Tea Seed Kaempferol Triglycoside Attenuates LPS-Induced Systemic Inflammation and Ameliorates Cognitive Impairments in a Mouse Model

(1) Background: The current research intended to obtain functional compounds from agricultural by-products. A functional tea seed flavonoid, kaempferol-3-O-[2-O-β-d-xylopyranosyl-6-O-α-L-rhanmopyranosyl]-β-d-glucopyranoside (KXRG), was isolated from tea seed dregs. We further determined its chemical structure and evaluated the protective effects of KXRG against local and systemic inflammation in vivo; (2) Methods: First, cytotoxicity and proinflammatory cytokine release were examined in a cell-culture system. The biological activities of KXRG were investigated in a mouse model of ear edema, and from inflammatory damage to organs as demonstrated by histologic examination, in addition to brain function evaluation using the Y-maze test. Serum biochemical analysis and western blotting were utilized to explore the related cellular factors; (3) Results: KXRG inhibited IL-6 in RAW264.7 cells at a non-toxic concentration. Further experiments confirmed that KXRG exerted a stronger effect than indomethacin in terms of the prevention of 12-O-tetradecanoylphorbol acetate (TPA)-induced ear inflammation in a mouse model. KXRG feeding significantly prevented LPS-induced small intestine, liver, and kidney inflammatory damage, as demonstrated by histologic examination. KXRG also significantly improved LPS-induced cognitive impairments. Serum biochemical analysis showed that KXRG elevated antioxidant capacity and reduced levels of proinflammatory cytokines. Western blotting revealed that KXRG reduced the COX-2 expression induced by LPS in mouse tissues; (4) Conclusions: KXRG can be purified from agricultural waste, and hence it is inexpensive, with large amounts of raw materials available. Thus, KXRG has strong potential for further development as a wide-use anti-systemic inflammation drug to prevent human disease.

Rare early presentation of bilateral compressive optic neuropathy with complete vision loss from nasopharyngeal carcinoma

Nasopharyngeal carcinoma is very rarely associated with bilateral vision loss, and only in advanced disease. We report a case of bilateral severe compressive optic neuropathy as a first presentation from massive nasopharyngeal carcinoma with poor visual outcome despite corticosteroid, chemotherapy and radiotherapy. Red flag symptoms and signs of mass lesions in the posterior nasal space should be investigated and treated promptly to prevent devastating visual and prognostic consequences.

Glottic Staphylococcus aureus in a patient with systemic lupus erythematosus: videolaryngostroboscopic characteristics

Systemic lupus erythematous (SLE) is an autoimmune disease commonly treated with steroid which leads to immunosuppression and increased susceptibility to infection. Chronic laryngitis with whitish lesion on the true vocal fold in SLE may be caused by opportunistic organisms, such as tuberculous, fungal and Staphylococcus aureus infections. Videolaryngostroboscopy may be helpful in leading to the diagnosis and optimum treatment of glottic S. aureus A woman in her 40s with SLE presented with progressively worsening hoarseness for 2 months, accompanied by sore throat and odynophagia. Videoendoscopy showed erythematous and oedematous bilateral vocal fold with whitish lesion seen at the edge of middle one-third while the videolaryngostroboscopic evaluation showed there was severe asymmetry of the bilateral vocal folds, with severely reduced amplitude during phonation where the vocal cords were not vibrating, aperiodic vibratory cycles and 'always open', incomplete closure of vocal cord pattern. Later, endolaryngeal microsurgery and biopsy of the lesion confirmed of glottic S. aureus Her symptoms and followed up videolaryngostroboscopy showed resolution to normal findings after 6 weeks of cloxacillin. S. aureus infection of the glottis is a differential diagnosis in a chronic laryngitis with leucoplakic lesion in an immunosuppressive patient. Videolaryngostroboscopy has an important role in diagnosis, evaluation and treatment decision.

Classical Hodgkin's lymphoma masquerading as Riedel's thyroiditis

We present the case of a 38-year-old woman with a progressively tender swelling of the thyroid gland, who was treated as Riedel's thyroiditis based on two fine needle aspirations and a core biopsy. She was later found, on partial thyroidectomy, to have nodular sclerosis classical Hodgkin's lymphoma.

