Objective To study the microanatomic structure of the subtemporal transtentorial approach to the lateral side of the brainstem,and to provide anatomical information that will assist clinicians to perform surgeries on the lateral,circumferential,and petroclival regions of the brainstem.Methods Anatomical investigations were conducted on 8 cadaveric head specimens(16 sides)using the infratemporal transtentorial approach.The heads were tilted to one side,with the zygomatic arch at its highest point.Then,a horseshoe incision was made above the auricle.The incision extended from the midpoint of the zygomatic arch to one third of the mesolateral length of the transverse sinus,with the flap turned towards the temporal part.After removing the bone,the arachnoid and the soft meninges were carefully stripped under the microscope.The exposure range of the surgical approach was observed and the positional relationships of relevant nerves and blood vessels in the approach were clarified.Important structures were photographed and the relevant parameters were measured.Results The upper edge of the zygomatic arch root could be used to accurately locate the base of the middle cranial fossa.The average distances of the star point to the apex of mastoid,the star point to the superior ridge of external auditory canal,the anterior angle of parietomastoid suture to the superior ridge of external auditory canal,and the anterior angle of parietomastoid suture to the star point of the 10 adult skull specimens were 47.23 mm,45.27 mm,26.16 mm,and 23.08 mm,respectively.The subtemporal approach could fully expose the area from as high as the posterior clinoid process to as low as the petrous ridge and the arcuate protuberance after cutting through the cerebellar tentorium.The approach makes it possible to handle lesions on the ventral or lateral sides of the middle clivus,the cistern ambiens,the midbrain,midbrain,and pons.In addition,the approach can significantly expand the exposure area of the upper part of the tentorium cerebelli through cheekbone excision and expand the exposure range of the lower part of the tentorium cerebelli through rock bone grinding technology.The total length of the trochlear nerve,distance of the trochlear nerve to the tentorial edge of cerebellum,length of its shape in the tentorial mezzanine,and its lower part of entering into the tentorium cerebelli to the petrosal ridge were(16.95±4.74)mm,(1.27±0.73)mm,(5.72±1.37)mm,and(4.51±0.39)mm,respectively.The cerebellar tentorium could be safely opened through the posterior clinoid process or arcuate protrusion for localization.The oculomotor nerve could serve as an anatomical landmark to locate the posterior cerebral artery and superior cerebellar artery.Conclusion Through microanatomic investigation,the exposure range and intraoperative difficulties of the infratemporal transtentorial approach can be clarified,which facilitates clinicians to accurately and safely plan surgical methods and reduce surgical complications.

Objective:To learn about the status of iodine deficiency disorders in children and pregnant women in coastal areas of Guangxi Zhuang Autonomous Region (Guangxi for short).Methods:From January 2017 to December 2020, 12 counties (cities, districts) in Beihai City, Qinzhou City and Fangchenggang City in coastal areas of Guangxi were selected as the survey sites to carry out iodine deficiency disorders monitoring. Each county (city, district) was divided into five areas according to administrative regions: East, West, South, North and Middle. One township (town) was selected from each area, and 40 non-boarding children aged 8 to 10 (age balanced, half male and half female) and 20 pregnant women were selected from each township (town) as the survey subjects. Edible salt samples and urine samples were collected from children and pregnant women to detect salt iodine and urinary iodine levels; thyroid volume of children was determined and the rate of goiter was calculated.Results:From 2017 to 2020, a total of 8 905 children were monitored, and the median salt iodine of children was 23.4 mg/kg, and the medians salt iodine in each year were 23.7, 22.8, 23.5, 23.6 mg/kg, respectively; the median urinary iodine of children was 164.7 μg/L, and the medians urinary iodine in each year were 161.2, 169.7, 156.0, 171.1 μg/L, respectively; 30 of them had goiter, the rate of goiter of children was 0.34% (30/8 905). A total of 6 626 pregnant women were monitored, and the median salt iodine of pregnant women was 23.5 mg/kg, and the medians salt iodine in each year were 23.7, 22.5, 24.3, 23.8 mg/kg, respectively; the median urinary iodine of pregnant women was 139.6 μg/L, and the medians urinary iodine in each year were 129.6, 131.6, 134.4, 175.0 μg/L, respectively.Conclusions:The iodine nutrition of children in coastal areas of Guangxi is at an appropriate level (100 - 199 μg/L), and the rate of goiter has reached the national iodine deficiency disorders elimination standard (< 5%). But pregnant women are at risk of iodine deficiency (urinary iodine < 150 μg/L).

