[Application of internal carotid artery stent in skull base surgery]

Objective: To report the experience of the application of internal carotid artery stent in skull base surgery, and to clarify the important role of internal carotid artery stent in skull base surgery. Methods: A retrospective study of 22 cases with skull base neoplasms implanted with internal carotid artery stents in the Department of ENT Head and Neck Surgery at the Sixth People's Hospital affiliated with Shanghai Jiao Tong University between July 2019 and January 2021 was conducted. Among them, 17 were male and 5 were female, aged between 33 and 75 years. There were 5 cases on the left, 16 cases on the right, and 1 case on both sides. Of these, there were 4 cases of jugular paraganglioma, 1 case of chondrosarcoma in the jugular foramen, 1 case of carotid body paraganglioma, and 16 cases of nasopharyngeal carcinoma after radiotherapy. Results: The degree of internal carotid artery erosion was assessed by computed tomography angiography (CTA), magnetic resonance imaging and digital subtraction angiography (DSA) images in 22 patients before surgery. It was found that the internal carotid artery was involved to varying degrees in all patients, so internal carotid artery stents were implanted before surgery. Tumor tissue was found to surround the internal carotid artery to varying degrees. Total or subtotal tumor resection was performed in all patients, and no intraoperative and postoperative complications occurred. The postoperative follow-up was 5 months to 2 years, and all patients had no complications such as spontaneous bleeding and pseudo aneurysm. There were no signs of stenosis or occlusion of the internal carotid artery stent segment in all cases. Conclusions: For patients with skull base tumors, preoperative imaging indicates the limited involvement of the internal carotid artery, and internal carotid artery stent implantation before surgery is a safe and effective treatment.

[Application prospect of artificial intelligence technology in vestibular disorders]

Summary Vestibular disorders are a group of disorders that may result from damage to peripheral or central vestibular system, which seriously affect the patients' lives and work and even life-threatened. The causes of most vestibular disorders are still unclear, the auxiliary examination is not effective enough and the treatment is not individualized. It needs to improve the diagnosis and treatment efficiency of patients with vestibular disorders. Recent advance in artificial intelligence technology could provide novel promising strategies for the diagnosis and treatment of patients and assist clinical trials. Here we summarized the application of artificial intelligence technique in the field of vertigo, and look to the possible application in the future.

[Vertigo in children：composition and clinical characteristics]

Objective: To explore composition and characteristics of vertigo in children. Method:The diagnosis, medical history and examinations of 46 patients (≤17 years old) with vertigo were studied retrospectively. Result:Of the 46 children patients with vertigo enrolled in this study, 19 patients were with BPVC(41.3%), 11 patients with VM(23.9%),4 patients with BPPV(8.7%), 3 patients with unclassifiable vestibular syndrome(6.5%), 2 patients with Meniere's disease (4.3%), 1 patient with sudden deafness with vertigo, 1 patient with labyrinthitis, 1 patient with vestibular paroxysmal, 1 patient with vestibular neuritis, 1 patient with head trauma, 1 patient with light cupula, 1 patient with benign paroxysmal torticollis (2.2%, respectively). The statistical analysis was conducted among 4 kinds of the most common causes of vertigo in children. There was no significant differences in sex composition among different groups(P>0.05). The mean age and mean age of onset in patients with BPVC were the youngest(P<0.05). Headache was complained more often in patients with VM(P<0.05) and there was no difference in other accompanying symptoms (such as nausea, vomiting and tinnitus) among each groups(P>0.05).Most patients with VM had family history of vertigo or migraine, but not in patients with VM and patients with BPVC(P>0.05). Conclusion:The most common vertigo in children were BPVC, VM and BPPV. The medical history, physical examinations and vestibular function tests can help doctors to diagnose more correctly.

