Objective To explore the microsurgical technique in managing medial sphenoid ridge meningioma.Methods The clinical data of 23 cases of medial sphenoidal ridge meningioma were analyzed retrospectively.The main points of microsurgical treatment of medial sphenoid ridge meningioma were discussed.Results Of 23 cases of medial sphenoid ridge meningiomas,total removal was made in 15 cases,subtotal removal in 6 cases and partial removal in 2 cases.The microsurgical outcomes were satisfactory in all the patients and no patients died.Conclusion The microsurgery via the pterional approach to the medial sphenoid ridge meningiomas can greatly heighten total resection rate of the tumors.Total resection of the tumor depends on its position,character and degree of edema of surrounding tissues.Palliative operations combined with postoperative radiotherapy should be carried out for treating the tumors that can only be subtotally and partially removed.

Objective To observe the occurrence of cardiovascular adverse events in patients undergoing mechanical ventilation with dexmedetomidine sedation,and to evaluate its safety in intensive care unit (ICU).Methods A prospective randomized controlled trial was conducted.Adult critical patients undergoing mechanical ventilation over 48 hours admitted to ICU of Zigong First People's Hospital in Sichuan Province were enrolled.The patients were divided into dexmedetomidine group (Dex group) and midazolam group (Mid group) according to the randomise number generated by computer.The patients in both groups were given slow intravenous infusion of 0.05 mg/kg midazolam and 1-2 μg/kg fentanyl to induce anesthesia before tracheal intubation,followed by 0.06 mg· kg-1· h-1 midazolam and 20-50 μg· kg-1 · h-1 fentanyl or 0.1-0.2 μg· kg-1 · h-1 sufentanil for continuous intravenous pumping to maintain analgesia and sedation;on the next day,the patients in Dex group was given dexmedetomidine (with the initial dose of 0.4 μg· kg-1 · h-1,and maintenance dose of 0.1-0.7 μg· kg-1 · h-1),and midazolam was stopped half an hour later;the original sedation and analgesia plan remained unchanged in Mid group.The goal of sedation was to maintain a Richmond agitation-sedation scale (RASS) score of-2 to 1 or a Ramsay sedation score of 3 to 4;patients were given midazolam if obvious agitation occurred,in combination with propofol for sedation if necessary;wakeup test was performed every day.Observation endpoints included patients discharged from ICU,death or mechanical ventilation over 28 days.Occurrence of cardiovascular adverse events during sedation such as hypertension,hypotension,bradycardia,tachycardia and arrhythmia,dose of sedatives and analgesics,duration of mechanical ventilation,length of ICU stay and 28-day mortality were observed in two groups.Results A total of 383 patients were enrolled,with 190 patients in Dex group and 193 in Mid group.There was no statistically significant difference in general data such as gender,age,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and predicted mortality between two groups.Doses of midazolam,propofol and fentanyl in Dex group were reduced as compared with those of Mid group,while the dose of sufentanil was similar in two groups.The Ramsay score and RASS score of Dex group were significantly reduced as compared with those of Mid group (3.34± 0.63 vs.3.95 ± 0.86,-1.33 ±0.87 vs.-1.98 ± 1.27,both P ＜ 0.01).Bradycardia was prominent in Dex group,which was observed in more than half of patients at the beginning of the treatment (1-2 hours),but the patients requiring isoprenaline treatment for heart rate lower than 50 bpm were less than that of Mid group (3.7％ vs.5.2％,x 2 =0.506,P =0.477).The incidences of hypotension (45.3％ vs.68.4％),tachycardia (16.3％ vs.33.7％) and arrhythmia (14.7％ vs.31.1％) in Dex group were significantly lower than those of Mid group (all P ＜ 0.01),and no other cardiovascular adverse events such as cardiac arrest,sinus arrest,hyperglycemia or hypoglycemia were observed in two groups.There was no statistically significant difference in duration of mechanical ventilation between Dex group and Mid group [days:5 (2,28) vs.4 (2,56),Z =-1.917,P =0.055],but compared with Mid group,the length of ICU stay in Dex group was significantly prolonged [days:9 (2,67) vs.6 (2,57),Z =-4.302,P =0.000],and the 28-day mortality in Dex group was significantly reduced (22.6％ vs.44.6％,x2 =20.610,P =0.000).Conclusion Long time dexmedetomidine sedation is safe in critical patients undergoing mechanical ventilation,which can significantly reduce cardiovascular adverse events except bradycardia,and lower the 28-day mortality.

