[A sampling survey of intraoperative facial nerve monitoring in China]

Objective: This study aims to investigate the current application and the level of knowledge of intraoperative facial nerve monitoring among medical staff in China. Methods: A comprehensive online questionnaire was conducted among medical professionals across different regions in China from October 2022 to February 2023. The survey exclusively targeted departments specializing in otolaryngology, head and neck surgery, neurosurgery, and oral and maxillofacial surgery. The questionnaire covered various aspects including general information, intraoperative facial nerve monitoring practices, training history, indications for monitoring, parameters used during monitoring procedures, as well as factors influencing its implementation. Results: A total of 417 participants from 31 provincial, municipal, and autonomous regions were included. Intraoperative facial nerve monitoring was found to be implemented in 227 (54.4%,227/417) repondents of 53 institutions (24.9%, 53/213). The top three indications for implementing this technique were acoustic neuroma, parotid gland surgery, and modified middle ear surgery (mastoidectomy). Herein 81.1%(184/227) medical staff involved in intraoperative facial nerve monitoring had received relevant training, 57.3%(130/227)-92.1%(209/227) reported a lack of clear description regarding recording thresholds, stimulation currents/frequencies/wave widths. Conclusion: The majority of the institutions surveyed have not yet adopted intraoperative facial nerve monitoring. Furthermore, significant gaps concerning the procedure exist. It is imperative to establish standards or guidelines to promote its better development and application.

MRI-guided microwave ablation and albumin-bound paclitaxel for lung tumors: Initial experience

Magnetic resonance-guided microwave ablation (MRI-guided MWA) is a new, minimally invasive ablation method for cancer. This study sought to analyze the clinical value of MRI-guided MWA in non-small cell lung cancer (NSCLC). We compared the precision, efficiency, and clinical efficacy of treatment in patients who underwent MRI-guided MWA or computed tomography (CT)-guided microwave ablation (CT-guided MWA). Propensity score matching was used on the prospective cohort (MRI-MWA group, n = 45) and the retrospective observational cohort (CT-MWA group, n = 305). To evaluate the advantages and efficacy of MRI-guided MWA, data including the accuracy of needle placement, scan duration, ablation time, total operation time, length of hospital stay, progression-free survival (PFS), and overall survival (OS) were collected and compared between the two groups. The mean number of machine scans required to adjust the needle position was 7.62 ± 1.69 (range 4–12) for the MRI-MWA group and 9.64 ± 2.14 (range 5–16) for the CT-MWA group (p < 0.001). The mean time for antenna placement was comparable between the MRI and CT groups (54.41 ± 12.32 min and 53.03 ± 11.29 min, p = 0.607). The microwave ablation time of the two groups was significantly different (7.62 ± 2.65 min and 9.41 ± 2.86 min, p = 0.017), while the overall procedure time was comparable (91.28 ± 16.69 min vs. 93.41 ± 16.03 min, p = 0.568). The overall complication rate in the MRI-MWA group was significantly lower than in the CT-MWA group (12% vs. 51%, p = 0.185). The median time to progression was longer in the MRI-MWA group than in the CT-MWA group (11 months [95% CI 10.24–11.75] vs. 9 months [95% CI 8.00–9.99], p = 0.0003; hazard ratio 0.3690 [95% CI 0.2159–0.6306]). OS was comparable in both groups (MRI group 26.0 months [95% CI 25.022–26.978] vs. CT group 23.0 months [95% CI 18.646–27.354], p = 0.18). This study provides hitherto-undocumented evidence of the clinical effects of MRI-guided MWA on patients with NSCLC and determines the relative safety and efficiency of MRI- and CT-guided MWA.

[Management of the internal carotid artery during lateral skull base surgery: a series of 41 cases]

Objective: To introduce our experience on dealing with the internal carotid artery (ICA) during the resection of lateral skull base tumors, and to explore the reference values for using radiological findings to make a rational surgical plan. Methods: A retrospective study of patients who underwent resection of lateral skull base tumors involving ICA at Peking Union Medical College Hospital from May 2015 to May 2021 was conducted. The demographic information, preoperative examinations, diagnosis, surgical details and follow-ups were collected. A total of 41 patients were enrolled [24 (58.5%] females, 17 (41.5%) males], with an average age of 47.9 years. According to the preoperative imaging findings, the relationships between the tumors and ICA were divided into four types: adjacency, compression, invasion and ICA aneurysm. Results: The ICA was preserved in 32 (78.0%, 32/41) cases and was reconstructed in nine (22.0%, 9/41) cases. All the 27 (65.9%, 27/41) tumors adjacent to ICA were successfully separated from the artery. Among the 11 tumors compressing the ICA, six were resected with the involved ICA segment and vascular reconstruction was conducted. One (2.4%, 1/41) tumor invading ICA and two (4.9%, 2/41) ICA aneurysms required revascularization. The mean follow-up time was (26.1±2.9) months. There was no recurrence, except one case of adenoid cystic carcinoma which had brain metastases one year after surgery. Conclusions: According to the preoperative imaging, lateral skull base tumors adjacent to ICA can be detached from the vascular surface. Separation should be attempted first for tumors compressing ICA, and revascularization should be followed if separation failed. Vascular reconstruction is usually needed in the removal of tumors invading ICA and ICA aneurysms. Preoperative radiology can provide good references for planning a surgery for lateral skull base tumors.

