Objective To investigate the appropriate surgical approaches and microsurgical resection of communicative skull base chordoma. Methods Twenty two cases of communicative skull base chordomas were microsurgically treated from 1995 to 2005 and followed up. The tumors were removed with extended anterior skull base approach in eight cases, with modified Weber-Ferguson (transmaxillary) approach in eight cases, and with transmandibular approach in six cases. Some cases were resected with combined approaches including pterional approach in 3 eases, subtemporal-zygomatie approach in 1 case, and suboccipital-retromastoid approach in 2 cases. Results Total, subtotal and partial removal of the tumors were achieved in 10 cases, 7 and 5 cases respectively. No patients died and had severe nervous system dysfunction after surgery. However, one had CSF rhinorrhea, one with infection, three with cranial never dysfunction. Twenty patients were followed-up with average 3.4 years, 12 returned to normal or partial works, 5 took care by oneself, 1 needed help, 2 died from tumor recurrence. Conclusion The treatment of communicative skull base chordoma is a challenge to neurosurgeon. The key point is the total removal of the tumor with the microsurgical technique and the appropriate approach depend on the location of the tumor. Moreover, skull base reconstruction is also important to avoid the cerebrospinal fluid leak and infection.

Objective To explore the effect of different temperature of the forced- air warming system on the prevention of hypothermia during laparotomy of infants. Methods A total of 60 infants undergoing laparotomy under general anesthesia were recruited and divided into three groups by random digits table method with 20 cases each according to admitting time; when used the force- air warming system intraoperatively, the three groups were respectively setting on 45℃(automatic adjustment for 43 ℃ after 45 minutes), 43 ℃ and 38 ℃.The core temperature were respectively recorded before anesthesia and 15, 30, 45, 60 minutes after anesthesia (every 30 minutes after 1 hour).The hypothermia incidence and anesthesia recovery conditions were recorded simultaneously. Results There was no significant difference on the core temperature among three groups before anesthesia (P > 0.05). 30 minutes after the anesthetic, the core temperature of 45 ℃ group was (36.31±0.20) ℃,43 ℃ group was (36.32±0.24) ℃ and 38 ℃ group was (36.08±0.21) ℃.The differences among three groups was statistically significant (F=8.12, P < 0.01), but there was no significant difference between 45 ℃ group and 43 ℃ group (P > 0.05). 60 minutes after the anesthetic, the core temperature of 45 ℃ group was (36.39±0.26) ℃,43 ℃ group was (36.19±0.22) ℃ and 38 ℃ group was (35.92±0.15) ℃. The differences among three groups was statistically significant(F=25.19, P<0.01).The hypothermia incidence of 45℃group, 43℃ group,38℃ group was 10.0%(2/20), 25.0%(5/20), 50.0%(10/20)respectively and the differences among three groups was statistically significant( χ2=8.04, P<0.05). The time to complete consciousness of 45 ℃ group was (15.40±5.09) minutes,43 ℃ group was (19.80±4.10) minutes and 38 ℃ group was (22.00±4.36) minutes. The differences among three groups was statistically significant (F=10.96, P<0.01). The time to tracheal extubation of 45 ℃ group was (18.10±5.97) minutes, 43 ℃ group was (21.85±4.02) minutes and 38 ℃ group was (24.90±5.54) minutes.The differences among three groups was statistically significant (F=9.83, P<0.01). Conclusions The forced-air warming system can increase the infants′peripheral tissue heat content and reduce the heat losing.So that it will help decrease the intraoperative hypothermia incidence and shorten the anesthesia recovery period.Meanwhile the higher temperature of the forced-air warming system is setted ,the better effect it is.

Objective To evaluate the effect of various herniorraphy in treating inguinal hernia. Methods The clinical data of 108 patients who underwent conventional Bassini herniorraphy (BH), tension free herniorraphy (TH), or laparoscopic herniorraphy (LH),respectively were analysed and comparated. Results The operation time in TH was less than that in BH, and in LH was longer than that in TH. The ability recovery, hospita stay and postoperative complication in TH and LH were less than those in BH.All the patients were followed up for at least 1 year.Of them, 1 recurred after BH, but there was no recurrence after TH and LH. The blood neutrophils, serum level of fibrin, C-reactive protein and alpha-1 antitrypsin increased significantly in the patients undergoing herniorraphy, which were significantly higher in the patients underwent TH and LH. Conclusions The curative effect of TH and LH is much better than that of BH in treating ingumal hernia. Application of marlex for herniorraphy might increase inflammation response, but it will not increase the incidence of infection.