BACKGROUND:Tantalum rod implant technology is a new method of early osteonecrosis treatment. Current research on stress distribution before and after tantalum rod implant in different sizes of femoral head necrosis area is few. OBJECTIVE:To analyze the stress distribution before and after tantalum rod implantation in different sizes of necrotic femoral head area using three-dimensional finite element method. METHODS:Three-dimensional finite element models of normal femoral head and necrotic femoral head of 15, 20 and 30 mm diameterwere constructed. Eight measuring points were chosen on two tiers of each necrotic model to detect the stress distribution and its alteration before and after tantalum rod implantation. RESULTS AND CONCLUSION:(1) Stress concentration werefound on every necrotic femoral head, most pronounced on the one with 30 mm lesion. (2) Tantalum implant appeared to reduce the stress concentration generaly. Comparison of the peak points of these models indicated most significant benefit in 15 mm lesion, next in 30 mm lesion, last in 20 mm lesion. (3) Results indicate that larger lesion entails more concentrated stress distribution and more likely to colapse. Tantalum rod implantation can delay the development of necrosis of the femoral head, andismost effective in smal lesion.

Pancreatic cancer is a one of the most malignant digestive cancer.Because the lack of effective methods for early diagnosis,most patients have been ineligible for surgical resection when diagnosed.Kallikrein family is a group of serine proteases,because of its ability to decompose the extracellular matrix proteins,it may be closely related to the invasion and metastasis of various cancers.And some members of kallikrein family may become cancer diagnostic biomarkers.This paper reviews all the recent articles about kallikrein family study in pancreatic cancer.

Objective To report the functional reconstruction and rehabilitation for a patient who under- went allograft for both of his forearms and hands.Methods One male patient underwent allograft for both of his forearms and hands in October 2002 in our department to reconstruct his hand functions.The allografted hands were intervened with an integrated rehabilitation program,which involved administration of immunosuppressants,post- operative monitoring,postoperative functional training,massage,physiotherapy,orthosis,performance training, sensation training,secondary operation and mental rehabilitation.The patient was followed up for 4 years.Results The forearms and hands of the patient were in good shape and regained nearly normal sensation.The distance of two-point-discrimination was 2.5 cm to 4.0cm.The TAM (total active motion) of fingers was fine.The patient could look after himself well and were healthy in psychology.Conclusion An integrated rehabilitation program can yield satisfactory results in the management of allografted forearms and hands.

Objective: To study the effects of propafenone on action potential (AP) of rabbit ventricular myocytes with the tonic block and use-dependent block of transient sodium current (INa-T). Methods: A total of 10 adult New Zealand white rabbits were sacriifced and 10 individual ventricular myocytes were isolated by enzyme digestion method. Microelectrode technologies were used to record AP-related parameters: maximum diastolic potential (MDP), maximum rate of rise of the action potential upstroke (Vmax), action potential amplitude (APA) and action potential duration at 20%, 50% and 90% (APD20, APD50 and APD90).INa-T was measured, I-V curves and peak currents at different frequencies were detected by whole cell patch clamp before and after propafenone perfusion at 10 μmol/L. Results: There was no statistical difference in MDP at before and after propafenone perfusion as (-80 ± 6) mV vs (-82 ± 5) mV,P>0.05. After perfusion, APA was signiifcantly decreased as (95 ± 12) mV vs ( 125 ± 10) mV,P<0.05, the Vmax slowed down as (330 ± 43) V/s vs (420 ± 54) V/s,P<0.05, while APD20, APD50 and APD90 were unchanged as (8 ± 2) ms vs (6 ± 2) ms,P>0.05, (16 ± 3) ms vs (12 ± 3) ms,P>0.05 and (86 ± 14) ms vs (85 ± 12) ms,P>0.05. After propafenone perfusion, I-V curve ofINa-T was shifted upward and the peak current was decreased as (3001 ± 383) pA vs (4193 ± 378) pA, P<0.05. Before perfusion, when stimulated at 0.06 Hz, 1 Hz, 2 Hz, 5 Hz and 10 Hz, there were no signiifcant use-dependent block inINa-T , and no real difference inINa-T between the 10th and 1st pulse,P>0.05. After perfusion, no significant use-dependent block was observed when stimulated at 0.06 Hz and 1 Hz,P>0.05, while at 2 Hz, 5 Hz and 10 Hz, propafenone perfusion demonstrated signiifcant use-dependent block uponINa-T with the inhibition fractions of (22 ± 11)%, (38 ± 14)% and (52 ± 17)% respectively, those were signiifcantly different from the inhibition fractions at either 0.06 Hz or 1Hz,P<0.05. When the inhibition fractions were compared by each 2 conditions, allP<0.05. Conclusion: Propafenone may slow down the Vmax of AP, reduce APA and without the impact on APD; the effects onINa-T is not only in tonic block, but also more obviously in use-dependent block in isolated ventricular myocytes of New Zealand rabbit. Such inlfuences minimized the impact on QT interval and meanwhile, decreased the incidence of brad arrhythmia.

