Relation between eardrum flap area and healing outcome of traumatic eardrum perforation

OBJECTIVE

To retrospectively study the clinical effects of eardrum flap area on the healing outcome following traumatic perforation.

METHODS

Totally 291 traumatic eardrum perforations with in-/everted edges were included in this study. They were randomly divided into three groups and received conservative treatment, epidermal growth factor (EGF) via Gelfoam patching, or edge-approximation plus Gelfoam patching respectively. Patients in each group were further divided into two subgroups according to the eardrum flap area less than or equal to 1/2 or >1/2 of the perforation size. The healing rate and mean closure time after tympanic membrane perforation were evaluated at three months.

RESULTS

Of the total 291 participants, 281 were included in the final statistical analysis. The area of curled edge did not affect the healing outcome significantly in any groups (P>0.05). The healing rate varied slightly: 90.7% vs 92.3% in spontaneous healing group, 98.2% vs 97.4% in EGF via Gelfoam patching group, and 96.5% vs 100% in edge-approximation plus Gelfoam patching group. In addition, in all groups the area of curled edge did not affect the mean closure time significantly (P>0.05). The closure time was (32.3+/-2.4) d vs (30.6+/-3.1) d in sponaneous healing group, (13.4+/-2.5) d vs (13.1+/-1.9) d in EGF via Gelfoam patching group, and (11.9+/-3.1) d vs (12.2+/-2.1) d in edge-approximation plus Gelfoam patching group.

CONCLUSION

The eardrum flap area of traumatic eardrum perforation does not significantly affect the clinical outcomes.

Topical application of epidermal growth factor with no scaffold material on the healing of human traumatic tympanic membrane perforations

OBJECTIVE

We evaluated the effects of conservative treatment and topical application of epidermal growth factor (EGF) with no scaffold material on the healing of human traumatic tympanic membrane perforations (TMPs).

STUDY DESIGN

Prospective, randomised clinical trial.

METHODS

A prospective analysis was performed between January 2015 and March 2015 for the treatment of human traumatic TMPs. The closure rate, closure time, hearing gain and rate of purulent otorrhoea were compared between the topical application of EGF and conservative treatment.

RESULT

In total, 97 patients were analysed. The total closure rates did not significantly differ between the observation and EGF groups (83.0% versus 92.0%, P = 0.182). The total average closure time in the observation group was significantly longer than in the EGF group (25.1 ± 10.5 versus 11.7 ± 5.2 days, P = 0.001). When the closure rate was evaluated according to perforation size, no significant difference was seen for medium or large perforations (P = 0.18 and 0.21, respectively). When closure time was evaluated according to perforation size, a significant difference was seen for medium and large perforations (P = 0.001).

CONCLUSIONS

This study suggests that topical application of EGF with no scaffold material may significantly shorten the closure time of human traumatic TMPs. Such a shorter recovery time may lead to reduced healthcare costs. This alternative technique to a classic myringoplasty is particularly beneficial and suitable for the closure of large human traumatic TMPs.

Traumatic tympanic membrane perforations: a study of etiology and factors affecting outcome

OBJECTIVE

The purposes of this study were to determine the factors involved in the spontaneous healing and to profile the various etiologies of traumatic tympanic membrane (TM) perforation.

METHODS

A retrospective review was performed on 729 cases of traumatic TM perforation diagnosed in the emergency department and outpatient clinic from January 2007 to March 2011.

RESULTS

A total 641 patients with traumatic TM perforations were enrolled in the study. The group consisted of 320 male and 321 female patients with a mean age of 33.6 years (3-79 years). The types of trauma included compression injury (554 patients), blast injury (55 patients), and instrumental injury (32 patients). The causes of conflict by a slap or a fist were spouse or lover (52%), parents and sibling (3%), school teachers (4%), schoolmate (12%), state police and prisoner (7%), and blow against the ear during street fight (22%). Of the 641, 137 were lost during follow-up; of the remaining 504, perforations closed spontaneously in 451 (89%), within a mean of 27.4 days. Wet perforations with bloody or watery discharge significantly improved the healing rate (P < .01) and shortened the average perforation closure time (P < .01), as compared with dry perforations. Although the perforation that involved malleus or umbo damage did not significantly affect the healing rate (P > .05), a significantly prolonged closure time (41.6 vs 23.8 days) was observed as compared with no damage. However, the curled edges did not also affect the outcome of spontaneous healing; the healing rate was 91% and 88% (P > .05), and the average closure time was 28.1 and 26.7 days (P > .05), respectively, for with and without curler edges. By perforation size, the overall healing rate was 92% and 54% (P < .01), and the average closure time was 22.8 and 47.3 days (P < .01), respectively, for small and larger perforations. Moreover, 7 patients had neomembrane formation on follow-up, 2 developed cholesteatoma, 1 developed tympanosclerosis, and 1 developed facial paralysis.

