Zinc and chitosan-enhanced ß-tricalcium phosphate from calcined fetal bovine bone for mandible reconstruction.

Background: Mandibular defects pose significant challenges in reconstructive surgery, and scaffold materials are increasingly recognized for their potential to address these challenges. Among various scaffold materials, Beta-tricalcium phosphate (ß-TCP) is noted for its exceptional osteogenic properties. However, improvements in its biodegradation rate and mechanical strength are essential for optimal performance. Methods: In this study, we developed a novel ß-TCP-based scaffold, CFBB, by calcining fetal bovine cancellous bone. To enhance its properties, we modified CFBB with Chitosan (CS) and Zinc (Zn), creating three additional scaffold materials: CFBB/CS, CFBB/Zn2+, and CFBB/Zn2+/CS. We conducted comprehensive assessments of their physicochemical and morphological properties, degradation rates, biocompatibility, osteogenic ability, new bone formation, and neovascularization both in vitro and in vivo. Results: Our findings revealed that all four materials were biocompatible and safe for use. The modifications with CS and Zn2+ significantly improved the mechanical strength, osteogenic, and angiogenic properties of CFBB, while concurrently decelerating its resorption rate. Among the tested materials, CFBB/Zn2+/CS demonstrated superior performance in promoting bone regeneration and vascularization, making it a particularly promising candidate for mandibular reconstruction. Conclusion: The CFBB/Zn2+/CS scaffold material, with its enhanced mechanical, osteogenic, and angiogenic properties, and a controlled resorption rate, emerges as a highly effective alternative for the repair of oral mandible defects. This study underscores the potential of combining multiple bioactive agents in scaffold materials to improve their functionality for specific clinical applications in bone tissue engineering.

Risk factors for poor outcomes in patients with acute lower leg compartment syndrome: a retrospective study of 103 cases.

PURPOSE: The primary aim of this study was to investigate the risk factors associated with poor outcomes following acute compartment syndrome (ACS) of lower leg. The secondary objective was to determine if delayed fasciotomy is linked to poor outcomes. METHODS: In this retrospective case control study approved by the institutional review board, we identified 103 patients with ACS of the lower leg. Poor outcome was defined as a composite variable that included limb amputation, neurological deficit and contracture. Among these, 44 patients exhibited poor outcome while 59 patients demonstrated a good outcome. Patient-related factors, laboratory values, and treatment-related factors were analyzed using electronic medical records. Univariate statistical and logistic regression analyses were conducted to determine significance. RESULTS: Bivariate analyses showed that the mechanism of injury (P = 0.021), open injury (P = 0.001), arterial injury (P<0.001), hemoglobin levels (HB) (P < 0.001), white blood cell count (WBC) (P = 0.008), albumin levels (ALB) (P<0.001), creatine kinase levels (CK) at presentation (P = 0.015), CK at peak (P<0.001), creatine kinase levels (Ca) (P = 0.004), dehydrating agent (P = 0.036), and debridement (P = 0.005) were found to be associated with the risk of poor outcomes. Logistic regression analyses revealed that arterial injury [ P< 0.001, OR = 66.172, 95% CI (10.536, 415.611)] was an independent risk factor for poor outcomes. However, HB [P = 0.005, OR = 0.934, 95% CI (0.891, 0.979)] was a protective factor against poor outcomes. Receiver operating characteristic (ROC) curve analysis showed that the cut-off values of HB to prevent poor outcome following ACS was 102.45 g/L. CONCLUSIONS: ACS of the lower leg is a serious complication often associated with a poor prognosis. Patients with arterial injury or lower HB have a significantly increased risk of having poor outcomes. Poor outcomes were not found to be associated with the timing of fasciotomy in this study.

Risk factors for rapid eye-movement sleep-related behavioral disorders (RBDs): A systematic review and a meta-analysis.

