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.

Objective To simulate the hemodynamic feature in cerebral bridging veins (BVs), in order to provide a morphologic basis for the pathogenesis explanation and imaging diagnosis of cerebral venous thrombosis (CVT). MethodsTotally 6 human cadavers (12 sides) were examined in this study. Each head of the cadavers was injected with blue-coloured latex via the superior sagittal sinus (SSS) and internal jugular veins. The diamter and the angle of BVs entering SSS were measured. Based on the data of cadavers and computational fluid dynamics software pack, the hemodynamic models were established. The wall shear stress (WSS) was carefully studied and compared between different models. Results The total of 137 BVs formed two clusters along the SSS: anterior group and posterior group. Compared with anterior group BVs, the diameter of posterior group BVs was large, and the angle was smaller. In 137 models,when the diameter of a BV was more than 1.2mm, and the angle was between 65 and 105 degree, the local WSS decreased in the downstream wall of SSS. When the diameter of a BV was more than 1.2mm, and the angle was less than 65 degree, the local WSS decreased in the downstream wall of SSS and the upstream wall of BVs. The minimum WSS in BVs was 63% of the minimum WSS in SSS. Compared with the anterior group BVs, the minimum WSS in the wall of posterior group BVs was samller, and the distance from the minimum WSS to the dural entrance was longer. Conclusion CVT occurs easily when the diamter of a BV is more than 1.2mm and the angle is less than 65 degree. The embolus forms early in the upstream wall of BVs entering the posterior part of SSS.

Objective To explore the strategy of emergency medical rescue of the massive crowd in general hospital during spring festival with snow disaster. Method The clinical data of 20 966 emergency cases were analyzed retrospectively from 22 Jan,2008 to 6 Feb, 2008 with snow disaster, and concerned about the ratio of different diseases, the character of pre-hospital care and the contrast between emergency medical treatment and routine work. Results The accidence of respiratory disease ( 57.3 % ) was followed by gastrointestinal ( 25.5 % ) and trauma (6.2% )during the emergency medical treatment, and surgical trauma, syncope, coma and convulsion were the most common symptoms, also in some conditions, but empties returning was 30.3% . Similar to the above situation, the extremities (56%)and head injury (24%)were most commonly in the hospital emergency department. The incidence of falling accidents was high( 35.7 % ), and two of them were dead due to trauma on died of being trampled, and on the other was electrothermal burn and falling. Conclusions The general hospital is very important in emergency medical treatment, and it should be ready to tackle the emergency disaster, in order to reduce the loss to minimum.

Objective To investigate the effect of arterial and venous subarachnoid hemorrhage ( SAH)on voltage-dependent calcium channel( VDCC)currents of cerebral artery smooth muscle cells and the relationship between the concentration of oxyhemoglobin( OxyHb)in arterial and venous blood and cerebral blood flow. Methods Thirty-six clean grade rats were colleted. A rat SAH model was induced by injection of autologous arterial or venous blood in suprasellar cistern using assisted stereotaxic apparatus. The rats were divided into three groups:an arterial SAH( n=14 ),a venous SAH( n=13 ),and a sham operation( n=9 )group. The arterial and venous OxyHb concentrations were measured. Three days after SAH modeling,a patch clamp was used to detect the relative surface area of the cerebral artery smooth muscle cells,resting potential,and VDCC currents in rats. A fluorescent microsphere method was used to quantitatively analyze cerebral blood flow(CBF). Results (1)Arterial SAH OxyHb concentration (127 ± 4 g/L)was significantly higher than venous SAH OxyHb concentration(54 ± 6 g/L),and that of the sham operation group was 50 ± 5 g/L. The differences were statistically significant among the 3 groups( P<0. 01).(2)The maximum current of VDCC of the arterial SAH group(3. 22 ± 0. 31 pA)was significantly higher than that of the venous SAH group(2. 19 ± 0. 27 pA)and the sham operation group(2. 18 ± 0. 29 pA). The differences were statistically significant among the 3 groups( P<0. 01 ). The VDCC currents of the arterial SAH group were consisted of L- and R-currents,while the currents of the venous SAH group were only consisted of L-VDCC.(3)The cerebral blood flow of the arterial SAH group(0. 83 ± 0. 14 mL/[g·min])was significantly higher than that of the venous SAH group(1. 28 ± 0. 28 mL/[g·min])and the sham operation group(1. 35 ± 0. 19 mL/[g·min]). The differences were statistically significant(P<0. 01). Conclusions The changing effect of arterial SAH on the expression and function of the cerebral artery smooth muscle cells are greater than that of the venous SAH. This difference may be associated with the concentration and composition of vasospasm factors of OxyHb in arterial and venous blood.

