Study on release and antioxidant activity of quercetin after loaded by hot alkali hydrolysis modified UiO-66 material / 药学学报

UiO-66 (University of Oslo 66) is a kind of promising material that can improve the release and bioavailability of poorly water-soluble bioactive compounds of traditional Chinese medicine. However, the loading of quercetin in raw UiO-66 was not ideal. In this study, UiO-66-BH (UiO-66-blend-heating) was obtained by heating UiO-66 and KOH solution following blended them. UiO-66-BH maintained the outline of octahedral structure of UiO-66 but with obvious rough and uneven pores on the surface. UiO-66-BH had good adsorption of quercetin with saturation adsorption was 138.92 mg·g-1, the adsorption process belonged to single molecular layer adsorption and was controlled by chemisorption. UiO-66-BH can control the release of quercetin in simulated gastrointestinal fluid, and the drug concentration was significantly higher than that of free quercetin after long-term release (36% vs 9%). Compared with quercetin, the ABTS (2,2′-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) ammonium salt) radical scavenging activity of UiO-66-BH@quercetin drug delivery system decreased, while the DPPH (1,1-diphenyl-2-picrylhydrazyl) radical scavenging activity remained almost unchanged. The drug delivery system showed a strong antioxidant effect similar to quercetin. The findings indicated that UiO-66-BH could control release of quercetin and was expected to be used as a drug carrier material for some insoluble active components of traditional Chinese medicine such as quercetin.

Shengmai San for Treatment of Cardiotoxicity from Anthracyclines: A Systematic Review and Meta-Analysis / 中国结合医学杂志

OBJECTIVE@#To systematically evaluate the efficacy of Shengmai San in patients with cardiotoxicity of anthracyclines.@*METHODS@#Randomized controlled trials (RCTs) were identified by searching China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), PubMed, Cochrane Library, and Embase Databases from the inceptions until December 2020. The Cochrane Handbook was used to evaluate the risk of bias in the included studies. Data analysis was conducted using RevMan 5.3 software.@*RESULTS@#Totally 19 RCTs with 2,331 participants were included in this review. Results showed that in improving arrhythmia (13 RCTs, n=1,877, RR=0.37, 95%CI 0.25 to 0.52, P<0.00001), the treatment group was superior to the control group. In terms of reducing left ventricular end-diastolic diameter (LVEDD, 2 RCTs, n=128, MD=-0.79, 95%CI -0.93 to -0.65, P<0.00001) and left ventricular end systolic diameter (LVESD, 2 RCTs, n=128, MD=-0.58, 95%CI -0.82 to -0.35, P<0.00001), the treatment group was also better than the control group. In reducing myocardial enzymes such as creatine kinase (CK) [(3 RCTs, n=256, SMD=-0.80, 95%CI -1.16 to -0.44, P<0.0001), (2 RCTs, n=126, SMD=-0.62, 95%CI -0.98 to -0.26, P=0.0007)], the treatment group was superior to the control group.@*CONCLUSION@#Shengmai San has a positive effect on the treatment of cardiotoxicity from anthracyclines. However, in the future, it is still necessary to conduct high-quality RCTs to verify its efficacy.

Coronavirus disease 2019 vaccines: landscape of global studies and potential risks / 中华医学杂志(英文版)

With the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, the importance of vaccines in epidemic prevention and public health has become even more obvious than ever. However, the emergence of multiple severe acute respiratory syndrome coronavirus 2 variants worldwide has raised concerns about the effectiveness of current COVID-19 vaccines. Here, we review the characteristics of COVID-19 vaccine candidates in five platforms and the latest clinical trial results of them. In addition, we further discuss future directions for the research and development of the next generation of COVID-19 vaccines. We also summarize the serious adverse events reported recently after the large-scale vaccination with the current COVID-19 vaccines, including the thromboembolism caused by the AstraZeneca and Johnson & Johnson vaccines.