Objective To explore the relationship between preoperative plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and recurrence of atrial fibrillation (AF) after cardiac valve replacement (CVR) combined with radiofrequency ablation.Methods Fifty-eight patients with AF undergoing CVR combined with radiofrequency modified Maze procedure were enrolled in this study.The patients were allocated to either AF recurrence group (AF group,18 cases) or AF no recurrence group (SR group,40 cases) according to whether patient's AF recurrence or not within 3 months after surgery.NT-proBNP were respectively measured in two groups in 1st day before operation and 9th day after operation by radioimmunoassay.Results All the 58 patients were involved in the final analysis.NT-proBNP levels in 1st day before operation and 9th day after operation in AF group was significantly higher than that in SR group (2061.30 ng/L vs.579.00 ng/L,996.60 ng/L vs.209.20 ng/L,P＜ 0.01 ).NT-proBNP levels in 1st day before operation in two groups was significantly higher than that in 9th day after operation (P ＜ 0.01 ).Conclusions There is a good relationship between preoperative plasma NT-proBNP levels and recurrence of AF.It has a clinical value in predicting of recurrence AF after CVR combined with radiofrequency modified Maze procedure.

Gastric cancer is one of the most common malignant tumors in China, and its pathogenesis is complex. At present, there is no good method for the diagnosis and treatment of gastric cancer. However, studies have shown that microRNA (miRNA) has abnormal expression in gastric cancer, which participates in the regulation of gastric cancer related genes, and has an impact on the occurrence, development, diagnosis and treatment of gastric cancer. This paper aims to review the relationship between miRNA and the diagnosis and treatment of gastric cancer, as well as the drug resistance in the treatment, so as to lay the foundation for the follow-up research and clinical diagnosis and treatment.

OBJECTIVETo study clinical effects of a new internal fixation by using a cable through the bone and Kirschner with a hole in the tail, for the treatment of patellar fractures.

METHODSFrom May 2012 to July 2013, thirty-four patients with patellar fractures were treated with cable through the bone and Kirschner with a hole in the tail. All the patients had close fracture,including 12 transverse fractures and 22 comminuted fractures. There were 18 males and 16 females, ranging in age from 26 to 81 years old, with an average of (46.0 ± 3.0) years old. After open reduction, two appropriate length of Kirschner with a hole in the tail were driven into the patella as perpendicular to the fracture line or the major fragments as possible. A transverse bone tunnel was then drilled with a Kirschner at one side of the patella. Then the cable, which was successively pulled through the bone tunnel and the hole of Kirschner, was crossed in a figure-eight over the anterior of the patella, tightened and fixated by special instruments. The Kirschner was clipped off on the edge of the hole. If it was a comminuted fracture, another cable was used to fasten the patella with cerclage. Postoperative evaluation was based on Bostman.

RESULTSAll the patients were followed up, and the duration ranged from 12 to 26 months, with a mean of (16.0 ± 2.0) months. Fractures healed in all the cases without such complications as infection, loosening of Kirschner and cable loop, and skin irritation. According to the Böstman score system, 33 cases got an excellent result, and 1 good.

CONCLUSIONThe cable through the bone and Kirschner with a hole in the tail is a simple, stable and effective method for the treatment of patellar fractures, especially the transverse fractures, with earlier knee exercise and fewer complications.

Adult ; Aged ; Aged, 80 and over ; Bone Wires ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Patella ; injuries ; surgery ; Treatment Outcome ; Young Adult

Objective To investigate the incidence, diagnosis and treatment of complications after endoscopic retrograde cholangiopancreatography (ERCP), and to explore the ways of prevention. Methods Clinical data of 930 subjects, in which 510 were older than 60, with cholangiopancreatic diseases who underwent ERCP in the past 2 years were retrospectively analyzed. Results Success rate of ERCP was 96.34% (896/930),and the postoperative complication incidence was 7.85% (73/930). Of all the complications, there were 42 cases of acute pancreatitis, among which 1 was accompanied with biliary tract infection, 4 cases of duodenum perforation, 6 delayed hemorrhage, 2 cardiac dilacerations bleeding, and 19 biliary tract infection (5 combined with infectious shock). All subjects with complications were cured except for 2 deaths. Conclusion ERCP is a safe and effective method for elderly patients. However, due to decreased organ functions and other underlying diseases, complications after ERCP in elderly patients are usually difficult to manage. The key factors in prevention of complications after ERCP includes in obedience to indications, improvement in procedure skills, treatment of accompanied diseases before and after ERCP, and active management of complications.

