Regional arterial intra-chemotherapy (RAIC) was an effective method of combined therapy for pancreatic carcinoma, which could elevate the regional con-centration of anticancer agents for sufficient dosage in pan-creas, reduce the systemic adverse events, increase the toler-ation of chemotherapy.It could also increase the concentra-tion of anticancer agents in regional lymph node of pancreas, thus decrease the lymph node metastasis.The mechanism of RAIC for pancreatic cancer and the impact for lymph node metastasis needed to be further investigated.

OBJECTIVE To study the anatomical dimension of the path to the petrous apex via the infralabyrinthine approach. METHODS Thirty dry temporal bones were dissected along the internal carotid canal. The distances from the vertical portion of the facial nerve to the genu of the internal carotid canal,the vertical portion of the facial nerve to the petrous apex,the genu of the internal carotid canal to the posterior surface of the petrous bone were measured. Ten heads of adult cadaver were dissected to gain access to the petrous apex via the infralabyrinthine approach. The horizontal and vertical dimensions of the approach window created were measured. RESULTS The vertical portion of the facial nerve to the lap of the internal carotid canal was (13.26?1.66)mm,portion of the facial nerve to the petrous apex was (34.48?1.07)mm,the lap of the internal carotid canal to the posterior surface of the petrous bone was (9.68?1.53)mm. The mean dimensions of the window in dissected bones were(5.76?3.38)mm vertically and (6.42?2.65)mm horizontally. Thirteen sides had been doing well with the infralabyrinthine approach. CONCLUSION The possibility of those anatomical variations should be considered when the infralabyrinthine approach is being planned to manage the petrous apex lesion. The infralabyrinthine approach is useful to the patients with good hearing.

Objective To study the surgical approach of the jugular foramen and the clinical anatomy of the transmastoid endoscoPy-assisted jugular foramen surgery.Method The transmastoid endoscopy-assisted jugular foramen surgery was simulated in 15 adult cadaveric specimens(3O side). The main anatomic mark in the surgical approach was studied,and the distance between the important stmcture to the glomus jugular has been measured. Results The distance between the glomus jugular and the Vertlcal segmental of the facial nerve,the anterior wall of the glomus jugular to the facial nerve,the glomus jugular to the posterior semicircular canal and tympanic cavity were(3.58±1.32)mm,(5.07±2.93)mm,(4.68±3.47)mm and(0.14±4.32)mm.In 30 cases,the top of the glomus jugular inferior the tympanic cavty in 5cases, 7 cases behind the facial nerve and the tympanic, 16 cases the facial Berve is m the middle of the glomus iugular. 2 cases is near the inferior wall of internal auditory meatus.the cranial nerve and blood vessel in the jugular foramen is clearly to be show. Conclusion It is a samPle and little damaged way to use the transmastoid endoscopy-assisted jugular foramen surgery and it is hopeful to Protect function of the facial Berve,acoustic nerve and the post-cranial nerve.

Objective To investigate the association of residual renal function with intradialysis dialysis hypotension among maintenance hemodialysis patients. Methods Fifty-six patients who had underwent maintenance hemodialysis from March 2014 to November 2015 were enrolled according to researching protocol in this study. Data of baseline and clinical parameter of every hemodialysis session were collected. The patients were divided into two groups by 24 h urine output:urine group (24 h urine output≥100 ml, 22 patients)and no urine group (24 h urine output<100 ml, 34 patients). The clinical data were compared between two groups. Results In the 12 weeks’ treatment, 965 times hemodiafiltration were performed in 56 patients, and the rate of intradialysis hypotension was 24.04%(232/965). The rate of intradialysis hypotension in urine group was 19.28%(80/415), in no urine group was 27.64%(152/550), and there was significant difference (P=0.000). The levels of interdialytic weight gain, ultrafiltration volume, ultrafiltration percentage , pre-dialysis systolic and diastolic blood pressure in urine group were significantly lower than those in no urine group (P<0.01). The levels of pre-dialysis weight, intradialysis systolic blood pressure variability, intradialysis diastolic blood pressure variability, heart rate variability, hemoglobin, serum albumin in two groups had no significant differences (P>0.05). Pearson correlation analysis showed that residual glomerular filtration rate (rGFR) had negative correlation with interdialytic weight gain (r =- 0.257, P = 0.001). Kaplan-Meier analysis showed that with the increase of dialysis time, the rate of intradialysis hypotension increased. The comulative rate of intradialysis hypotension in no urine group was higher than that in urine group (log-rank = 14.67, P =0.000). Conclusions Residual renal function is associated with intradialysis hypotension, and it is important for clinician to consider a residual renal function protection schedule for maintenance hemodialysis patients.

