High-transmission polarization-dependent active plasmonic color filters

Plasmonic color filters, exhibiting great promise as an alternative for existing colorant-based filters, often only output one fixed color. Developing active color filters with controllable color output will lead to more compact color filter-based devices. In this paper, we present an approach to achieve active color filtering with a polarization-dependent plasmonic structural color filter, which comprises arrays of asymmetric cross-shaped nanoapertures in an ultrathin film of silver. A systematical study for aperture size, array period, and the thickness of silver film dependences of color filter properties is carried out, and strategies for polarization-dependent color filter designing are generated. A polarization-dependent and high tunability of color can be achieved by selecting the appropriate nanostructure parameters, which imply many potential applications.

Correlations of ultrasonic features with severity of liver cancer and p16 expression in patients with liver cancer

This paper analyzes the correlations of ultrasonic features with clinical-pathological manifestations and p16 expression in patients with liver cancer. A total of 84 patients with primary liver cancer were randomly enrolled. The characteristics of liver cancer were examined via conventional ultrasound and contrast-enhanced ultrasound (CEUS) before operation. The p16 protein expressions in liver cancer and para-carcinoma tissues were detected via immunohistochemistry (IHC), and the correlations of p16 positive expression with ultrasound parameters were also analyzed. It was manifested via ultrasound that 6.4% (3/47) of stage I-II liver cancer showed the equal-echo change in portal phase, while others faded and showed the equal-echo change with 32.4% (12/37) of stage III-IV liver cancer. There were no statistically significant differences in ultrasonic features of patients in stage I-II and stage III-IV in the arterial and delayed phases (p>0.05). The positive expression rate of p16 protein in para-carcinoma tissues was 85.71% (72/84) which was significantly higher than that in liver cancer tissues (30.95%, 26/84) (p<0.05). Maximum intensity (IMAX), time to peak (TTP) and mean transit time (mTT) had no statistically significant differences between the p16 positive and negative groups, but there were statistically significant differences in rising slope (RS) and washout time (WT) (p<0.05). Correlation analyses revealed that the positive expression of p16 had no significant correlations with IMAX, mTT and TTP (p>0.05), but it positively correlated with RS (correlation coefficient r=0.377, p<0.05) and negatively correlated with WT (r=-0.410, p<0.05). Conventional ultrasound and CEUS can evaluate the expression of p16 protein in liver cancer repeatedly and non-invasively. The evaluations therefore have great significance in clinical treatment of liver cancer.

[The progress of topical drug delivery to the inner ear for the inhibition of inflammation and fibrosis following cochlear implantation]

Nowadays, more than 300 000 deaf people around the world benefit from cochlea implantation. With the extension of cochlear implantation indications, it has become a research focus for how to apply the anti-inflammatory and anti-fibrotic drugs safely and effectively to better retain residual hearing, as well as to protect hair cells and the spiral ganglion cells from apoptosis. Due to the blood-labyrinth barrier, perioperative systemic steroids are often unable to achieve satisfactory drug concentration in the inner ear. Also, given that higher doses of steroids will cause more serious side effects and sometimes steroids are strictly limited to apply on some patients with certain diseases, the attention has been attracted on topical drug delivery to the inner ear. In this review, the methods of topical drug delivery to the inner ear are divided into four categories: transtympanic injection of liquid solutions, tympanic implantation of drug delivery systems, intracochlear injection and modified implant electrode. The results in each category and up to date progress are reviewed.

Characteristics of AccSTIP1 in Apis cerana cerana and its role during oxidative stress responses

