Cochlear implantation in a patient with congenital microtia, cochlear hypoplasia, venous anomalies of the temporal bone and laryngomalacia: Challenges and surgical considerations.

RATIONALE AND PATIENT CONCERNS: Congenital hearing loss is often caused by an inner ear malformation, in such cases, the presence of other anomalies, such as microtia, and venous anomalies of the temporal bone and laryngomalacia makes it challenging to perform cochlear implantation surgery. DIAGNOSES: This study reports the case of a 28-month-old girl with congenital profound hearing loss, laryngomalacia, and malformed inner ear, who received cochlear implantation surgery. The bony structure, vessels and nerves were first assessed through magnetic resonance imaging and computed tomography before exploring the genetic basis of the condition using trio-based whole exome sequencing. Perioperative evaluation and management of the airway was then performed by experienced anesthesiologist, with the surgical challenges as well as problems encountered fully evaluated. INTERVENTIONS: Cochlear implantation was eventually performed using a trans-mastoid approach under uneventful general anesthesia. OUTCOMES: Due to the small size of the cochlea, a short electrode FLEX24 was inserted through the cochleostomy. LESSONS: Considering the high risk of facial nerve injury and limited access to the cochlea when patients present significant bony and venous anomalies, cochlear implantation in such patients require careful preoperative evaluation and thoughtful planning. In these cases, airway assessment, magnetic resonance venography, magnetic resonance arteriography, and magnetic resonance imaging and computed tomography can be useful to minimize the risks. Intraoperative facial nerve monitoring is also recommended to assist in the safe location of facial nerve.

Spatial Distribution Characteristics of the Rural Tourism Villages in the Qinghai-Tibetan Plateau and Its Influencing Factors.

The development of rural tourism (RT) has great significance in reducing poverty and achieving rural vitalization. Qinghai-Tibetan Plateau (QTP) is a depressed area with rich RT resources due to its unspoiled nature and diverse culture. For future sustainable development of RT in QTP, this paper analyzes the spatial distribution characteristics and its influencing factors of RT villages using various spatial analysis methods, such as nearest neighbor index, kernel density estimation, vector buffer analysis, and geographic detectors. The results show the following. First, the RT villages present an agglomeration distribution tendency dense in the southeast and spare in the northwest. The inter-county imbalance distribution feature is obvious and four relatively high-density zones have been formed. Second, the RT villages have significant positive spatial autocorrelation, and the area of cold spots is larger and of hot spots is smaller. Third, the RT villages are mainly distributed with favorable topographic and climate conditions, near the road and water, around the city, and close to tourism resources. Fourth, the spatial distribution is the result of multifactor interactions. Socio-economic and tourism resource are the dominant factor in the mechanism network. Fifth, based on the above conclusions this study provides scientific suggestions for the sustainable development of the RT industry.

Evaluation of Potential for Nature-Based Recreation in the Qinghai-Tibet Plateau: A Spatial-Temporal Perspective.

Nature-based recreation (NBR) is an important cultural ecosystem service providing human well-being from natural environments. As the most concentrated and high-quality wilderness in China, the Qinghai-Tibet Plateau (QTP) has unique advantages for NBR. In this study, we designed an integrated nature-based recreation potential index (INRPI) based on four aspects: nature-based recreation resources, landscape attractiveness, recreation comfort and opportunity, and recreation reception ability. A combination of the analytic hierarchy process (AHP) and entropy evaluation method was adopted to assess the NBR potential in the QTP from 2000 to 2020. The research shows that: (i) The INRPI for the QTP decreases gradually from southeast to northwest and increases slightly from 2000 to 2020. (ii) The INRPI displays a pronounced difference on either side of the Qilian-Gyirong line. The areas with very high and high potentials mainly distributed in the southeast of the line, while areas with very low and low potentials distributed in the northwest. (iii) The construction of protected areas effectively improves NBR potential. Areas of INRPI at diverse levels within protected areas obviously increased in 2020. (iv) Increasing altitude has a notable effect on INRPI, and 3000 m is a critical dividing line for the NBR in the QTP. These findings can contribute to decision-makers in guiding rational use and spatial planning of natural land and promoting sustainable recreational development.

Identification of Priority Conservation Areas for Natural Heritage Sites Integrating Landscape Ecological Risks and Ecosystem Services: A Case Study in the Bogda, China.