CONCLUSION

In our experience, domestic violence and street fight were the most common causes of the traumatic TM perforation. Traumatic TM perforations have excellent prognosis. However, preexisting tympanosclerosis and the perforation that involved malleus or umbo damage could lengthen the healing time of perforation, Wet perforations with bloody or watery discharge accelerate the healing, but the curled edges did not affect the outcome of spontaneous healing.

Effect of treatment at different time intervals for traumatic tympanic membrane perforation on the closure

CONCLUSION

Treatment of traumatic tympanic membrane (TM) perforation with everted or involute edge flaps at different time intervals within 1 week after the injury did not affect the perforation closure rate and mean closure time.

OBJECTIVE

To retrospectively analyze the effect of treatment at different time intervals for traumatic tympanic membrane perforation with gelatin sponge patch and edge approximation plus gelfoam patching.

METHODS

Patients with traumatic TM perforation visited at different days since the injury for medical treatment (1, 2, 3, 4, and 5-7 days post trauma). These patients were treated with the following prominent methods of treatment: gelatin sponge patch treatment and edge approximation plus gelfoam patching. Measurement indicators were perforation closure rate and mean closure time at 3 months.

RESULTS

In the group treated with the gelatin sponge patch technique, the patients sought medical treatment at different time intervals since the injury. Accordingly, the outcome of the treatment varied in terms of the perforation closure rates achieved in different patients in this group. The respective perforation closure rates were 100%, 100%, 96%, 94%, and 89% in accordance with the time interval at which the patients were treated since the injury. The results were not significantly different when compared by statistical analysis (p > 0.05); the mean closure times in each of the different sets of cases in this group were calculated and the following values were reported: 7.1 ± 2.3, 8.2 ± 1.6, 8.7 ± 1.2, 9.2 ± 3.1, and 10.7 ± 3.9 days. On the other hand, in the edge approximation plus gelfoam patching group, the perforation closure rates were 100%, 97%, 96%, 97%, and 94%, respectively. This was in accordance with the time elapsed since the injury for the patients who visited the hospital on different days. Statistical analysis confirmed that the perforation closure rates for the different cases of this group did not have any significant difference (p > 0.05); the mean closure times were 7.6 ± 1.9, 7.9 ± 2.2, 9.2 ± 2.8, 8.5 ± 3.6, and 11.2 ± 4.1 days, respectively, indicating that differences were not significant even in terms of mean closure rates for the different cases of this group (p > 0.05).

A new biologically active acylated triterpene saponin from Silene fortunei

A new acylated triterpene-saponin (1), together with a mixture of the known jenisseensosides C and D, has been isolated from the roots of Silene fortunei. The structure of the new compound was established by chemical means and spectroscopic methods as 3-O-[beta-D-galactopyranosyl-(1-->2)-beta-D-glucuronopyranosyl]-28 -O- [[alpha-L-arabinopyranosyl-(1-->2)-alpha-L-arabinopyranosyl- (1-->3)-b eta-D-xylopyranosyl-(1-->4)-alpha-L-rhamnopyranosyl-(1-->2)]-[beta-D- glucopyranosyl-(1-->3)]-4-O-acetyl-beta-D-fucopyranosyl]quillaic acid. This saponin showed a significant enhancement of granulocyte phagocytosis in vitro.

Jennisseensosides C and D, biologically active acylated triterpene saponins from Silene jenisseensis

We previously reported the isolation and structure elucidation of a new trans-p-methoxycinnamoyl triterpene-saponin along with its cis-p-methoxycinnamoyl isomer as an inseparable mixture from the roots of Silene jenisseensis. In a continuing study on this plant, two additional new acylated triterpene-saponins were obtained as an inseparable mixture. Their structures have been established by chemical means and spectroscopic methods including 1D and 2D homonuclear and heteronuclear correlation NMR spectroscopy as 3-O-[beta-D-galactopyranosyl-(1-->2)-beta-D-glucuronopyranosyl]-28 -O-[{alpha-L-rhamnopyranosyl-(1-->2)}-{4-O-trans-p-methoxycinnamoyl++ +}-beta-D-fucopyranosyl] quillaic acid and its cis-isomer, respectively. They showed a significant enhancement of the granulocyte phagocytosis in vitro.

[Studies on liposoluble constituents from the aerial parts of Siegesbeckia orientalis L]

Eight compounds were isolated from the aerial parts of Siegesbeckia orientalis L. and their structures were elucidated by spectroscopic methods(IR, EI-MS, 13C-NMR, 1H-NMR, 1H-1H COSY, 1H-1H NOESY and 1H-13C COSY). Compounds I and II are new natural products and named siegesesteric acid(I) and siegesetheric acid(II), their structures were confirmed as ent-17-acetoxy-18-isobutyryloxy-16(alpha)-kauran-19-oic acid(I) and ent-17-ethoxy-16(alpha)-(-)-kauran-19-oic acid(II). The others were identified as known compounds: ent-16 beta, 17-dihydroxy-kauran-19-oic acid (III), kirenol(IV), beta-sitosteryl glucoside(V), heneicosanol(VI), methyl arachidate(VII) and beta-sitosterol(VIII). These compounds, except kirenol and beta-sitosterol, were isolated for the first time from the title plant.

