Objective To explore the microsurgical skills and clinical value of transorbitozygomatic approach for cavernous sinus tumors. Methods A retrospective research was given to 19 patients with cavernous sinus tumors microsurgically treated by transorbitozygomatic approach.Their tumors pathological types,clinic symptoms,characteristic images,surgical approach,surgical skills and postoperative complications were systemically analyzed. Results Total removal of the tumor was achieved in 17 cases and subtotal removal in 2 cases.38 percent of cranial nerves deficit was improved,43 percent of cranial nerves symptoms did not change,and 19 percent of cranial nerves palsies worsened.New cranial nerves symptoms occurred in 5 cases.No other severe complications or death occurred in all cases. Conclusion Transorbitozygomatic approach can preferably expose and totally resect cavernous sinus tumors.Knowing macro-micro anatomy of this approach,understanding the pathological-anatomic relationships betweem tumor and cavernous sinus,having practiced microsurgical skills are the linchpins to resect the tumor totally and protect cranial nerves effectivctively.

Objective To explore clinical curative effect of microsurgery of petroclival tumors by transpetrosal presigmoid approach. Methods A series of 23 patients of petroclival tumors resected by microneurosurgery were analyzed retrospectively, including tumors histological types, clinical and preoperative MRI features, operative approaches, surgical technique and common postoperative complications. Results Total resection of the tumor was achieved microsurgically in 16 cases, subtotal resection in 4 cases, partial resection in 3 cases. No patient died in this series. 8 patients presented worsening crainal nerves palsies postoperatively. CSF leaks were uncommon, occuring in 2 patients. Conclusion The tumors in petroclival region can be totally resected by transpetrosal presigmoid approach. The advantages were offered by this approach such as the temporal lobes and cerebellum are minimally retracted; the operative distance of petroclival tumors is shortened with exposure of clivus and juxta-clival region.

A 54-kDa protein overexpressed by chloroquine-resistant Plasmodium berghei ANKA strain was first reported by us. In this paper, the localization of this protein by immunoelec-tron microscopy is presented. The results showed that the protein was mainly scattered inside the cytoplasm of the early date trophozoites and schizonts of erythrocytic stage of P. berghei ANKA strain , and some of it was also found in cytoplasm of erythrocytes infected with parasites. The protein content was much higher in chloroquine-resistant P. berghei ANKA strain than in chloroquine-sensitive P. berghei ANKA strain, suggesting the importance of this protein in understanding mechanism of chloroquine resistance in malaria parasites .

Objective To investigate the effect of detail management in ward drug administration.Methods Details management for ward drug management were applied,including the standardization of the drug storage,storage method,to carry out new knowledge learning,to strengthen the drug management,to set up the standardized nursing medication process identification and optimization measures.Results details management,the incidenues of drug mixed and delayed delivery were lower;the time of checking drug was significantly shorter(P<0?001).Conclusions The details management are the effective measures to ensure drug quality and safety.

BACKGROUND: A stable and exact animal model is the necessary tool and basis for studying hemorrhagic cerebrovascular diseases.OBJECTIVE: To establish and evaluate the intracerebral capsular hemorrhage models in rats.DESIGN: A randomized and controlled animal experiment.SETTING: Second Hospital Affiliated to Xuzhou Medical College; First Hospital Affiliated to Nanjing Medical University.MATERIALS: This experiment was carried out in the animal experimental center of Nanjing Medical University during May to November 2002.Totally 35 SD rats were randomized into two groups: experimental group (n=30) and sham-operation group (n=5).METHODS: ① Autoblood was injected into the intracerebral capsule of rats to create intracerebral capsule hemorrhage models with stereotaxy in the experiment group. ②Scoring was conducted according to 5-point neurological scoring criteria from ZeaLonga, somatic sensation and motor function of rats were observed. ③Somatosensory evoked potential(SEP) of rats was detected pre- and post-operation under anesthetic state. ④ After determination of SEP, the rats were sacrificed under anesthetic state. Brains were taken out to made slices, then sections were stained with haematoxylin and eosin. Changes in haematoma and histomorphology were observed at the largest focus under optical microscope.MAIN OUTCOME MEASURES: ①Nerve function scoring; ②Latent period of various waves of SEP; ③ Observation of brain tissue morphology.RESULTS: Totally 35 rats entered the stage of result analysis. ①Appearance of obvious paralysis of the rats suggested the modeling was successful. The successful rate of this experiment was 93.3%(28/30). Significant difference existed in neurological scoring between experimental group [(2.74±0.46)points] and sham-operation group (0 point)(P＜0.05). ②SEP showed that the latent periods of various waves of experimental group after operation were significantly delayed than those before operation and those of sham-operation group [P1: (15.72±0.78) ms, (10.69±0.52) ms, (10.73±0.48) ms;Nl: (17.95±1.27) ms,(13.21±1.31) ms, (13.34±1.27) ms;N2:(21.16±1.62) ms, (15.42±1.46) ms,(15.58±1.44) ms;N3:(24.86±1.58) ms, (18.72±1.76) ms, (18.99±1.67) ms,P＜0.05]. ③In the shamoperation group, a few red blood cells were scattered in the peripheral area of needle channel were found, but hemorrhagic focus was not; In the experimental group, irregular or oval blood clots presented in the left internal capsule area. In about a low-fold visual field, brain tissue in the surrounding of hemorrhagic focus was loosened and swelled, and pathological changes were obviously severer than those in the sham-operation group.CONCLUSION: Intracerebral capsular hemorrhage induced by injection of autoblood with stereotaxy is more close to clinical situation, and it is easy to operate and has good reproducibility.