OBJECTIVE: The present study aimed to systematically analyze the risk factors for RBD. METHODS: A systematic review and meta-analysis of case-control studies, cohort studies, and cross-sectional studies derived from the articles published in eight electronic databases before December 1, 2021. The primary outcome was the odds ratio (OR) and 95% confidence interval (95% CI), and heterogeneity was quantified using I2. Subgroup analyses and meta-regression were used to explore sources of heterogeneity. Egger's test and sensitivity analysis were performed. The PROSPERO ID number of the present study is CRD42021293942. RESULTS: We identified 26 studies (44,230 subjects) among 2022 citations, and 13 factors were considered. Male sex (OR = 1.36, 95% CI = 1.13-1.64), smoking (OR = 1.37, 95% CI: 1.26-1.50), depression (OR = 2.06, 95% CI = 1.66-2.56), antidepressant use (OR = 2.36, 95% CI = 1.98-2.82), duration of neuropsychiatric disorders(OR = 1.43, 95% CI = 1.13-1.73), levodopa equivalent daily dose (LEDD, OR = 60.15, 95% CI = 23.95-96.35) and observable motor dysfunction (OR = 2.43, 95% CI = 0.65-4.22) were associated with a higher risk of RBD. Tertiary education and above (OR = 0.58, 95% CI = 0.35-0.96) was associated with a lower RBD risk. Men (OR = 1.40, 95% CI: 1.10-1.78, I2 = 0%, P = 0.005) and older individual (OR = 2.73, 95% CI: 1.03-4.43, I2 = 60%, P = 0.002) were more likely to have iRBD. CONCLUSION: Six modifiable risk factors and one protective factor were associated with RBD. Further research is required to understand the mechanisms and to develop preventative strategies.

Application of the hydrochemistry, stable isotopes and MixSIAR model to identify nitrate sources and transformations in surface water and groundwater of an intensive agricultural karst wetland in Guilin, China.

Karst water as the vital water supply source is generally suffered from NO3- contamination in intensive agricultural areas worldwide. Identifying NO3- sources and transformations is the key for understanding nitrogen pathways, and also for effectively controlling diffuse NO3- pollution. In this study, chemical variables and stable isotopes (δ2H-H2O, δ18O-H2O, δ15N-NO3- and δ18O-NO3-) were measured in 10 surface water (SW) samples and 13 groundwater (GW) samples collected from the Huixian karst wetland, with the application of a Bayesian stable isotope mixing model (MixSIAR) to identified NO3- sources and biogeochemical transformations. The results showed that the NO3- concentrations ranged from the below detection limit to 117 mg/L, with 30.8% of GW samples obtained from the north central part of the study area exceeding the maximum permissible limit for drinking water, and posing significant non-carcinogenic health risks for native people through drinking water pathway. Moreover, based on characteristics of the hydrochemistry and stable isotopes, different biogeochemical fates were evaluated in SW and GW: nitrification process was a dominant factor in GW, as a result of high NO3- levels, and this microbial process was unlikely occurred in SW associated with relatively anaerobic condition and low NO3- levels; however, the denitrification might not be a main process of degradation NO3- levels throughout the study area. The MixSIAR outputs revealed that the long-term application of synthetic NH4+ fertilizer (36.6%) and soil organic nitrogen (28.0%) were the main contributors to NO3- pollution, followed by synthetic NO3- fertilizer (16.8%) and domestic sewage and manure (15.1%), whereas NO3- in precipitation (3.44%) played a less important role. Additionally, NO3- concentration was significantly influenced by agricultural activities rather than NO3- source's contribution between SW and GW. This work suggests that synthetic NH4+ fertilizer should be the primary target for control to prevent further NO3- pollution of the karst groundwater.

Clinical efficacy and safety of maintenance therapy for advanced non-small cell lung cancer: a retrospective real-world study.

BACKGROUND: The clinical efficacy and safety of maintenance therapy (MT) for patients with advanced non-small cell lung cancer (NSCLC) have not been determined in the real word. This retrospective study of real-world data analyzed these issues in patients with advanced NSCLC and stable or responsive tumors after 4-6 cycles of first-line chemotherapy. METHODS: We classified 158 patients into MT (34 IIIB and 37 IV stage) and non-MT (47 IIIB and 40 IV stage) groups and then compared the clinical outcomes of progression-free survival (PFS) and overall survival (OS). The influences of maintaining chemotherapy or targeted drugs, regimens, and duration on PFS were also investigated. Prognostic factors for OS were identified by univariate and multivariate analyses. RESULTS: Among the patients, 71 received MT and 87 did not. The median PFS and OS were significantly prolonged in the MT group than non-MT group (5.6 and 14.2 vs. 2.8 and 9.8 months, respectively; both p < 0.0001). The PFS was extended when patients were maintained with targeted drugs compared with chemotherapy, > 4 cycles of chemotherapy, and targeted drugs for > 3 months (all P < 0.0001). Patients with adenocarcinoma and without distant metastasis derived a better OS benefit from MT (P = 0.041 and P = 0.037, respectively). Multivariate analysis revealed that female sex and MT were independent prognostic factors for extended OS (P = 0.039 and P < 0.0001, respectively). The major adverse events of MT comprised tolerable hematological toxicity and gastrointestinal reactions. CONCLUSIONS: MT was advantageous and tolerable for patients with advanced NSCLC, especially those with adenocarcinomas without distant metastasis who were treated with targeted drugs, which was an independent prognostic factor for OS.