Objective:To investigate the efficacy, safety and common adverse reactions of Apatinib monotherapy in elderly patients with advanced colorectal cancer(CRC)who failed to respond to standard regimens.Methods:This was a retrospective study.A total of 106 elderly patients with advanced CRC who had failed standard regimens from January 2015 to December 2019 were included.Patients enrolled in this study received Apatinib with an initial dosage of 500 mg or 250 mg.The objective response rate(ORR)and disease control rate(DCR)were assessed after treatment with apatinib.The progression-free survival(PFS)and overall survival(OS)were evaluated during the follow-up period.Additionally, adverse reactions during treatment with apatinib were recorded.Results:The efficacy was assessed by using the best overall response during apatinib treatment.Of 106 patients, there were 9 patients with partial response(PR), 68 patients with stable disease(SD)and 29 patients with progressive disease(PD). The ORR was 8.5% and the DCR was 72.6%.The median PFS was 3.6 months and the median OS was 10.1 months.Relatively common adverse reactions in these patients were hypertension(63 patients, 59.4%)and hand-foot syndrome(HFS)(51 patients, 48.1%)during apatinib treatment.The median PFS of patients with hypertension and of patients without hypertension were 5.0 months and 3.0 months, respectively( P=0.008). The median PFS of patients with and without HFS were 5.4 months and 3.0 months, respectively( P=0.013). Conclusions:Preliminary evidence suggests that Apatinib monotherapy has good efficacy and safety in elderly patients with advanced CRC who have failed standard regimens, and patients with adverse reactions such as hypertension and HSF still have a good prognosis.

Objective:To investigate the effects of Fructus Corni extract on the B7-H6 expression in primary liver cancer cells of rats. Methods:Sixty SD rats were randomly divided into three groups, namely, model, matrine, and Cornus officinalis. The rat model bear-ing the primary liver cancer was induced by diethylnitrosamine, except for the rats in the control group. The rats in both the matrine and Cornus officinalis groups were fed with matrine and Cornus officinalis. The rats in model groups were fed with 0.9％sodium chlo-ride solution. The number of hepatocellular carcinoma nodules was calculated, and the tumor growth inhibition rate was also calculat-ed. The pathological changes of hepatic tissues in rats of each group were observed by hematoxylin and eosin staining. The expression levels of B7-H6 in these three groups were determined by immunohistochemistry and Western blot. Results:The number of liver nod-ules of the matrine and Fructus Corni group rats was lower than that of the model group (P<0.05). The tumor inhibition rate of the Cor-nus group was significantly higher than that of the matrine group (P<0.05). The tumor growth inhibition rate of the Cornus officinalis group was significantly higher than that of the matrine group (P<0.05). Immunohistochemistry showed that the positive expression of B7-H6 in the Cornus officinalis group and the matrine group was significantly higher than that in the model group (P<0.05), and the positive expression of B7-H6 in the Cornus officinalis group was significantly higher than that in the matrine group (P<0.05). Similarly, the protein expression of B7-H6 in the Cornus officinalis and matrine groups was significantly higher than that in the model group (P<0.05) by Western blot, while the protein expression of B7-H6 in the Cornus officinalis group was significantly higher than that in the matrine group (P<0.05). Conclusion:Fructus Corni extract may inhibit the growth of hepatocellular carcinoma through upregulating the B7-H6 expression.