Meta-analysis on effectiveness of live attenuated influenza vaccine against seasonal influenza in children / 中华流行病学杂志

To evaluate the effectiveness of live attenuated influenza vaccine (LAIV) in the prevention of seasonal influenza in children aged 2-17 years. Literature retrieval of case-control studies on the effectiveness of LAIV against seasonal influenza in children published from January 2003 to November 2018 was conducted through Web of Science, PubMed, and ScienceDirect databases. The Stata 13.1 software was used for Meta-analysis. A total of 14 studies were included in this study, and all were test-negative design (TND) studies. Our Meta-analysis showed that the effectiveness of LAIV in children was 49 (95: 40-57). Subgroup analysis found that the protection rate of LAIV was 35 against influenza A (H1N1) pdm09 (95: 5-56), 35 against influenza A (H3N2) (95: 21-46), and 71 against influenza B (95: 55-82). The protection rates of trivalent LAIV and quadrivalent LAIV in children were 56 (95: 48-63) and 44 (95: 27-57), respectively. The protection rates of LAIV in Europe and North America were 65 (95: 47-77) and 46 (95: 36-55), respectively. LAIV has a certain preventive effect on seasonal influenza in children aged 2-17 years.

Effect of Flurbiprofen Axetil on Low-frequency Fluctuation Amplitude of Resting-state Functional Magnetic Resonance Imaging in Trigeminal Neuralgia / 中国医学科学院学报

Objective To observe the changes of brain function in patients with trigeminal neuralgia after administration of flurbiprofen axetil by using the resting-state functional magnetic resonance imaging(fMRI)and based on the amplitude of low-frequency fluctuation(ALFF). Methods Resting fMRI data of 20 patients with trigeminal neuralgia before and after treatment with flurbiprofen axetil were collected by 1.5T magnetic resonance imaging system.The resting fMRI data were pretreated by Statistical Parametric Mapping and DPABI(a toolbox for Data Processing and Analysis for Brain Imaging)software,and the difference of low-frequency oscillation amplitude of brain spontaneous activity before and after treatment with flurbiprofen axetil was analyzed by ALFF. Results The Visual Analogue Scale of pain intensity after flurbiprofen axetil injection was significantly lower than that before administration,and the pain relieved significantly(P=0.000).The ALFF values of right dorsolateral prefrontal lobe,bilateral medial prefrontal lobe,and right middle cingulate gyrus in patients treated with flurbiprofen axetil at rest were significantly lower than those before administration(P=0.000). Conclusions The analgesic effect of flurbiprofen axetil is exerted on the central system.This agent can inhibit the abnormal brain function caused by chronic pain stimulation and thus reduce pain.However,the specific mechanism needs further investigations.

Effect of Biling Qutong Prescription on SIRT3 Protein Expression and URAT1 mRNA in Skeletal Muscle of Diabetic Gout Rats / 中国实验方剂学杂志

Objective: To observe the effect of phlegm and blood stasis on the expressions of sirtuin 3(SIRT3)protein and urate transporter 1(URAT1) mRNA in skeletal muscle of diabetic rats with gout. Method: The 40 healthy rats, excepting the normal group, the remaining groups were fed with high-fat diet combined with low-dose streptozotocin solution (40 mg·kg-1) once a day, with blood glucose "16.7 mmol·L-1" as the criterion for the diabetes model. After 4 days, the 5% sodium urate solution was injected into the joint cavity once to induce the gout model. After the successful modeling, the Biling group (10 g·kg-1), the indomethacin group (5 mg·kg-1) and the pioglitazone group (10 mg·kg-1) continued to be administered for 21 days. The normal group and the model group were given the same amount of normal saline. The expression of SIRT3 protein in skeletal muscle tissue was determined by Western blot, URAT1 mRNA expression in bone tissue was detected by quantitative real-time fluorescence polymerase chain reaction(Real-time PCR),and blood was collected to measure blood glucose (GLU), blood uric acid (UA) and C-reactive protein (CRP). Result: Compared with the normal group, GLU, UA and CRP in the model group were significantly increased (PPPPPPPPConclusion: Biling Qutong prescription with effects in purging turbidity, detoxifying and dredging collaterals can significantly reduce the content of serum inflammatory factor CRP, significantly increase the protein expression of SIRT3 in skeletal muscle tissue of model rats, lower the content of URAT1 mRNA, reduce the blood glucose and blood uric acid levels in diabetic gout rats, and protect joints.

Textual Research on Processing Methods of Pinelliae Rhizoma in Successive Dynasties / 中国实验方剂学杂志

This paper discussed the processing methods of Pinelliae Rhizoma in the successive dynasties by consulting ancient and modern books, literature and related codes. The processing methods of Pinelliae Rhizoma has experienced various historical periods. Since the processing method of Pinelliae Rhizoma processed by slicing appeared in the Huangdi Neijing, there have been a series of different processing methods and requirements are founded, such as cleansing, cutting, decocting and so on. Among them, the raw Pinelliae Rhizoma, Pinelliae Rhizoma Praeparatum, Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine, Pinelliae Rhizoma Praeparatum cum Alumine are still in use today and are widely used. However, there are differences in the processing methods, accessories and their dosages of these various processed products in different dynasty. The processing technology and quality standard of Pinelliae Rhizoma need to be further standardization.

