Analysis of Etiology, Diagnosis, and Treatment Strategy and Efficacy of Pulsatile Tinnitus Caused by Abnormal Vascular Anatomy.

OBJECTIVE: To investigate the etiology, clinical characteristics, diagnosis, and treatment strategies and efficacy of pulsatile tinnitus (PT) caused by vascular anatomy abnormality. METHODS: The clinical data of 45 patients with PT in our hospital from 2012 to 2019 were collected and retrospectively analyzed. RESULTS: All 45 patients had vascular anatomical abnormalities. The patients were divided into 10 categories according to the different locations of vascular abnormalities: sigmoid sinus diverticulum (SSD), sigmoid sinus wall dehiscence (SSWD), SSWD with high jugular bulb, pure dilated mastoid emissary vein, aberrant internal carotid artery (ICA) in the middle ear, transverse-sigmoid sinus (TSS) transition stenosis, TSS transition stenosis with SSD, persistent occipital sinus stenosis, petrous segment stenosis of ICA, and dural arteriovenous fistula. All patients complained of PT synchronous with heartbeat rhythm. Endovascular interventional therapy and extravascular open surgery were used according to the location of the vascular lesions. Tinnitus disappeared in 41 patients, was significantly relieved in 3 patients, and was unchanged in 1 patient postoperatively. Except for one patient with transient headache postoperatively, no obvious complications occurred. CONCLUSION: PT caused by vascular anatomy abnormalities can be identified by detailed medical history and physical and imaging examination. PT can be relieved or even completely alleviated after appropriate surgical treatments.

Gastric cancer complicated with hemophagocytic lymphohistiocytosis: case report and a brief review.

Hemophagocytic lymphohistiocytosis (HLH) comprises a group of severe immune function disorders that can lead to immune-mediated organ damage. There are two subtypes of HLH: primary and secondary. Secondary HLH is associated with infectious, oncologic, chemotherapeutic, and other underlying causes, and studies on HLH triggered by tumors have mainly focused on hematological malignancies. Secondary HLH in patients with solid tumors is rare. Here, we present two cases of gastric cancer complicated with HLH. The patient 1 was diagnosed as gastric cancer at stage I and got intractable fever after a distal subtotal gastrectomy without any evidence of infections or other complications. The patient 2 suffered from unresectable gastric adenocarcinoma and got fever, hemorrhagic rashes, and petechiae in mouth after six cycles of neoadjuvant chemotherapy. After detailed and comprehensive examinations, HLH was diagnosed in the two patients according to 2004 HLH diagnostic criteria, and the patients received treatment including immunosuppressive agents immediately. After therapy, the two patients showed partial remission, but both eventually died due to HLH relapse or progression of the primary tumor. The treatment regimen for HLH is intricate, and only a few relevant studies have focused on the treatment of cancer patients with HLH. The high mortality associated with this disease calls for more attention and additional research to improve the prognosis for these patients.

Identifying a Safe Range of Stimulation Current for Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve: Results from a Canine Model.

BACKGROUND: Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) has been widely applied during thyroid surgery. However, the safe range of stimulation intensity for IONM remains undetermined. METHODS: Total thyroidectomies were performed on twenty dogs, and their RLNs were stimulated with a current of 5-20 mA (step-wise in 5 mA increments) for 1 min. The evoked electromyography (EMG) of vocal muscles before and after supramaximal stimulation were recorded and compared. Acute microstructural morphological changes in the RLNs were observed immediately postoperatively under an electron microscope. RESULTS: The average stimulating threshold for RLNs stimulated with 15 mA and 20 mA showed no significant changes compared to the unstimulated RLNs (15 mA group: 0.320 ± 0.123 mA vs. 0.315 ± 0.097 mA, P = 0.847; 20 mA group: 0.305 ± 0.101 mA vs. 0.300 ± 0.103 mA, P = 0.758). Similar outcomes were shown in average evoked EMG amplitude (15 mA group: 1,026 ± 268 µV vs. 1,021 ± 273 µV, P = 0.834; 20 mA group: 1,162 ± 275 µV vs. 1,200 ± 258 µV, P = 0.148). However, obvious acute microstructural morphological changes were observed in the nerves that were stimulated with 20 mA. CONCLUSIONS: A stimulation intensity less than 15 mA might be safe for IONM of the RLN.

Significant differences in the clinicopathological characteristics and survival of gastric cancer patients from two cancer centers in china and Korea.