The conservation of World Natural Heritage Sites has become a global concern. The identification of priority conservation areas can preserve the value of heritage sites while promoting sustainable development, which is important for balancing the conservation and development of heritage sites. This paper proposes an integrated framework for the identification of priority conservation areas for natural heritage sites based on landscape ecological risks (LERs) and ecosystem services (ESs), taking the Bogda heritage site in Xinjiang, China as a case study. The innovative approach combined the natural and cultural elements of natural heritage sites and included the following steps: (1) the LER index, Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) model and questionnaire method were adopted to assess the LERs and ESs of Bogda heritage sites during 1990-2018; (2) ordered weighted averaging (OWA) was used to identify conservation priorities by weighing LERs and ESs; and (3) the optimal priority conservation area was determined by comparing the conservation efficiencies under different scenarios. The results revealed that the LER, carbon storage (CS), habitat quality (HQ), aesthetic value (AV), and recreational value (RV) showed significant spatiotemporal variation. The most suitable priority conservation area was located at the central forestlands and high-coverage grasslands, with conservation efficiencies of 1.16, 2.91, 1.96, 1.03, and 1.21 for LER, CS, HQ, AV, and RV, respectively. Our study demonstrated that integrating LERs and ESs is a comprehensive and effective approach to identifying conservation priorities for heritage sites. The results can provide decision support for the conservation of the Bogda heritage site and a methodological reference for identifying conservation priorities for natural heritage sites. Furthermore, this study is also an effective application of LERs and ESs in identifying priority conservation areas.

[Nodular fasciitis of external ear: a case report].

A young male patient presented with a rapidly growing mass on the left ear. Histopathologic and immunohistochemical findings were consistent with nodular fasciitis. The disease is rare in the ear, without obvious clinical features. The diagnosis mainly relies on the postoperative pathological findings.

[Expression of odorant receptor genes on the olfactory epithelium following olfactory nerve disconnection].

OBJECTIVE: To constitute the animal model of unilateral olfactory nerve transection and observe the expression level and distribution of odorant receptors. METHODS: Thirty-two rats were divided into two groups: the olfactory nerve transection group (20) and the control group (12). The former group received the operation to transect the left olfactory nerve following the left olfactory bulb was exposed under microscope and the latter group did not give any disposal. At every stage of five days, two weeks, four weeks and six weeks after the operation, five rats from the nerve transection group and three from the control group were anaesthetized simultaneously, and olfactory epithelium were taken out after transcardial perfusion, then paraffin imbedding. Coronal sections were sliced for HE staining to observe the thickness changes of the olfactory epithelium, and for in situ hybridization (ISHs) to investigate the expression of olfactory receptor genes (Olr287, Olr226, Olr1493 and Olr1654) in the epithelium, also to evaluate the changes of the expression level and location of the selected receptors during the regeneration of olfactory epithelium. RESULTS: HE staining showed that 5 days after the operation cell quantity and thickness of the olfactory epithelium decreased obviously, which increased gradually 2 or 4 weeks after operation. After 6 weeks' recovery, the thickness of the epithelium could reach the control level. The pattern of cell staining by ISH showed a specific spatial distribution along the anteroposterior (AP) and dorsoventral (DV) axis. Evidence suggested that odorant receptors were distributed in continuous and multiple overlapping bands in the normal or nerve transected-recovered epithelium rather than in the conventionally accepted three or four zones. The data also demonstrated that the distribution of sensory neuron types, as identified and defined by odorant receptor expression, was restored to normal or nearly so by 6 weeks after operation. Likewise, the numbers of probe-labeled neurons in the nerve transected-recovered had an obvious decrease 5 days after olfactory nerve transection. Reactive cells (x(-) +/- s) of Olr1493 in the operated side was (53.9 +/- 19.9), compared with (419.0 +/- 21.2) in the unoperated side, there was statistic significance between them (t = 63.960, P < 0.01). Reactive cells increased gradually according to the regeneration of the epithelium, and were nearly equivalent to the normal side 6 weeks later without significant differentiation (t = 2.600, P > 0.05), according to the absolute positive cells in the operated and unoperated side of (417.8 +/- 32.4) and (445.3 +/- 10.0) respectively. CONCLUSION: The regeneration of the sensory neurons and receptors, both the number and the distribution, can recover to normal after olfactory nerve transection.