Objective To understand the implementing situation of prevention measures for iodine deficiency disorders before (2011) and after (2013) the adjustment of salt iodine content in Guangxi,to evaluate the changes of iodine nutritional status,and to provide a basis for future prevention work.Methods Monitoring data of iodized salt,drinking water iodine and iodine nutritional status before and after the adjustment of iodine content of salt was collected.Changes in water iodine,salt iodine and urinary iodine before and after adjusting iodine content of salt were compared.Results The monitoring work of iodized salt,drinking water iodine and iodine nutritional status was carried out in all the 109 counties (cities,districts) in 2011 and 2013.①Drinking water iodine monitoring:a total of 4 968 water samples was tested in 2011,the median water iodine was 2.69 μg/L.Of which,4 210 water samples below 10.00 μg/L,the proportion was 84.74％.A total of 7 554 water samples were tested in 2013,the median water iodine was 2.11 μg/L.Of which,6 512 water samples below 10.00 μg/L,the proportion was 86.12％.②Iodized salt monitoring:a total of 30 786 salt samples were tested in 2011; the salt median iodine was 32.30 mg/kg.The iodized salt coverage rate was 98.31％,iodized salt qualification rate was 97.36％,and qualified iodized salt consumption rate was 95.98％ weighted by population.A total of 32 779 salt samples were tested in 2013; the salt median iodine was 24.94 mg/kg,the iodized salt coverage rate was 98.36％,iodized salt qualification rate was 95.97％,and qualified iodized salt consumption rate was 94.49％ weighted by population.The difference of salt iodine was statistically significant between 2011 and 2013 (x2 =17 830.03,P ＜ 0.05).③Urinary iodine monitoring:a total of 8 278 urinary samples were detected in 2011; the median urinary iodine was 241.10 μg/L.Among these,889 urinary samples below 100.00 μg/L,the proportion was 10.74％; 2 174 urinary samples in 100.00 -＜ 200.00 μg/L,the proportion was 26.26％; 2 451 urinary samples in 200.00-＜ 300.00 μg/L,the proportion was 29.61％; and 2 764 urinary samples ≥300.00 μg/L,the proportion was 33.39％.A total of 10 988 urinary samples were tested in 2013; the median urinary iodine was 200.35 μg/L Among these,1 716 urinary samples below 100.00 μg/L,the proportion was 15.62％; 3 745 urinary samples in 100.00-＜ 200.00 μg/L,the proportion was 34.08％;2 970 urinary samples in 200.00-＜ 300.00 μg/L,the proportion was 27.03％; and 2 557 urinary samples ≥300.00 μg/L,the proportion was 23.27％.The difference of urinary iodine was statistically significant between 2011 and 2013 (x2 =391.98,P ＜ 0.05).Conclusions Guangxi belongs to an area with low iodine level.The situation of iodine deficiency disorders is in accordance with the national Standard to Eliminate Iodine Deficiency Disorders.Scientific salt iodization and sustained elimination of iodine deficiency disorders should continue to ensure appropriate levels of iodine nutrition among residents in Guangxi.

Objective Analyzing the impact of teachers' background characteristics on the Students' evaluation to improve the quality of teaching from the angle of the teachers professional development. Methods Based on the data of students' evaluation of teaching of Shanghai medical college of Fudan University from 2008 to 2011, the article analyzed the teachers' gender, age, job title, diploma, and other relevant background characteristics. Excell2007 was used to build dataset and the data was analyzed statistically by software of SPSS 11.0 and expressed with x±s. The statis-tical method of one-way analysis of variance was used to compare the teachers with different genders, education backgrounds, ages and professional titles, showing statistically significant difference (P<0.05). Results comparative analysis showed that no statistically significant differences existed in fac-ulty teaching evaluation scores among the teachers of different genders or different education back-grounds(P=0.613 9、0.891 0). There were however significant differences in teaching evaluation of teachers of diverse ages and professional ranks(P=0.017 3 and P=0.032 5). Conclusions According to the analysis results of faculty teaching evaluations, associate professors' teaching evaluation scores were lower than intermediate grade teachers', and the score of the teachers between the age of 41 to 45 was lower than that of the teachers between the age of 36 to 40. Therefore individual variations and various social backgrounds of teaching faculties should be taken into consideration and the corre-sponding countermeasures for the professional development of teachers should been put forward. In addition, the cultivation of new teachers, young and middle-aged teachers should be strengthened, and the proportion of teaching evaluation in the Performance Appraisal should be increased.