Objective To study the endoscopic anatomy of operative fissures in the sellar region related to pterional key-hole approach and to provide the anatomic basis for endoscope-assisted microneuro-surgery in the region. Methods Fifteen cadaver heads were dissected via pterional key-hole approach and the five operative fissures(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ) were studied with both microscope and endoscope, by which the outcomes observed were recorded and compared. Results The basic information obtained by the pterio-nalkeyhole approach was comparable to that of the classic ptefional approach. According to the anatomic guideposts under neuroendoscope, the microstructures of the five fissures and Willis' circle would be well demonstrated. It is better to display the various anatomic structures in sellar region by neuroendoscope rather than microscope, particularly some important microstructures. Angled endoscope can be used to inspec thidden but important structure behind the arteries and nerves. Conclusion According to the anatomic guideposts, an endoscopy can be used to enhance the visible field of an operative microscope related to pterional key-hole approach. The endoscope-assisted microsurgery can reduce complications and injury of the important structures and increase the curative effect on the lesions in the sellar region.

Objective To explore the microneurosurgical treatment of recurrent intra-spinal canal tumors. Methods The clinical data on the microsurgical parameters, operative procedures, operative efficacy and post-operative complications of 16 cases with recurrent intra-spinal canal tumors from June 1993 to June 2002 were reviewed retrospectively. Results Under the operative microscope, the tumors were totally removed in 10 cases, subtotally in 4 cases, and partially in 2 cases. Fllowed up from 5 months to 8 years, 11 cases recovered well, 4 cases suffered from moderate disability, and 1 case died. Preoperative CT or MRI scan, knowledge of the anatomy and structures, and skillful operative techinique all were important to microsurgical treatment of recurrent intra-spinal canal tumors. Conclusion Once diagnosis of recurrent intra-spinal canal tumors, the operative treatment is effective. Radiation therapy for the malignant tumors or incompletely removed recurrent tumors is necessary.

Objective To explore the changes of IL-12,IL-18,IL-10 in the pleural fluid and serum of tuberculosis (TB)patients during the disease course.Methods 60 TB patients were selected as test subjects in this study,all patients with pleural fluid and serum were taken for testing.The pleural fluid and serum IL -12,IL -18 IL-10 changes,more naive patients and patients with pleural effusion retreatment and serum IL -12,IL -18,IL -10 content differences were observed and analyzed.Results Both in the initial treatment or retreatment group of pa-tients,the IL -12 and IL -10 levels in pleural effusion were significantly higher than those in the serum,the differ-ences were statistically significant(all P =0.000),and IL -18 content of pleural effusion in a little early treatment group was lower than that of the serum,the differences was not statistically significant(P =0.151),and the IL -12 and IL -10 contents in the pleural fluid and serum were higher than the retreatment of patients previously untreated patients.The IL -12 level in pleural effusion of Ⅱ type patients was (3 025.80 ±1 324.75)pg/mL,which in the ser-um was (498.84 ±326.73)pg/mL,which in the pleural effusion was significantly higher than in the serum(P =0.020),and the IL -12 levels in pleural effusion of Ⅲ -TB and Ⅳ type TB patients were also significantly higher than those in the serum,the differences were statistically significant(all P =0.000).The IL -18 level in pleural effu-sion of Ⅱ type patients was (1 735.54 ±872.65)pg/mL,which in pleural effusion of Ⅲ patients was (754.63 ± 426.87)pg/mL,in pleural effusion of Ⅳ patients was (655.19 ±412.63)pg/mL or so,and serum IL -18 levels in patients with different types of pleural TB had no obvious rule,the differences were not statistically significant(P =0.998 4).The IL -10 level in pleural effusion of Ⅱ type patients was (29.35 ±8.46)pg/mL,which in pleural effu-sion of Ⅲ patients was (183.49 ±56.76)pg/mL,which in pleural effusion of Ⅳ patients was (162.95 ±52.43)pg/mL,the IL -10 content of pleural in different clinical types of TB patients was different,which were significantly high-er than those in the serum,the differences were statistically significant(P =0.000).Conclusion TB patients in the disease,pleural effusion IL -12 and IL -10 are significantly higher than the serum,and retreatment of patients with pleural effusion IL -12,IL -10 levels are significantly higher than the untreated patients,but IL -18 in serum has no significant variation in pleural fluid.