Naso-Bronchial Rhinosporidiosis

Rhinosporidiosis is a chronic mucocutaneous granulomatous disease caused by Rhinosporidium seeberi, commonly affecting the nose and nasopharynx. Endobronchial involvement is of rare occurrence but can pose challenging problems for diagnosis, surgical excision and anaesthetic management. We report a 40-year-old man with a history of recurrent nasal rhinosporidiosis who presented with unilateral nasal obstruction, cough, shortness of breath and a radiological feature of left lung collapse. Eight years since the last surgery, he presented with a recurrent lesion in the nose with concurrent endobronchial involvement. The patient underwent excision of the nasal and the endobronchial lesion successfully under general anaesthesia without any complication and good symptomatic improvement. The clinical presentation and the management of endobronchial rhinosporidiosis are discussed here. The surgical difficulties faced during the procedure are highlighted.

Synchronous oral squamous cell carcinoma and a lymphoproliferative disorder in an adult: a challenge in diagnosis and management

Synchronous primary malignancies present challenges in diagnosis, treatment sequencing and management. We present a rare case of a synchronous oral cavity and lymphoproliferative malignancy in a middle-age man. Our patient presented with a primary oral cavity squamous cell carcinoma and was subsequently found to have a secondary lymphoproliferative malignancy (chronic lymphocytic leukaemia/small lymphocytic lymphoma). The challenge of staging and sequencing of treatment is discussed. In addition, this case highlights the importance of multidisciplinary consultation, designing a personalised treatment plan that is coincident with the standard of care for each malignancy, and close follow-up.

Laryngeal keel in severe congenital glottic web: case report and review of literature

Glottic web is an abnormal soft tissue adhesion between the vocal cords which occurs due to failure of recanalisation. Congenital glottic webs comprises 5% of laryngeal anomalies. Cohen classified glottic webs into four types based on percentage of airway obliteration. Patients with severe glottic web-grade III and grade IV present with respiratory distress, stridor, phonatory difficulties or recurrent respiratory infections warranting urgent intervention. We are presenting our experience in managing two such patients with severe congenital glottic web. Diagnosis was confirmed by fibreoptic laryngoscopy under monitored anaesthetic care. Combined endoscopic excision of web with laryngofissure approach for keel stenting. In both our patients, we have used a silicone based keel for laryngeal stenting to provide strength and prevent re-webbing. During follow-up, both patients were found to have adequate phonation and normal airway thus demonstrating this method as safe option for adequate phonatory and airway outcomes.

Mixed hemangioma of the external auditory canal and the tympanic membrane in a young woman: A case report

Hemangiomas are benign vascular tumors frequently located in the head and neck area, but rarely encountered in the ear, often originally misdiagnosed due to their rarity and absence of specific clinical manifestations. We report the second case of a mixed hemangioma involving the external auditory canal in literature to date.

Advanced technology for type 1 diabetes care in a deaf-mute patient

A 48-year-old deaf-mute man attending our outpatient clinic for long-term severely decompensated type 1 diabetes (mean glycated haemoglobin over 100 mmol/mol) has proved to be the best candidate for the beneficial implant of a next-generation closed loop insulin pump featuring a new refined auto-correction algorithm. The patient had already worn a stand-alone real-time continuous glucose monitoring (rt-CGM) device for 2 years, but his haemoglobin A1c (HbA1c) remained out of target with ample glucose variability. Then, we decided to use a novel advanced hybrid closed-loop insulin pump (the MiniMed 780G) coupled with his CGM device. After only 4 months this system led to a significant improvement in mean daily glucose levels (201±100 mg/dL vs 141±57 mg/dL), time in glucose range (43% vs 78%), percentage of time spent in hyperglycaemia (52% vs 20%), glucose variability (Coefficient of Variation 46% vs 38%), and HbA1c levels (121 mmol/mol vs 56 mmol/mol). The patient was highly satisfied.

A 10-year-old child with acute torticollis due to polymicrobial deep neck infection

Torticollis in children can be a sign of a potentially dangerous disease; the correct diagnosis is not always obvious on history and physical examination. The use of point-of-care ultrasound (POCUS) helps to limit the differential diagnosis and direct appropriate further laboratory and radiology-performed evaluation. We present a case of a 10-year-old child whose deep neck infection (DNI) was timely diagnosed in the paediatric emergency department by early use of POCUS and drained under POCUS guidance after admission to the hospital. The culture from the fluid grew Eikenella corrodens, Streptococcus constellatus and Prevotella buccae This case demonstrates that DNIs occur in children with acute acquired torticollis, even without fever and demonstrates the importance of early use of POCUS in cases where DNI is a potential diagnosis. Moreover, this case emphasises the importance of microbiological identification of DNIs that can be the key to successful treatment.

