Objective To investigate the surgical exposure of the subtemporal approach and explore clinical indications using a minimal-access.Methods Ten adult cadaveric heads fixed with formalin were used in this study.The holes with 3.0 cm × 2.5 cm of zygomatic arch vertically were operated on each head with subtemporal approach.During the anatomical procedures,measured the maximal exposure lengths of tentorial margin,posterior cerebral artery,and anterior border of brain stem,vertical distances between highest structure in the field of view and posterior clinoid process,the shortest distances form the zygomatic arch 1/3 to tentorial edge,sulcus lateralis mesencephali and anterior clinoid process; After tentorium of cerebellum was cut,measured the straight distance form the internal carotid artery to the optic nerve and form the posterior communicating artery to the tentorial edge.Results Oculomotor,trochlear nerve,tentorial edge,superior cerebllar artery.,P1-P2 segment of posterior cerebral artery,ventrolateral surface of mesencephalon and pon higher than root of trigeminal nerve,anterior and posterior clinoid process,posterior communicating artery and anterior choroidal artery,and superior portion of pituitary stalk could be observed via subtemporal approach using a minimal-access.Conclusion 1.The subtemporal approach using a minimal-access can protect the superficial temporal artery and the facial nerve branches especially in the process of the flap formation.It does little damage to the temporallis,reduces the invalid exposure of brain tissue,farthest lowers the damage to the scalp,skull and adjacent tissue ; 2.The subtemporal approach using a minimal-access can obtain the exposure rang.It can see the upper pons,petroclival region,tentorial notch area,ventrolateral brain stem.

ObjectiveTo observe the effects ofYushen Zhuyun Prescription on ovarian morphology and sex hormone of rats with decreased ovarian reservation (DOR) induced by tripterygium glycosides; To explore its mechanism of action.Methods Tripterygium glycosides solution was used to establish DOR model rats by gastric gavage. 48 female SD rats were randomly divided into blank group, model group, positive medicine group andYushen Zhuyun Prescription low-, medium- and high-dose groups.Yushen ZhuyunPrescription groups were given the low, medium, high dosagesYushen Zhuyun Prescription liquid; positive medicine group were given estradiol valerate liquid; model group and blank control group were given normal saline with the same amount, by gavage 2 times per day for 14 consecutive days. The general condition of the rats was observed; ovarian was weighed and the viscera index was calculated; ovarian morphology was observed by HE staining; the levels of serum estradiol (E2), follicle stimulating hormone (FSH) and testosterone (T) were detected by radioimmunoassay; the levels of inhibin B (INHB) and anti Mullerian hormone (AMH) were detected by ELISA.Results Compared with the blank group, ovarian tissue atrophied; the number of follicles was reduced; ovarian index and the level of E2, INHB and AMH decreased; the levels of FSH and LH increased in the model group (P<0.01). Compared with the model group, ovarian tissue morphology improved significantly; the number of follicle and corpus luteum increased; follicular atresia was reduced; ovarian index and the levels of E2, INHB, and AMH increased; the levels of FSH and LH decreased in Yushen Zhuyun Prescription high-dose group (P<0.01). INHB and AMH had significant correlation (P<0.01). ConclusionYushen Zhuyun Prescription can regulate hormone levels, promote the growth and secretion of follicle, and inhibit follicular atresia, thereby improve ovarian reserve function.

Aim To explore the inhibition of Sinica Maxim′s extract( CSME) on resistant infections of burn wounds,such as the methicillin-resistant staphylococcus aureus ( MRSA ) , resistant pseudomonas aeruginosa (RPA) and resistant escherichia coli(RECO). Meth-ods The resistant strains were cultured by MH agar plates. After resistance genes of quality control strains were extracted and appraised, such as mecA, mexB, merA, qacE△1-sull, tnpU/A and mexB, etc, and then,some projects of CSME were detected,such as the antibacterial spectrum, the minimum inhibitory con-centration(MIC), different concentrations of sensitive rate and inhibition curves, etc. Finally, these results were compared with the inhibitory effects of some anti-biotics to determine the sensitivity rates of CSME. Re-sults The MIC of CSME was 62. 5 ,125 ,250 g · L-1 respectively on the MESA, RPA and RECO. The inhi-bition rates of CSME appeared concentration-dependent on these three kinds of resistant bacteria,and the inhi-bition rates of the multi-concentration CSME on RECO were significantly lower than on MRSA and RPA ( P<0. 05). While in MIC,the resistance rates of MRSA on carbenicillin, cefazolin, erythromycin were significant-ly higher than those of CSME(P<0. 05); The inhibi-tion zones of CSME were significantly smaller than those of ceftriaxone, cefepime, imipenem, but greater than those of other antibiotics( P<0. 05 ); The inhibi-tion zones of CSME on RPA were significantly smaller than those of carbenicillin, and greater than those of other antibiotics ( P <0. 05 ) . The inhibition zones of CSME on RECO were significantly smaller than those of ceftriaxone,cefepime,imipenem,ciprofloxacin,nitro-furazone,and greater than those of other antibiotics ( P<0. 05 ) . Conclusions CSME has a significant inhi-bition on burn wound infection with these three kinds of resistant bacteria,such as MRSA,RPA and RECO. It is prompted that CSME could become one of the effective drugs to control burn wound infections with multi-re-sistant strains.

