The clival region refers to the skull base between dorsum sellae and anterior border of foramen magnum. It is located in central area of skull base and is in close proximity to pons, medulla oblongata, basilar artery and other crucial intracranial structures. Although there are various microsurgical approaches using craniotomy to reach this region, there are still a lot of difficulty in exposure of clivus. With the increasing development in extended endoscopic endonasal approach, a new route to clivus, as well as meticulous endoscopic anatomy studies is emerging. This article reviewed related researches progress of the detailed anatomical studies from endoscopic perspective.
Cranial Fossa, Posterior ; anatomy & histology ; Craniotomy ; Endoscopy ; methods ; Humans ; Nasal Surgical Procedures ; methods ; Nose ; anatomy & histology ; Skull Base ; anatomy & histology

OBJECTIVE To investigate the protein kinase C (PKC) activity in peripheral blood T lymphocytes and its significance in patients with allergic rhinitis (AR) and the relationship between PKC activity and Th2 cytokines, interleukin 4 (IL-4) and interleukin 5 (IL-5) . METHODS Twenty seasona allergic rhinitis patients and 20 normal control persons participated in the study. T lymphocytes isolated and purified from blood of each person were divided into 2 groups:stimulated with and without phorbol 12-myristate 13-acetate (PMA) . The total PKC activity was detected by non-radioactive assay. The expression of IL-4 and IL-5 protein in supernatants was measured with ELISA RESULTS PKC activity, the expression of IL-4 and IL-5 protein in supernatants in AR T lymphocyte stimulated with PMA were significantly higher than those of AR T lymphocyte stimulated without PMA and those of norma (P

Objective To investigate the characteristics of ocular movement disorders in patients with multiple sclerosis (MS) and neuromyelitis optica (NMO), and explore the clinical application of videonystagmograph (VNG) exami?nation in the diagnosis and differential diagnosis of MS. Methods Sixteen MS ,10 NMO and 30 control ( sudden deafness ) patients were enrolled prospectively. Ocular movement disorders including saccades, gaze fixation, smooth pursuits, opto?kinetic nystagmus and spontaneous nystagmus were evaluated by using VNG. Results The positive rate of ocular motility disorders in MS patients detected by VGN was 68.75%. The incidences of abnormalities in saccades, smooth pursuits and optokinetic nystagmus were significantly higher in MS than in control groups (P= 0.000, 0.001 and 0.001, respectively). The positive rate of ocular motility disorders in NMO patients detected by VGN was 80.00%. The incidences of abnormal?ities in saccades, gaze fixation, smooth pursuits and optokinetic nystagmus were significantly higher in NMO than control groups (P=0.000, 0.012, 0.000 and 0.002, respectively). The positive rate of ocular motility disorders was not significant? ly different in MS and MS patients (68.5%vs. 80%,P>0.05). Compared with bedside physical examination, VNG showed a notable higher sensitivity in the detection of ocular motility disorders(68.75% vs. 37.50%). Furthermore, VNG disor?ders might indicate brain lesions undetected by MRI. Conclusion This small sample research indicates that VNG is a valuable tool in the detection of ocular motility disorders as well as brain lesions in MS and NMO patients. However, its role in the differential diagnosis between MS and NMO is not confirmed.

OBJECTIVE: To observe the CT three-dimensional imaging features of the frontal recess region with advanced three-dimensional reconstruction, and develop the real image of the important anatomical structures around the region to conduct surgery. METHOD: Thirty patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard three-dimensional reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely. RESULT: After the reconstruction, we get the three-dimensional model very close to the true state of the nasal cavity-sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In these patients, the height, width and depth of the agger nasi and frontal sinus were (9.45 ± 3.60)mm, (8.08 ± 3.37)mm, (26.98 ± 6.82)mm and (26.86 ± 9.45)mm, respectively. CONCLUSION This study tried to develop the standardized techniques and measurements from three-dimensional reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The project results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.
Ethmoid Sinus ; diagnostic imaging ; Frontal Sinus ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Nasal Cavity ; Paranasal Sinuses ; diagnostic imaging ; Tomography, Spiral Computed ; methods

