Objective:To evaluate the feasibility and outcomes of transnasal endoscopic clipping of the paraclival internal carotid artery (ICA) in skull base surgery.Methods:The paraclival ICA was anatomically dissected in cadaveric head specimens. The clinical data of 15 patients with skull base lesions involving the ICA who admitted to the Department of Otorhinolaryngology Head and Neck Surgery at Tianjin Huanhu Hospital from January 2021 to December 2023 were retrospectively analyzed. Among them, 4 patients underwent transnasal endoscopic clipping of the paraclival ICA and concurrent lesion resection. The surgical methods were summarized, and the key points and indications of this technique were analyzed.Results:Intraoperative clipping of the ICA was successful and hemostatic in all 4 patients. Postoperatively, 3 patients had no complications, while 1 patient developed delayed ischemic cerebral infarction. Two patients were cured, 1 patient was maintained on immunotherapy, and 1 patient died. During follow-up, the clip was in situ in 1 patient, had detached in another, and was obscured by temporal muscle coverage in the remaining 2 patients.Conclusions:Transnasal endoscopic clipping of the paraclival ICA represents a potential option for managing the ICA in skull base surgery. However, it carries significant risks and limitations, mandating careful patient selection based on specific circumstances.

Objective To explore the prevalence of 9 respiratory pathogens from March 2023 to February 2024,as well as the detection efficiency of various methods for pathogens.Methods A retrospective analysis was conducted on the detection of 9 pathogens in 38 948 patients who first presented with respiratory symp-toms from March 2023 to February 2024,as well as the detection efficacy of nucleic acid,antigen,antibody and other methods.Results Firstly,among 38 948 patients,a total of 8 345 cases(21.43%)were detected with at least one pathogen,of which 8 158 cases(20.95%)were detected with only one pathogen,and 187 cases(2.29%,187/8 158)were detected with two or more pathogens.The top three detection rates were SARS-CoV-2(20.37%),mycoplasma pneumoniae(MP,15.58%)and influenza A virus(IVA,10.79%).Secondly,among patients who detected at least one of the nine pathogens,the detection rate was 24.94%in autumn,21.45%in spring,18.54%in summer,and 19.22%in winter,and the difference in detection rates between the four seasons was statistically significant(P<0.001).Thirdly,except for the relatively high detection rates of SARS-CoV-2 in spring(51.24%)and summer(37.31%),and the highest detection rate of IVB in winter(11.28%),the detection rates of other pathogens were highest in autumn.Fourthly,there was a statistically significant difference in the total detection rates among the children group(31.83%),the youth group(12.48%),the middle-aged group(10.70%),and the elderly group(12.43%)(P<0.001).The detection rates of 7 pathogens,including MP,IVA,Influenza B virus(IVB),syncytial virus,CP,adenovirus,and parain-fluenza virus type 1,were highest in children,and there was a statistically significant difference in comparison between different age groups(P<0.05).The detection rate of SARS-CoV-2 in the children group(3.45%)was lower than that in other age groups(30.90%,29.09%,32.16%,P<0.001).There was no statistically significant difference in HPIV-3 between different age groups(P=0.478).Fifthly,there was no significant difference in overall detection rate between male and female(P>0.05).However,the detection rates of MP and CP in female were higher than those in male(P<0.05),while IVA in male was slightly higher than that in female(P=0.014).There were no significant differences in the detection rate of other 6 pathogens between female and male(P>0.05).Sixthly,the detection rate of MP antigen was lower than that of MP nucleic acid detection(P<0.001),and the detection rate of MP antibody detection was lower than that of MP nucleic acid detection(P<0.001).The detection rate of MP antibody detection increased significantly with the extension of time from initial symptoms to medical treatment(P<0.001).Seventhly,the detection rates of antigen of IVA,IVB,RSV and ADV were significantly lower than those of the corresponding nucleic acid(P<0.001),and the detection rates of nucleic acid testing for 4 kinds of pathogen was about 5 times that of the correspond-ing antigen testing(4.75-6.25 times).And the consistency of the detection rate between antigen detection and nucleic acid detection was poor(Kappa=0.046-0.239).Conclusion The prevalence of common respir-atory pathogens from March 2023 to February 2024 exhibits certain characteristics.Moreover,the detection ef-ficiency of different methods for pathogens varies greatly,and appropriate detection methods should be select-ed based on a thorough understanding of their performance.