PURPOSE: To compare the clinicopathological data and long-term survival of gastric cancer patients in China and Korea. MATERIALS AND METHODS: Patients who had undergone gastrectomy for gastric cancer between 1998 and 2009 in 2 high-volume institutions in both China (n=1,637) and Korea (n=2,231) were retrospectively evaluated. Clinicopathological variables, overall survival (OS), progression-free survival (PFS), and surgery-related complications were assessed for all patients and compared between the 2 institutions. RESULTS: Chinese patients included in the study were significantly older and had a significantly lower body mass index (BMI) than the Korean patients. Esophagogastric junction tumors were more frequent in Chinese patients. However, the number of patients with stage I gastric cancer, the number of harvested lymph nodes, and the number of total gastrectomies were significantly higher in the Korean population. Korean patients also presented with fewer undifferentiated tumors than Chinese patients. Furthermore, Korean patients had prolonged OS and PFS for stage III cancers only. BMI, tumor-node-metastasis (TNM) stage, tumor invasion, number of positive lymph nodes, and distant metastases were all independent factors affecting OS and PFS. CONCLUSIONS: Although China and Korea are neighboring Asian countries, the clinicopathological characteristics of Chinese patients are significantly different from those of Korean patients. Korean gastric cancer patients had longer OS and PFS than Chinese patients. Influencing factors included TNM stage, tumor invasion, and lymph node metastasis.

Heterodinuclear M(II)-Ln(III) single molecule magnets constructed from exchange-coupled single ion magnets.

The synthesis and characterization of four dinuclear 3d-4f complexes [M(II)Ln(III)(L)(DBM)3] (ZnDy = 1, CoY = 2, CoDy = 3·3.5CH3CN, CoGd = 4·3.5CH3CN) are reported (H2L = N,N'-dimethyl-N,N'-(2-hydroxy-3-methoxy-5-methyl-benzyl)ethylenediamine, DBM(-) = anion of 1,3-diphenyl-propane-1,3-dione). In each of the four complexes, the M(II) ion occupies the internal N2O2 site whereas the Ln(III) ion occupies the external O4 site. There are diphenoxo bridges between the M(II) and Ln(III) ions in these complexes. The remaining coordination sites are occupied by three DBM(-) anions. Direct current (dc) magnetic susceptibility measurements indicate the presence of intramolecular ferromagnetic interactions in complexes 3 and 4. The magnetic coupling constant, JCoGd, of complex 4 is estimated to be 0.26 cm(-1) (H = -2JCoGdSCoSGd). Alternating current (ac) magnetic susceptibility studies reveal that complexes 1 and 2 show field-induced single molecule magnet behavior, with ΔE values of 36.5 K and 8.56 K, respectively. Complex 3 shows frequency dependent out-of-phase signals, indicating the presence of a slow relaxation of the magnetization, whereas complex 4 does not display slow magnetization relaxation.

Synthesis, crystal structure and magnetic properties of dinuclear NiIILnIII complexes based on a flexible polydentate ligand.

The synthesis and characterization of three isomorphous complexes [NiII(L)LnIII(DBM)3] (Ln = Gd (1·2.5CH3CN·0.5H2O), Tb (2·2CH3CN·0.5MeOH), and Dy (3·2CH3CN·0.5MeOH·0.5H2O)) are reported (H2L = N,N'-dimethyl-N,N'-(2-hydroxy-3-methoxy-5-methylbenzyl)ethylenediamine, DBM⁻ = anion of 1,3-diphenylpropane-1,3-dione). The flexible ligand L²â» contains an N2O2-inner and an O4-outer coordination site. There are diphenoxo bridges between NiII and LnIII ions in these complexes. The remaining coordination sites are occupied by DBM⁻ anions. Direct current (dc) magnetic susceptibility measurements indicate the presence of intramolecular ferromagnetic interactions in desolvated complexes 1-3. The magnetic coupling constant JNiGd in complex 1 is estimated to be 1.11 cm⁻¹ (H = -2JNiGdSNiSGd). Alternating current (ac) magnetic susceptibility studies reveal that complexes 2 and 3 show frequency-dependent out-of-phase signals, which indicate that they exhibit SMM behavior. The energy barriers for complexes 2 and 3 under a 2 kOe applied direct current (dc) magnetic field are estimated from Arrhenius plots to be 14.4 and 11.3 K, respectively.

Supramolecular lanthanide metallogrids exhibiting field-induced single-ion magnetic behavior.

A supramolecular strategy has been applied to construct two tetranuclear lanthanide complexes for investigating the magnetic properties of individual lanthanide ions. The Ln(III) complexes (Ln = Dy, Tb) display field-induced slow magnetization relaxation, typical of single-molecule magnet behavior. The four lanthanide ions in the molecules are well separated by distances of ca. 9 Å, and thus the slow magnetization relaxation should be assigned to single-ion magnet (SIM) behavior. Therefore, the present complexes are novel supramolecular aggregates of four isolated SIMs.