Various environmental stresses, such as heat shock, heavy metals, ultraviolet (UV) radiation and different pesticides, induce a cellular oxidative stress response. The cellular oxidative stress response is usually regulated by heat shock proteins (Hsps) acting as molecular chaperones. Stress-induced phosphoprotein 1 (STIP1), one of the most widely studied co-chaperones, functions as an adaptor that directs Hsp90 to Hsp70-client protein complexes. However, the biological functions of STIP1 remain poorly understood in honeybee (Apis cerana cerana). In this study, AccSTIP1 was identified in Apis cerana cerana. AccSTIP1 transcription was found to be induced by heat (42 °C), HgCl2, H2O2 and different pesticides (emamectin benzoate, thiamethoxam, hexythiazox and paraquat) and inhibited by CdCl2, UV and kresoxim-methyl. Moreover, western blot analysis indicated that the expression profiles of AccSTIP1 were consistent with its transcriptional expression levels. The disc diffusion assay showed that chemically competent transetta (DE3) bacteria expressing a recombinant AccSTIP1 protein displayed the smaller death zones than did control bacteria after exposure to paraquat and HgCl2. The DNA nicking assay suggested that recombinant purified AccSTIP1 protected supercoiled pUC19 plasmid DNA from damage caused by a thiol-dependent mixed-function oxidation (MFO) system. After knocking down AccSTIP1 gene expression via RNA interference (RNAi), the transcript levels of antioxidation-related genes were obviously lower in dsAccSTIP1 honeybees compared with those in the uninjected honeybees. Collectively, these results demonstrated that AccSTIP1 plays an important role in counteracting oxidative stress. This study lays a foundation for revealing the mechanism of AccSTIP1 in the Apis cerana cerana antioxidant system.

Strategy for facial nerve management during surgical removal of benign jugular foramen tumors: Outcomes and indications

OBJECTIVE

Classical surgical management of jugular foramen (JF) tumors usually requires facial nerve rerouting which results in permanent facial palsy in most patients. The purpose of the article is to study the outcomes of different rerouting techniques, and to discuss their indications.

MATERIAL AND METHODS

We retrospectively reviewed 98 patients with JF tumors operated at our center between January 2008 and December 2016 using different surgical approaches with the following procedures for facial nerve management: total anterior rerouting (TR), partial anterior rerouting (PR), and fallopian bridge (FB) technique. The data for facial nerve management, surgical outcome and postoperative facial nerve function were collected from the medical records.

RESULTS

In the study, there were 48 males and 50 females. Of them, 61 (62.2%) were jugular paragangliomas, 22 (22.4%) schwannomas, and 15 (15.3%) meningiomas. Total tumor removal was achieved in 95 (96.9%) patients, while near-total removal was achieved in 3 (3.1%) paragangliomas. TR was applied in 31 (31.6%) patients with PR in 26 (26.5%) patients, and FB in 41 (41.8%) patients. The mean follow-up duration was 39.4±22.6 months, and 2 recurrences of paragangliomas were observed. Seventy-five patients (76.5%) had good facial function (HB I-II) at 1 year after surgery, the patients who received a TR approach presented significantly less HB I-II FN function (48.4%) than those with PR (82.6%, P<0.05) or those with FB technique (95.1%, P<0.001). 21 patients (21.4%) presented new-onset lower cranial nerve dysfunction of which 13 recovered at 1 year after surgery.

CONCLUSION

Facial nerve management in JF tumors should be tailored individually. No-rerouting methods, such as the fallopian bridge technique, bring significantly better results in terms of facial nerve function, which might be performed first during surgery; its indication is based mainly on the tumor type and extent.

Barriers to research among residents in Otolaryngology - Head & Neck Surgery around the world

OBJECTIVES

To document the challenges faced by residents in Otolaryngology - Head & Neck Surgery (OTL-HNS) around the world to successfully complete research projects. The second objective is to assess if the challenges are uniform worldwide.

METHODS

A survey was sent to all OTL-HNS under 45 years old from the 2017 IFOS meeting. This survey was conducted by the YO-IFOS group (Young Otolaryngologists of the International Federation of Otolaryngological Societies). Data was collected for a period of 1 month. Demographic characteristics, information regarding research projects conducted and data concerning perceived barriers to completion of research projects were collected.

RESULTS

Among the 2787 attendees, 928 responded to the survey (response rate=33.3%). Of these 928 answers, 267 responses were from residents/interns in OTL-HNS, while 635 responses were from certified otolaryngologists. The three most frequent obstacles to conducting research projects for trainees were limited dedicated time (64%), insufficient financial resources (55%) and lack of education in research (45%). There was no statistical difference in these barriers among the different countries (P>0.05).