[Characteristics of Dix-Hallpike test induced nystagmus]

Objective:To retrospectively analyze the characteristics of 100 cases with Dix-Hallpike test induced nystagmus, especially the vertical downward component.Method:One hundred cases with positive Dix-Hallpike test between December 2017 and January 2018 were included in this study. Dix-Hallpike test and roll test were performed in all patients, and the max slow phase velocity (SPV), latency and duration of positional nystagmus were analyzed with SPSS 22.0 software.Result:According to the difference in the direction and duration of the nystagmus in the head-hanging position on Dix-Hallpike test, 100 patients were classified into 9 types. When only the vertical components were considered, 56 cases presented with bilateral or unilateral vertical upward component, among which 52 cases had unilateral torsional with vertical upward component, 4 cases had bilateral torsional with vertical upward component; 7 cases presented with vertically upward in one side and the vertically downward in the other side; 47 cases presented with bilateral or unilateral vertical downward component. In addition, 8 cases showed the reverse phase nystagmus. Of the 100 patients with positive Dix-hallpike, 20 cases were positive in roll test and 5 cases showing horizontal nystagmus and 15 cases showing torsional and vertical nystagmus.Conclusion:Vertical component in the positional nystagmus was common, and care should be taken to interpret the nystagmus into the underlying disorder.

[Persistent geotropic direction-changing positional nystagmus: an independent disease entity?]

Persistent geotropic direction-changing positional nystagmus (DCPN) has been described in recent years as no latency or fatigability but a null plane when head is turned toward the affected side. Different from the canalolithiasis of horizontal semicircular canal, it is similar with cupulolithiasis, but the direction of nystagmus are opposite. Light cupula theory has been used to explain the characteristics of this unique nystagmus. In this paper, the characteristics, possible etiologies, pathogenesis, related diseases, diagnosis, treatment and prognosis of DCPN are reviewed.

[The downbeat nystagmus in 2 cases with unilateral Meniere's disease]

We retrospectively analyzed 2 patients of unilateral Meniere's disease with downbeat nystagmus. Audiometric test, the Dix-Hallpike maneuver and the supine roll test were performed. Both patients presented with spontaneous nystagmus with downbeat components, and downbeat components were exaggerated by Dix-Hallpike maneuver. Spontaneous and positional nystagmus with downbeat component can occur in Meniere's disease, which may be resulted from excitation of three semicircular canals.

[Nystagmus characteristics of the horizontal semicircular canal light cupula]

Objective:To analyze the nystagmus characteristics of 9 patients with horizontal semicircular canal light cupula.Method:Patients who visited the department of otolaryngology of Shanghai sixth people's hospital from September 2017 to December 2017 with a typical history of positional vertigo and roll test evoked horizontal geotropic direction changing nystagmus that lasted more than one minute were enrolled in the study.Nystagmus was monitored using the videonystagmoscopy (VNG), and parameters of nystagmus,including latency, duration and the intensity of nystagmus were analyzed. Barbecue maneuvers were tried for all patients and no other treatment was performed.Result:Nine patients were enrolled,DixHallpike test had no nystagmus, Roll test showed a persistent geotropic DCPN, the recorded average duration of nystagmus was (64.2±13.7)s (longer actually), and averaged latency was (5.3±4.7)s.In some cases, positional nystagmus increased rapidly in intensity and then declined slowly as seen in patients with canalolithiasis. Immediate effectiveness is 0 after barbecue maneuver,but 4 patients recovered within one week,2 patients improved within 1 week,and recovered within 2 weeks, 1 patient transferred into posterior semicircular canal BPPV, and 2 cases had not been followed up.Conclusion:Nystagmus of horizontal canal light cupula has a latency of several seconds,with a crescendodecrescendo pattern of intensity.Barbecue maneuver may be not effective in resolving nystagmus,but the prognosis is good for those patients.

