ObjectiveTo investigate the surgical method, experience, and skills in clipping anterior communicating artery aneurysm (ACoAA) via supraorbital keyhole approach.MethodsThe ACoAA case data of selectively clipping via non-dominant supraorbital keyhole approach according to the A2 open plane formed by the anterior communicating artery and the bilateral A2 segments were analyzed retrospectively.The surgical method and experience were analyzed.The indications and advantages and disadvantages of this method were summarized.ResultsACoAA in 12 patients were completely clipped via supraorbital keyhole approach from the side of non-dominant A1, and the dominant A1 segment arteries were well exposed.The patients were followed up for 4-29 months after procedure.No recurrence or rupture of the aneurysms was found.The Glasgow Outcome Scale score was 5 in 11 patients and 4 in 1 patient.Conclusions ACoAA can be completely clipped via supraorbital keyhole approach from the side of non-dominant A1.It is a minimally invasive surgical approach with good efficacy.

Objective To analyze and identify the mutations of ATP6V0A4 and ATP6V1B1 gene in autosomal recessive distal renal tubular acidosis (rdRTA) children,and study the association of genotype and phenotype. Methods Genome DNA was amplified by PCR.Mutations of ATP6V0A4 and ATP6V1B1 gene in 3 children from 3 families were examined by direct sequencing.One hundred unrelated healthy subjects were selected to evaluate all mutations found in this study. Results A novel homozygous nonsense mutation was identified in ATP6VOA4 gene in one child, and a novel heterozygous nonsense variant and a frame-shift alteration were found in another child.No mutation of both genes was found in the third child.Conclusions Study of mutant genes of rdRTA in Chinese patients is helpful to understand the association in genotype and phenotype and increase the level of cognition and treatment to this disease.

Objective To investigate the effects on rat hearts induced by three kinds of band electromagnetic radiation (X-band, S-band and Electromagnetic pulse (EMP))and the differences of injury grade. Methods 180 healthy male Wistar rats were randomly divided into four groups:control group (n = 36) and three experimental groups (n = 48) treated with X-band, S-band high power microwave and EMP, respectively. At different time-points (6 hours,1, 3, 7, 14, 28 days,6 months and 12 months) after irradiation, the rats were killed and the pathological changes of the heart tissues were observed. Results The rat hearts of three experimental groups were differently injured, but the change character was similar. The injury was more and more serious at 6 hours -7 days:deranged cardiomyofilaments, decreased glycogen, Pyknosis;lysed Purkinje cells;swelling matrix and serous exudates. The injured hearts showed convalesecence at 14-28 days, and returned to normal progressively at 6-12 months.compared with the injured hearts irradiated by the three different band wave electromagnetic at the same time: the hearts were injured most seriously irradiated by X-band high power microwave(HPM), and slighter for those by S-band HPM, most slightest for those by EMP. Those in control group were normal. Conclusions Three kinds of band wave electromagnetic radiation injure the rat hearts differently. The injury grades are X > S > EMP. The research indicates that the shorter wave length or higher frequency make rat hearts injure more seriously, and need the longer time to resume.