[Metal Distributions and Human Health Risk Assessments on Waters in the Huixian Karst Wetland, China].

The concentrations of nine metals (As, Cr, Al, Cu, Pb, Zn, Ni, Mn, and Hg), in 23 water samples collected from four main types of water (well, surface river, subterranean stream and blue hole), in the Huixian karst wetland were determined and analyzed to investigate their distributions and health risks. A multivariate statistical analysis was used to study the distribution characteristics of the metals. A human health risk assessment model was developed to assess the health risks. The results found that the mean concentrations of metals in water from the Huixian karst wetland were in the order:Al > Mn > Zn > Cr > Ni > As > Hg > Cu > Pb. The maximum concentrations of Hg (1.08 µg·L-1) in the well water, Hg (0.78 µg·L-1) and Mn (259.00 µg·L-1) in the surface river water, and Hg (0.47 µg·L-1) and Al (300.00 µg·L-1) in the blue hole water all exceeded the corresponding standard limits. The metal concentrations in the subterranean stream samples were all within the regulated limits. For the nine metals, the well water and the subterranean stream water qualities were better than those of the surface river and the blue hole. The results of the multivariate statistical analysis showed that the concentrations of Cr, Ni, Cu, and Zn in the well water were mainly related to the regional geological background, while the concentrations of Al and Pb in the blue hole water were mainly affected by pyrite mining and residential activities. The concentrations of As and Mn in rivers may be affected by tourism activity, aquaculture and river sediments. The results of the health risk assessment on water through the drinking and skin penetration pathway indicated that the total health risks order was:well > subterranean stream > blue hole > surface river. The total health risks values of well water as drinking water for adults (6.11×10-5 a-1) and children (6.67×10-5 a-1) exceeded the maximum allowance level (5.0×10-5 a-1). Cr was the main metal element that causes carcinogenic risks. For drinking water safety, the concentrations of Hg and Cr in well water should be controlled before drinking.

Benefits and Risks of Subsection Laminectomy with Pedicle Screw Fixation for Ossification of the Ligamentum Flavum of the Thoracic Spine: A Retrospective Study of 30 Patients.

BACKGROUND This study aimed to evaluate the effectiveness of subsection laminectomy with pedicle screw fixation (SLPF) for the treatment of ossification of the ligamentum flavum of the thoracic spine. MATERIAL AND METHODS Thirty patients (age, 40-71 years) with ossification of the ligamentum flavum of the thoracic spine underwent SLPF (13 men, 17 women). Operative time, intraoperative blood loss, preoperative and postoperative change in thoracic kyphosis, and perioperative complications were recorded. The Japanese Orthopedic Association (JOA) score for severity of myelopathy and the American Spinal Injury Association (ASIA) motor and sensory impairment scale were used before and after surgery. RESULTS Mean operative time for SLPF was 208.4±38.3 min and mean intraoperative blood loss was 689.3±171.7 ml. The mean JOA score significantly increased from 5.7±1.9 before surgery to 8.8±2.2 at one month after surgery and 9.3±2.7 at the last follow-up (P<0.01). Postoperative improvement in neurological function increased by 68.3±14.4%. The postoperative ASIA grades significantly improved compared with the preoperative grades (P<0.01). The mean local Cobb angle significantly decreased from 17.8±4.3° before surgery to 15.4±3.6° at one month after surgery and 15.8±3.8° at the last follow-up (P<0.01). Three patients (10%) had operative cerebrospinal fluid (CSF) leak. Postoperatively, one patient had neurological deterioration, two patients had deep venous thrombosis (DVT), and one patient developed a wound infection. CONCLUSIONS SLPF was an effective procedure for the treatment of ossification of the ligamentum flavum of the thoracic spine.