[Progress in research of vestibular migraine]

Estibular migraineis a common disease with symptoms of vertigo and migraine，which is the most common type of recurrent vertigo. The overall prevalence rate of the population is up to 1%. However, owing to its diversity of symptoms, large individual differences, the scarcity of professional clinical knowledge and the lack of effective diagnostic means, the rate of misdiagnosis is very high. Therefore, this article summarized the parts of clinical manifestations, pathogenesis, diagnostic criteria, treatment and prevention of vestibular migraine.

[Challenge in the management of benign paroxysmal positional vertigo]

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder,which is defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo as changes in head position.The effective positioning maneuvers has made BPPV the most successfully treated type of vertigo.However,some patients experience a serious disturbance with residual vertigo,light cupula and persistent or repeated attacks of BPPV even after several trials of canalith repositioning procedures.In this article,the challenge as light cupula,management of residual vertigo and repeated attacks of BPPV after canalith repositioning procedures were reviewed.

Effect of micro-arc oxidation surface modification on the properties of the NiTi shape memory alloy

In this paper, the effects of micro-arc oxidation (MAO) surface modification (alumina coatings) on the phase transformation behavior, shape memory characteristics, in vitro haemocopatibility and cytocompatibility of the biomedical NiTi alloy were investigated respectively by differential scanning calorimetry, bending test, hemolysis ratio test, dynamic blood clotting test, platelet adhesion test and cytotoxicity testing by human osteoblasts (Hobs). The results showed that there were no obvious changes of the phase transformation temperatures and shape memory characteristics of the NiTi alloy after the MAO surface modification and the coating could withstand the thermal shock and volume change caused by martensite-austenite phase transformation. Compared to the uncoated NiTi alloys, the MAO surface modification could effectively improve the haemocopatibility of the coated NiTi alloys by the reduced hemolysis ratio, the prolonged dynamic clotting time and the decreased number of platelet adhesion; and the rough and porous alumina coatings could obviously promote the adherence, spread and proliferation of the Hobs with the significant increase of proliferation number of Hobs adhered on the surface of the coated NiTi alloys (P < 0.05).

Distribution of Baseline Sensitivities to Natural Product Physcion Among Isolates of Sphaerotheca fuliginea and Pseudoperonospora cubensis

The ethanol extract from rhubarb was commercialized in China (Veguard, Physcion, 5 g/liter AS) for control of cucumber powdery mildew (Sphaerotheca fuliginea) and cucumber downy mildew (Pseudoperonospora cubensis). To provide the basic data for the risk assessment of resistance to this product, physcion was selected to represent the active ingredients to establish baseline sensitivity of powdery mildew and downy mildew populations. For powdery mildew, 262 isolates of S. fuliginea from nine regions and, for downy mildew populations, 116 isolates of P. cubensis from six regions were collected in China during 2004 and 2005 and tested for sensitivity. In addition, the sensitivity of a powdery mildew isolate was monitored for 15 asexual generations under selection pressure with physcion. The results showed that there was no significant difference among regions in the frequency distribution of baseline sensitivity to this ingredient for either cucumber powdery mildew isolates or cucumber downy mildew isolates. Baseline sensitivity was distributed as a normal unimodal curve with a mean median (50%) effective concentration (EC₅₀) of 0.304 μg/ml for powdery mildew population and mean EC₅₀ of 0.501 μg/ml for downy mildew population. The variation of sensitivity to physcion was low because the range factor (maximum EC₅₀/minimum EC₅₀ of isolates within population) varied from 1.63 to 3.42 among powdery mildew populations and from 1.70 to 2.38 among downy mildew populations. The powdery mildew isolate XZ4 did not decrease sensitivity under the selection pressure of physcion at the dose of EC₇₀ for 15 generations.