Postoperative infection of the skull base surgical site due to suppurative parotitis: A case report

BACKGROUND

Paraganglioma occurring at the lateral skull base is a rare tumor. Surgery is the primary treatment of benign paragangliomas. Postoperative infection of the surgical site at the lateral skull base is very dangerous and hard to manage.

CASE SUMMARY

A 30-year-old man with a 1-year history of left-side progressive hearing loss, tinnitus, facial palsy, and choking failed conventional treatment and is the focus of this case report. Imaging revealed a mass around the left jugular foramen that was approximately 47 mm × 38 mm × 34 mm in size and had eroded the bone of the vertebral and horizontal segments of the internal carotid artery. The tumor breached the meninges and occupied the cerebella pontine region. A two-stage surgery was designed for the resection of the mass. In the first-stage, the epidural portion of the mass was removed. The abdominal fat and the temporal muscle flap were transposed within the surgical site. The surgery was successful; however, 25 d after surgery, he developed suppurative parotitis, and the infection spread to the surgical site at the skull base. Broad-spectrum antibiotics were used, and debridement was deployed. After that, the wound was cleaned daily. Five months after the first-stage surgery, the wound was still unclosed, and there was intermittent purulent exudation within the surgical site. vacuum sealing drainage (VSD) was used, and the wound healed in a month. One year after the first surgery, the second-stage of the operation was performed to remove the intracranial portion of the tumor. Recurrence of the tumor was not detected after a 6-month follow-up.

CONCLUSION

After a lateral skull base surgery, suppurative parotitis can spread into the operative cavity leading to infection of the surgical site. VSD can help to effectively heal the infected wound. A two-stage surgical approach offers a safer option for removing the lateral skull base paraganglioma that involves the meninges.

Development of a fluorescent probe for detecting Al3+ in cooked wheaten food based on phosphonic acid group functionalized polythiophene derivatives

As an unnecessary trace element, the content of aluminium in biological systems should be strictly controlled. Therefore, it was necessary to develop a convenient method for detection of aluminium ions. In this study, a fluorescent probe based on polythiophene derivatives was developed and used to detect Al³⁺ in Chinese traditional pasta. The fluorescence of this probe showed a significant decrease in hexamethylenetetramine-HCl buffer solution (pH 5) when Al³⁺ was present. In addition, the probe exhibited good sensitivity and selectivity to Al³⁺ over other metal ions when EDTA was used as the masking agent. Fluorescence intensity had a good linear relationship with the Al³⁺ concentration in the range 0.1-10 μM and the limit of detection for Al³⁺ was 39 nM. Furthermore, the probe was successfully applied to detect Al³⁺ in food samples and the results were consistent with ICP-AES.

Pyoderma gangrenosum confused with congenital preauricular fistula infection: A case report

BACKGROUND

Pyoderma gangrenosum resulting from or associated with congenital preauricular fistula is rarely reported.

CASE SUMMARY

We report a rare case of pyoderma gangrenosum misdiagnosed as preauricular fistula infection. To our knowledge, this is the first report to describe pyoderma gangrenosum originating from the site of preauricular fistula. The lesion continued expanding even after combined treatment of systemic antibiotics and thorough debridement. Taking into account the possibility of pyoderma gangrenosum, we applied soft care with normal saline and Vaseline gauze dressing. Systemic corticosteroids were not used until intestinal Clostridium difficile was controlled. No local recurrence was noted at the 12-mo follow-up.

CONCLUSION

This case highlights the necessity of considering rare diseases, such as pyoderma gangrenosum, when the preauricular sinus deteriorates with general management. The treatment strategy is mutually conflicting between pyoderma gangrenosum and infection of the preauricular sinus.

Properties of Rigid Polyurethane Foam Modified by Tung Oil-Based Polyol and Flame-Retardant Particles

Although tung oil is renewable, with an abundant production and low price in China, and it is used to synthesize different polyols for rigid polyurethane foam (RPUF), it remains a challenge to improve the properties of RPUF by redesigning the formula. Therefore, we propose four novel compounds to strengthen the properties of RPUF, such as the catalyst-free synthesis of tung oil-based polyol (PTOK), aluminum phosphate micro-capsule (AM), silica micro-capsule (SiM), and grafted epoxidized monoglyceride of tung oil on the surface of SiO2 (SiE), which were designed and introduced into the RPUF. Because of the PTOK with a catalytic function, the foaming process of some RPUF samples was catalyst-free. The results show that the incorporation of AM, SiM, and SiE, respectively, endow RPUF with a better thermal stability at a high temperature, and the T5%, Tmax1, and Tmax2 of RPUF appeared to be reduced, however, the Tmax3 and residue rate at 800 °C were improved, which may have a positive effect on the extension of the rescue time in case of fire, and the limiting oxygen index (LOI) value was increased to 22.6%. The formula, containing 25% PTOK made the RPUF environment-friendly. The results were obtained by comparing the pore size and mechanical properties of the RPUF-the AM had a better dispersion in the foam, and the foam obtained a better mechanical, thermal, and flame retardancy.