[FTIR spectral fitting algorithm based on continuous wavelet transform].

An FTIR spectrum fitting algorithm based on continuous wavelet transform is proposed. In calculating the factor of difference spectrum, the algorithm takes into account both the original spectrum and its continuous wavelet transformed spectra, which effectively overcomes the problem of reference peak selection and manual factor selection in most commercial software. The detailed discussions on wavelet scale, order and basis are included. The spectral fitting is performed on six wavelet basis functions and the obtained scale factor is used to quantify the content of liquor, and the corresponding mean absolute error ranges from 0.047 to 0.072, and the standard deviation ranges from 0.056 to 0.091. Experimental results show that the CWT combined with least squares fitting provides an accurate and reliable new method for FTIR spectral subtraction.

[Feasibility of complete mesocolic excision in elderly patients with colon cancer].

OBJECTIVE: To explore the short-term outcomes and safety of complete mesocolic excision (CME) in elderly patients with colon cancer. METHODS: The clinical pathological factors of 71 patients with colon cancer undergoing CME procedure by the same group of surgeons were analyzed retrospectively from November 2009 to February 2012. The elderly group(≥70 years) and the non-elderly group(<70 years) were compared regarding short-term outcomes and safety. RESULTS: Similar extent of resection could be achieved in the elderly and non-elderly groups in terms of area of mesentery[(13 049±4332) vs. (13 163±4725) mm2, P=0.916], distance between the tumor and the high ligation site[(95±22) vs. (98±20) mm, P=0.516], distance between normal bowel and high ligation site [(130±25) vs. (128±25) mm, P=0.731], the length of colon [(262±60) vs. (245±49) mm, P=0.212], and lymph nodes retrieved(22.0±6.4 vs. 24.8±9.9, P=0.168). The mean operative time, intraoperative blood loss, postoperative complications, time to first flatus, time to first bowel movement, drainage removal time, diet resumption, drainage volume in three days after surgery, and hospital deaths showed no statistical significances(all P>0.05), while hospital stay and expenses of the elderly group were significantly increased(both P<0.01). CONCLUSION: Elderly patients undergoing elective CME operation can achieve similar operative extent and lymph nodes harvest, and the surgical risk is not increased.

Syntheses, structure, and magnetic properties of hexanuclear Mn(III)(2)M(III)(4) (M = Y, Gd, Tb, Dy) complexes.

The synthesis and characterizations of a family of isomorphous [Mn(III)(2)M(III)(4)L(2)(µ(4)-O)(2)(N(3))(2)(CH(3)O)(2)(CH(3)OH)(4)(NO(3))(2)]·2H(2)O (M = Y(1), Gd(2), Tb(3), Dy(4)) are reported, where H(4)L = N,N'-dihydroxyethyl-N,N'-(2-hydroxy-4,5-dimethylbenzyl)ethylenediamine. They were obtained from the reactions of H(4)L with M(NO(3))(3)·6H(2)O, Mn(ClO(4))(2)·6H(2)O, NaN(3) and NEt(3) in a 1:1:1:2:2 molar ratio. The core structure consists of a Mn(2)M(4) unit. The four M(III) ions that are held together by two µ(4)-bridging oxygen atoms form a butterfly M(4) moiety. The M(4) core is further connected to the two five-coordinate trigonal-bipyramidal Mn(III) ions via one µ(4)-O(2-), two alkyloxo and one methoxo triple bridges. Magnetic susceptibility measurements indicate the presence of intramolecular antiferromagnetic interactions in complex 2, and overall intramolecular ferromagnetic interactions in complexes 3 and 4. The alternating current (AC) magnetic susceptibility studies revealed that complexes 3 and 4 showed frequency-dependent out-of-phase signals, which indicates that they exhibit slow relaxation of the magnetization.

[Complete mesocolic excision versus traditional radical resection in colon cancer].

OBJECTIVE: To compare the short-term efficacy and safety between complete mesocolic excision (CME) and traditional radical resection in colon cancer. METHODS: Between January 2008 and August 2011, 92 patients undergoing elective open surgery for colon were included in the study. CME was performed in 54 patients in the period from November 2009 to August 2011. The other 38 patients underwent traditional radical resection from January 2008 to October 2009. Short-term outcomes were compared between the patients of two different time periods. RESULTS: Lymph nodes retrieved in the CME group (22.2 ± 8.0) were significant more than that in the control group (18.6 ± 4.7)(P<0.05). In patients with stage III cancer, CME group was associated with higher lymph node counts (23.8 ± 7.6 vs. 16.7 ± 3.6, P<0.01), however, there were no significant differences for those with stage I and stage II cancer (P>0.05). The number of positive lymph nodes and metastatic lymph node ratio (LNR) for stage III patients in two groups were not significantly different (P>0.05). There were no differences in operation time, time to first bowel movement, hospital stay, and postoperative complications between the two groups (P>0.05). However, intraoperative blood loss in the CME group was significantly reduced (median, 100 vs. 115 ml, P<0.05). CONCLUSIONS: CME can achieve en-bloc resection of the tumor and mesocolon, and have optimal lymph nodes harvest. Despite wider resection extent with CME technique, the surgical risk and postoperative complications are not increased and the short-term efficacy is good.

