe patients developed acute respiratory distress syndrome or septic shock,and even death.On January 7,2020,Chinese researchers have for the first time detected a new coronavirus.On January 20,2020,the National Health Commission issued Announcement No.1 of 2020,which included the new coronavirus pneumonia as a Class B infectious disease,and conducted epidemic prevention and control according to the Class A infectious disease.This new kind of pneumonia has been named coronavirus disease 2019(COVID-19).The sixth edition of"Diagnosis and Treatment Scheme for New Coronavirus Infected Pneumonia"points out that the main transmission routes include respiratory droplets and close contact transmission.There is a possibility of aerosol transmission in a relatively closed environment with prolonged exposure to high concentrations of aerosol.New coronavirus pneumonia has a certain incubation period.