CONCLUSION

This is the first international study that provides insight on trainee's challenges to conduct research projects during residency. Despite the notion that research is essential for generating new knowledge to guide patient care, many residents fail to successfully incorporate research in their surgical curriculum. These obstacles must be addressed by Otolaryngology - Head & Neck Surgery programs in order to facilitate and support resident's research.

Simultaneous supervision by microscope of endoscope-assisted microsurgery via presigmoid retrolabyrinthine approach: A pilot study

OBJECTIVE

To examine the impact of integrated hybrid operating rooms for endoscope-assisted microsurgery using the presigmoid retrolabyrinthine (RL) approach, and to determine the value of simultaneous supervision of skull base endoscopic procedures by microscope.

MATERIAL AND METHODS

We retrospectively reviewed endoscope-assisted surgery using the RL approach at our institution between September 2013 and January 2017. The simultaneous supervision of endoscopic procedures by microscope was realized using the integrated hybrid system. Intra- or postoperative complications and surgical outcomes were analyzed. All patients were followed for at least 1 year.

RESULTS

In total, 32 patients were studied: 4 vestibular schwannomas, 5 cholesteatomas, 8 hemifacial spasms, 5 glossopharyngeal neuralgias, and 10 Ménière's disease. In patients with vestibular schwannoma or cholesteatoma, complete removal was performed in all patients. In patients with Ménière's disease, hemifacial spasm or glossopharyngeal neuralgia, satisfactory symptom relief was achieved in all patients. Two (6.3%) patients had hearing loss after surgery which did not recover. One (3.1%) patient with vestibular schwannoma had mild facial palsy (HB III) at 2 weeks after the operation and recovered to near normal facial nerve function (HB II) at 1 year after surgery. No permanent or transient dysfunction of the trigeminal nerve or the lower cranial nerves was observed during follow-up. No complications such as cerebrospinal fluid (CSF) leakage or meningitis were observed.

CONCLUSION

The endoscope provided a clearer and larger view, which solved the limitations of surgery using the RL approach. Endoscopic surgery under simultaneous supervision by microscope was safe and efficient in hearing preservation as well as in preservation of facial nerve function. An integrated operation room provided better support and the ability to switch quickly between these various complex devices.

A statistical tool for risk assessment as a function of the number of lymph nodes retrieved from rectal cancer patients

AIM

Although a minimum of 12 lymph nodes (LNs) has been recommended for examination in colorectal cancer patients there remains considerable debate with regard to rectal cancer. Inadequacy of examined LNs could lead to understaging and inappropriate treatment as a consequence. We describe a statistical tool that allows an estimate of the probability of false-negative nodes.

METHOD

A total of 26 778 patients diagnosed between 2004 and 2013 with rectal adenocarcinoma [tumour stage (T stage) 1-3] who did not receive neoadjuvant therapies and had at least one histologically assessed LN were extracted from the Surveillance, Epidemiology and End Results (SEER) database. A statistical tool using beta-binomial distribution was developed to estimate the probability of missing a positive node as a function of the total number of LNs examined and T stage.

RESULTS

The probability of falsely identifying a patient as node-negative decreased with increasing number of nodes examined for each stage. It was estimated to be 72%, 66% and 52% for T1, T2 and T3 patients, respectively, with a single node examined. To confirm an occult nodal disease with 90% confidence, 5, 9 and 29 nodes need to be examined for patients from stages T1, T2 and T3, respectively.

CONCLUSION

The false-negative rate of the examined LNs in rectal cancer was verified to be dependent preoperatively on the clinical T stage. A more accurate nodal staging score was developed to recommend a threshold for the minimum number of examined nodes with regard to the favoured level of confidence.