Relationship of PTEN/PI3K/AKT Signaling Pathway Protein Expression with Apoptosis and Drug-resistance of Children's ALL Primary Cells Treated with Daunorubicin / 中国实验血液学杂志

OBJECTIVE@#To investigate the relationship of PTEN/PI3K/AKT signaling pathway protein expression with apoptosis and drug-resistance of children's ALL primary cells treated with daunorubicin (DNR).@*METHODS@#The bone marrow mononuclear cells in newly diagnosed and untreated B-ALL children were collected and cultured. After the treatment of primary-cultured cells with DNR of final concentration 0.5 mg/L for 24 h, the cell apoptosis rate was detected by using cell apoptosis assay kit; the samples were collected at the on test of culture and after drug treatment, then expression levels of PTEN, PI3K and AKT proteins were detected by Western blot, moreover the interindex correlation was analyzed.@*RESULTS@#After DNR treatment, the apoptosis rate in PTEN low expression group was lower than that in PTEN high expression group (P＜0.05), showing high positive correlation of the cell apoptosis rate with the expression of PTEN before DNR treatment; the cell apoptosis rate in PI3K and AKT low expression group was higher than that in PI3K and AKT high expression group (P＜0.01); however, the expression of PI3K and AKT proteins was down-regulated after treatment with DNR (P＜0.01).@*CONCLUSION@#The difference of PTEN expression is present in primary cells of B-ALL children, however the change of PTEN expression is not significant after DNR treatment, suggesting that the PTEN expression correlates with DNR-resistance. The DNR can induce the apoptosis of childrens B-ALL primary cells by down-regulating the expression of PI3K and AKT signaling pathway proteins.

Therapy approaches in treatment of recurrent ischemic angina with internal mammary artery bridge after coronary artery bypass grafting / 西安交通大学学报(医学版)

Objective To investigate the clinical therapeutic methods and their curative effects in recurrent ischemic angina for internal mammary artery resterosis after coronary artery bypass grafting (CABG).Methods We enrolled the patients who had recurrence of ischemic angina for restenosis of internal mammary artery graft after CABG as research subjects in the Affiliated Hospital of Yan'an University from January 2014 to January 2016.The 42 patients were divided into three groups according to the different treatment approaches for recurrence of ischemic angina:Group A (n=22)who received internal mammary artery interventional therapy;Group B (n=12)who received coronary artery bypass grafting treatment;and Group C (n=8)who received left subclavian artery proximal stent treatment.Then we compared the clinical therapeutic effects in the three groups.Results The success rate in Group C was 100%,which was the highest in the three groups,and the post-operative restenosis rate was 0.The hospitalization time was significantly shorter in Group A than in Group B (P＜0.05).However,the two groups did not significantly differ in mortality,success rate or restenosis rate (P＞0.05).Conclusion We should select the appropriate treatment according to the patient's specific situation for recurrent ischemic angina. Endovascular treatment has evident therapeutic effects,rapid postoperative recovery,and lower treatment risk, making it the preferred treatment when possible.

Discussion on Professor WU Liang-cun's Experience in Treating Primary Hepatic Carcinoma with Enriching Water to Nourish Wood Method / 中国中医药信息杂志

Professor WU Liang-cun is good at the treatment of primary hepatic carcinoma. He views that the main pathogenesis of primary hepatic carcinoma is liver and kidney deficiency. Therefore, treatment should be based on enriching water to nourish wood, with soothing the liver and regulating qi, clearing the gallbladder and removing dampness, promoting blood circulation for removing blood stasis, detoxicating and resolving masses.

Medical Cases of Clinical Application of Food Guide Sluggish Method / 中国中医药信息杂志

Different diseases may have the same pathogenesis in the development process of the disease. Accurately grasping the main symptoms of the disease to analyze pathogenesis is a prerequisite for prescription and medication, and the guarantee to enhance the clinical efficacy as well. Diet injuries are common pathogenic factors of pediatric diseases, which can cause respiratory, digestive and nervous and others system diseases. Diet injures should be paid attention in clinical syndrome differentiation. This article analyzed the application of food guide sluggish method in pediatric diseases through medical cases, with a purpose to give more inspiration to clinical doctors.