Objective To investigate the effects of stellate ganglion block (SGB) on brain injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB). Methods Forty ASA Ⅱ or Ⅲ patients of both sexes aged 22-50 yr weighing 40-64 kg undergoing elective cardiac valve replacement were randomly divided into 2 groups (n = 20 each): control group (group C) and SGB group. Radial artery and right internal jugular vein were cannulated for BP and CVP monitoring. A catheter was inserted into left internal jugular vein under local anesthesia and advanced cephalad until resistance was met for blood sampling. Right SGB was performed with 0.25% ropivacaine 10 ml. Successful block was confirmed by ipsilateral Homer's syndrome.ECG, BP, CVP and SpO2 were monitored. Anesthesia was induced with midazolam 0.2 mg/kg, fentanyl 5-8 μg/kg and vecuronium 0.12 mg/kg and maintained with fentanyl infusion at 8-10 μg· kg- 1· h- 1 and intermittent iv boluses of midazolam and vecuronium. Blood samples were collected for determination of plasma NO, ET-1, S100β protein and NSE concentrations and NOS activity immediately after left internal jugular vein was retrogradely catheterized (T0 ), at 30 min of CPB (T1), 10 min after release of aortic cross clamp (T2 ), 6 and 24 h after operation (T3 ,T4 ). The patients' cognitive function was assessed by using mini-mental state examination (MMSE) the day before operation and on 1st and 7th day after operation. Results The plasma ET-1, S100β protein and NSE concentrations were significantly increased during and after operation at T1-3 as compared with baseline values at T0 in both groups and were significantly lower in group SGB than in group C. Plasma NO concentration was significantly increased during CPB at T1 as compared with the baseline at T0 in both groups but was significant higher after CPB at T2 but lower after operation at T3,4 in gToup SGB than in group C. The NOS activity was significantly higher during operation at T1,2 in group SGB than in group C. The cognitive function was significantly better at 1st postoperative day in group SGB than in group C. Compared with the baseline value,NO/ET-1 ratio was significantly decreased during and after operation in group C,but no significant change in NO/ET-1 ratio was found in group SGB. Conclusion SGB can attenuate brain injury induced by CPB by improving cerebral perfusion through maintenance of relative balance of NO/ET-1.

Objective To evaluate the safety of Ad-Mathl administration to inner ear and provide the base data for vestibular dysfunction gene therapy.Methods Ten mature Wistar rats were divided into normal control group(srats) and adenovirus(E1,E3-Deleted and carried mathl and enhanced green fluorescent protein report gene,Ad-Mathl-EGFP)scala vestibuli transfer group(5 rats).Right ears of the Ad-Mathl-EGFP transfering group rats were deliveried 5ul Ad-Mathl-EGFP(physieal tite 2.1 10~(11)v.P./ml)into cochleas through the way of drilling scala vestibuli of cochlear basal turn.As a control,the normal group received nothing to inner ear.In order to estimate functional condition of vestibule and cochlea,the click-evoked potentials on the surface of the cervical dura mater(CDM-CEP),auditory brain stem response(ABR)and swimming time were recorded in all rats at 7 days after treatment,and then histologic and morphologic observation were carried out after animals were sacrificed.Results All animals' morphologic observation showed that inner ear hair cells were normal after transfer.Seven days after transfer,the swimming time was 4.0±0.71 s in normal control group and 5.0±0.71 s in scala vestibuli delivery group.The threshold of CDM-CEP and ABR were 85±3.54 dB SPL and 37±4.47 dB SPL in normal control group,and 89±6.52 dB SPL and 40±3.54 dB SPL in Ad-Mathl-EGFP scala vestibuli delivery group,respectively.There was no significant difference existed between control group and Ad-Mathl-EGFP scala vestibuli delivery group.Conclusion The Ad(E1,E3-Deleted)is safe for vestibular and cochlea hair cells and can be used as an ideal vector of gene transfer.

Objective To explore the effect of dexmedetomidine combined with ropivacaine for continuous lumbar plexus block on the quality of early recovery in patients undergoing total hip ar-throplasty.Methods Sixty patients (35 males and 25 females)with ASA physical status Ⅱ or Ⅲ, aged 65-84 years,undergoing total hip replacement were randomly assigned to dexmedetomidine com-bined with ropivacaine group (group D)or ropivacaine group (group C).All patients received ropiva-caine which was administered via continuous lumbar plexus block as patient-controlled analgesia (PCA)after surgery.The PCA were programmed with a background infusion 8 ml/h of ropivacaine, bolus dose was 4 m1 and the block time was 30 min;the patients in group C received 0.2% ropiva-caine,and the patients in group D received 0.1% ropivaciane combined with 1 μg/ml of dexmedeto-midine by the way of intravenous infusion.In addition,all patients received another patient-controlled intravenous analgesia (PCIA)with 1 mg/ml of morphine for relieving the explosive pain.The PCIA was programmed with a lobus dose of morphine 1 mg without background dose,the block time was 5 min.Consumption of morphine and visual analog scale (VAS)score,muscle strength and maximum flexion and abduction of hip joint were recorded at the time points of 6,12,24 and 48 h after opera-tion.The side-effect reactions such as nausea,vomiting,drowsiness and itching were recorded.The sleep quality was assessed with Pittsburgh sleep quality index (PSQI)on day 1 before operation,day 1 and day 7 after operation.Results The consumption of morphine in group D was significantly fewer than group C (P <0.05).Compared with group C,muscle strength and maximum flexion and abduc-tion of hip joint in group D were increased at 6,12,24 and 48 h after operation (P <0.05 ).PSQI scores were decreased on the day 1 and day 7 after operation.The incidence of delirium,nausea and vomiting,drowsiness and itching in group D were decreased (P <0.05).Conclusion 0.1% ropiva-ciane continuous lumbar plexus block combined with 1 μg/ml of dexmedetomidine by the way of in-travenous infusion could provide satisfied analgesia for the operation of total hip arthroplasty;the sleep quality is improved,the functional exercise of hip joint is promoted.