Susceptibility to Bacteriocins of Multiresistant, mecA Gene Possessing Staphylococcus pseudintermedius Strains from Lesions on Dogs in Vojvodina (Serbia)

Aims: Staphylococci are considered commensal organisms; however, they can also cause diseases in animals. The species Staphylococcus pseudintermedius was originally isolated from the nares and anal mucosa of healthy dogs; nowadays, the incidence of methicillin-resistant S. pseudintermedius strains in dogs has increased, and this species has also become the most common cause of canine skin lesions. S. pseudintermedius were tested for their susceptibility to bacteriocins to show the potential of bacteriocins to eliminate/reduce S. pseudintermedius as a causative agent. Material and Methods: In this study, S. pseudintermedius were isolated from skin lesions on dogs of various breeds and ages in the Vojvodina region (Serbia) in the framework of our international co-operation. Results: S. pseudintermedius strains were identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry, and the species allocation was confirmed by genotypization and corroborated using phenotyping tests. The strains were multiresistant, involving methicillin-resistance. In addition, the mecA gene was detected in S. pseudintermedius strains, confirming the presence of a genetic feature for methicillin resistance. S. pseudintermedius strains produced large amounts of the enzymes alkaline phosphatase and acid phosphatase; they were low-grade biofilm forming (0.1 ≤ A₅₇₀ < 1.0), except S. pseudintermedius SPs1. All strains were susceptible to gallidermin (inhibition activity up to 204,800 arbitrary unit [AU]/mL); however, they were mostly resistant to enterocins. However, biofilm-forming S. pseudintermedius SPs1 was susceptible to enterocins (200 AU/mL). Conclusion: Establishing the susceptibility of multiresistant and mecA gene-possessing S. pseudintermedius strains to gallidermin is an innovative, original result; it provides a new opportunity for preventing/eliminating infection caused by those agents.

[The combination of recurrent otitis media and adenotomy in early childhood as diagnostic marker of mucopolysaccharidosis type II (Hunter syndrome)]

Mucopolysaccharidoses are a group of rare lysosomal accumulation diseases caused by a deficiency of the lysosomal enzyme and the accumulation of mucopolysaccharides in various organs and tissues. Children with mucopolysaccharidosis type II (Hunter syndrome) develop multisystem dysfunction, including severe airway obstruction. At the same time, 34% of patients already at an early age (2-3 years) undergo surgical manipulations related to ENT organs (tonsillectomy, adenotomy). The article describes a clinical case of diagnosis of type II mucopolysaccharidosis by a pediatric otorhinolaryngologist. The main manifestations of the disease are discussed in detail, including the presence of indications for adenotomy at the age of 2 years, episodes of otitis media, which served as diagnostic markers for suspected orphan disease mucopolysaccharidosis type II. The leading role of the pediatric otorhinolaryngologist in the early diagnosis of the rare disease mucopolysaccharidosis type II is substantiated.

Three-Dimensional Finite Element Modeling of Blast Wave Transmission From the External Ear to a Spiral Cochlea

Blast-induced injuries affect the health of veterans, in which the auditory system is often damaged, and blast-induced auditory damage to the cochlea is difficult to quantify. A recent study modeled blast overpressure (BOP) transmission throughout the ear utilizing a straight, two-chambered cochlea, but the spiral cochlea's response to blast exposure has yet to be investigated. In this study, we utilized a human ear finite element (FE) model with a spiraled, two-chambered cochlea to simulate the response of the anatomical structural cochlea to BOP exposure. The FE model included an ear canal, middle ear, and two and half turns of two-chambered cochlea and simulated a BOP from the ear canal entrance to the spiral cochlea in a transient analysis utilizing fluid-structure interfaces. The model's middle ear was validated with experimental pressure measurements from the outer and middle ear of human temporal bones. The results showed high stapes footplate (SFP) displacements up to 28.5 μm resulting in high intracochlear pressures and basilar membrane (BM) displacements up to 43.2 μm from a BOP input of 30.7 kPa. The cochlea's spiral shape caused asymmetric pressure distributions as high as 4 kPa across the cochlea's width and higher BM transverse motion than that observed in a similar straight cochlea model. The developed spiral cochlea model provides an advancement from the straight cochlea model to increase the understanding of cochlear mechanics during blast and progresses toward a model able to predict potential hearing loss after blast.