OBJECTIVE:To systematically review the efficacy and safety of escitalopram versus paroxetine in treatment of se-nile patients with depression in China,and provide evidence-based reference for clinical treatment. METHODS:Retrieved from CJFD,VIP,Wanfang database,CBM database,randomized controlled trials(RCT)of escitalopram(test group)versus paroxetine (control group) in the treatment of senile patients with depression in China were collected. After quality evaluation and data ex-tract,Meta-analysis was performed by using Rev Man 4.2 statistics software. RESULTS:A total of 14 RCT were included,involv-ing 1 148 patients. Results of Meta-analysis showed there was no significant difference in the cure rate[OR=1.20,95%CI(0.93, 1.53),P=0.16],significant effective rate[OR=1.23,95%CI(0.94,1.61),P=0.12],the incidences of headache[OR=0.81,95%CI (0.40,1.65),P>0.05],the incidences of tachycardia [OR=0.37,95%CI(0.09,1.52),P>0.05],the incidences of insomnia [OR=1.26,95%CI(0.33,4.82),P>0.05] and the incidences of tremor [OR=0.31,95%CI(0.04,2.24),P>0.05] between test group and control group;the incidences of xerostomia[OR=0.50,95%CI(0.31,0.80),P<0.05],the incidences of nausea[OR=0.49,95%CI (0.36,0.66),P<0.05],the incidences of sweating [OR=0.31,95%CI(0.15,0.62),P<0.05],the incidences of constipation[OR=0.31,95%CI(0.15,0.64),P<0.05],the incidences of dizziness[OR=0.38,95%CI(0.20,0.72),P<0.05] and the incidences of an-orexia[OR=0.45,95%CI(0.21,0.99),P<0.05] in test group were significantly lower than control group,there were significant dif-ferences in 2 groups. CONCLUSIONS:The efficacy of escitalopram and paroxetine is similar in the treatment of senile patients with depression,however,the safety of escitalopram is better than paroxetine. Due to the limit of methodological quality and sam-ple size,it remains to be further verified with more rigorously designed and long-term follow-up of large-scale RCT.

[Objective]To obtain the normal linear parameters of different resection levels of normal proximal tibia in Chinese people, and discuss the influence of the gender and resection level on the design of the tibia prosthesis. [Methods]Thirty-six normal Chinese people (36 left knees, 18 males and 18 females), with an average age of 43 years (range 18～55 years) were enrolled in this study.Original CT image data were used to set up three-dimensional model of Chinese normal knees.The related linear parameters of different proximal tibia sections were measured and compared.[Results]Parameters of mediolateral (ML) ,medial and latera anteroposteriordimensions(MAP/ LAP) and the aspect ratio(AP/ML) of the resect proximal tibia surface were obtained. The parameters were confirmed by statistics analysis.[Conclusion]The geometry and anatomy of the knee in Chinese people have significant differences from the western people.The prosthesis designed by western people should be choosen carefully.Sex and resection levels should be taken into account in designing tibia prosthesis and or choosing the imported prosthesis in the total knee arthroplasty.