OBJECTIVE: The purpose of the study was to observe the three-dimensional (3D) CT imaging features of the frontal recess region with 3D reconstruction, and obtain the real image of the important anatomical structures of the region to conduct surgery. METHOD: Five patients were undergone spiral CT by 16 line high speed spiral CT, and multiplanar reconstruction images using standard 3D reconstruction protocol on a computer workstation. The structure of the frontal recess, the agger nasi cell and adhere style of the uncinate process were observed. The parameter of the important anatomic structure of frontal recess was measured precisely. RESULT: After the reconstruction, we get the 3D model very close to the true state of the nasal cavity--sinuses cell, in which parts of the frontal recess can clearly identify the agger nasi cell, frontal cell and other important structures. In this patient, the height, width and depth of the agger nasi and frontal sinus were 12.3 mm, 12.1 mm, 38.5 mm, respectively. CONCLUSION This study tried to develop the standardized techniques and measurements from 3D reconstructed images of the frontal sinus and to ascertain the usefulness of the frontal sinus in identification of patients. The results in better preoperative patient counselling and in predicting postoperative improvement in clinical status.
Adolescent ; Adult ; Aged ; Female ; Frontal Sinus ; diagnostic imaging ; Humans ; Imaging, Three-Dimensional ; Male ; Middle Aged ; Tomography, Spiral Computed ; Young Adult

OBJECTIVE To study the anatomic relationship of the divus region and provide the anatomical basis for the extended endoscopic endonasal approach to clivus region.METHODS 10 cadaveric heads were dissected using the surgical microscope and endoscope.RESULTS 1.With the extended endoscopic endonasal approach,we can expose the ventral side of brain stem from interpeduncal fossa to the foramen magnum and upper,middle,and lower neurovascular complexes.2.The clivus region,formed by the sphenoid body and the clival part of occipital bone,is situated between the dorsum sellae and the anterior margin of the foramen magnum.Occipital bone and the petrous part of the temporal bone were separated by the petroclival fissure.CONCLUSION 1.The extended endoscopic endonasal approach can be tailored to deal with the local lesions involving the clivus and adjacent posterior cranial fossa structures.2.Full andcomprehensive understanding of the anatomy around the clivus region can help surgeons to improve accuracy and safety of procedures in this region.

OBJECTIVE: To sum up the diagnosis and treatment experience of the nasal-cardiac reflex initiated by postoperative nasal packing. METHOD: The clinical data of 3 cases with nasal-cardiac reflex initiated by postoperative nasal packing were analyzed retrospectively. RESULT: In the period of postoperative nasal packing, 3 patients had abruptly drops in heart rate and blood pressure associated with symptoms of autonomic dysfunction such as flustered, chest tightness, tachypnea, body sweating et al. There are no positive signs of pathological significance in the cardiovascular and respiratory system. The reflex had spontaneously to be offset with oxygen, comfort touch therapy, pull out the stuffing, no other special treatment for all cases. CONCLUSION The key of the diagnosis for nasal-cardiac reflex is a drop in mean arterial blood pressure (MABP) and the heart rate (HR) more than 20% above the baseline values. The cause of nasal-cardiac reflex initiated by postoperative nasal packing is long-term mechanical pressure on the nasal mucosa and mental factors. Comfort touch therapy and pull out the nasal packing material is effective method to terminate the reflex and the prognosis is good. Correct understanding of the characteristics of the reflex and preventing the occurrence of its adverse consequences have important clinical significance.
Adolescent ; Adult ; Blood Pressure ; Female ; Heart Rate ; Humans ; Male ; Nasal Cavity ; surgery ; Postoperative Period ; Reflex, Abnormal ; Retrospective Studies ; Tachypnea ; etiology ; Trigeminal Nerve ; physiopathology ; Young Adult