Objective To discuss the efficacy of intravesical instillation of sodium hyaluronate for the treatment of cystitis glandularis after transurethral resection.Methods 85 patients (9 male and 76 female,age range 37-70 years,mean age 51) who were diagnosed as CG in China-Japan Union Hospital of Jilin University underwent transurethral resection.After the operation they were divided into three groups randomly according to different intravescal instillation:sodium hyaluronate for group A,epirubicin for group B and no medicine for group C.The group A started to instill with sodium hyaluronate 40mg once a week for four weeks,and then once a month for four months.The group B did the same way of intravesical instillation of epirubicin.All the patients were followed-up for 12 months.The cystoscopy was done every three months to detect recurrence and the clinical symptom score was evaluated at 1,3,6 and 12 months.Results No patients in group A treated by sodium hyaluronate relapsed but 6 cases and 9 cases in group B and group C respectively.Recurrence rate of group A is significant low compared with group B and C (P ＜ 0.05).The scores of clinical symptom score appendix after 1,3,6 and 12 months for group A were (3.18 ± 1.44),(1.29 ±0.66),(1.25 ±0.65) and (1.21 ±0.63),respectively.It was (3.37 ±1.62),(3.33 ±1.59),(1.37±0.74) and (1.30±0.61) for group B,and (3.47±1.81),(3.40±1.52),(3.27±1.41) and (3.23 ± 1.19) for group C.Compare the score of clinical symptom in the same group,there were significant differences for the score after 3 months compare with the score after 1 month in group A (P ＜ 0.05).But in group B,the significant differences showed after 6 months (P ＜ 0.05).There was no significant difference in group C (P ＞ 0.05) in the whole year.Conclusions Intravesical sodium hyaluronate therapy can effectively decline the recurrence rate of cystitis glandularis after transurethral resection.It could also significantly improve the urinary tract symptoms.

Objective To observe the alteration of capillary density and apelin/APJ expression in soleus muscles of high-fat diet rats.Methods Male 5-week-old Sprague-Dawley rats were randomly divided into a control group and a high-fat diet group.After 12 weeks of high-fat diet,16 rats were se lected and randomly divided into a sedentary group and a treadmill running group.The exercise rats underwent 60-minute treadmill running at 26 m/min 5 days a week for 10 weeks.The body weight,body fat and blood lipid level were measured for all rats.The protein expression of Soleus CD31 and apelin was determined using immunohistochemical staining,soleus apelin content was determined using the radioimmunoassay,and the mRNA expression of apelin/APJ was detected using real-time PCR.Results Compared with the control group,significant increase was observed in the body weight,body fat and the level of total triglyceride,total cholesterol and low density lipoprotein cholesterin,but significant decrease was found in the high density lipoprotein cholesterin in the high-fat diet group.There were no significant differences in the capillary density and mRNA levels of apelin/APJ between the two groups.Compared with the sedentary high-fat diet group,significant improvement was observed in the body weight and blood lipid level of the treadmill running group.Moreover,significant increase was also observed in the capillary density,the expression of apelin/APJ mRNA,as well as that of apelin protein in the treadmill running group (P＜0.05).Conclusion The treadmill running can significantly increase capillary density of obese rats,as it may activate the expression of Apelin/APJ.