An analysis on the surveillance results of safety of post-marketing immunization of varicella attenuated live vaccine in Henan Province / 预防医学

Objective To analyze the characteristics of adverse reactions for varicella attenuated live vaccine (VarV) in Henan Province from 2011 to 2016, in order to evaluate the immunization safety related to VarV. Methods The adverse reaction data and vaccination doses of VarV in Henan Province from 2011 to 2016 were collected through the China Information Management System for Immunization Programming. The descriptive methodology was used for data analysis. Results A total of 686 adverse reactions cases were reported in Henan Province from 2011 to 2016, and the average reported incidence rate was 16.89 per 100000 dose. The ratio of male to female was 1.14:1, and 80.61% cases occurred between 1 and 2 years old, and the reported incidence rate was 13.62 per 100000 dose. And 32.80% cases were reported from April to June, and the reported incidence rate was 5.54 per 100000 dose. The cases were mainly concentrated in Zhengzhou, Luoyang, Zhoukou and Xinyang. Most cases occurred after the first dose and within 1 d after vaccination. The main diagnoses of adverse reactions were fever, local swelling, indurations and transient anaphylactic disorders. The reported incidence rate of anaphylactic shock and fever convulsion were 0.37 per 100000 dose and 0.12 per 100000 dose respectively. All cases were recovered or got better. Conclusion The safety of VarV was good in Henan Province. However, the surveillance should focus on the anaphylactic shock and fever convulsion and other serious rare adverse reaction.

Clinical features and ETFDH mutations of children with late-onset glutaric aciduria type II: a report of two cases / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical and genetic features of two families with late-onset glutaric aciduria type II caused by ETFDH mutations.</p><p><b>METHODS</b>Target gene sequence capture and next generation sequencing were used for sequencing of suspected patients and their family members. The patients' clinical features were retrospectively analyzed and literature review was performed.</p><p><b>RESULTS</b>The probands of the two families had a clinical onset at the ages of 10 years and 5.5 years respectively, with the clinical manifestations of muscle weakness and muscle pain. Laboratory examinations revealed significant increases in the serum levels of creatine kinase, creatine kinase-MB, and lactate dehydrogenase. Tandem mass spectrometry showed increases in various types of acylcarnitines. The analysis of urine organic acids showed an increase in glutaric acid. Electromyography showed myogenic damage in both patients. Gene detection showed two novel mutations in the ETFDH gene (c.1331T>C from the mother and c.824C>T from the father) in patient 1, and the patient's younger brother carried the c.1331T>C mutation but had a normal phenotype. In patient 2, there was a novel mutation (c.177insT from the father) and a known mutation (c.1474T>C from the mother) in the ETFDH gene. Several family members carried such mutations. Both patients were diagnosed with glutaric aciduria type II. Their symptoms were improved after high-dose vitamin B2 treatment.</p><p><b>CONCLUSIONS</b>For patients with unexplained muscle weakness and pain, serum creatine kinase, acylcarnitines, and urinary organic acids should be measured, and the possibility of glutaric aciduria type II should be considered. Genetic detection is helpful to make a confirmed diagnosis.</p>

The reference value of NGAL in sepsis patients with AKI to choose the timing of CRRT treatment / 中国基层医药

Objective To evaluate the reference value of NGAL in sepsis patients with AKI to choose the timing of continuous renal replacement therapy (CRRT)treatment.Methods 62 sepsis patients with AKI were enrolled in this study.Within 24 hours after the diagnosis,the patients'urine samples were collected,the urinary NGAL levels were measured by ELISA.At the same time,the clinical parameters were collected,such as serum creatinine, blood urea nitrogen,blood leukocytes,etc.Depending on whether patients need to receive CRRT,the patients were divided into sepsis CRRT group and septic non CRRT group,the clinical data of the two groups were compared.ROC analysis was performed to evaluate the reference value of NGAL in sepsis patients with AKI to choose the timing of CRRT treatment.Results Total 62 sepsis patients with AKI were enrolled in this study.Ultimately,27 patients received CRRT treatment.Within 24 hours after the diagnosis,the clinical parameters of the two groups,such as serum creatinine,blood urea nitrogen and blood leukocytes showed no significant differences (all P >0.05);but the urinary NGAL level of sepsis CRRT group[(7.9 ±2.5)pg·mL -1 ·cr -1 ]was significantly higher than sepsis non CRRT group[(4.1 ±1.3)pg·mL -1 ·cr -1 ](t =12.912,P <0.01).ROC analysis showed that the area under the curve (AUC)for the value of NGAL in sepsis patients with AKI to choose the timing of CRRT treatment was 0.892(95%CI:0.775 ~0.898,P <0.01).Conclusion Urinary NGAL has a certain reference value in sepsis patients with AKI to choose the timing of CRRT treatment,could contribute to early intervention CRRT treatment.