Objective To investigate the effects of chronic periodontitis on heart attack and stability of coronary artery disease (CAD). Methods Number of missed teeth was recorded and periodontal index evaluated in 266 patients with CAD, including 72 cases of acute mycocardial infarction (AMI sub-group), 91 cases of unstable angina pectoris (UAP sub-group) and 103 cases of stable angina pectoris (SAP sub- group ), and 266 healthy controls. Comparison was made between the both groups and between each sub-group and controls. Results Periodontal index in CAD group was higher than that in control group ( P 0.05). Conclusions Chronic periodontitis can affect heart attack and stability of CAD, which may be an independent risk factor for CAD.

Objective To investigate the effects of oxidative stress and lipoic acid(antioxidant)on bone metabolism and explore the underlying mechanism. Methods A total of 24 Wistar rats aged 8 weeks were randomly divided into three groups. Osteoporosis rats model was established by bilateral ovaries deleted. Rat in lipoic acid group was injected with lipoic acid(60 mg/kg)for 8 weeks. The bone mineral density(BMD),steo?calcin,ALP,Ca,P,MDA,SOD and GSH?Px were detected. The levels of OPG and RANKL in serum were measured by Western blotting. OPG and RANKL mRNA were detected by real?time PCR. Results The level of BMD level in blood,SOD,GSH?Px,OPG mRNA and protein level in femur of osteoporosis group were significantly lower than the control group(P<0.05). On the other hand,steocalcin,ALP,MDA,RANKL mRNA and protein level were significantly higher than the control group(P<0.05). The level of BMD level in blood,SOD,GSH?Px,OPG mRNA and protein level of lipoic acid group were significantly higher than the osteoporosis group(P<0.05). The steocalcin,ALP,MDA,RANKL mRNA and protein level were significantly lower than the osteoporosis group(P<0.05). Conclusion Oxidative stress may increase osteoporosis through the upregulation of OPG/RANKL pathway in rats ,and antioxidant lipoic acid can alleviate the progress of osteoporosis.

Objective To find the effect of alter-expressed PER2 on proliferation,apoptosis and other clock genes expression in human oral squamous cell carcinoma SCC15 cells.Methods Short hairpin RNA interference was used to knockdown PER2 in SCC15 human oral squamous cell carcinoma cells.Flow cytometry analysis was used to testify the cell proliferation and apoptosis.Quantitative real-time PCR was used to testify the mRNA expressions of PER3,BMAL1,DEC1,DEC2,CRY2,TIM,RORα,NPAS2,PER1 and REV-ERBα.Results The proliferation was enhanced and apoptosis was decreased after PER2 knockdown in SCC15 cells (P<0.05).The mRNA expression of PER3,BMAL1,DEC1,DEC2,CRY2,TIM,RORα and NPAS2 was significantly down-regulated,and the mRNA expression of PER1 and REV-ERBα was significantly up-regulated (P<0.05).Conclusions Clock gene PER2 plays an important role in regulating other clock genes of the clock gene network in cancer cells,PER2 knockdown can enhance proliferation and recede apoptosis of cancer cell.

Objective To investigate the influence of synangio-excision-restruction in pancreatic cancer radical operation on the complications,living quality and survival status in the patients with pancreatic cancer.Methods A total of 255 patients with pancreatic cancer in our hospitals from January 2010 to October 2015 were selected and divided into 3 groups according to different operation modes:41 cases in the Synangio-excision-restruction group(A),113 cases in the non-synangio-excision-restruction group (B) and 101 cases in the palliative by-pass operation group(C).The clinical data in 3 groups were analyzed.The influence of Synangio-excision-restruction on operative complications,living quality and survival status was investigated.Results The incidence rate of complications in the group A was 56.10％,which was obviously higer than 34.51％ in the group 1β and 20.79％ in the group C,and the difference was statistically significant(P＜0.05).In the group A,the incidence rates of belly ache and body weight gain were 36.59％ and 51.22％ respectively,which comparing with 91.09％ and 9.09％ in the group C showed statistically significant difference(P＜0.05).The median survival time(MST) in the group A was 11.83 months,which in the group B and C were 15.43 months and 7.50 months,the difference between the group A and C was statistically significant(x2 =4.27,P＜0.05);while the difference between the group A and B was not statistically significant(x2=3.67,P＞0.05).Conclusion For the pancreatic cancer patients with affected portal vein and inferior mesenteric vein,the synangio-excision-restruction radical operation can obviously prolong the patients' survival time and improves their living quality.