Opposite Aerosol Index-Cloud Droplet Effective Radius Correlations Over Major Industrial Regions and Their Adjacent Oceans

The Moderate Resolution Imaging Spectroradiometer (MODIS) C6 L3 and the European Centre for Medium-Range Weather Forecasts (ECMWF) ERA-Interim reanalysis data from 2003 to 2016 are employed to study aerosol-cloud correlations over three industrial regions and their adjacent oceans, as well as explore the impact of meteorological conditions on the correlations. The analysis focusing on liquid and single-layer clouds indicates an opposite aerosol-cloud correlation between land and ocean; namely, cloud effective radius is positively correlated with aerosol index over industrial regions (positive slopes), but negatively correlated over their adjacent oceans (negative slopes), for a quasi-constant liquid water path. The positive slopes are relatively large under low lower-tropospheric stability (LTS; weakly stable condition), but much weaker or even become negative under high LTS (stable conditions) and high liquid water path. The occurrence frequency of cloud top height (CTH) and LTS suggests that positive correlations are more likely corresponding to relatively high CTH and low LTS, while negative to low CTH and high LTS.

Intraoperative Conebeam CT for Assessment of Intracochlear Positioning of Electrode Arrays in Adult Recipients of Cochlear Implants

BACKGROUND AND PURPOSE

Intraoperative conebeam CT has been introduced into the operating room and provides quick radiologic feedback. This study aimed to investigate its utility in the assessment of the positioning of the electrode array after cochlear implantation.

MATERIALS AND METHODS

This was a retrospective study of 51 patients (65 ears) with intraoperative imaging by conebeam CT (O-arm) after cochlear implantation between 2013 and 2017. Correct placement into the cochlea was immediately identified. Positioning assessments were later analyzed with OsiriX software.

RESULTS

Intraoperative imaging was quickly performed in all cases. No misplacement into the vestibule or semicircular canals was found. A foldover of the implanted array was identified in 1 patient. Secondary analysis by 2 raters showed excellent agreement on insertion depth angle (intraclass correlation = 0.96, P < .001) and length of insertion of the electrode array (intraclass correlation coefficient = 0.93, P = .04) measurements. The evaluation of the number of extracochlear electrodes was identical between the 2 raters in 78% of cases (Cohen κ = 0.55, P < .001). The scalar position was inconsistent between raters. When we compared O-arm and high-resolution CT images in 14 cases, the agreement was excellent for insertion depth angle (intraclass correlation coefficient = 0.97, P < .001) and insertion length (intraclass correlation coefficient = 0.98, P < .001), good for the number of extracochlear electrodes (Cohen κ = 0.63, P = .01), but moderate for the scalar position (Cohen κ = 0.59, P = .02).

CONCLUSIONS

Intraoperative conebeam CT using the O-arm is a safe, rapid, easy, and reliable procedure to immediately identify a misplacement or foldover of an electrode array. The insertion depth angle, insertion length, and number of electrodes inserted can be accurately assessed.

International consensus (ICON) on management of otitis media with effusion in children

Otitis media with effusion (OME) is a common childhood disease defined as the presence of liquid in the middle ear without signs or symptoms of acute ear infection. Children can be impacted mainly with hearing impairment and/or co-occurring recurrent acute otitis media (AOM) thus requiring treatment. Although many meta-analyses and national guidelines have been issued, management remains difficult to standardize, and use of surgical and medical treatments continue to vary. We convened an international consensus conference as part of the 2017 International Federation of Oto-rhino-laryngological Societies Congress, to identify best practices in OME management. Overall, regional differences were minor and consensual management was obtained on several important issues. At initial assessment, although a thorough medical examination is necessary to seek reflux, allergy or nasal obstruction symptoms; an age-appropriate auditory test is the only assessment required in children without abnormal history. Non-surgical treatments poorly address the underlying problem of an age-dependent dysfunctional Eustachian tube; auto-inflation seems to be the only beneficial, low-risk and low-cost non-surgical therapy. There was a clear international recommendation against using steroids, antibiotics, decongestants or antihistamines to treat OME, because of side-effects, cost issues and no convincing evidence of long-term effectiveness. Decisions to insert tympanostomy ventilation tubes should be based on an auditory test but also take into account the child's context and overall hearing difficulties. Tubes significantly improve hearing and reduce the number of recurrent AOM with effusion while in place. Adjuvant adenoidectomy should be considered in children over four years of age, and in those with significant nasal obstruction or infection.