Research advances in association between pediatric obesity and bronchial asthma / 中国当代儿科杂志

This review article introduces the research advances in the pathophysiological mechanism of obesity in inducing pediatric bronchial asthma, including the role of leptin in obesity and asthma, the association of plasminogen activator inhibitor-1 with obesity and asthma, the association of adiponectin and interleukins with obesity and asthma, and the influence of neurotransmitter on asthma. In particular, this article introduces the latest research on the inhibition of allergic asthma through targeting at the nociceptor of dorsal root ganglion and blocking the signaling pathway of the nociceptor.

Association between Helicobacter pylori infection and newly diagnosed childhood immune thrombocytopenia / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the role of Helicobacter pylori (H. pylori) infection in newly diagnosed childhood immune thrombocytopenia (ITP).</p><p><b>METHODS</b>A total of 495 children with newly diagnosed ITP who were hospitalized for the first time between January 2011 and December 2013 were included as the case group. A total of 123 children with common respiratory tract infection (not ITP or other diseases of blood system) were randomly selected as the control group. All patients were divided into four groups by age: <1 year group, 1-3 years group, 3-7 years group, and 7-14 years group. The incidence of H. pylori infection in all age groups and the clinical outcomes of ITP children with or without H. pylori infection were retrospectively analyzed.</p><p><b>RESULTS</b>The incidence rate of H. pylori infection in the case group increased with increasing age. There was no significant difference in the incidence rate of H. pylori infection between the case and the control groups among subjects of the same age (P>0.05). All the ITP patients were not given anti-H. pylori treatment and only received the treatment (glucocorticoid and/or immunoglobulin) for ITP, and their remission rate declined with increasing age. There was no significant difference in the remission rate between the ITP children with H. pylori infection and those without H. pylori infection in the same age group (P>0.05).</p><p><b>CONCLUSIONS</b>H. pylori infection may not be a major cause of ITP in children, and the clinical outcomes of children with acute ITP are not affected by receiving anti-H. pylori treatment or not.</p>

Comparison of protective effects of safflor injection and extract of Ginkgo biloba on lung ischemia/reperfusion injury in rabbits / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the protective effects of safflor Injection (SI) and extract of Ginkgo biloba (EGB) on lung ischemia-reperfusion injury (LIRI) and investigate its mechanism.</p><p><b>METHODS</b>In vivo rabbit model of LIRI was reconstructed. Forty rabbits were randomly and equally divided into four groups: sham-operation group (sham group), ischemia-reperfusion group (model group), ischemia-reperfusion plus SI group (safflor group) and ischemia-reperfusion plus EGB injection group (EGB group). Malondialdehyde (MDA) content, superoxide dismutase (SOD) and xanthine oxidase (XO) activity in serum were measured. The wet/dry weight ratio (W/D) of the lung tissue and activity of myeloperoxidase (MPO) were also tested. Ultrastructure change of the lung tissue was observed by the electron microscope. The expression of intercellular adhesion molecule-1 (ICAM-1) was measured by immunohistochemistry (IHC).</p><p><b>RESULTS</b>In the model group, MDA and XO increased and SOD decreased in serum compared with the sham group (P<0.01). The values of W/D, MPO and ICAM-1 of the model group were higher than those of the sham group (P<0.01), but those of the safflor group and EGB group were significantly lower than those of the model group (P<0.01). The IHC demonstrated that ICAM-1 expression in lung tissue of the model group was significantly higher than those of the safflor group (P<0.01). Compared with safflor group, in the EGB group MDA, XO, MPO decreased, SOD and ICAM-1 expression increased (P<0.05), but the change of W/D was not statistically significant (P>0.05).</p><p><b>CONCLUSIONS</b>SI and EGB may attenuate LIRI through antioxidation, inhibition of neutrophil aggregation and down-regulation of ICAM-1 expression. But EGB had more effect on the antioxidation, while SI did better on regulating ICAM-1 expression.</p>