Source-Sink Dynamics in Field-Grown Durum Wheat Under Contrasting Nitrogen Supplies: Key Role of Non-Foliar Organs During Grain Filling

The integration of high-throughput phenotyping and metabolic approaches is a suitable strategy to study the genotype-by-environment interaction and identify novel traits for crop improvement from canopy to an organ level. Our aims were to study the phenotypic and metabolic traits that are related to grain yield and quality at canopy and organ levels, with a special focus on source-sink coordination under contrasting N supplies. Four modern durum wheat varieties with contrasting grain yield were grown in field conditions under two N fertilization levels in north-eastern Spain. We evaluated canopy vegetation indices taken throughout the growing season, physiological and metabolic traits in different photosynthetic organs (flag leaf blade, sheath, peduncle, awn, glume, and lemma) at anthesis and mid-grain filling stages, and agronomic and grain quality traits at harvest. Low N supply triggered an imbalance of C and N coordination at the whole plant level, leading to a reduction of grain yield and nutrient composition. The activities of key enzymes in C and N metabolism as well as the levels of photoassimilates showed that each organ plays an important role during grain filling, some with a higher photosynthetic capacity, others for nutrient storage for later stages of grain filling, or N assimilation and recycling. Interestingly, the enzyme activities and sucrose content of the ear organs were positively associated with grain yield and quality, suggesting, together with the regression models using isotope signatures, the potential contribution of these organs during grain filling. This study highlights the use of holistic approaches to the identification of novel targets to improve grain yield and quality in C₃ cereals and the key role of non-foliar organs at late-growth stages.

Traumatic brain injury induced by exposure to blast overpressure via ear canal

Exposure to explosive shockwave often leads to blast-induced traumatic brain injury in military and civilian populations. Unprotected ears are most often damaged following exposure to blasts. Although there is an association between tympanic membrane perforation and TBI in blast exposure victims, little is known about how and to what extent blast energy is transmitted to the central nervous system via the external ear canal. The present study investigated whether exposure to blasts directed through the ear canal causes brain injury in Long-Evans rats. Animals were exposed to a single blast (0-30 pounds per square inch (psi)) through the ear canal, and brain injury was evaluated by histological and behavioral outcomes at multiple time-points. Blast exposure not only caused tympanic membrane perforation but also produced substantial neuropathological changes in the brain, including increased expression of c-Fos, induction of a profound chronic neuroinflammatory response, and apoptosis of neurons. The blast-induced injury was not limited only to the brainstem most proximal to the source of the blast, but also affected the forebrain including the hippocampus, amygdala and the habenula, which are all involved in cognitive functions. Indeed, the animals exhibited long-term neurological deficits, including signs of anxiety in open field tests 2 months following blast exposure, and impaired learning and memory in an 8-arm maze 12 months following blast exposure. These results suggest that the unprotected ear canal provides a locus for blast waves to cause TBI. This study was approved by the Institutional Animal Care and Use Committee at the University of Mississippi Medical Center (Animal protocol# 0932E, approval date: September 30, 2016 and 0932F, approval date: September 27, 2019).

Laryngeal varices: an atypical cause of globus

Laryngeal varices are rare and are usually associated with vocal cord trauma secondary to excessive use of voice. This report is the first documented case of laryngeal varices secondary to thyroid goitre. This is a report of an 83-year-old woman with a known retrosternal goitre chiefly with symptoms of globus. Retrosternal goitre was found to be compressing the pharyngeal venous plexus causing laryngeal venous structures bilaterally to be engorged along the aryepiglottic folds, arytenoids, posterior commissure and extending in to the postcricoid region. The presence of laryngeal varices carries a significant increased risk of haemorrhage. This case presents an atypical presentation of globus and the first reported case in the literature of laryngeal varices secondary to a thyroid goitre.

Utility of a Ruler for Reconstructed Auricle Positioning

Purpose

This study evaluated the utility of a ruler for reconstructed article positioning.

Methods

Forty-seven patients with unilateral microtia were selected from August 2020 to September 2021.

Results

The linear distance from the highest point of the reconstructed auricle to the central axis of the nose was not significantly different from the distance from the highest point of the normal contralateral auricle to the central axis of the nose (P>0.05). The distance from the lowest point of the reconstructed auricle to the central axis of the nose was not significantly different from the distance from the lowest point of the normal auricle to the central axis of the nose (P>0.05). The linear distance from the highest to the lowest point of the reconstructed auricle was not significantly different from the distance from the highest to the lowest point of the normal auricle (P>0.05). These results indicate that the reconstructed auricle was symmetrical to the contralateral ear.