GhMAP3K65, a Cotton Raf-Like MAP3K Gene, Enhances Susceptibility to Pathogen Infection and Heat Stress by Negatively Modulating Growth and Development in Transgenic Nicotiana benthamiana

Mitogen-activated protein kinase kinase kinases (MAP3Ks), the top components of MAPK cascades, modulate many biological processes, such as growth, development and various environmental stresses. Nevertheless, the roles of MAP3Ks remain poorly understood in cotton. In this study, GhMAP3K65 was identified in cotton, and its transcription was inducible by pathogen infection, heat stress, and multiple signalling molecules. Silencing of GhMAP3K65 enhanced resistance to pathogen infection and heat stress in cotton. In contrast, overexpression of GhMAP3K65 enhanced susceptibility to pathogen infection and heat stress in transgenic Nicotiana benthamiana. The expression of defence-associated genes was activated in transgenic N. benthamiana plants after pathogen infection and heat stress, indicating that GhMAP3K65 positively regulates plant defence responses. Nevertheless, transgenic N. benthamiana plants impaired lignin biosynthesis and stomatal immunity in their leaves and repressed vitality of their root systems. In addition, the expression of lignin biosynthesis genes and lignin content were inhibited after pathogen infection and heat stress. Collectively, these results demonstrate that GhMAP3K65 enhances susceptibility to pathogen infection and heat stress by negatively modulating growth and development in transgenic N. benthamiana plants.

[Analysis of the effect of mesial implant position on surrounding bone stress of mandibular edentulous jaw under dynamic loads]

Objective: To evaluate the effect of different placement of mesial implants in edentulous jaws on the stress of the implant and the surrounding bone tissue by three-dimensional (3D)finite element analysis. Methods: Cone-beam CT data of mandibular edentulous patients was transferred into Mimics 17.0 and UG NX8.5 software, and three groups of 3D solid model were established: two mesial implants were implanted in the anterior region of the mandible (bilateral central incisor, lateral incisor, canine), and two distal oblique implant with 30° were implanted in the mandibular second premolar area(5 mm near the mental foramen). Set mandible 3D model with 4 implant by using UG NX8.5 software, produced 3 groups (mandible Ⅰ-Ⅲ). We took dynamic loading on models with help of software Abaqus 6.12, working side posterior teeth loading was set to 150 N and the simulation cycle was 0.875 s. The first stage: 0.000 s to 0.130 s, the lower jaw moves outward (moving toward the side of the work), with no contact between the upper and lower teeth; the second stage: 0.130 s to 0.150 s, mandibular upward, the same tooth tip of the working side were relative, the loading position were the posterior buccal tip, tongue tip; the third stage: 0.150 s to 0.260 s, the buccal slopes of buccal tips of mandibular posterior teeth glide along the lingual slopes of buccal tips of maxillary posterior teeth, the loading force was from the buccal side to the lingual side, the long axis of the tooth was 45°, loaded on the buccal slopes of buccal tips of posterior teeth; the fourth stage: 0.260 s to 0.300 s, the lingual slopes of buccal tips of mandibular posterior teeth glide along the buccal slopes of the tongue tips of maxillary posterior teeth, separate from the tip of the tooth at half the length, the loading force was from the lingual side to the buccal side, the long axis of the tooth was 45°, loaded on the lingual slopes of buccal tips of posterior teeth; the fifth stage: 0.300 s to 0.875 s, at the unloading stage, mandibular posterior teeth were separated from the maxillary teeth and returned to the intercuspal position. The loading position varied according to the mastication cycle. The stress distribution of implant and surrounding bone tissue at different stages of each model were observed. Results: From the early stage to chew occlusal contact to the end of the mastication cycle, three groups of models were displayed: the stress of distal implants was greater than that of mesial implants and the neck stress reached the maximum and gradually decreased to the root tip. The stress of distal implant bone was greater than that of mesial implant bone and the stress of distal bone of distal implant was greater than that of mesial bone of distal implant. All the stress peak showed a gradual increase, and the stress reach the maximum at the fourth stage. In the 3 models, the bone stress around the distal implant of model of the anterior implant located in the lateral incisor region was the lowest. The peak stress of cortical bone of the distal position of implant was 58.7 MPa. The bone stress around the distal implant of model of the anterior implant located in the canine region reached the maximum, and the peak stress of cortical bone of the distal position of implant was 135.6 MPa. Conclusions: When mesial implants of edentulous jaws located in the lateral incisor region, it is good for stress dispersion.