Is intramedullary fixation of displaced midshaft clavicle fracture superior to plate fixation? Evidence from a systematic review of discordant meta-analyses.

OBJECTIVE: An increasing number of meta-analyses comparing intramedullary fixation (IF) with plate fixation (PF) for displaced midshaft clavicle fracture have been reported, but the inconsistent results obtained might confuse decision-making. We systematically reviewed discordant meta-analyses for assisting the decision-maker in interpreting and selecting amongst discordant meta-analyses and providing surgical recommendations for displaced midshaft clavicle fracture according to currently best available evidence. METHODS: Meta-analyses on IF and PF for displaced midshaft clavicle fracture were identified by searching PubMed, Emabase and the Cochrane Library. A review of meta-analysis quality and data extraction was individually conducted by two reviewers. The meta-analysis providing the best available evidence was identified using the Jadad decision algorithm. RESULTS: Nine studies were included, five of which were of Level-II evidence and four of which were of Level-III evidence. These meta-analyses scored from 6 to 10 according to the Assessment of Multiple Systematic Reviews instrument. With respect to the Jadad decision algorithm, the best meta-analysis was chosen depending upon publication characteristics and methodology of primary studies, language restrictions, and whether data on individual patients were analysed. A meta-analysis incorporating more randomised controlled trials was eventually selected. The best available evidence indicated that the differences between IF and PF were not significant in terms of shoulder function or the rate of treatment failure. However, IF significantly decreased the operative time and the rate of non-operative complications, especially the rate of infection. CONCLUSIONS: Based on the best available evidence, IF may be superior to PF for treating displaced midshaft clavicle fracture.

Semisynthesis of (-)-Rutamarin Derivatives and Their Inhibitory Activity on Epstein-Barr Virus Lytic Replication.

(+)-Rutamarin inhibits EBV lytic DNA replication with an IC50 of 7.0 µM. (-)-Chalepin, a (-)-rutamarin derivative, was isolated from the whole plant of Ruta graveolens and used as a precursor of (-)-rutamarin. Altogether, 28 (-)-rutamarin derivatives were synthesized starting from (-)-chalepin. Of these, 16 compounds (2a-e, 3b-e, 3g, 4f, 4k, 4m-p) were found to be more potent against EBV lytic DNA replication than (-)-chalepin. Compounds 4m, 4n, and 4p exhibited IC50 values of 1.5, 0.32, and 0.83 µM and showed selectivity index values (SI) of 801, 211, and >120, respectively. Thus, compounds 4m, 4n, and 4p are considered promising leads for further laboratory investigation.

MicroRNA-21 Inhibits the Apoptosis of Osteosarcoma Cell Line SAOS-2 via Targeting Caspase 8.

Currently, multiple microRNAs (miRNAs) have been found to play vital roles in the pathogenesis of osteosarcoma. This study aimed to investigate the role of miR-21 in osteosarcoma. The level of miR-21 in 20 pairs of osteosarcoma and corresponding adjacent tissues was monitored by qPCR. Human osteosarcoma cell line SAOS-2 was transfected with either miR-21 mimic or miR-21 inhibitor, and then cell viability, survival, and apoptosis were measured by MTT, colony formation assay, and flow cytometry. A target of miR-21 was predicted by the microRNA.org database and verified in vitro by using luciferase reporter, qPCR, and Western blot analyses. Finally, cells were cotransfected with siRNA against caspase 8 and miR-21 inhibitor, and the apoptotic cell rate was determined again. Results showed that the mRNA level of miR-21 was highly expressed in osteosarcoma tissues compared with adjacent tissues. Overexpression of miR-21 improved cell viability and survival but suppressed apoptosis. Caspase 8 was a direct target of miR-21, and it was negatively regulated by miR-21. Moreover, miR-21 suppression attenuated caspase 8 silencing and induced the decrease in apoptosis. In conclusion, overexpression of miR-21 suppressed SAOS-2 cell apoptosis via directly targeting caspase 8.

Discovering new mTOR inhibitors for cancer treatment through virtual screening methods and in vitro assays.