Purpose:To discuss the function of Gd-BOPTA on the deferment of manifestation of MRI,which bring influence to the immune mensuration of antigen PCNA,PTEN.Materials and Methods:Scanning with MRI on the 35 patients with pathologically verified HCC the image were analyzed concretely.Pathologic diagnose was made with Edmondson pathologic classification standard,and it was expressed with index of PCNA and PTEN of immune quantitative analysis.Results: HCC was negatively related to the index of PCNA,and most patients with high index were lightly or not deferred enhanced(13/16),Patients with low index were evidently enhanced ( 10/19).The degree of HCC deferred enhancing was positively related to the expression of PTEN.Most HCCs( 15/17) with negative PTEN were lightly or not deferred enhanced,while positive patients of PTEN were mostly enhanced obviously(11/18).Conclusion: Deferment of Gd-BOPTA can be used to basically estimate the tincture of tumor biology,therefore,the enhanced degree of which,the PCNA,PTEN,can offer great help in choosing the therapuetic method and estimating the outcome of the the therapy.

ObjectiveUsing the technology of siRNA to inhibit the gene expression of no-receptor　tyrosine protein kinase Lck in T cells of asthmatic mice,and to study the therapeutic effect of Lck specific　siRNA in asthmatic mice.MethodsReceptor tyrosine protein kinase Lck specific siRNA fragments were　taken from chemosynthesis.In vivo-jetPEITM was used to transfect the siRNA into mice body through tail　vein injection.The mice were killed 48 hours later,and the levels of IL-4,IL-17 in bronchoalveolar lavage　fluid (BALF) were detected with respondent ELISA kits.The change of inflammatory histopathology in lung　was observed with H.E.staining.The expression of Lck in lung was detected with immunohistochemistry　(IHC),and the level of Lck in lung tissue homogenate was detected with Western Blot.Results Compared with asthmatic group[ (234.68 ± 11.15 ) pg/ml,( 96.76 ± 8.28 ) pg/ml],the levels of IL-4,IL-17　[ (234.68 ± 11.15)pg/ml,(96.76 ±8.28) pg/ml] in the BALF of siRNA interference group decreased,　and the inflammation in the lung relieved.IHC indicated that the expression of Lck in lung decreased and　the level of Lck in lung tissue homogenate decreased ( P ＜ 0.05 ).Conclusions Lck specific siRNA　could reduce the level of IL-4,IL-17 in the lung tissues of asthmatic mice,and relieve the inflammatory reaction in lung.

Objective To investigate the efficacy and safety of salvage radical prostatectomy for men with recurrent prostate cancer (PCa) after radiotherapy.Method Ten pathologically confirmed PCa patients who relapsed after radiotherapy from Jan.2008 to Dec.2013 were retrospectively reviewed.The mean age was (64.7 ±3.7) years,with range from 56 to 72 year.Local recurrence was confirmed by retransrectal biopsy.All patients had increased PSA and/or lower urinary tract symptoms.Pelvis MRI and bone scan were performed to detect lymph node involvement and bone metastasis.All patients received radical prostatectomy with standard pelvic lymphadenectomy.Seven received open surgery (open group),three patients underwent laparoscopic surgery (laparoscopic group).Postoperative complication and PSA level were compared.Results Salvage radical prostatectomies with lymph node dissection were performed in all patients without major complications.The mean operation time of open group versus laparoscopic group were (225 ± 57)min vs.(210 ± 80)min and the mean blood loss was (275 ± 49)ml vs.(260 ± 93) ml,both of which were with no significant difference (P ＞ 0.05).The average length of stay was (14 ± 4) vs.(8 ± 2) day with significant difference (P ＜ 0.05).No rectal injury was observed.Two (20％) patients were with positive margin,and three (30％) patients had postoperative complications,including one case of deep vein thrombosis,one case of incision infection and and one case of anastomotic leakage.After a mean of 20.6 months'follow-up,two patients (25％) reached biochemical recurrence.Conclusion Both open and laparoscopic salvage radical prostatectomies after radiotherapy failure were feasible.Largescaled prospective studies were needed to verify the long-term effectiveness.