[Learning curve of complete mesocolic excision for colon cancer].

OBJECTIVE: To evaluate the learning curve of complete mesocolic excision(CME) for colon cancer. METHODS: Clinical data of 75 cases in whom CME was performed by a group of surgeons in the Department of Gastrointestinal Surgery, Peking University People's Hospital from November 2009 to June 2011 were reviewed. The patients were divided into three groups(groups A, B, C, 25 cases in each group) by operative chronologic sequence. RESULTS: There were no significant differences in age, sex, preoperative staging, cancer location, operation history of abdomen, ASA among the three groups(P>0.05). The operative time in group A was (205.4 ± 53.2) min and decreased to (180.4 ± 29.7) min in group B and (169.8 ± 41.3) min in group C (P<0.05). The postoperative hospital stay decreased from (17.8 ± 10.9) d in group A to(12.9 ± 4.1) d in group B and(11.0 ± 3.5) d in group C(P<0.05). The postoperative complication rate decreased from 32%(8/25) in group A and 36%(9/25) to 8%(2/25) in group C. The specimen quality was superior in group C compared to group A (WEST grade C above were 20 and 11 respectively, P<0.05). There were no significant differences in intraoperative bleeding, time to first flatus, postoperative fasting time, number of retrieved lymph nodes among the three groups(P>0.05). CONCLUSION: From the learning curve of CME, surgeons can learn CME skill after performing 25 cases.

Impact of postoperative omega-3 fatty acid-supplemented parenteral nutrition on clinical outcomes and immunomodulations in colorectal cancer patients.

AIM: To investigate the effect of omega-3 fatty acid parenteral supplementation postoperatively on clinical outcomes and immunomodulation in colorectal cancer patients. METHODS: Forty-two patients undergoing radical colorectal cancer resection with an indication for total parenteral nutrition postoperatively were enrolled in this prospective, double-blind, randomized, controlled study. Patients received total parenteral nutrition supplemented with either soybean oil (LCT; Intralipid, Fresenius-Kabi, SO group, n = 21) or a combination of omega-3 fish oil and soybean oil (LCT:fish oil = 5:1, fish oil; Omegaven, Fresenius-Kabi, FO group, n = 21), up to a total of 1.2 g lipid/kg per day for 7 d postoperatively. A same volume calorie and nitrogen was administrated. Routine blood test, biochemistry, systemic levels of IL-6 and TNF-alpha, percentage of CD3+, CD4+, and CD8+ lymphocytes were evaluated preoperatively and on postoperative d 1 and 8. Patient outcome was evaluated considering mortality during the hospital stay, length of postoperative hospital stay, and occurrence of infectious complications. RESULTS: Both lipid regimens were well tolerated. No differences between the two groups were noticed in demographics, baseline blood test, biochemistry, serum levels of IL-6 and TNF-alpha, percentage of CD4+, CD8+ lymphocytes, and ratios of CD4+/CD8+. Compared with those on postoperative d 1, serum IL-6 levels on postoperative d 8 were significantly depressed in the FO group than in the reference group (-44.43 +/- 30.53 vs -8.39 +/- 69.08, P = 0.039). Simultaneously, the ratios of CD4+/CD8+ were significantly increased in the FO group (0.92 +/- 0.62 vs 0.25 +/- 1.22, P = 0.035). In addition, depression of serum TNF-alpha levels (-0.82 +/- 2.71 vs 0.27 +/- 1.67, P = 0.125) and elevation of CD3+ and CD4+ lymphocyte percentage (12.85 +/- 11.61 vs 3.84 +/- 19.62, P = 0.081, 17.80 +/- 10.86 vs 9.66 +/- 17.55, P = 0.084, respectively) were higher in the FO group than in the reference group. Patients in the FO group tended to need a shorter postoperative hospital stay (17.45 +/- 4.80 d vs 19.62 +/- 5.59 d, P = 0.19). No statistically significant difference was found when stratified to mortality and occurrence of infectious complications. CONCLUSION: Postoperative supplementation of omega-3 fatty acids may have a favorable effect on the outcomes in colorectal cancer patients undergoing radical resection by lowering the magnitude of inflammatory responses and modulating the immune response.