Association between ZNF365 gene polymorphisms and bronchial asthma in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the association of single nucleotide polymorphisms (SNP) (rs2393903 and rs10995251) in ZNF365 gene with bronchial asthma and its clinical characteristics in Han Chinese children in Hubei, China.</p><p><b>METHODS</b>A total of 221 children with bronchial asthma and 243 normal children, all of whom were from Hubei, were recruited to carry out a case-control study. The genotype and allele frequencies of two SNPs in ZNF365 gene were determined using the polymerase chain reaction-restriction fragment length polymorphism technique.</p><p><b>RESULTS</b>There were no significant differences in the distribution of three genotypes (GG, GA, AA) and allele frequency in SNP rs2393903 between the asthma and control groups (P>0.05). However, there were significant differences in the distribution of three genotypes (CC, CT, TT) and allele frequency in SNP rs10995251 between the asthma and control groups (P<0.05); C allele was a risk factor (OR=1.380). The asthmatic children with CC genotype of SNP rs10995251 had a significantly higher serum level of total immunoglobulin E (IgE) than those with TT genotype (P<0.05).</p><p><b>CONCLUSIONS</b>The SNP rs10995251 in ZNF365 gene is associated with the susceptibility to bronchial asthma in children in Hubei, China, and the SNP may affect the level of serum IgE in these children.</p>

Association between gene polymorphism of CD40 gene and coronary artery lesion in Kawasaki disease / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the association between two single nucleotide polymorphisms (rs4810485 and rs1535045 in CD40 gene) and Kawasaki disease (KD) in Han Chinese children.</p><p><b>METHODS</b>A case-control study was performed on 184 children with KD and 206 normal controls. The polymorphisms of two SNPs in CD40 gene were detected using PCR-RFLP.</p><p><b>RESULTS</b>There were no significant differences in the genotype distribution and allele frequency of SNP rs4810485 in CD40 gene between the KD and normal groups (P>0.05). The genotype distribution of SNP rs1535045 in CD40 gene in the KD group was significantly different from the control group (P<0.05). T allele of SNP rs1535045 was shown as a risk factor for development of KD (OR=1.592, 95%CI: 1.182-2.144, P=0.004). There were no association between the polymorphisms of the two SNPs and coronary artery lesions (P>0.05).</p><p><b>CONCLUSIONS</b>SNP rs1535045 may be associated with the development of KD in Han Chinese children, while SNP rs4810485 may not.</p>

Trans-extradural approach to resect trigeminal schwannomas involving the cavernous sinus region / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the techniques and effect of extradural approach for the resection of trigeminal schwannomas involving the cavernous sinus.</p><p><b>METHODS</b>Twenty-three patients (range 26-63 years, mean age 46.2 years) with trigeminal schwannomas involving the cavernous sinus treated by middle fossa extradural approach were retrospectively analyzed. Frontotemporal orbitozygomatic extradural approach was performed in 2 patients. Frontotemporal zygomatic extradural approach was carried out in 21 patients. The first follow-up visit was on the 3rd month after surgery, and if residual was observed on enhanced MRI, then the patient was followed up every 6 months; otherwise, the patient was followed up every 8-12 months.</p><p><b>RESULTS</b>The length of hospital stay after surgery was 7-13 days (mean 8.5 days). Two tumors originated from the ophthalmic branch, 2 from the maxillary branch, 5 from the mandibular branch and 14 from the gasserian ganglion. Total resection was achieved in 21 of the 23 patients (91.3%) and subtotal resection in the other 2 patients. All the patients were followed up from 3 months to 4 years. Median follow-up time was 19 months. The most common symptom was facial hypoesthesia, occurring in 18 patients. This symptom improved in 10 patients and worsened in 8 patients after surgery. New postoperative facial hypoesthesia was observed in 2 patients. Facial pain was observed in 3 patients and subsided after surgery. Two patients had loss of hearing, this symptom improved in 1 patient and worsened in 1 patient after surgery. Diplopia was observed in 6 patients. In 1 of these 6 patients, diplopia resulted from palsy of the oculomotor nerve. In the other 5 patients, diplopia resulted from palsy of the abducens nerve. This symptom improved postoperatively in all these 6 patients. New postoperative atrophy of the temporalis muscle was observed in 3 patients. There was no operation-related mortality. Tumor recurrence was only found in 1 patient after 24 months and was treated by Gamma knife.</p><p><b>CONCLUSIONS</b>The middle fossa extradural approach may be an ideal option for the resection of trigeminal schwannomas involving the cavernous sinus. This approach produces no further impairment, less complication, and is less likely to injured the trigeminal nerve, abducens nerve, trochlear nerve and internal carotid artery.</p>