Crystal and Band-Gap Engineering of One-Dimensional Antimony/Bismuth-Based Organic-Inorganic Hybrids

Hybrid halide perovskites are emerging semiconducting materials with a diverse set of remarkable optoelectronic properties. Besides the widely studied lead halide perovskites, Pb-free metal halides such as Bi- and Sb-containing hybrid organic-inorganic materials have shown potential as semiconductors and have been deemed candidates for optoelectronic devices. Here, we report a series of 1D Sb/Bi-based organic-inorganic hybrid alloys: [4ApyH]Sb_xBi_1-xI_yBr_4-y, where 4ApyH stands for the 4-aminopyridine cations. These compounds are assembled by edge-sharing octahedral [MX₆] units stabilizing 1D chains with organic cations filled in between. The crystallographic data of eight selected complexes show that [4ApyH]Sb_xBi_1-xI_yBr_4-y has at least five phases (space group) with the difference metal and halogen content: Pbca ([4ApyH]BiI₄), Pca2₁ ([4ApyH]Sb_0.5Bi_0.5I₄), P2₁/c ([4ApyH]SbI₄ (100 K), [4ApyH]BiI₂Br₂, [4ApyH]BiBr₄, and [4ApyH]SbBr₄ (100 K)), I2/a ([4ApyH]Sb_0.5Bi_0.5I₂Br₂and [4ApyH]SbI₂Br₂), and C2/c ([4ApyH]SbI₄ (298 K) and [4ApyH]SbBr₄ (298 K)). Powder X-ray diffraction shows that the phase of the sample changes with a change of the metal and halogen ratios, and the change law accords with Vegard's law. The optical band gaps are heavily affected by the metal and halide contents, ranging from 1.94 eV for [4ApyH]BiI₄ to 2.73 eV for [4ApyH]SbBr₄. When Sb substitutes for Bi to form an alloy, the band gap increases from 1.94 for [4ApyH]BiI₄ to 1.67 eV for [4ApyH]SbI₄, from 2.13 eV for [4ApyH]BiI₂Br₂ to 2.41 eV for [4ApyH]SbI₂Br₂, and from 2.55 eV for [4ApyH]BiBr₄ to 2.73 eV for [4ApyH]SbBr₄. The conductivity of [4ApyH]Sb_xBi_1-xI₄ increased from ∼1.00 × 10^-15 to 2.14 × 10^-8 S cm^-1 with an increase of the Sb content. Solution-deposited thin films of the nine complexes show the same (110) orientation, displaying a parallel growth orientation with respect to the substrate. The devices of [4ApyH]Sb_0.8Bi_0.2I₄ and [4ApyH]SbI₄ demonstrated stable open-circuit photovoltages of 0.55 and 0.44 V, steady-state short-circuit photocurrent densities of 1.52 and 1.81 mA cm^-2, and light-to-electrical energy conversion efficiencies of 0.29% and 0.30%, respectively.

Developed a novel sensor based on fluorescent graft conjugated polymer for the determination of aristolochic acid in traditional Chinese medicine

A novel fluorescent graft conjugated polymer (poly (2, 5-bis (Polyethylene glycol oxybutyrate)-1, 4-phenylethynylene-alt-1, 4-phenyleneethynylene, PPE-OB-PEG) has been designed and synthesized for the determination of aristolochic acid (AA). The detection conditions and detection characters of PPE-OB-PEG were systematically explored in this work. The fluorescence intensity of PPE-OB-PEG changes with the different concentration of AA. PPE-OB-PEG has a good linear range towards AA from 1.00 × 10^-7 to 8.00 × 10^-5 mol L^-1 and the limit of detection (LOD) is 3.00 × 10^-8 mol L^-1 (S/N = 3). PPE-OB-PEG have been applied to detect AA in traditional Chinese medicine samples and the results are satisfactory. The experimental results show that PPE-OB-PEG can be used as a fluorescence probe for rapid and sensitive detection of AA.

[Advances of chronic tympanic membrane perforation animal model]

Chronic tympanic membrane perforation in an animal model has been widely used. The ideal model is a lasting and stable perforation without infection. For half a century, several physical modalities have been evolved, such as thermal injury, infolding technique, tympanostomy tube, re-myringotomy, and laser myringotomy. Chemical methods using chemical substance inhibiting growth and repair of cells as well as using gene defect animals are also applied. We have found the success rate is lower when using only one method and it would be better to combine physical and chemical approaches. In this article, we review the research advances in the establishment of chronic tympanic membrane perforation animal model.

Tracking the dimensional conversion process of semiconducting lead bromide perovskites by mass spectroscopy, powder X-ray diffraction, microcalorimetry and crystallography

The structural information of a material in both the solid state and solution state is essential to the in-depth understanding of the properties of inorganic-organic hybrid materials. A one-dimensional (1D) lead bromide formulated as [H][NH₃(CH₂)₂SS(CH₂)₂NH₃][H₂O][PbBr₅] (1) could be converted into a new two-dimensional (2D) complex, [NH₃(CH₂)₂SS(CH₂)₂NH₃][PbBr₄] (2), by soaking the crystals in water. The isolated 2D compound showed single-layer lead-halide perovskite structures. Electrospray ionization mass spectrometry (ESI-MS) analyses of the reaction solution revealed that the [PbBr₃]^- fragments are initially formed from the rapid decomposition of the 1D [PbBr₅]^3- chains and subsequently reassemble into 2D [PbBr₄]^2- layers, which was verified by powder X-ray diffraction (PXRD) and microcalorimetry. Because of the decomposition and reassembly process, complex 1 could be used as a precursor to synthesize M²⁺-doped 2D lead bromide perovskites, namely, Mn@2, Ni@2 and Cd@2. In addition, preliminary tests indicated that complex 2 exhibited a lower optical band gap (3.25 eV) and higher electrical conductivity (3.2 × 10^-11 S cm^-1) than complex 1 (3.38 eV, 5.4 × 10^-12 S cm^-1).