Mammalian target of rapamycin (mTOR) is an attractive target for new anticancer drug development. We recently developed in silico models to distinguish mTOR inhibitors and non-inhibitors. In this study, we developed an integrated strategy for identifying new mTOR inhibitors using cascaded in silico screening models. With this strategy, fifteen new mTOR kinase inhibitors including four compounds with IC50 values below 10 µM were discovered. In particular, compound 17 exhibited potent anticancer activities against four tumor cell lines, including MCF-7, HeLa, MGC-803, and C6, with IC50 values of 1.90, 2.74, 3.50 and 11.05 µM. Furthermore, cellular studies and western blot analyses revealed that 17 induces cell death via apoptosis by targeting both mTORC1 and mTORC2 within cells and arrests the cell cycle of HeLa at the G1/G0-phase. Finally, multi-nanosecond explicit solvent simulations and MM/GBSA analyses were carried out to study the inhibitory mechanisms of 13, 17, and 40 for mTOR. The potent compounds presented here are worthy of further investigation.

Synthesis, antitumor activity, and mechanism of action of 6-acrylic phenethyl ester-2-pyranone derivatives.

Based on the scaffolds of caffeic acid phenethyl ester (CAPE) as well as bioactive lactone-containing compounds, 6-acrylic phenethyl ester-2-pyranone derivatives were synthesized and evaluated against five tumor cell lines (HeLa, C6, MCF-7, A549, and HSC-2). Most of the new derivatives exhibited moderate to potent cytotoxic activity. Moreover, HeLa cell lines showed higher sensitivity to these compounds. In particular, compound showed potent cytotoxic activity (IC50 = 0.50-3.45 µM) against the five cell lines. Further investigation on the mechanism of action showed that induced apoptosis, arrested the cell cycle at G2/M phases in HeLa cells, and inhibited migration through disruption of the actin cytoskeleton. In addition, ADMET properties were also calculated in silico, and compound showed good ADMET properties with good absorption, low hepatotoxicity, and good solubility, and thus, could easily be bound to carrier proteins, without inhibition of CYP2D6. A structure-activity relationship (SAR) analysis indicated that compounds with ortho-substitution on the benzene ring exhibited obviously increased cytotoxic potency. This study indicated that compound is a promising compound as an antitumor agent.

Quality assessment of 3D-CTVR, MPR and section plane techniques in ossicular chain reconstruction in middle ear cholesteatoma.

AIM: To assess the quality of three-dimensional volume rendered computer tomography (3D-CTVR), multi-planar reformation (MPR) and CT section plane in the fine diagnosis of ossicular chain in middle ear cholesteatoma. METHODS: Sixty patients with middle ear cholesteatoma were selected in this retrospective study. All cases underwent pre-operative CT scan. The respective radiologic reports of the ossicles status via three protocols were then compared to surgical findings. RESULTS: Quality assessment of these three protocols in the fine diagnosis of fine ossicles buried inside the soft tissue showed that both CTVR and MPR are more superior to conventional section plane, especially CTVR. CONCLUSION: The uses of CTVR and MPR, in conjunction with conventional section plane, are better able to show where the true and fine ossicular chain in the cholesteatoma mass is. In the final analysis, we believe that the use of CTVR and MPR techniques can have profound contributive value in future clinical work.

Epitympanoplasty with cartilage obliteration in the preservation of posterior canal wall: a technique for surgical treatment of attic cholesteatoma.

To report and evaluate the surgical outcomes of the treatment of attic cholesteatoma using epitympanoplasty with cartilage obliteration in the preservation of the posterior canal wall. Our study group consists of 138 subjects with attic cholesteatoma who underwent surgery of the mastoidectomy of the intact posterior canal wall and epitympanoplasty with cartilage obliteration, from November 2008 to November 2010. The major techniques employed included the following: (1) mastoidectomy with the preservation of the posterior canal; (2) removal of the scutum; (3) epitympanum obliteration with cartilage, and (4) mastoid obliteration with bone dust. The post-operative observation period was between 2 and 4 years. All patients were examined via microscopy and oto-endoscopy. Of these 138 subjects, 91 subjects have a follow up period of more than 3 years. There was no retraction pocket formation in the epitympanum in all cases. However, in two subjects, there was a recurrence of cholesteatoma within the mesotympanum. Other observable post-surgery complications were also recorded. For hearing results, 64 of the 138 subjects underwent post-operative audiometric testing for 2 to 3 years and 3 to 4 years consecutively. The average pre- and post-operative air-bone gap closure was found to be 11.97 ± 11.02 dB for the 2 to 3 year period, and 10.08 ± 10.34 dB for the 3 to 4 year period. Based on the results of our study group, epitympanoplasty with cartilage obliteration in the preservation of the posterior canal wall is a better alternative treatment technique for attic cholesteatoma.