Objective To explore the predictive value of CT radiomics and morphological features for the prognosis and survival in non-small cell lung cancer(NSCLC)patients.Methods The clinic data of 300 NSCLC patients(300 lesions)were downloaded from the Cancer Imaging Archive,with 210 randomly selected as the training set and 90 as the test set.According to the prognosis and survival,the patients were divided into two groups with survival period≤3 and＞3 years.3D Slicer software was used to delineate the regions of interest layer by layer in CT images,and the radiomics features were extracted from each region of interest.Both t-test and least absolute shrinkage and selection operator were utilized for radiomics feature screening.Three types of prediction models,namely radiomics model,morphological model and combined model,were constructed with Logistic regression,whose performances were evaluated using the receiver operating characteristic(ROC)curve.Results The differences in radiomics labels and mediastinal lymph node metastasis between the training set and the test set were statistically significant.For radiomics model,morphological model and combined model,the area under the ROC curve was 0.784(95%CI:0.722-0.847),0.734(95%CI:0.664-0.804)and 0.748(95%CI:0.680-0.815)in the training set,and 0.737(95%CI:0.630-0.844),0.665(95%CI:0.554-0.777)and 0.687(95%CI:0.578-0.797)in the test set,which demonstrated that radiomics model had the best diagnostic performance.Conclusion The CT radiomics model can effectively predict the prognosis and survival in NSCLC patients.

OBJECTIVE：To establish the HPLC fingerprints of ethanol extracts of Dendrobium nobile from different habitats ， and to study spectrum effect relationship of its anti-inflammatory effect. METHODS ：The ethanol extracts from 12 batches of D. nobile from different habitats （S1-S12）were prepared. The fingerprints of ethanol extracts from 12 batches of D. nobile were established by HPLC and TCM Fingerprint Similarity Evaluation System （version 2012）. Common peaks were identified and the similarity was evaluated. Using the contents of inflammatory factors （IL-4，IL-6）as anti-inflammatory indexes ，ELISA was used to investigate the effects of ethanol extracts from 12 batches of D. nobile on RAW 264.7 macrophages in inflammatory model induced by lipopolysaccharide. Grey correlation analysis was used to analyze the correlation between common peaks and anti-inflammatory indexes in the fingerprint of ethanol extract from D. nobile . RESULTS ：There were 18 common peaks in ethanol extracts from 12 batches of D. nobile ，and No. 12 peak was identified as dendrophenol. The similarity of each sample was 0.911-0.996. The content of IL- 4 in cell culture medium was significantly reduced by ethanol extracts of D. nobile S1-S12（P＜0.05 or P＜0.01）；the content of IL- 6 in cell culture was significantly reduced by ethanol extracts of D. nobile S1-S8，S10（P＜0.05 or P＜0.01）. Grey correlation analysis found that except for peaks 4 and 18，the correlation degree between the other common peaks and the content of IL- 4 was greater than 0.6，and the correlation degree between peaks 5 and 7 and the content of IL- 4 was greater than 0.8；except for peaks 9，14，4，3 and 18，the correlation degree between the other common peaks and the content of IL- 6 was greater than 0.6，and the correlation degree between peaks 1，12 and 13 and the content of IL- 6 was greater than 0.8. CONCLUSIONS ：HPLC fingerprints of ethanol extracts from 12 batches of D. nobile ； from different habitats have high similarity and good consistency in composition ； the chemical constituents represented by peaks 1，5，7，12（dendrophenol）and 13 may 769096783@qq.com be potential anti-inflammatory components of D. nobile .

OBJECTIVE: To describe the anatomy,radiographic manifestation, and surgical treatment of pulsatile tinnitus due to sigmoid sinus diverticulum. METHOD: The retrospectively study of diagnosis,clinical and radiographic manifestations,and surgical treatment of 2 cases of pulsatile tinnitus caused by sigmoid sinus diverticulum was carried out. RESULT: Bony defect was found in the anterior sigmoid wall in both cases, and one of them was combined with invasion of soft tissues in mastoid cells. Both of them undertook a surgery to reconstruct sinus wall and received a satisfactory results. CONCLUSION Sigmoid sinus diverticulum is one of causes which lead to pulsatile tinnitus. It can be identified by imaging examination and can be cured by sinus wall reconstruction.
Adult ; Diverticulum ; complications ; Female ; Humans ; Male ; Meninges ; Retrospective Studies ; Tinnitus ; etiology ; pathology ; surgery