[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.

[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.

[Clinical application of combined infratemporal fossa approaches for internal carotid artery in petrous bone reconstruction for large lateral skull base tumors].

Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complete excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.

[Surgery technique of combined different infratemporal fossa approaches for lesions in lateral skull base].

Objective: To investigate the technical points and clinical application of combined infratemporal fossa approaches (CIFA) by analyzing the clinical results with CIFA for lesions involved skull base. Methods: A retrospective study was performed on 11 patients underwent CIFA for skull base lesions dissection from December 2014 to January 2019 in the department of otolaryngology, Peking Union Medical College Hospital. There were 6 male and 5 female patients, with age range of 16-72 years old and median age of 53 years old. Five patients underwent CIFA Type B and D, and the other 6 underwent CIFA A and B. All patients were followed up regularly by CT and MRI to observe possible recurrence. Results: Among the 5 patients with CIFA Type B and D, 3 were giant cell tumor and 2 were giant cell reparative granuloma, and median maximum cross-section size was 42 mm×46 mm (range from 37 mm×18 mm to 56 mm×53 mm). Among the 6 patients with CIFA Type A and B, 4 were paraganglioma of head and neck, 1 was schwannoma of skull base, 1 was petrous cholesteatoma, and median maximum cross-section size was 43 mm×36 mm (range from 24 mm×22 mm to 63 mm×35 mm). Nine patients underwent complete resection of the tumor in the first stage. In 2 patients, the extracranial parts were removed in the first stage, and the intracranial part was removed in the second stage. Tympanum and ossicular reconstruction were done in one of the CIFA Type B and group D, and 1 year's postoperative hearing was mild conductive hearing loss. There was no cerebrospinal fluid leakage of all patients. All the 5 patients with normal facial nerve function before surgery recovered to H-B grade Ⅰ to Ⅱ within 3 months after surgery. Among the 4 patients whose preoperative facial nerve function were grade Ⅱ, 2 recovered to grade I after surgery and the other 2 were still grade Ⅱ. For the patient whose preoperative facial nerve function was grade Ⅴ, his postoperative recovery was grade Ⅲ. There was 1 patient whose pre-operative FN function was H-B grade Ⅲ, and the post-operative FN function was grade Ⅵ due to FN resection. Except for 2 cases with cochlear involved before surgery, cochleae of the other 9 cases were preserved. The follow-up time was 14 to 58 months. No recurrence was observed in all patients. Conclusions: The CIFA can safely and completely remove the extensive lesions that invade the skull base, and the facial nerve function can be well protected and recovered intro-and post-operation. Appropriate use of combined IFA can not only achieve good exposure and complete resection of lesions, but also create conditions for functional reconstruction.

[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.

[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.

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.

[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.

[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.

A novel water-soluble sulfonated porphyrin fluorescence sensor for sensitive assays of H2O2 and glucose.

Water soluble porphyrins have many perfect analytical figures of merit. A water-soluble sulfonated porphyrin (H2TEHPPS) was used to build a novel platform for sensitive assays of hydrogen peroxide and glucose based on the different effects of Fe(2+) and Fe(3+) on H2TEHPPS. H2O2 or Fe(2+) alone cannot induce a fluorescence change in H2TEHPPS, but Fe(3+) can quench the fluorescence of H2TEHPPS significantly. Interestingly, glucose is oxidized to gluconolactone by GOD and generates an equivalent hydrogen peroxide, and the produced H2O2 also oxidizes Fe(2+) to Fe(3+) and causes the fluorescence quenching of H2TEHPPS. According to this, a sensitive sensor for hydrogen peroxide and glucose has been demonstrated, which can determine H2O2 and glucose in a relative simple and sensitive way. The detection limits were 1.3 × 10(-7) M and 3.2 × 10(-7) M for H2O2 and glucose, respectively. In addition, the glucose in serum samples was determined successfully using this sensing platform. It is also noteworthy that H2O2 can be released in almost all oxidations catalyzed by oxidases, which suggests that this newly proposed H2O2 probe can be readily extended to sense other oxidases and their specific substrates.

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)