Objective To compare the efficacy of continuous lumbar plexus block (LPB) with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement.Methods Sixty elderly patients of both sexes,aged 65-85 yr,weighing 50-71 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective total hip replacement,were divided into 2 groups (n =30 each) using a random number table:0.5 μg/ml dexmedetomidine+0.1％ ropivacaine group (group D1) and 1.0 μg/ml dexmedetomidine + 0.1％ ropivacaine group (group D2).Lumbar-sacral plexus block combined with general anesthesia was used.At the end of operation,LPB pump was started and set up to deliver a 4 ml bolus dose with a 30 min lockout interval and background infusion at a rate of 8 ml/h.The analgesia solution contained 0.5 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D1 and 1.0 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D2.Postoperative analgesia lasted for 48 h,and the visual analogue scale score was maintained ≤ 3.Patientcontrolled intravenous analgesia (PCIA) pump was connected when break-through pain happened.PCIA solution contained morphine 50 mg diluted to 50 ml in 0.9％ sodium chloride.PCIA pump was set up to deliver a 1 ml bolus dose with a 5 min lockout interval and no background infusion.When the visual analogue scale score ＞3,the patient-controlled LPB pump was used first,and 15 min later if analgesia was still ineffective,PCIA pump was applied.The number of patients in whom analgesia was effective and occurrence of adverse reactions were recorded.Results Compared with group D1,the rate of effective analgesia was significantly increased,and the incidence of nausea,vomiting and pruritus was decreased in group D2 (P＜ 0.05).No bradycardia,hypotension,over-sedation,respiratory depression,urinary retention or local skin infection was found in the two groups.Conclusion Continuous LPB with 1.0 μg/ml dexmedetomidine added to 0.1％ ropivacaine provides better efficacy for postoperative analgesia in elderly patients undergoing hip replacement.

Objective:To analyze the relationship between the clinical medical college students' time investment (including study, activities, entertainment and exercise) and general self-efficacy (GSE) in a medical university in Liaoning province, China.Methods:The first-year medical students were asked to participate the survey. Their GSE was measured by using general self-efficacy scale (GSES) in 2018. One year later, the independent variable table was used to investigate the extracurricular activity time, and 683 valid questionnaires were collected. Ordered logistic regression method was used to analyze the correlation between students' extracurricular activities and GSE.Results:Medical students' GSE was positively associated with their time in extracurricular study ( OR = 1.94, 95%CI = 1.49-2.54), volunteer activities ( OR=1.36, 95%CI = 1.01-1.83), and physical activities ( OR = 1.37, 95%CI = 1.01-1.85). However, there was no significant correlation with the time in activities organized by students ( OR = 1.09, 95%CI = 0.79-1.50) or activities organized by school ( OR = 1.15, 95%CI = 0.84-1.59). Furthermore, compared with clinical students of "5+3" year program, the 5-year program clinical students had a stronger correlation between medical students' GSE and the input of extracurricular study time. Conclusion:There is a positive correlation between medical students' GSE and their extracurricular time investment, which indicates that increasing medical students' GSE could be an effective method to improve their extracurricular time investment and eventually improve their comprehensive quality.

Objective To detect the lymph node micrometastasis in resected pancreatic head carcinoma, to investigate the role of lymphatic micrometastasis in clinical staging and predicting prognosis of the pancreatic head carcinoma. Methods Pancreaticoduodenectomy with extended lymph nodes dissection were performed in 20 patients with pancreatic head carcinoma. All the lymph nodes were taken out by operating microscope method and metastasis was diagnosed by routine histological examination with hematoxylin and eosin staining, and the presence of lymph node micrometastasis was examined by immunohistochemisty. Results A total of 677 lymph nodes were found in the 20 eases, routine histological examination revealed metastasis occurred in 87 lymph nodes in 13 cases. Of the 590 negative lymph nodes by routine histological examination, 57 lymph nodes in 3 cases were diagnosed as having micrometastasis by immunohistochemisty. With the combination of routine histological examination and immunohistochemisty, the percent of patients with positive lymph nodes increased from 65% (13/20) to 80% (16/20), the detection rate of metastasis lymph node increased from 12.9% (87/677) to 21.3% (144/677) with significant difference (P <0.05). The detection of lymph node micrometastasis changed the staging of Ⅱ A to Ⅱ B in 3 patients. Tumor metastasis and recurrence rate of patients with lymph nodes micrometastasis within one year after operation was 75%, while it was 25% of patients without lymph nodes micrometastasis. Conclusions The detection of lymph node mierometastasis metastasis was helpful in the determination of clinical staging and predication of prognosis.