Effects of bretylium tosylate on electrophysiologic properties of normal and digitalized papillary muscles of guinea pigs

The effects of bretylium tosylate (BT) on the electrophysiologic properties of normal and digitalized papillary muscles isolated from guinea pigs were studied with regular glass microelectrode. BT prolonged effective refractory period (ERP) and action potential duration (APD) of normal papillary muscles. The ERP and APD of papillary muscles were shortened by perfusion with ouabain (Oua) 0.2 mumol.L-1. No recovery was seen in perfusion without drug for 30 min. In digitalized papillary muscles with Oua, ERP, APD90, and APD50 were prolonged by BT 120 mumol.L-1 form 175 +/- 20, 187 +/- 20, and 146 +/- 21 ms to 222 +/- 21, 220 +/- 19, and 190 +/- 19 ms, respectively. The results demonstrated that BT can prolong ERP and APD of papillary muscles digitalized with Oua.

[Electrophysiologic effects of sophocarpine on papillary muscle in guinea pig]

Sophocarpine prolonged the action potential duration of guinea pig papillary muscle in a dose-dependent manner. After the preparations were exposed to sophocarpine 50 mumol/L for 30 min, APD50 and APD90 were prolonged from 189 +/- 21 and 216 +/- 24 ms to 205 +/- 27 and 241 +/- 25 ms (P less than 0.01). Simultaneously, ERP was prolonged from 202 +/- 14 to 211 +/- 16 ms, although the ERP/APD90 ratio was not changed. Sophocarpine had no significant effects on other AP parameters. Propranolol did not block sophocarpine effects.

Effects of protracted hypothyroidism on pituitary function and structure in endemic cretinism

Pituitary function and structure were assessed in 69 endemic cretins from western China. In hypothyroid cretins (TSH greater than 10 mIU/l), CT imaging of the pituitary revealed adenoma in five of 20 (25%) and partially empty sella (PES) in a further eight of 20 (40%). The majority of tumours were microadenomas and showed a relation with higher levels of serum TSH but not with duration of hypothyroidism. Dynamic pituitary testing with TRH and GnRH in four patients with adenoma on CT gave a flat TSH response but significant rises in serum PRL, GH, LH and FSH concentrations. Hyperprolactinaemia (greater than 350 mIU/l) was present in hypothyroid cretins only (13 of 26; 50%) and serum PRL showed a curvilinear relation with serum TSH levels (r = 0.7, P less than 0.0001). Hypogonadism was seen in approximately half the cretins with high PRL levels. Our data suggest that severe protracted thyroid hormone deficiency may result in thyrotrophin adenomas of the pituitary gland. Disturbances of growth, puberty, and sexual function in endemic cretins are explained by the secondary effects of thyroid hormone deficiency on pituitary function.

Proteolysis of V antigen from Yersinia pestis

Lcr-plasmids of yersiniae are known to mediate a unique low calcium response characterised by restriction of growth in vitro with induction of putative virulence factors including yersiniae outer membrane-peptides (YOPs) and V antigen (Lcr+). A medium was developed that permitted expression of high yields of V by Yersinia pestis KIM in large fermenter vessels. Immunoblots of specific precipitates prepared by prior molecular sieving showed that native unaggregated V exists as a monomeric 37,000 dalton peptide. Fractionation by precipitation with (NH4)2SO4 and chromatography on phenyl-Sepharose, DEAE cellulose, Sephacryl S200, calcium hydroxyapatite, and Sephadex G200 yielded highly purified antigen as judged by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of parallel preparations from Lcr+ and Lcr- yersiniae. However, yields of V obtained by this process were unexpectedly low. As determined from immunoblots with monospecific polyclonal and monoclonal anti-V, this loss of activity occurred as a function of evident degradation at every step of purification yielding antigenic fragments of about 36,000, 34,000, 31,000, 30,000, and 28,000 daltons. Neutral or acidic pH favored hydrolysis; insignificant cleavage occurred in viable Lcr+ cells of Y. pestis or in culture supernatant fluids. V in neutral cytoplasm from Yersinia pseudotuberculosis or Yersinia enterocolitica did not undergo comparable degradation.