Brain ; physiology ; Child ; Child Behavior ; physiology ; Child Development ; physiology ; Humans ; Infant ; Motor Activity ; physiology ; Motor Skills Disorders ; diagnosis

Objective To study the incidence and etiology of knee pain in patients with tibial shaft fracture after intramedullary nailing treatment. Methods From Jan 1997 to Dec 2002, 1332 patients with tibial shaft fracture were treated with intramedullary nailing in our hospital. Their clinical data were retrospectively studied. All the patients were followed up at least once after fracture healing, and the average clinical follow up duration was 27 months. Results 409 of the 1332 cases experienced knee pain. 31.9 percent of the patients treated with transtendinous nailing reported anterior knee pain, and 28.9 percent of the patients treated with paratendinous nailing reported knee pain. Conclusion Compared with the transpatellar tendon approach, the paratendinous approach for nail insertion does not reduce the incidence of anterior knee pain.

Objective To investigate the effect of seretide plus montelukast on clinical symptoms、pulmonary functions and the serum IL-6 and TNF-α of patients with asthma.Methods 73 cases patients with asthma were randomly divided into seretide group and seretide plus montelukast group and were treated respectively for two weeks.The clinical symptoms,lung functions and serum IL-6,TNF-α contents of patients were measured respectively before treatment and after two weeks treatment.Results After two weeks treatment,the clinical symptom scores、FEV1.0、FVC and PEFR of two groups had significantly changed than that before treatment(P<0.05);Each index was further compared after treatment,and it was found that two groups had significant differernces statistically (P<0.05),these showed that combination of seretide and montelukast could significantly enhance the therapeutic effect.After treatment,the TNF-α and IL-6 contents in the peripheral blood of seretide group and seretide plus montelukast group had both significantly reducted (P<0.05 or P<0.01);The TNF-α and IL-6 contents of seretide plus montelukast group had reduced more significantly than that of the seretide group(P<0.05).Conclusion The seretide plus montelukast group could improve the clinical symptoms and pulmonary function of patients with asthma,and the action mechanism might be related to lower the serum IL-6 and TNF-α contents.

Objective To detect the changes in vertebral marrow fat fraction (MFF) using T2 *-corrected water-fat MRI and to analyze the relationships between MFF with bone biomarkers of non-dialysis chronic kidney disease (CKD).Methods 78 CKD patients were divided into five groups according to the eGFR and underwent water/fat MRI to obtain MFF.The reliability of MFF measurements by two radiologists was assessed with intra-class correlation coefficient (ICC).Serum calcium,phosphorus,alkaline phosphatase,osteocalcin,intact parathyroid hormone and 25(OH)D3 were determined.Results Mean CV for MFF measurements reproducibility was 2.37％.The inter-observer agreement for MFF was excellent (ICC=0.901).The ICC for each intra-observer agreement was excellent (ICC=0.959 and 0.948,respectively).There were statistical differences in MFF among five groups of CKD.Changes of MFF were earlier than those of serum calcium,phosphorus,parathyroid hormone,alkaline phosphatase and osteocalcin.MFF was positively correlated with serum phosphorus (r =3.011,P =0.003),parathyroid hormone (r=3.852,P＜0.001),and negatively associated with calcium (r=-2.767,P=0.017),25(OH)D3 (r=6.032,P＜0.001),eGFR (r=-5.104,P＜0.001),respectively.Multivariable regression analysis showed MFF was negatively correlated with 25(OH)D3(Sβ=-0.343)and eGFR(S(S=-0.284,P＜0.001).Conclusion CKD patients had higher marrow fat.T2 *-corrected water fat MRI could serve as a useful tool to quantify marrow fat content for CKD patients.

Seven genes (fabD, fabG, fabH, fabA, fabZ, fabB and fabI) of E.coli fatty acid biosynthetic enzymes were cloned by PCR amplifying and appropriate expression vectors were constructed. Under induction assay expression of plasmid encoded proteins was carried out in strain BL21(DE3) and seven enzymes were purified using Ni-NTA agarose resin. In the absence of [2-14C] malonyl-CoA fatty acid synthetic reaction was reconstituted in vitro by adding seven enzymes and co-factors. And several model reactions were established for identification of special fatty acid biosynthetic enzymes. Meanwhile Clostridium acetobutylicium FabZ function was characterized by this method.