[The advance of materials for preventing adhesion in tympanoplasty]

For otitis media patients with severe mucosal lesions, adhesion is the most common poor prognosis of tympanoplasty. We generally consider tympanic cavity adhesion is due to eustachian tube dysfunction and poor middle ear ventilation. The mechanism of adhesion is unclear so far, which we thought is mainly associated with wounded surface and activation of the fibrinolytic system. To solve the problem of adhesion, several materials have been used in the middle ear surgery, such as plastic sheet, silicone sheet and absorbable material. And there are some benefits. The most widely used is silicone sheet, and there are some researches focused on its thickness, shape and components to achieve better anti-adhesion effect. In this article, we will do a review for the research advances of anti-adhesion materials in tympanoplasty.

[A double-blind randomized controlled trial on the efficacy of mixed pure tone sound therapy in chronic tinnitus patients with different hearing loss]

Objective: The effectiveness of two different sound therapies in chronic subjective tinnitus was compared. The effectiveness of different degrees of hearing loss patients on two different sound therapies were analyzed preliminarily and the possible mechanisms were discussed. Methods: This clinical trial was conducted in the Peking Union Medical College Hospital, China from January 2018 to April 2018. Patients were received sound therapy when they were diagnosed as subjective tinnitus. This was a double-blinded randomized controlled trial. In our clinical trial, we included 56 participants who were randomly divided into Groups A and B with different sound therapies by using a computer allocation sequence. Pure tone audiometry, tympanometry and tinnitus matching were performed. The patients were followed up for 2 weeks, 1 month, 2 months and 3 months. Tinnitus handicap inventory (THI) and visual analog scales (VAS) measuring were used to evaluate the handicap, loudness and anxiety of tinnitus. An analysis of variance (ANOVA) of 2×5 repeated-measures was conducted. Results: With the prolongation of the treatment time, both groups showed significantly lower scores after 3 months training compared with baseline which were measured by THI scores. While there was no effect between the two groups. According to the degree of hearing loss, Group A and B were divided into normal to mild hearing loss group (26-40 dB HL, Group A1, Group B1), moderate to profound hearing loss group (41 dB HL group and above, Group A2, Group B2). In the patients with normal hearing and mild hearing loss, the THI (P=0.013), VAS loudness and annoyance scores (P<0.01) after 3 months in Group B1 was significantly lower than those at baseline and the sound therapy in Group B1 was effective. In patients with moderate to profound hearing loss, the THI, VAS loudness and annoyance scores (P<0.01) after 3 months in Group A2 was significantly lower than those at baseline and the sound therapy in Group A2 was effective. Conclusions: Sound therapy may be effective for some patients. Sound therapy for patients with different degrees of hearing loss are different. The tinnitus of most patients could not disappear completely, but reduce or eliminate. Doctors should use appropriate and individualized acoustic parameters for different characteristics of tinnitus. Doing so would provide effective and specific sound therapy for patients and reduce or eliminate tinnitus.

Syntheses, crystal-solution structures and magnetic properties of a series of decanuclear heterometallic [LnCoCo] (Ln = Eu, Gd, Tb, Dy) clusters

Four unprecedented decanuclear heterometallic [Ln2CoII4CoIII4] clusters based on a diethanolamine ligand (H2dea), namely [Eu2CoII4CoIII4(dea)8(HCOO)4(OH)2(Cl)2(CH3OH)2]Cl2·4CH3OH·2H2O (1), [Gd2CoII4CoIII4(dea)8(HCOO)4(OH)2(Cl)2(CH3OH)2]Cl2·4CH3OH·2H2O (2), [Tb2CoII4CoIII4(dea)8(HCOO)4(OH)2(Cl)2(CH3OH)2]Cl2·2CH3OH·4H2O (3) and [Dy2CoII4CoIII4(dea)8(HCOO)4(OH)2(Cl)2(CH3OH)2]Cl2·2CH3OH·4H2O (4) were synthesized through a facile solution method. Single-crystal X-ray diffraction analyses reveal that complexes 1-4 consist of a [Ln2CoII4CoIII4] core, which is constructed by bridging a quasi-double cuboidal [Ln2CoII2CoIII2] core with two [CoIICoIII] units. Electrospray ionization mass spectrometry (ESI-MS) using methanol solution reveals that complexes 1-4 are stable in the solution, and the clusters undergo three different substitution reactions (Cl- replaced by OH-, OH- replaced by CH3O- and HCOO- replaced by OH-/CH3O-) at the same time in the ionization state. Magnetic susceptibilities reveal ferromagnetic couplings within complexes 3 and 4, and the magnetocaloric effect (MCE) for 2 was also evaluated and the maximum entropy change (-ΔSm) value reaches 16.3 J kg-1 K-1 at about 3 K and 5 T.