[Analysis of phenylethanoid glycosides of Herba cistanchis by RP-HPLC]

The Chinese drug "Rou Cong-rong" (Herba Cistanchis) is one of the commonly used drugs in Chinese traditional medicine. It is used to reinforce the vital function of kidney, especially that of the sexual organs and induce laxation, for the treatment of impotence, premature ejaculation in men, infertility, morbid leukorrhea, profuse metrorrhagia in women, and chronic constipation in the aged. This paper deals with the qualitative and quantitative analysis of phenylethanoid glycosides of four species and one variety of Genus Cistanche and 23 lots of commercial crude drugs of Herba Cistanchis by RP-HPLC. The results were as follows: the chemical constituents of Cistanche deserticola Ma, C. salsa (C. A. Mey) G. Beck, C. salsa var. albiflora P. F. Tu et Z. C. Lou and C. tubulosa were similar while those of C. sinensis were different from the others; the contents of echinacoside and acteoside of C. salsa, which were 2.13% and 1.51%, were the highest of the genus Cistanche. An ODS column (Alltima C18, 5 microns, 250 x 4.6 mm) was employed. Linear gradient elution of acetonitrile--1.5% acetic acid was used as mobile phase, and concentration of acetontrile was from 8% to 20% (0-60 min) in the qualitative analysis, and from 11.5 to 20% (0-35 min) in the quantitative analysis. The flow rate was 1.2 ml.min-1. The detection wavelength was set at 335 nm.

Acylated triterpene saponins from Silene jenisseensis

From the roots of Silene jenisseensis a new trans-p-methoxycinnamoyl triterpene saponin has been isolated along with its cis-p-methoxycinnamoyl isomer as an inseparable mixture. Their structures were established by chemical means and spectroscopic methods including 1D- and 2D-homonuclear and heteronuclear correlation NMR spectroscopy as 3-O-[beta-D-galactopyranosyl-(1 --> 2)-beta-D-glucuronopyranosyl]-28-O-[beta-D-glucopyranosyl-(1 --> 2)-alpha-L-rhamnopyranosyl- (1 --> 2)-beta-D-4-O-trans-p-methoxycinnamoyl-fucopyranosyl] quillaic acid and its cis-isomer, respectively. They did not show any activity in the in vitro chemoluminescence granulocytes assay, but exhibited only a weak inhibitory effect in the cyclooxygenase inhibition assay.

[Chemical components of volatile oil from Echinops grijisii Hance]

The volatile oil obtained from Echinops grijisii roots was analysed by GC-MS method. Twenty four constituents have been identified from the oil, among which cis-beta-farnesene and 5-(3-buten-1-ynyl)bithiophene are the main ones.

[Herbalogical studies on rou congrong (herba Cistanchis)]

This paper deals with the investigation of the original plants of Rou Congrong and Cao Congrong recorded in the herbalogical works of the past dynasties. The results have shown that Rou Congrong is the dried fleshy stem of Cistanche deserticola and C. salsa, and Cao Congrong is the dried fleshy stem of Orobanche coerulescens. The substitutes and false drugs of Rou Congrong were also investigated.

[An investigation of medicinal Rhodiola in Sichuan Province]

Twenty-two species of Rhodiola produced in Sichuan Province are reported in this paper, including their distributions, habitats and localities. Among them, there is a new species named Rhodiola wolongensis. Its morphology has been described in Latin. I key for the identification of all these 22 species has been compiled and presented.

Glyyunnansapogenins G and H: Two New Pentacyclic Triterpenoids of the 18alphaH-Oleana-9(11),12-diene Type from Glycyrrhiza yunnanensis Roots

Two new pentacyclic triterpenoid sapogenins of the 18alpha H-oleana-9(11),12-diene type named glyyunnansapogenins G and H were isolated from the roots of GLYCYRRHIZA YUNNANENSIS Cheng f. et L. K. Tai. Their structures were elucidated as 18alpha H-oleana-9(11),12-diene-3beta,21alpha,29-triol and 18alpha H-3beta,21alpha-dihydroxyoleana-9(11),12-dien-29-oic acid, respectively, by spectroscopic methods. This is the first report of the occurrence of the 18alpha H series of oleana-9(11),12-diene compounds in nature.

[Herbalogic studies on the Chinese drug fangfeng]

Through a critical study of the descriptions of Fangfeng in the ancient Chinese herbals, it may be concluded that the chief botanical source of this drug was Saposhnikovia divaricata, besides, the roots of Peucedanum ledebourielloides and P. wawrii may also be used. The root of Glehnia littoralis may be used as an substitute and called Shifangfeng. The difference in geographical sources of Fangfeng in ancient and present times is also discussed.