[Multi-center clinical study on the treatment of the low-middle frequency sudden hearing loss].

OBJECTIVE: To investigate and compare the short-term outcome of patients with low-middle frequency sudden deafness treated with alone or combination treatment. METHODS: From August 2007 to October 2011, 205 patients with the diagnosis of low-middle frequency sudden deafness who were from 33 different clinical centers were recruited. All patients were followed up for four weeks from the initial examination. Patients were treated with steroid , Ginaton, batroxobin respectively, or Ginaton and steroid combination treatment. RESULTS: The total effective rate was 90.73%. In Ginaton group, the total effective rate was 87.27%, 89.19% in steroid group, 87.80% in batroxobin group, and 95.83% in Ginaton and steroid group. Considering the total effective rate, there was no statistical difference between four groups (χ(2) = 7.98, P = 0.54). The clinical cure rate for steroid alone was 81.01%, Ginaton alone 76.36%, batroxobin alone 68.29%, and Ginaton and steroid combination treatment 80.56%. There were no clinically significant differences between the different treatments (P > 0.05). CONCLUSIONS: The low-middle frequency sudden deafness tends to have a relatively favorable prognosis. The steroid played a good effect in the treatment. But different treatments either improving the microcirculation of inner ear or alleviating edema blood has undifferentiated results. Therefore the combination therapy may be more effective.

[Analysis of risk factors for spontaneous rupture of hepatocellular carcinoma].

OBJECTIVE: To assess the risk factors for spontaneous rupture of hepatocellular carcinoma (SRHC). METHODS: A retrospective analysis of 34 consecutive patients with SRHC treated by emergency interventional embolization in our hospital from July 2003 to July 2011 was conducted. General condition, laboratory examination and imaging data were analyzed, and compared with the data of 34 patients with primary hepatocellular carcinoma but without rupture, randomly selected from 215 concurrent patients. The patients with SRHC were selected for risk factor analysis, and the non-SRHC patients were taken as control group. RESULTS: No significant difference between the SRHC group and control group was found in age, sex, Child-Turcotte-Pugh (CTP) grade, Barcelona clinic liver cancer (BCLC) stage, HBsAg, HBsAb, HBeAg, HBeAb, HBcAb, prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), glucose (GLU), cirrhosis, portal tumor thrombus, the maximum diameter of tumor, location, and cholecystitis or cholelithiasis. The univariate analysis showed that activated partial thromboplastin time (APTT), lower or normal plasma fibrinogen (FIB) level, alpha fetoprotein (AFP), tumor protrusion > 1 cm above the liver surface were all associated with increased risk of SRHC (P < 0.05). Multivariate analysis only showed that lower or normal level of FIB (P = 0.033) and tumor protrusion > 1 cm above the liver surface (P = 0.041) were significant independent risk factors for SRHC. CONCLUSION: Lower or normal level of FIB and tumor protrusion > 1 cm above the liver surface are significant independent risk factors for spontaneous rupture of hepatocellular carcinoma.

[Comparative study of determining the sites of airway obstruction in obstructive sleep apnea hypopnea syndrome between real-time CT scans and laryngofiberscope technology].