[A combination use of endoscope and microscope in cerebral pontine angle surgery]

Objective: To evaluate the application of combination use of microscope and endoscope in cerebral pontine angle (CPA) surgery. Methods: A total of 72 patients undergone lateral skull base surgeries via endoscope under microscopic control from January 2006 to January 2015 was reviewed respectively. The patients including 35 males and 37 females were composed of 22 cases of vestibular swannnomas, 45 cases of cranial neuropathy and 5 cases of CPA chelesteatoma. Twenty cases of vestibular swannnomas, 15 cases of cranial neuropathy and 2 cases of CPA chelesteatoma undergone the surgery via retrosigmoid approach, while other cases undergone the surgery via retrolabyrinthine approach. Surgical procedures were accomplished under the control of microscope and different angular endoscope with imaging fusion. The surgical results were evaluated according to subjective and objective criteria, and all patients were followed up for 15 years. Results: The symptoms was disappeared in the cranial neuropathy patients, without facial paralysis, complication of other nerves or hearing loss. Twenty-two patients with vestibular schwannomas got total tumor removal without facial palsy or neurological deficits; useful hearing was preserved in 16 of 22 patients (72.7%), and no tumor recurrence was found during 1-5 years follow-up. There was also no facial palsy or other complications in 5 cases of CPA chelesteatoma, which gained completely surgical removal; useful hearing was preserved in 3 of 5 cases of these patients and no recurrence was occurred during 1-1.5 years follow-up. Conclusions: A combination use of endoscope and microscope could combine advantages and avoid disadvantages of two techniques. It can provide better exposure with minimal invasion in CPA surgery, and is especially applicable in surgery for cranial neuropathy, vestibular schwannoma and CPA cholesteatoma, which should be performed through retrosigmoid approach and retrolabyrinthine approach.

[Relationship and influencing factors between the amplitude change of supramaximal facial nerve stimulation during acoustic neuroma removal and facial function outcome]

OBJECTIVE

To investigate the relationship between the amplitude change of supramaximal facial nerve stimulation during acoustic neuroma removal and facial function outcome, and discuss its influencing factors.

METHODS

Retrospective study of 34 acoustic neuroma patients. Intraoperative amplitude by supramaximal stimulation, facial function outcome, tumor size, surgical approach, facial nerve course pattern, and tumor cystic status, as well as tumor adhesion degree were collected and analyzed by SPSS 17.0.

RESULTS

Acoustic neurnomas were removed in all 34 patients without intra- and postoperative complications, the facial nerve were all anatomically preserved. Two weeks later, 5 cases showed facial function HB Grade Ⅰ, 13 HB Ⅱ, 11 HB Ⅲ and 5 HB Ⅳ. The amplitude changes under supramaximal stimulation after tumor removal were 12.9%-100%, average (63.9±25.7)%. The facial function outcomes were poor (HB Ⅳ) in the cases whose intraoperative amplitude decreases were more than 70%. Different postoperative facial function group showed significantly different intraoperative amplitude changes (F=7.585, P=0.001), except HB Ⅰ group and HB Ⅱ group. The existence of cystic degeneration showed strong correlation (r=-0.635) to the amplitude changes, the level of tumor adhesion showed moderately negative correlation (r=-0.455), and tumor size showed weak negative correlation (r=-0.292), surgical approach and the facial nerve course pattern were not statistically relevant.

CONCLUSIONS

The amplitude change of facial nerve supramaxial stimulation can predict the postoperative facial function. The amplitude change is valuable for early treatment of facial nerve damage.