Effects of maize naturally contaminated with aflatoxin B1 on growth performance, intestinal morphology, and digestive physiology in ducks

This study was conducted to determine the effects of maize naturally contaminated with aflatoxin B1 (AFB1) on growth performance, intestinal morphology, relative digestive organs weight, digestive enzymes activities, and biochemical index of intestinal development in ducks. A total of 640 ducks was blocked on the basis of sex and body weight, and then allocated randomly to 2 treatments with 20 pens per treatment and 16 ducks per pen. The experiment lasted for 5 wk, and dietary treatments included basal diet (CON) and diets with 100% of normal maize replaced by AFB1 contaminated maize. Detectable levels of other toxins were present but only AFB1 exceeded limits and the level of AFB1 was 195.4 ug/kg in the contaminated maize, and ranged from 2.91 to 120.02 ug/kg in the starter diet and 2.03 to 153.12 ug/kg in the grower diet. Feeding AFB1 contaminated diets decreased (P < 0.05) ADG and ADFI during the whole experiment, whereas F/G during d 15 to 35 and d zero to 35 was reduced (P < 0.05). The mortality of ducks fed AFB1 contaminated diets increased (P < 0.05). Ducks fed AFB1 contaminated diets had greater (P < 0.05) relative weights of proventriculus and gizzard on d 14 as well as the duodenum, jejunum, and ileum on d 14 and 35. Feeding AFB1 contaminated diets increased (P < 0.05) crypt depth, villus width, and surface area in the duodenum on d 35 and villus height, villus width, and surface area in the jejunum on d 14. The activities of alkaline phosphatase and leucine aminopeptidase in the jejunum brush border together with chymotrypsin and trypsin in the pancreas increased (P < 0.05) on d 14 with the inclusion of AFB1 contaminated maize. The jejunum villus became long and wide in ducks fed AFB1 contaminated diets. Taken together, the feeding of maize naturally contaminated with AFB1 caused adverse effects on growth performance and intestinal morphology, and altered digestive physiology and development.

Spontaneous spinal epidural hematomas: One case report and rehabilitation outcome

RATIONALE

Spontaneous spinal epidural hematoma (SSEH) is a relatively rare but potentially disabling disease, and the classical presentation of it includes an acute onset of severe, sometimes radiating back or neck pain, followed by signs and symptoms of rapidly evolving nerve root or spinal cord compression.

PATIENT CONCERNS

Here, we report a 26-year-old female patient presented with weakness in bilateral lower extremities, progressing to intense paraplegia and anesthesia without recent medical history of trauma, infection, surgery, or drug use.

DIAGNOSIS

A magnetic resonance imaging (MRI) scan of spinal cord was planned and a posterior epidural hematoma of the thoracic spine was observed.

INTERVENTIONS

A posterior decompression and hematoma evacuation was performed after diagnosis immediately. Early rehabilitation program of the specific kind spinal cord injury was formulated and implemented.

OUTCOMES

The patient finally can handle basic living activities, such as completing wheelchair locomotion, transferring from bed to wheelchair independently after 3 months of rehabilitation.

LESSONS

SSEH is a rarely occurring case in emergency. Acute chest pain and paraplegia could be the initial presentation of acute spinal epidural hemorrhage, but the diagnosis of patient without classical manifestations is still a challenge for doctors. Early diagnosis, prompt decompression, and individualized rehabilitation program can improve the prognosis and outcome.

[Alarming system in real time and high quality display using volumerendering for otologic surgical navigation: a preclinical study]

Objective:The aim of this study is to design and develop a novel navigation framework that alarms the surgeon with sound during drilling and dynamically renders the high quality medical image data. Method:The accuracy of the proposed system were measured with a skull model using paired point registration and the target registration error (TRE) was computed. We segmented the accurate structure of target and compute the minimum distance between the drill tip and the target. Once the drill tip approached the target structures, the system would alarm the surgeon. We proposed a novelty method that used a mask to render the medical image data in real time. Result:The maximum distance error of 90 target points was 1.016 mm, the minimum was 0.427 mm, and the average distance error was (0.74±0.07) mm. The design and development of the alarming system and dynamically rendering the medical image data of navigation system was accomplished. Conclusion:The results show that the accuracy of the navigation system can meet the clinical needs. It also demonstrates the feasibility of the alarm system and dynamic display system and its application prospects.

Sub-optimal Specificity of Modified Ziehl-Neelsen Staining for Quick Identification of Tuberculous Meningitis

Background: Microbiological confirmation of tuberculous meningitis (TBM) remains problematic. We assessed the diagnostic performance of a modified Ziehl-Neelsen (MZN) staining method that showed promise in earlier studies.

Methods: Patients evaluated for TBM in Shaanxi province, China, were prospectively enrolled from May, 2011 to April, 2013. Cerebrospinal fluid (CSF) specimens were evaluated using the Xpert MTB/RIF® assay, MZN staining, and standard biochemical and microbiological tests, together with detailed clinical and radiological assessment.

Results: Among 316 patients included in the study, 38 had definite TBM, 66 probable TBM, 163 possible TBM and 49 “no TBM,” using consensus uniform research case definition criteria. Comparing “definite or probable TBM” to “no TBM” MZN staining had higher sensitivity than Xpert MTB/RIF® (88.5 vs. 36.5%), but greatly reduced specificity (71.4 vs. 100.0%); 14/49 (28.6%) cases with “no TBM” tested positive on MZN. Mycobacterium tuberculosis culture was performed in 104/179 (58.1%) of MZN positive samples; 12.5% (13/104) were positive. Using Xpert MTB/RIF® as the reference standard, MZN had a sensitivity of 92.1% (95% CI 79.2–97.3) and specificity of 71.4% (95% CI 57.6–82.2).

Conclusion: Xpert MTB/RIF® offered a rapid and specific TBM diagnosis, but sensitivity was poor. MZN was mainly hampered by false positives. Strategies to enhance the sensitivity of Xpert MTB/RIF® or improve the diagnostic accuracy of MZN should be explored.