Objective To analyze the risk factors of fevers after percutaneous nephrostolithotomy (PCNL) and to determine a more effective prophylaxis method.Methods A retrospective analysis of 320cases who underwent PCNL for renal calculi from 2008 to 2011 (men 233,women 87,age between 22 years to 72 years) was made.The average age of the patients and the average diameter of the stones were 42 years and 3cm(0.8 -6 cm),respectively.We analyzed factors such as age ( ＞60 years and ≤60 years),stone size ( ＞2.0 cm and ≤2.0 cm),operative time ( ＞60 min and ≤60 min),irrigation pump pressure ( ＞120 mm Hg and ≤ 120 mm Hg),obstructive conditions,preoperative urinary tract infection and fever.Wethen compared the fever rate with each of the risk factors.Results There were 59 cases with fever after PCNL; 18.4％ of the cases had a temperature over 38 ℃.There were two cases of pyemia.The patients whose stone diameter ＞ 2 cm had a post-operative fever rate of 22.4％.The fever rate in patients whose stone diameter ≤2.0 cm was 10.4％.The fever rate in patients with an operative time ＞60 min and ≤60 min was 27.2％ and 10.4％,respectively.Patients with irrigation pump pressure ＞ 120 mm Hg and ≤ 120mm Hg had post-operative fever rates of 28.3％ and 11.0％,respectively.There was statistical significance between each post-operative fever risk factor group.Conclusions The post PCNL fever risk factors are stone diameter ＞ 2.0 cm,operation time ≤60 min and irrigation pump pressure ＞ 120 mm Hg.The effective prophylaxis policy of post-operative fever are the pre-operative using of broad-spectrum antibacterial agents,shorter operative time and lower irrigation pump pressure.A two-stage operation procedure will also reduce the post-operative fever.

Objective:To investigate the influence of preoperative thyroid dysfunction on the 30-day postoperative mortality and complications in elderly patients with hip fracture.Methods:A retrospective analysis was conducted of the 349 elderly patients with hip fracture who had been admitted to Department of Orthopedic Trauma, Beijing Luhe Hospital Affiliated to Capital Medical University from January 2018 to December 2019. They were 108 males and 241 females, with an average age of 76.3 years (from 60 to 104 years). There were 190 femoral intertrochanteric fractures and 159 femoral neck fractures. By the preoperative level of thyroid function, the patients were divided into a normal function group of 290 cases and a dysfunction group of 59 cases. The 2 groups were compared in terms of hospital stay, mortality and incidence of complications within 30 days postoperation.Results:In this cohort, the rate of 30-day postoperative mortality was 3.4%(12/349) and the incidence of 30-day postoperative complications 14.6%(51/349). The 2 groups were comparable because there was no significant difference between them in the preoperative general data except for the preoperative comorbidity of coronary heart disease ( P>0.05). In the dysfunction group, the hospital stay averaged (10.2±6.9) d, the rate of 30-d postoperative mortality 1.7%(1/59) and the incidence of 30-day postoperative complications 16.9%(10/59), which were insignificantly different from those in the normal function group [(10.7±7.5) d, 3.8%(11/290) and 14.1%(41/290), respectively] ( P> 0.05). Conclusion:Since preoperative thyroid dysfunction does not affect the 30-day postoperative mortality and postoperative complications in the elderly patients with hip fracture but no definite thyroid disease, routine thyroid function screening is not recommended for them.

Objective To investigate the impact of enhanced recovery after surgery (ERAS) program on postoperative recovery in patients undergoing laparoscopic colorectal resection. Methods Eighty-four patients undergoing laparoscopic colorectal resection from March 201 5 to June 201 6 (55 males,29 females,aged 36-78 years,ASA physical status Ⅰ or Ⅱ),were randomly divid-ed into two groups (n = 38 each).Patients in group E were received epidural block combined with general anesthesia,and a series of perfect ERAS strategies,such as strengthen preoperative educa-tion, maintaining perioperative normothermia, perioperative goal-directed fluid therapy, intraoperative and postoperative analgesia.While the patients in group C received routine anesthetic management.The volume of fluid,the nasopharyngeal temperature,the time of recovery of bouel sound,first anal exhaust,eating fluid food,ambulation and remove of the catheter were recorded in two groups.Furthermore,time of PACU after surgery,the total days of hospitalization and total hos-pital costs were recorded.Results The volume of fluid [(1 328 ± 64)ml vs.(2 463 ± 135 )ml]in group E were significantly lower than group C (P <0.05),the nasopharyngeal temperature [(36.2± 0.2)℃ vs.(35.1±0.5)℃]was significantly higher in group E (P <0.05).Compared with group C,the time of recovery of bowel sound [(33.4 ± 12.5 )h vs.(42.8 ± 14.3 )h],first anal exhaust [(43.6±13.9)h vs.(60.7±1 5.4)h],eating fluid food [(26.8±4.1)h vs.(67.4±13.5)h],first ambulation [(7.4±1.6)h vs.(26.5±3.8)h]and remove of the catheter [(29.2±6.1)h vs.(5 1.8 ±7.6) h ], time of PACU [(26.4 ± 8.5 ) min vs.(37.2 ± 1 1.6 ) min ], the total days of hospitalization [(7.5±0.9)d vs.(9.7±1.2)d]were significantly shorter (P <0.05),and hospital costs [(2.1±0.6)ten thousand yuan vs.(2.6±0.8)ten thousand yuan]were significantly decreased (P <0.05).The incidence of adverse reactions such as nausea and vomiting (2.4% vs.21.4%),pru-ritus (7.1% vs.23.8%),agitation (4.8% vs.26.2%)and chills (0% vs.1 9.0%)were significantly lower in group E (P <0.05).Conclusion ERAS program applied to patients undergoing laparoscopic colorectal resection can reduce the intraoperative sufentanil consumption,avoid the occurrence of postoperative hypothermia, accelerate recovery of gastrointestinal function, which can obviously reduce the hospitalization costs and shorten the hospitalization time.