Objective To evaluate the erectile function following transperineal template-guided prostate saturation biopsy (TFPSB).Methods From June 2013 to October 2015,patients underwent prostate biopsy.All patients were indicated for biopsy according to the criteria of "Guidance on diagnosis and treatment of urology in China".Exclusion criteria include medical history of PCa,severe urinary tract infection,severe cardiovascular and cerebrovascular diseases or abnormal blood coagulation.All patients were divided into observation group (TT'PSB) or control group (traditional trans-perineal template-guided prostate biopsy,TTPB) according to patients' condition,pubic anatomy,PSA abnormality,rectal examination,imaging examination and pain tolerance,etc.Patients were evaluated for pre-biopsy erectile function with the international index of erectile function (IIEF-5).All pathology confirmed prostate cancer patients were excluded.Concomitant systemic diseases and medications that would interfere with erectile function were recorded.Patients who withdrew from the trial or used the drugs such 5-phosphodiesterase inhibitors for sexual activity improvement were excluded.Ninety-seven patients in observation group and 84 patients in control group underwent further evaluation with the IIEF-5 questionnaire at 1,3 and 6 months post-biopsy.Results The average age of the observation group and the control group were (64.1 ± 7.9) years and (61.8 ±8.9) years,PSA were (7.2 ± 3.7) ng/ml and (6.7 ± 3.4) ng/ml,prostate volume were (47.8 ±21.5)ml and (49.2 ±22.2) ml,and the BMI were (21.4 ±3.1) kg/m2 and (20.6 ±3.4) kg/m2,respectively.There was no significant difference between the two groups (P ＞ 0.05) in term of above patients' characteristics.The pre-biopsy IIEF-5 score of the observation group and the control group were 19.1 ±4.5 and 19.7 ±4.3,which had no significant difference (t =-0.890,P=0.375).One month after biopsy,the IIEF-5 of two groups were 17.4 ±4.8 and 18.2 ±4.5 respectively and both group had statistically significant difference when compared with pre-biopsy (both P ＜ 0.05),however,there was no statistical significance at 3 and 6 months after biopsy.Besides,no significant difference of the IIEF-5 score was detected between two groups in 1,3 and 6 months.Conclusions Although TTPSB may resulted in temporary (1 month) post-biopsy erection dysfunction,the erectile function recovered to pre-biopsy level at 3-6 months post-biopsy.TTPSB did not increase the risk of ED compared with traditional TTPB.

Objective To evaluate the clinical efficacy of brachytherapy with 125I seeds implantation in patients with castration resistant prostate cancer (CRPC).Methods Twenty-eight patients with CRPC from February 2010 to December 2015 in Northern Jiangsu People's Hospital were analyzed retrospectively.Patients were divided into 2 groups according to different treatment methods.Control group (n =13) received endocrine therapy,and study group (n =15) underwent brachytherapy combined with endocrine therapy.The progression was defined as posttreatment prostate specific antigen (PSA) ≥ 125％ PSA of baseline level.PSA-progression-free survival (PFS),overall survival (OS) and quality of life (physical functioning,social functioning,general health,general physical discomfort,urinary symptoms and treatment-related symptoms) of 2 groups were compared using Kaplan-Meier analysis and log-rank test.Results The median PSA-PFS and OS of study group were 29(24,37) months and 37(32,50) months respectively,both of them were longer than those of control group (13(7,21) months,19(14,23) months;x2 =13.300,19.362,both P＜0.01).Comparing with control group,the physical functioning,social functioning,general health and general physical discomfort of study group were improved.Conclusion Brachytherapy can effectively prolong the survival of CRPC patients and improve the patients' life quality.

Objective To investigate the influence factors of periprostatic nerve block (PNB) anaesthesia.Methods A total of 375 patients who underwent prostate biopsy under PNB were analyzed retrospectively from July 2014 to February 2018.It was evaluated the correlation of the anesthetic efficacy of PNB with age,prostate volume,PSA,body mass index,spouse,degree of education,occupation,diabetes history,operation time,number of cores and clinical stage.A visual analog scale (VAS) were used to assess pain of the patients.Univariate analysis was performed for each factor.Factors found to be significantly different that were further analyzed using multiple linear regression analysis.Results The average VAS score of all patients was 2.5 ± 1.4.Univariate analysis showed that the following factors were associated with the anesthetic efficacy of PNB:age (F =2.262,P =0.029),prostate volume (F =2.529,P =0.011),occupation (F =2.203,P =0.042),operation time (F =2.233,P =0.033),number of cores (F =2.401,P =0.016) and diabetes history (F =2.271,P =0.027).Multiple linear regression analysis showed that prostate volume (t =3.742,P ＜ 0.001),number of cores (t =4.252,P ＜ 0.001) and diabetes history (t =-2.242,P =0.032) were independent factors.The VAS score of patients with large volume prostate was higher than that of small volume prostate.The number of cores was high,and the VAS score was higher.However,diabetic patients had lower VAS score.Conclusions The anesthetic efficacy of PNB was poor in patients with larger prostate volume and more number of cores.However,patients with chronic diabetes had better pain tolerance.