[Measuring facial paralysis using the three-dimensional dynamic quantitative analysis system of facial motion: correlation with subjective grading systems]

OBJECTIVE

The aim of this study was to measure the facial motion of patients with facial paralysis using a three-dimensional dynamic quantitative analysis system of facial motion (3D ASFM) and analyze its correlation with subjective grading systems.

METHODS

We included 30 healthy volunteers and 50 patients with unilateral facial paralysis. After placing landmarks on the faces, the facial motions of the patients were measured using the 3D ASFM. The regional symmetry ratios(SRs) and gross scores of different parameters were calculated. Then a comparison with four subjective grading systems(House-Brackmann, Sunnybrook, Facial Nerve Grading System 2.0, Fisch) was performed.

RESULTS

The entire test could be completed within five minutes. The normal range of healthy volunteers were obtained, the gross score of which was 91.9±1.5. The SRs of the maximal moving distance(MMD) were most strongly correlated with regional subjective grading systems, followed by the SRs of the maximal moving velocity (MMV). The SRs of the maximal moving acceleration (MMA) were either poorly correlated or uncorrelated with the subjective grading systems. Moreover, the Spearman coefficients with four subjective grading systems were -0.630(House-Brackmann), -0.728(Facial Nerve Grading System 2.0), 0.697(Sunnybrook), and 0.617(Fisch)respectively(P<0.05).

CONCLUSIONS

The 3D ASFM is a convenient method to rapidly assess facial paralysis. It not only overcomes the shortcomings of conventional subjective grading systems, but also correlates well with them.

High rate of drug resistance among tuberculous meningitis cases in Shaanxi province, China

The clinical and mycobacterial features of tuberculous meningitis (TBM) cases in China are not well described; especially in western provinces with poor tuberculosis control. We prospectively enrolled patients in whom TBM was considered in Shaanxi Province, northwestern China, over a 2-year period (September 2010 to December 2012). Cerebrospinal fluid specimens were cultured for Mycobacterium tuberculosis; with phenotypic and genotypic drug susceptibility testing (DST), as well as genotyping of all positive cultures. Among 350 patients included in the study, 27 (7.7%) had culture-confirmed TBM; 84 (24.0%) had probable and 239 (68.3%) had possible TBM. DST was performed on 25/27 (92.3%) culture positive specimens; 12/25 (48.0%) had "any resistance" detected and 3 (12.0%) were multi-drug resistant (MDR). Demographic and clinical features of drug resistant and drug susceptible TBM cases were similar. Beijing was the most common genotype (20/25; 80.0%) with 9/20 (45%) of the Beijing strains exhibiting drug resistance; including all 3 MDR strains. All (4/4) isoniazid resistant strains had mutations in the katG gene; 75% (3/4) of strains with phenotypic rifampicin resistance had mutations in the rpoB gene detected by Xpert MTB/RIF®. High rates of drug resistance were found among culture-confirmed TBM cases; most were Beijing strains.

Development of an improved animal model of experimental autoimmune myositis

Multiple animal models of experimental autoimmune myositis (EAM) have been developed. However, these models vary greatly in the severity of disease and reproducibility. The goal of this study was to test whether vaccination twice with increased dose of rat myosin and pertussis toxin (PT) could induce EAM with severer disease in mice. BALB/c mice were injected with 1 mg rat myosin in 50% complete Freund's adjuvant (CFA) weekly for four times and one time of PT (EAM) or twice with 1.5 mg myosin in CFA and PT (M-EAM). In comparison with that in the CFA and PT injected controls, vaccination with rat myosin and injection PT significantly reduced the muscle strength and EMG duration, elevated serum creatine kinase levels, promoted inflammatory infiltration in the muscle tissues, leading to pathological changes in the muscle tissues, demonstrating to induce EAM. Interestingly, we found that vaccination twice with the high dose of myosin and PT prevented EAM-related gain in body weights and caused significantly less muscle strength in mice. More importantly, all of the mice receiving high dose of myosin and PT survived while 3 out of 16 mice with four times of low dose of myosin died. Finally, vaccination with high dose of myosin promoted CD4(+) and CD8(+) T cell infiltration in the muscle tissues and up-regulated MHC-I expression in the muscle tissues of mice. Hence, the new model of EAM is a time-saving, efficient and easily replicable tool for studying autoimmune myositis.

Evaluation of FT-IR and Nile Red methods for microalgal lipid characterization and biomass composition determination

To characterize lipid content of microalgal cells rapidly and accurately, the gravimetric determination, FT-IR and Nile Red (NR) staining were investigated on six typical eukaryotic and prokaryotic algae species. FT-IR and Nile Red were relative quantification methods and a standard curve was required in contrast to the gravimetric method. The FT-IR method determined the lipid, carbohydrate and protein contents simultaneously assuming that the algal cells only consisted of those three components. The Nile Red method was a relatively rapid method for neutral lipid content characterization by spectrofluorometry and could locate lipid body of the algal cell by fluorescence microscopy. According to sample sources and processing purposes, the gravimetric determination was preferable for large-scale cultivation with low-frequency monitoring, while FT-IR and Nile Red were suitable for general laboratory cultivation with medium-frequency monitoring, in particularly Nile Red was appropriate for small samples when high-frequency screening was required.