Objective: To observe the protective effect of salidroside pretreatment on rabbit heart after limb ischemia/reperfusion (I/R). Methods: A total of 24 New Zealand rabbits were randomly and equally divided into sham operation group, I/R + placebo group （I/R group）and salidroside pretreatment group（salidroside group）. Before establishment of rabbit models of limb I/R, salidroside group received salidroside injection via ear marginal vein, and I/R group received saline injection, once a day for three days. After model establishment, echocardiography was used to evaluate rabbit cardiac function of each group 4h after reperfusion, including left ventricular end-systolic dimension (LVESd), left ventricular end-diastolic dimension (LVEDd), left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (FS). Blood sample was taken to measure serum cardiac troponin I (cTnI) and tumor necrosis factor (TNF)-α. Some ventricular tissue homogenates were taken to measure levels of superoxide dismutase (SOD) and malonyl diadehyde (MDA). Then heart sample was taken to receive pathological examination. Results: Compared with I/R group 4h after reperfusion, there were significant decrease in LVESd [(0.69±0.07) mm vs. (0.62±0.05) mm] and significant increase in LVEF [(64.6±3.4) % vs. (72.1±3.6) %], FS [(34.2±3.2) % vs. (41.7±3.4) %] (P<0.05 all), but these indexes of salidroside group were all no significant different than those of sham operation group (P>0.05). Compared with I/R group, there were significant decrease in cTnI [(5.24±0.34) μg/ml vs. (1.06±0.12) μg/ml], MDA [(8.92±2.18) μmol/L vs. (6.79±1.43) μmol/L] and TNF-α [(37.43±10.02) pg/ L vs. (19.73±6.31) pg/ L], and significant increase in SOD level [(16.61±3.75) U/ml vs. (22.26±4.73) U/ml] in salidroside group (P<0.05 all). Pathological results indicated that injury degree in salidroside group was significantly attenuated than that of I/R group. Conclusion: Salidroside pretreatment could protect cardiac function and relieve rabbit cardiac injury after limb ischemia/reperfusion.

Objective To explore the clinical value of post mastoid transverse incision in keyhole microvascular decompression (MVD) for cranial neuropathy.Methods Fifty-eight patients with trigeminal neuralgia,hemifacial spasm or glossopharyngeal neuralgia,admitted to and accepted postmastoid transverse incision keyhole surgery in our hospital from October 2015 to October 2017,were chosen.Their clinical data and efficacy were retrospectively analyzed.Results Lesions of cranial nerves in all 58 patients were exposed satisfactorily (trigeminal nerve,facial nerve,or glossopharyngeal nerve).Postoperative complications included severe facial numbness in one patient,scalp hydrops in one patient,ear discomfort in two patients,and hearing loss in two patients.No cerebrospinal fluid leakage or intracranial infection,no facial paralysis or ear deafness,no hoarseness or drinking cough,and no intracranial hemorrhage or death were observed.All patients were followed up for 3-24 months,enjoying total effective rate of 98.3％ (57/58);and no recurrence or aggravation was noted.Conclusion MVD of post mastoid transverse incision in keyhole is a safe and effective surgical method for treatment of cranial nerve disorders;the steps of craniotomy and craniotomy in this method are simple,easy accessed,and fully neurologically exposed,having high surgical safety and good postoperative cosmetic results,which is worth of promoting application.

Objective By analyzing the clinical manifestations and pathologic features of Erdheim-Chester's disease (ECD) to improve the recognition of the disease.Methods The clinical characteristics,diagnosis and treatment of a young male with ECD were reported and the related literature was reviewed.Results A previously healthy young male patient with bilateral exophthalmos,blurred vision of right eye,polyuria and hypertension without obvious causes for nine months were admitted into our hospital.He developed low back pain two months ago.Thoracic vertebra Magnetic resonance imaging (MRI) showed multiple nodules extending from the 2th-7th thoracic vertebrae intra-medullary.MRI of the brain showed multiple masseswith abnormal intensities within the retro-ocular intraconal muscle cone,sellar and cavernous sinus,maxillary sinus.Biopsy specimens from the right orbital lesion demonstrated proliferation of fibrous connective tissue and fat tissue infiltrating with lymphocytes,plasma cells,eosinophils,foam cells,spindle cells,and multinucleated giant cells accompanied by fat necrosis.Immunohistochemistry showed infiltrated lymphocytes stained positive for CD68,CD20,CD3,LCA and negative for CD1a,S-100 protein and langerin.The clinical symptoms of exophthalmos and low back pain relieved after treated with methylprednisolone and interferon-α.Conclusion Understanding the characteristics of ECD can help to make the correct diagnosis and treatment.