Objective To investigate the effects of inhalation anesthetics on human sperm motility and capacitation in vitro. Methods Sperm samples were obtained from normal adults and prepared with discontinuous percoll gradient centrifugation technique. The samples were incubated for 5 h in an airtight glass container filledwith 5% CO2-95% air at 37 ℃ with or without sevoflurane (SEV 2%, 4% ) or isoflurane (ISO 1.1%, 2.2% ).Then human sperm motility was examined in vitro at 37℃ and analyzed by the computer-assisted sperm analysis (CASA), including sperm motility (a + b)%, curvilinear velocity (VCL), straight line velocity (VSL), averagepath velocity (VAP) and amplitude of lateral head displacement (ALH). The capacitation effect was assessed by using the chlortetracycline (CTC) staining and phase-contract microscopy. Results 2% and 4% SEV significantly reduced (a + b)% , VCL, VSL and VAP in a dose-dependent manner, while only 4% SEV significantly decreased ALH and the capacitation ability of the sperm compared with control group. 2.2% ISO significantly decreased ( a + b)%, VCL, VSL and VAP compared with control and 1.1% ISO group. The capacitation ability of the sperm was significantly decreased by 1.1% and 2.2% ISO as compared with control group. Conclusion Sevoflurane and isoflurane have significant inhibitory effects on human sperm motility and capacitation in a dose-dependent manner. Sevoflurane has stronger inhibitory effect than isoflurane.

Objective:To identify the risk factors for postoperative pulmonary complications (PPCs) after thoracoscopic lung resection and evaluate the predictive value for the development of PPCs.Methods:The perioperative data of patients, aged≥18 yr, of American Society of Anesthesiologists (ASA) physical statusⅠ-Ⅲ, were obtained through the electronic medical record system.The blood routine within 24 h after surgery was recorded, and systemic immune-inflammation index (SII) was calculated.According to the development of PPCs, the patients were divided into non-PPCs group and PPCs group.Multivariate logistic regression analysis was used to analyze the variables of which P values were less than 0.05 to identify the risk factors for PPCs, and the receiver operating characteristic curve was drawn to evaluate the predictive value of risk factors. Results:A total of 699 patients were enrolled in this study, including 620 patients in non-PPCs group and 79 patients in PPCs group.The results of logistic regression analysis found that body mass index ≥25 kg/m 2, ASA physical status Ⅲ, lung segmental resection, resection of lobes or above, multi-port thoracoscopic surgery and increased postoperative SII were the risk factors for PPCs ( P<0.05 or 0.01). The AUC (95% confidence interval) of postoperative SII in predicting PPCs was 0.636 (0.599-0.671) ( P<0.05), the cut-off value of SII in predicting PPCs was set at 1 052.3, and the sensitivity and specificity were 68.4% and 57.3%, respectively. Conclusions:Body mass index ≥25 kg/m 2, ASA physical status Ⅲ, lung segmental resection, resection of lobes or above, multi-port thoracoscopic surgery and increased postoperative SII are the risk factors for PPCs.Postoperative SII can predict the occurrence of PPCs to a certain extent in the patients undergoing thoracoscopic lung resection.