A novel method for three-dimensional analysis of endoscopic spatial relationships of pterygopalatine fossa structures and associated regions

BACKGROUND

The spatial orientation rules of the important skull base structures are essential for performing endoscopic surgery. However, there is no satisfactory three-dimensional (3-D) anatomy study available to the surgeon at present. The aims of this study are to construct a new method to learn the spatial orientation of anatomical features under endoscopy and to help the surgeon establish a 3-D image of skull base structures in his mind.

METHODS

A modified MicronTracker navigation system was used to measure the pitch angle, direction angle and distance from the reference points to various anatomical landmarks of the pterygopalatine fossa and related structures (PPFRS) at the skull base in 10 fresh cadavers (20 sides).

RESULTS

The location data of the positions of the major landmarks were acquired and a digital model of the anatomical structures of the PPFRS was built, which can be moved, whirled or demonstrated easily.

CONCLUSION

It is practical to measure the positions of the anatomical structures of the PPFRS with a modified binocular vision-based MicronTracker navigation system. It is a valuable exploration tool to help the surgeon establish the orientation of surgical landmarks in his mind by the 3-D parameters and model.

Different neuroprotection and therapeutic time windows by two specific diazepam regimens on retinal ganglion cells after optic nerve transection in adult rats

PURPOSE

To compare neuroprotection and therapeutic time windows of two diazepam regimens on retinal ganglion cells (RGCs) after rat optic nerve transection (ONT).

METHODS

Adult rats received initial intraperitoneal diazepam injections 30 minutes before left ONT, followed by daily diazepam (regimen-A) or every 8 hours for 3 days (regimen-B) until they were killed at day 7 or 14. Initial diazepam in regimen-A and regimen-B was delayed to 3, 6, 7, 9, 10, 12 and 6, 7, 8, 9, 10, 12 hours after ONT and these animals survived for 7 days. The effect of daily combinational uses of diazepam and bicuculline was assayed at 7 days.

RESULTS

Regimen-A induced higher RGC densities than those in control and regimen-B groups at day 7, but lower density than regimen-B did at day 14. When initial diazepam was delayed beyond 6 or 8 hours after ONT with regimen-A and regimen-B, the promoting effects of diazepam on RGC densities disappeared. Bicuculline completely inhibited the protection of diazepam.

CONCLUSIONS

Prolonged neuroprotection on RGCs at day 14 and extended therapeutic time window for 8 hours can be achieved by regimen-B, while regimen-A induces a stronger neuroprotection at day 7. Diazepam neuroprotection is mediated through GABAA receptor.

[DR image denoising based on Laplace-Impact mixture model]

A novel DR image denoising algorithm based on Laplace-Impact mixture model in dual-tree complex wavelet domain is proposed in this paper. It uses local variance to build probability density function of Laplace-Impact model fitted to the distribution of high-frequency subband coefficients well. Within Laplace-Impact framework, this paper describes a novel method for image denoising based on designing minimum mean squared error (MMSE) estimators, which relies on strong correlation between amplitudes of nearby coefficients. The experimental results show that the algorithm proposed in this paper outperforms several state-of-art denoising methods such as Bayes least squared Gaussian scale mixture and Laplace prior.

[Surgical treatment in otogenic facial nerve palsy]

OBJECTIVE

To study the character of facial nerve palsy due to four different auris diseases including chronic otitis media, Hunt syndrome, tumor and physical or chemical factors, and to discuss the principles of the surgical management of otogenic facial nerve palsy.

METHODS

The clinical characters of 24 patients with otogenic facial nerve palsy because of the four different auris diseases were retrospectively analyzed, all the cases were performed surgical management from October 1991 to March 2007. Facial nerve function was evaluated with House-Brackmann (HB) grading system.

RESULTS

The 24 patients including 10 males and 14 females were analysis, of whom 12 cases due to cholesteatoma, 3 cases due to chronic otitis media, 3 cases due to Hunt syndrome, 2 cases resulted from acute otitis media, 2 cases due to physical or chemical factors and 2 cases due to tumor. All cases were treated with operations included facial nerve decompression, lesion resection with facial nerve decompression and lesion resection without facial nerve decompression, 1 patient's facial nerve was resected because of the tumor. According to HB grade system, I degree recovery was attained in 4 cases, while II degree in 10 cases, III degree in 6 cases, IV degree in 2 cases, V degree in 2 cases and VI degree in 1 case.

CONCLUSIONS

Removing the lesions completely was the basic factor to the surgery of otogenic facial palsy, moreover, it was important to have facial nerve decompression soon after lesion removal.

[Effects of CD4+ T cell transplantation on facial motoneuron survival in nude mice model with facial nerve axotomy]

OBJECTIVE

To investigate the specific T cell subpopulation and the relationship with facial motoneuron in immune deficiency mouse model with facial nerve paralysis, so as to find information for new strategy of facial palsy treatment.

METHODS

Firstly, purifying the CD4+ T cell from wild type mouse and reestablishing the immune function of nude mouse by infusing the CD4+ T cell through the tail vein a week before the surgery. Then the all nude mouse (BALB/c background) and wild type mouse (BALB/c background) were subjected to a right facial nerve axotomy. Then the mouse was studied by application and assessment with fluorogold retro tracer at specific time. After collecting the slices of brain stem three days post the operation, the facial motoneurons was observed under fluorescence microscope, then analyzed and counted with the software Image Pro Plus5. 1.