Objective:To evaluate the feasibility and outcomes of transnasal endoscopic clipping of the paraclival internal carotid artery (ICA) in skull base surgery.Methods:The paraclival ICA was anatomically dissected in cadaveric head specimens. The clinical data of 15 patients with skull base lesions involving the ICA who admitted to the Department of Otorhinolaryngology Head and Neck Surgery at Tianjin Huanhu Hospital from January 2021 to December 2023 were retrospectively analyzed. Among them, 4 patients underwent transnasal endoscopic clipping of the paraclival ICA and concurrent lesion resection. The surgical methods were summarized, and the key points and indications of this technique were analyzed.Results:Intraoperative clipping of the ICA was successful and hemostatic in all 4 patients. Postoperatively, 3 patients had no complications, while 1 patient developed delayed ischemic cerebral infarction. Two patients were cured, 1 patient was maintained on immunotherapy, and 1 patient died. During follow-up, the clip was in situ in 1 patient, had detached in another, and was obscured by temporal muscle coverage in the remaining 2 patients.Conclusions:Transnasal endoscopic clipping of the paraclival ICA represents a potential option for managing the ICA in skull base surgery. However, it carries significant risks and limitations, mandating careful patient selection based on specific circumstances.

Diabetic ketoacidosis (DKA) is the most serious acute complication of diabetes mellitus,characterized by rapid onset and progression,which can lead to coma or even lead to death in severe cases. Modern pharmacological studies have shown that some traditional Chinese medicines have the efficacy of inhibiting glycogenolysis,attenuating pancreatic β-cell damage,improving pancreatic β-cell function,and alleviating the obstruction of insulin signalling,which can effectively reduce hyperglycemia and hyperinsulinemia in diabetic mice,as well as improve insulin resistance and other symptoms. At present,the clinical treatment of DKA based on insulin and combined with the use of traditional Chinese medicines,such as clearing heat and diarrhoeing fire to detoxify,benefiting qi and nourishing yin to nourish blood,cooling blood and activate blood circulation to remove blood stasis,strengthening the spleen and the stomach to warm the yang,etc.,can control the condition rapidly,alleviate the symptoms,lower the blood glucose,promote the disappearance of ketones and correct the acidosis,and it can also reduce the dosage of insulin,thus reducing the duration of the disease. This article reviews the literature on the pathogenesis and main treatment options for DKA in western medicine,the etiology and mechanisms of DKA in traditional Chinese medicine,as well as Chinese medicine treatments and prescriptions. The aim is to highlight the advantages of traditional Chinese medicine and provide valuable references for the clinical management of DKA.

Objective To compare the clinical effects of minimally invasive percutaneous plate osteosynthesis (MIPO) and minimally invasive intramedullary nailing osteosynthesis (MINO) in the treatment of humeral shaft fractures. Methods The clinical data of 53 patients with humeral shaft fractures treated with MIPO and MINO were retrospectively analyzed. The patients were divided into MIPO group of 25 patients and MINO group of 28 patients according to differed surgical approaches. The operation time, blood loss, length of hospital stay, fracture healing time, University of California at Los Angeles (UCLA) shoulder function score at 1 year postoperatively, and Mayo elbow performance score at 1 year postoperatively were compared between the two groups. Results All 53 patients successfully completed the surgery, and no postoperative complications such as surgical site infection, radial nerve injury, fracture nonunion, implant breakage, or loosening occurred. There were no statistically significant differences between the two groups in terms of operation time, blood loss, length of hospital stay, fracture healing time, and Mayo elbow performance score at 1 year postoperatively (P>0.05). The UCLA shoulder function score at 1 year postoperatively was better in the MIPO group than in the MINO group (P < 0.05). One patient in the MIPO group experienced wound fat liquefaction, and one patient in the MINO group experienced radial nerve palsy. Conclusion Both MIPO and MINO can achieve satisfactory results in the treatment of humeral shaft fractures, and both minimally invasive techniques are worthy of clinical promotion. However, MIPO has lesser impact on shoulder function.