Conclusion

The positioning ruler evaluated in this study is simple, easy to use, accurate, and non-invasive.

Three-Dimensional-Printed External Scaffolds Mitigate Loss of Volume and Topography in Engineered Elastic Cartilage Constructs

OBJECTIVE

A major obstacle in the clinical translation of engineered auricular scaffolds is the significant contraction and loss of topography that occur during maturation of the soft collagen-chondrocyte matrix into elastic cartilage. We hypothesized that 3-dimensional-printed, biocompatible scaffolds would "protect" maturing hydrogel constructs from contraction and loss of topography.

DESIGN

External disc-shaped and "ridged" scaffolds were designed and 3D-printed using polylactic acid (PLA). Acellular type I collagen constructs were cultured in vitro for up to 3 months. Collagen constructs seeded with bovine auricular chondrocytes (BAuCs) were prepared in 3 groups and implanted subcutaneously in vivo for 3 months: preformed discs with ("Scaffolded/S") or without ("Naked/N") an external scaffold and discs that were formed within an external scaffold via injection molding ("Injection Molded/SInj").

RESULTS

The presence of an external scaffold or use of injection molding methodology did not affect the acellular construct volume or base area loss. In vivo, the presence of an external scaffold significantly improved preservation of volume and base area at 3 months compared to the naked group (P < 0.05). Construct contraction was mitigated even further in the injection molded group, and topography of the ridged constructs was maintained with greater fidelity (P < 0.05). Histology verified the development of mature auricular cartilage in the constructs within external scaffolds after 3 months.

CONCLUSION

Custom-designed, 3D-printed, biocompatible external scaffolds significantly mitigate BAuC-seeded construct contraction and maintain complex topography. Further refinement and scaling of this approach in conjunction with construct fabrication utilizing injection molding may aid in the development of full-scale auricular scaffolds.

Paralysis from an ear infection: a severe case of otitis externa leading to acute complete cervical cord syndrome

We report a case of a generally fit and well 54-year-old man who presented with a 2-day history of worsening left-sided otorrhea, headache, neck stiffness, vomiting and fever on the background of a 7-week history of otitis externa (OE). His condition progressed dramatically as he developed symptoms consistent with acute complete cervical cord syndrome with radiological evidence of skull base osteomyelitis, parapharyngeal, retropharyngeal and paravertebral abscesses and sigmoid sinus thrombus. Ultimately, he made a significant, although not complete, recovery. This case is unique in demonstrating how OE can develop into a potentially life threatening condition. It emphasises the importance of early diagnosis and treatment of OE, the recognition of 'red flag' symptoms and highlights the importance of a multidisciplinary team approach when managing complex complications of OE.

Surgical treatment of a congenital dacryocystocele by means of microdebrider marsupialization in a newborn

Congenital dacryocystocele is a rare clinical condition, more commonly unilateral, secondary to the defective canalization of the nasolacrimal duct. In case of failure of conservative treatment, surgical marsupialization is recommended. We describe the case of a 40-day-old male newborn treated by means of microdebrider marsupialization.

Audiological Involvement in Patients with Systemic Sclerosis

OBJECTIVE

The aim of the present study was to evaluate hearing loss in patients diagnosed with SSc (systemic sclerosis) and to investigate the relation between hearing loss, subtypes of the disease, its duration and clinical findings, and antibody positivity.

METHODS

The study included 47 patients with SSc and 44 healthy controls. Audiometric, tympanometric and otoacoustic emission measurements were applied to both groups.

RESULTS

The evaluation of the participants medical history showed that among the patients with SSc, 19.1% experienced ear fullness, 27.7% experienced vertigo and 36.2% experienced tinnitus. Hearing loss was detected in 23.4% of the patients with SSc. The corresponding result was 4.3% in the control group with a statistically significant difference (p = 0.001). Transient evoked otoacoustic emission (TEOAE) amplitude values were significantly lower in the patients both ears with SSc than the control group (p < 0.005). Duration of disease was significantly longer and DLCO (diffusing capacity of the lungs for carbon monoxide) values were significantly higher in the patients with SSc and sensorineural hearing loss.

CONCLUSIONS

The present study found that the incidence of hearing loss was significantly higher in the study group than healthy control group. In addition to other organ involvements, cochlear involvement occurs in these patients, and further studies are required.