RESULTS

The number of survival facial motoneuron in the group with CD4+ T cell transplantation and control group was (3444.5 +/- 84.2, x +/- s) and (3013.2 +/- 65.3) respectively. There was significant difference of the number of survival facial motoneurons between nude mouse transplanted with CD4+ T cell and PBS at three days post the operation (t = 5.52, P = 0.0003). But there was no significant difference of survival facial motoneurons between nude mouse transplanted with CD4+ T cell and wild type mouse three days post the operation (t = 0.49, P = 0.6347). It was the transplantation of CD4+ T cell that rescued the survival facial motoneuron to the level of wild type.

CONCLUSIONS

CD4+ T cell have the ability to rescue the injuring facial motoneuron from death. It may suggest that there is a critical role of the specific T cell subpopulation in facial nerve repair and regeneration.

[Quality of life survey on patients with chronic rhinosinusitis by using Chinese version of the 22-item sinonasal outcome test (SNOT-22)]

OBJECTIVE

To explore the health-related quality of life (QOL) status of patients with chronic rhinosinusitis.

METHODS

Sixty four patients with chronic rhinosinusitis and twenty healthy volunteers were enrolled, and their QOL scores were assessed by using SF-36 questionnaire (Chinese version) and SNOT-22 questionnaire translated into Chinese.

RESULTS

The feasibility, reliability, validity, and responsibility of Chinese version of SNOT-22 questionnaire all passed the test. It showed that by Chinese version of SNOT-22 questionnaire the most five important items affecting health status were nasal obstruction, runny nose, loss of smell or taste, dizziness and post-nasal discharge respectively. The coefficient of correlation was 0. 233 between the SNOT-22 questionnaire and the Lund-MacKay CT score of patients with chronic rhinosinusitis.

CONCLUSIONS

Chinese version of SNOT-22 questionnaire can effectively assess the QOL status of patients with chronic rhinosinusitis. It showed less correlation between the SNOT-22 questionnaire and the Lund-MacKay CT score of patients with chronic rhinosinusitis.

[Development of a high resolution simultaneous microwave plasma torch spectrometer]

A unique high resolution simultaneous microwave plasma torch (MPT) atomic emission spectrometer was developed and studied preliminarily. Some advanced technologies were applied to the spectrometer, such as echelle grating, UV-intensified CCD array detector, adjustable microwave generator, and water cooling system for the generator, etc. The detection limits of the spectrometer for some elements were determined, the spectral resolution and pixel resolution of the spectrometer were calculated, and an analysis of a practical sample was carried out. The preliminary results demonstrate that such simultaneous spectrometer has advantages of saving sample and time, possessing high sensitivity and resolution, and low-cost for the purchase and maintenance. Taking analytical figures of merit into consideration, the high resolution simultaneous MPT spectrometer will have extended application areas and greater competition potential as compared with sequential MPT spectrometers.

Astrocytes in injured adult rat spinal cord may acquire the potential of neural stem cells

It has been well documented that in adult rats astrocytes in the subventricular zone and subgranular layer of the dentate gyrus are neural stem cells. Elsewhere in the CNS astrocytes are not generally recognized as stem cells. Here we describe nestin expression in a population of astrocytes in the spinal cord of adult rat following cord injury. In either hemitransectioned or longitudinally cut spinal cord, there was widespread nestin expression in astrocytes of both the gray and white matters. Isolation of the lateral part of the spinal cord from the central canal region, where stem cells may reside, could not block the appearance of nestin-immunoreactive astrocytes in the lateral cord, and none of them showed Fast DiI labeling after the central canal ependyma had been labeled by the dye, indicating that the nestin-immunoreactive astrocytes can evolve locally in the lateral cord. They were found to be undergoing a process of de-differentiation. Culture of the nestin-immunoreactive astrocytes of the lateral cord generated neurospheres, the cells of which had the ability of self-renewal, and were able to differentiate into neurons, astrocytes, or oligodendrocytes. Taken together, the results indicate that the astrocytes in injured adult rat spinal cord may acquire the potential of neural stem cells.

[Seeding of autologous epithelial cells into the allograft dermis as coverage for full-thickness burns]

Using a scalpel, crisscross grooves 1-2 mm apart were made on the dermis of an allogenic skin graft. Epithelial cells in a suspension, harvested from the patient, were seeded into the dermal grooves. The allograft thus prepared was used to cover wounds resulting from excision of full thickness burns. Four patients with burn areas ranged from 5% to 28% were treated with this technic. 10-13 days after the operation, when epidermis of the allografts were lifted, epithelial growth was seen on the dermal surface. It thickened rapidly, and cornification was seen. Except in one case, in whom newly grown epithelium was rubbed away owing to poor bandage and fixation, all the other wounds healed on 70-80 days after the operation. The healed surfaces of wounds were even and smooth. With this technic, the expansion of the donor area was estimated to be as much as 30-56 fold. Biopsy sections at regular intervals after the operation showed that the auto-skin epidermal cells grew out from the grooves to more superficial portions until they reached the surface of dermis, where they extended and finally covered the whole surface of the wound. 10-14 months after the operation the epidermis assumed more or less a wavy contour, and it seemed to be firmly united with the dermis. The cellular structure was clear, and their arrangement regular. With special staining, it was demonstrated that there were collagenous fibers, reticular fibers and elastic fibers in the dermis. However, there were no dermal appendages. One year later, the color of the new skin approximated that of the normal skin.(ABSTRACT TRUNCATED AT 250 WORDS)