Diabetic ketoacidosis (DKA) is the most serious acute complication of diabetes mellitus,characterized by rapid onset and progression,which can lead to coma or even lead to death in severe cases. Modern pharmacological studies have shown that some traditional Chinese medicines have the efficacy of inhibiting glycogenolysis,attenuating pancreatic β-cell damage,improving pancreatic β-cell function,and alleviating the obstruction of insulin signalling,which can effectively reduce hyperglycemia and hyperinsulinemia in diabetic mice,as well as improve insulin resistance and other symptoms. At present,the clinical treatment of DKA based on insulin and combined with the use of traditional Chinese medicines,such as clearing heat and diarrhoeing fire to detoxify,benefiting qi and nourishing yin to nourish blood,cooling blood and activate blood circulation to remove blood stasis,strengthening the spleen and the stomach to warm the yang,etc.,can control the condition rapidly,alleviate the symptoms,lower the blood glucose,promote the disappearance of ketones and correct the acidosis,and it can also reduce the dosage of insulin,thus reducing the duration of the disease. This article reviews the literature on the pathogenesis and main treatment options for DKA in western medicine,the etiology and mechanisms of DKA in traditional Chinese medicine,as well as Chinese medicine treatments and prescriptions. The aim is to highlight the advantages of traditional Chinese medicine and provide valuable references for the clinical management of DKA.

ObjectiveTo evaluate the efficacy of stereotactic body radiotherapy combined with coinstan taneous gemcitabine,and gemcitabine alone for advanced pancreatic cancer.Methods56 advanced pancreatic cancer patients were assigned into observation group,which accepted stereotactic body radiotherapy combined with coinstantaneous gemcitabine 500 mg/m2,d1,d8.Other 50 patients were assigned into the control group which only accepted gemcitabine 1 000 mg/m2,d1,d8,d15.Stereotactic body radiotherapy was delivered with a total dose of 4 000-4 500 cGy in 10 fractions.ResultsCT examinations were carried out 2 months after treatment.The response rate of the observation group and control group was 82％ and 16％ respectively,and the pain relief rate was 67％ and 17％ respectively.The time to progression of the observation group was 14 months,and was better than that of the control group(7.5 months,x2 =7.31,P =0.032).The median survival time of the observation group and control group was 15.8 months and 13.2 months,and the difference had no statistical significance(x2 =3.28,P =0.082).ConcolusionStereotactic body radiotherapy combined with gemcitabine has a better overall response rate and a pain relief rate.It can prolong the time to progression,but can't improve the overall survival.

Objective To compare and evaluate the efficacy of three operating procedures to produce permanent rat models of cerebral ischemia, including mortality, neurological evaluation score, infarction volume of ischemia and time consumed in the operation. Methods The rats were randomly divided into three groups. Group 1: The common carotid artery (CCA) and external carotid artery (ECA) were ligated during the operation and ICA was clipped temporarily by artery clamp. Group 2: The CCA and ECA were ligated and the superior thyroid artery and pterygopalatine artery were exposed but not ligated. Silk suture was utilized to hang the internal carotid artery (ICA). Plastic suture was inserted into ICA and stepped over the initiation point of pterygopalatine artery under microscopic observation. Group 3: The CCA and ECA were ligated and ICA was hanged with a silk suture, and the pterygopalatine artery was not exposed, but during the period of inserting plastic suture, the proximal part of the suture was pressed to make the suture's round distal end elevated, and then pass the initial point of pterygopalatine artery. Mortality, neurological score, volume of ischemic infarction and operation time consumed of the three groups were compared after the operation. Results The procedure to prepare the model was most efficient in the group 3, taking only 17.5 min to complete, significantly less than that in the group 1 (50 min) and group 2 (40 min), (P<0.05), and with a lower mortality and more steady neurological evaluation score and infarction volume. Conclusion The use of the third operating method can shorten the operation time and improve the efficacy of operation. Using this method, more consistent and repetitive focal cerebral ischemia models can be produced effectively, and meet the demands of clinical trials.

Objective Investigate the behaviors of cerebral ischemic rats after treatment with bone marrow mesenchymal stem cells(BMSCs).Methods Bone marrow was collected and BMSCs were separated and cultivated.Twenty-four adult male Sprague-Dawley rats were performed transient(2 hours) middle cerebral arterial occlusion(MCAO) and then divided into treated group(n=12) and control group(n=12).All rats received corresponding behavioral training before surgery,15 ?L hBMSCs(2?1010cells/L) and D-hanks(15 ?L) were injected into the brain cortex after 24 h of MCAO.Morris water maze test,NSS,Rotarod test and adhesive-removal test were performed serially and cyclically from the 4th day after transplantation.Results Since the 8th day after transplantation,the mean escape time and the mean swimming distance of treated group significantly are shorter than control's in Morris water maze test(P