Objective To investigate the value of 18F-FDG PET/CT in the phasing and grading of renal cell carcinoma (RCC) complicated with vena cava tumor thrombus (VCTT).Methods From December 2011 to September 2015,a total of 72 patients (52 males,20 females,age:36-74 years) were enrolled in this retrospectively study.All patients underwent 18F-FDG PET/CT and contrast-enhanced CT studies,and were diagnosed as RCC.The RCC patients combined with VCTT were classified by Mayo-level.Wilcoxon rank sum test was used to compare the grading of VCTT by PET/CT and contrast-enhanced CT.NM staging on abdominal area level was performed and the results were compared with x2 test.Results VCTT was identified in 18 RCC patients and the grading results by PET/CT were as follows:9 cases in Level 0,4 cases in Level Ⅰ,2 cases in Level Ⅱ,1 case in Level Ⅲ,and 2 cases in Level Ⅳ.When evaluated by PET/CT,20 cases were in N0M0,21 were in N1M0,9 were in N0M1,and 22 were in N1M1.NM staging results by contrast-enhanced CT were as follows:50 cases in N0M0,10 in N1M0,10 in N0M1,and 2 in N1M1.In addition,2 N1 and 2 M1 were found by the whole body PET/CT.The classification results of VCTT and staging of abdominal level by PET/CT were significantly better than those by contrast-enhanced CT (z=-2.462,P＜0.05;x2=32.806,P＜0.01).Conclusion 18F-FDG PET/CT is not only valuable for detecting primary RCC and local metastasis,but also useful for finding where the VCTT extends,which is conducive to therapeutic planning and further clinical treatment.

Objective To investigate the clinical effects of the modified Kock method of bladder re- construction with ileum,and to provide the objective basis for wide application of this technique.Methods A total of 51 patients with bladder cancer(T_2N_0M_0 stage tumor in 37 cases,T_3N_0M_0 stage tumor in 14; and pathologic gradeⅡ-Ⅲin all)were included.After radical cystectomy,modified Kock reconstruction of bladder with ileum was performed in them.The procedure consisted of preparing the segment of the ileum for reconstruction of the reservoir,anastomosing the low part of the neobladder with the urethra and regaining the original urinary conduit.Results The mean operative time was 6.5h(range,5.5-8.5h);mean in- traoperative blood loss was 650ml(range,300-1200ml),with blood transfusion in 31 cases.Perioperative complications included stress ulcer in 6 cases and urinary leakage in 1.The other 44 cases had no severe complications.Four cases died of cancer metastasis at 6-18 months after operation.During a follow-up of 8 -32 months,the other 47 cases recovered well and have been alive till now.Two cases had ureteral urine reflux with no impairment of renal function.The daytime urinary continent rate was 100%;and nocturnal uri- nary incontinence occurred in 6 cases.Conclusions The modified Koek reconstruction of bladder with il- eum can improve the patients'quality of life with fewer complications,therefore is a better treatment choice for infiltrative bladder cancer after radical eystectomy.

AIM: To investigate gene expression of bax, bcl-2 and p53 in fetal skin at different gestational ages and children skin in order to explore their potentially biological significance. METHODS: Apoptosis in skin specimens was determined by terminal deoxynucleotidy transferase mediated dUTP-biotin nick-end labeling technique (TUNEL). Gene expressions of bax, bcl-2 and p53 in skin at different developmental stages was examined with reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Along with fetal growth and development, the incidence rate of apoptosis was increased progressively in skin. In skin from early gestational fetus, bcl-2 was strongly expressed. This gene expression was progressively decreased with increment in gestational age. In children skin, the mRNA content of this gene was significantly reduced compared with fetal skin (P