Objective To study the skills of facial nerve preservation in acoustic neuroma microsurgery. Methods Seventy four cases of acoustic neuromas treated microsurgically by suboccipital retrosigmoid transmeatus approach were analyzed retrospectively, including their clinical symptoms and characteristic image, the pathological anatomic relationships of facial nerve and tumor, microsurgical technique. Results Total resection of the tumor was achieved microsurgically in 72 cases, subtotal resection in 2 cases. Facial nerve was kept anatomic intact in 67(90.5%) of the patients. Intracranial end to end anastomosis of the facial nerve was performed in 4 cases. No patient died in this series. Conclusions Microneurosurgical technique is a safe and effective method for total resection of acoustic neuroma. It is key point for keeping facial nerve anatomic intact to understand the pathological anatomic relationships of facial nerve and tumor.

Objective To explore the skill of mien)surgical removal and preservation and functional recovery of facial nerve for large acoustic neuromas.Methods The clinical data of 82 consecutive patients with large acoustic neuromas operated upon through the suboccipital retrosigmoid approach were retrospectively reviewed.The cases with HB grade Ⅲ - Ⅵ of facial nerve were divided randomly into two groups,the one group was given conventional therapy and the other group was given Kabato rehabilitation training.Results In those cases,acoustic neuromas were totally removed in 77 (93.9%),subtotally removed in 5.Facial nerve was kept anatomically intact in 78 cases of the patients (95.1%).Recovery of facial nerve function was faster and more effective in the training group than that in the un-training group.During the follow-up ranging from 6 months to 3 years,among 5 cases of subtotally resection,2 cases relapsed.Three patients in our series complained of chronic headache postoperatively.No patient long time coma or died.Conclusion The goal of large acoustic neuromas treatment should be total removal in one stage and preservation of facial nerve function,as they determine a patient's quality of life.Kabat rehabilitation training is the effective method of functional recovery of facial nerve after operation.

Objective To detect the expression of Raf kinase inhibitor protein (RKIP) and NF-κB in renal tissue of diabetic kidney disease (DKD) rats model,and to investigate the effect of rituximab (RTX) on the expression of RKIP in the renal tissue of DKD rats. Methods SD rats were randomly divided into normal group (N),DKD model group (M) and RTX treatment group (D).Blood glucose and 24-hour urine protein of rats were determined in three groups.RKIP protein and NF-κB protein were determined by immunohistochemistry staining. RKIP protein expression was detected by Western blotting. Results Compared with N group,blood glucose,24-hour urine protein and NF-κB expression in M group increased significantly (all P＜ 0.01),the expression of RKIP in M group decreased significantly (P＜0.05).Compared with M group,the expression of RKIP increased significantly in D group (P＜0.05),and 24-hour urine protein and NF-κB expression decreased in D group (all P＜0.05).NF-κB protein expression was negatively correlated with RKIP expression in M group. Conclusions The NF-κB pathway regulated by RKIP plays an important role in the development and pathogenesis of diabetic nephropathy.Rituximab may have a role in treatment of DKD.

ObjectiveTo study the treatment and prognosis of the breast phyllodes tumors.MethodsKG1Clinical data, and the results of follow-up in 203 cases of breast phyllodes tumors were analyzed using Logistic analysis and Cox regression in SPSS statistic software.ResultWT5”BZLocal recurrence and tumor mortality were in direct proportion to the pathologic grade of the tumor. There was a direct proportion between local recurrence and tumor infiltration; and between tumor caused-mortality and tumor mitosis and necrosis.Mitotic activity and tumor necrosis were the independent prognostic factors. After surgical resection 21 1% of patients with benign tumor, 45 2% of patients with borderline tumor, 64 3% of patients with malignant tumor suffered recurrence. The 5-year survival rate was 100% in patients with benign phyllodes tumor, 92 0% with borderline tumor, and 33 3% with malignance.KG2Conclusion Local excision is not the appropriate treatment for phyllodes tumor. Patients with benign or borderline phyllodes tumor should undergo wide local excision including a margin of uninvolved tissue, and that with local recurrent borderline and malignant phyllodes tumor receive mastectomy.

AIM:To investigate the perfusion parameters using dynamic contrast-enhanced magnetic resonance imaging ( DCE-MRI) in rectal cancer patients so as to explore its potential value in estimating the microvascular condition including perfusion and permeability .METHODS:The data of 38 rectal cancer patients examined with DCE-MRI was ret-rospectively analyzed .The perfusion parameters of carcinoma and normal rectal wall in each case were calculated , inclu-ding volume transfer constant (Ktrans), rate constant of back flux (Kep), extravascular extracellular space fractional volume (Ve) and initial area under curve (iAUC).The mean values of tumor and normal rectal wall , mucinous and nonmucinous carcinoma, poorly and moderately-to-well differentiated carcinoma , case with or without lymph node metastasis were com-pared.RESULTS:All the parameters of rectal cancer were higher than normal rectal wall (P<0.01).No significant difference was found between poorly and moderately-to-well differentiated carcinoma in terms of K trans, Kep and Ve, neither was the case with or without lymph node metastasis .The cases with lymph node metastasis had lower iAUC than those with-out (P<0.05).CONCLUSION:Quantitative perfusion DCE-MRI answered the microvascular perfusion and permeability change of rectal cancer compared with normal rectal wall , besides it could be used to distinguish between mucinous and nonmucinous carcinoma , which demonstrated its value in the evaluation of rectal cancer .However , it should not be recom-mended to predict the degrees of tumor cell differentiation and lymph node metastasis just according to the perfusion param -eters.