OBJECTIVE: To compare 256-layer spiral computed tomography (CT) scan in sleep and laryngofiberscope technology for locating obstructive sites of upper airway in patients with obstructive sleep apnea hypopnea syndrome, analyze their advantages and disadvantages and discuss the clinical application values. METHODS: A total of 59 patients with OSAHS diagnosed by polysomnography underwent spiral CT scan in awake and drug-induced sleep states and laryngofiberscope examination in awake state to assess the sites of airway obstruction. RESULTS: Real-time CT scans were completed successfully in all patients. There were airway obstruction at isolated retropalatal region (real-time CT revealing n = 26, laryngofiberscope revealing n = 34), retropalatal and retroglottal regions simultaneously (real-time CT revealing n = 19, laryngofiberscope revealing n = 10), retropalatal and epiglottal regions simultaneously (real-time CT revealing n = 6, laryngofiberscope revealing n = 2), retropalatal and retroglottal and epiglottal regions simultaneously (real-time CT revealing n = 7, laryngofiberscope revealing n = 3) and no airway obstruction (real-time CT revealing n = 1, laryngofiberscope revealing n = 10). There was not solitary airway obstruction at retroglottal or epiglottal region. The results of real-time CT scans and laryngofiberscope examination were statistically significant different in all regions, and real-time CT scanning compared with laryngofiberscope found more obstructive sites of upper airway [retropalatal region: 98.3% (n = 58) vs 81.4% (n = 48), χ(2) = 5.82, P < 0.05; retroglottal regions: 44.1% (n = 26) vs 22.0% (n = 13), χ(2) = 9.60, P < 0.01; epiglottal regions: 22.0% (n = 13) vs 8.5% (n = 5), χ(2) = 4.90, P < 0.05]. CONCLUSION: Compared with laryngofiberscope examination,real-time dynamic CT scans in drug-induced sleep state could get more information about anatomy changes of upper airway, providing relatively objective morphological basis for diagnosis and treatment of patients with OSAHS.

[Secondary laryngeal tuberculosis at high altitudes of Tibet].

OBJECTIVE: To improve the diagnostic and therapeutic efficiency for secondary laryngeal tuberculosis through an analysis on the clinical features of patients with this disease. METHOD: A retrospective study was made among 49 cases with laryngeal tuberculosis treated in Tibetan General Hospital of Chinese PLA, and the clinical data were carefully analyzed to summarize the clinical experience of this disease. RESULT: Of 49 patients, 24 cases had 1 year history, 11 cases had 1 to 3 years, 9 cases had 3 to 5 years, 5 cases had 5 years or more. Thirty-eight patients had the history of tuberculosis and 11 had none. Thirty-four patients had taken anti-tuberculosis drugs but none had standard therapy as demanded. All cases had mild general symptoms (mild fever, night sweats, weight loss, et al) and atypical local symptoms (hoarseness, sore throat). Therefore, 42 cases were misdiagnosed as non-specific chronic laryngitis, of which 15 cases got worse after oral administration or inhaling of steroid hormones. Seven persons were misdiagnosed as laryngeal cancer. All patients were confirmed pulmonary tuberculosis by X ray exam or CT scanning. Twelve cases had strong positive PPD tests and 2 cases were detected positive by sputum smear. All patients was treated by standard systematic and local chemical therapy against tuberculosis (inhaling of antituberculosis drugs for 1 to 2 months). All were cured but one died in a road accident, and none had recurrence after 1- to 9- year follow-up. CONCLUSION: All of those the patients with long period hoarseness and sore throat should take chest CT scan or X-ray exam for the highest incidence of pulmonary tuberculosis at high altitudes. CT scanning is the prefer for its high resolution. Pathological biopsy and diagnostic therapy should be taken to make accurate diagnosis. Usually steroid hormones should not be recommended.

Otoendoscopic treatment of hidden lesions in otomastoiditis.

BACKGROUND: Surgical treatments for chronic suppurative and cholesteatoma otitis media have been discussed for several decades, but recurrences still occur because of the complex dissection required and hidden lesions associated with otomastoiditis. This study investigated the technology and strategy behind the use of otoendoscopic-assisted otosurgery. METHODS: We reported on hidden lesions in 32 ears of patients with otomastoiditis between November 2006 and January 2009. All the patients were treated with the aid of an otoendoscope. The advantages of otoendoscopy, including multi-angle light scattering, aperture illumination, and magnification of the local operative field, were utilized in otologic microsurgery, and otoendoscopic operative techniques were introduced for operative sites such as the epitympanum, aditus of the antrum, facial recess, sinus tympani and the mastoid tip. RESULTS: All patients were followed up from 3 months to 2 years after surgery. All patients recovered well within 3 months following surgery, except for one case of epithelialization of the mastoid cavity occurring 6 months after surgery for cholesteatoma on the cerebellar surface and another case with Bezold's abscess, hyperplastic granulation tissue developed at the antrum. CONCLUSIONS: Otoendoscopy can overcome the technical deficiency of rectilinearity of the visual axis associated with otomicroscopic illumination, which presents a problem when dealing with otomastoiditis lesions in hidden areas. This technique allows such lesions within the complex three-dimensional structure to be visualized and cleaned. Otoendoscopy thus has significant potential for improving the quality of surgery and reducing the risk of postoperative recurrence.