The intrabulbar or extrabulbar growth pattern and its surgical outcomes of jugular foramen paragangliomas.

OBJECTIVE: This study is to define a subclassification system of jugular foramen paragangliomas (JFPs) and to demonstrate corresponding microsurgical outcomes of JFPs. STUDY DESIGN: Retrospective study. SETTING: A single-center study. METHODS: We conducted a retrospective review of the clinical data of 44 patients with JFPs who underwent surgical management. Extrabulbar(Be) tumor and intrabulbar(Bi) tumor are defined based on the growth patterns, receiver operating characteristic (ROC) curves of the imaging profile were generated and was confirmed based on intraoperative findings. Area Under Curve (AUC), accuracy, sensitivity, and specificity for diagnostic imaging were revealed. We also compared the correlation between the two growth patterns with Fisch's classification, blood loss, lower cranial nerves (LCNs) deficit. RESULTS: There are 27 (69%) cases of Bi tumor and 17 (39%) cases of Be tumor. Significant radiomics features between the two growth patterns were demonstrated, ROC curves achieved excellent AUCs for MRI sequences (T1W1 MRI, MR contrast-enhanced sequence, MR complex sequences and MR complex + DSA by 0.833, 0.833, 0.875, 0.944) and had statistically significant in diagnosis of two growth patterns (P<0.05). There was no statistical correlation between growth patterns of JFPs and intra-operative blood loss. Preoperative LCNs deficits and Fisch's classification of tumors were correlated with the growth patterns of JFPs (P < 0.05). CONCLUSION: We proposetd two growth patterns of JFPs in term of the inferior petrous sinus involvement. Identification of Bi or Be growth patterns preoperatively is helpful to design optimal surgical strategies and minimize postoperative complications.

Acoustic Signal-Based Defect Identification for Directed Energy Deposition-Arc Using Wavelet Time-Frequency Diagrams.

Several advantages of directed energy deposition-arc (DED-arc) have garnered considerable research attention including high deposition rates and low costs. However, defects such as discontinuity and pores may occur during the manufacturing process. Defect identification is the key to monitoring and quality assessments of the additive manufacturing process. This study proposes a novel acoustic signal-based defect identification method for DED-arc via wavelet time-frequency diagrams. With the continuous wavelet transform, one-dimensional (1D) acoustic signals acquired in situ during manufacturing are converted into two-dimensional (2D) time-frequency diagrams to train, validate, and test the convolutional neural network (CNN) models. In this study, several CNN models were examined and compared, including AlexNet, ResNet-18, VGG-16, and MobileNetV3. The accuracy of the models was 96.35%, 97.92%, 97.01%, and 98.31%, respectively. The findings demonstrate that the energy distribution of normal and abnormal acoustic signals has significant differences in both the time and frequency domains. The proposed method is verified to identify defects effectively in the manufacturing process and advance the identification time.

Mapping the research on Sjögren's syndrome-related dry eye disease: a bibliometric network analysis of the past 20 years.

PURPOSE: Our study aimed to make a bibliometric analysis on Sjögren's syndrome-related dry eye disease (SS-DED), explore its potential research hotspots, and provide critical information for future research interest and undeveloped topics in this field, which can benefit clinicians and researchers. METHODS: We extracted all publications relating to SS-DED from 2003 to 2022 from the Web of Science Core Collection database. Original articles and reviews in English were included. The contributions of different countries, institutions, journals, and authors were compared, and the research hotspots were visualized for network analysis through GraphPad Prism, CiteSpace, and VOSviewer. RESULTS: We enrolled a total of 987 publications. The United States contributed the most publications (281, 28.5%), followed by China (157, 15.9%) and Japan (80, 8.11%). Publications from the United States were cited more frequently (13,060 citations), with the highest H-index of 57. China ranked second in the total number of publications, the papers were not cited frequently (3790 citations), and the H-index ranked second (H-index = 31). PLoS One (32, 3.24%) published the most papers, and the University of California system had the highest number of publications (45, 4.56%). Bootsma H from the Netherlands published the most papers. The trend of research hotspots evolved mainly from the basic manifestation to pathogenesis and treatment of SS-DED and paid more attention to distinguishing SS-DED from that dry eye disease without SS. CONCLUSIONS: Based on the bibliometric, co-citation, and network analyses in this study, we obtained the annual publications and citations, the growth trends of publications, the productivity of countries, organizations, journals, and authors, high-quality publications, and the emerging hotspots of SS-DED, which may open new doors for promising research directions.

Temporal contrast adaptation in the analysis of visual function in primary open-angle glaucoma.

PURPOSE: To explore the utility of the recovery time (RT) after temporal contrast adaptation in primary open-angle glaucoma (POAG) visual function analysis, especially in severe and end-stage glaucoma, by the Erlanger Flicker Test (EFT). METHODS: This study included 80 POAG eyes (45 subjects) and 20 normal eyes (20 subjects). POAG eyes were divided into 5 groups. The diagnostic efficacy of the EFT was assessed, and the RT of POAG eyes at different stages was compared. The EFT results were compared with glaucomatous structure and function test results. A nomogram was developed to predict disease progression by the RT and structural indicators. RESULTS: In the normal eyes, as the test contrast increased, the RT gradually decreased. The EFT test-retest reproducibility was good, with intraclass correlation coefficient values of 0.6 (P < 0.05) for each test contrast. At 12%, 25%, and 35% contrast, the RT in the severe and end-stage glaucoma eyes was significantly prolonged compared with the control group (P < 0.05). The RT at different contrasts was significantly correlated with visual acuity, mean defect, mean sensitivity, and general and individual quadrant optic nerve fiber layer thickness (P ≤ 0.001). The receiver operating curve indicated that RT12% showed the best overall area under the curve (0.863). We included RT25% and average optic nerve fiber layer thickness in constructing the nomogram. POAG eyes were further divided into 8 stages. According to the probability distribution, this model showed good performance for visual function analysis in advanced glaucoma. CONCLUSIONS: Combined with traditional glaucomatous structural and functional parameters, the EFT can be used in the diagnosis and visual function analysis of POAG, especially for severe and end-stage glaucoma. It could be a potential test for disease staging in severe and end-stage glaucoma.

Sonication-Free Dispersion of Single-Walled Carbon Nanotubes for High-Sorption-Capacity Aerogel Fabrication.

Homogenously dispersing single-walled carbon nanotubes (SWNTs) in solvents has been one critical step towards exploiting their exceptional properties in high-performance components. However, the solubility of SWNTs is severely limited by the inert tube surfaces and strong tube-tube van der Waals attractions. Starting with carbon nanotubides, i.e., negatively charged SWNTs reduced by alkali metals, we herein propose a sonication-free approach to prepare an aqueous dispersion of SWNTs. The approach combines the spontaneous dissolution of nanotubides in polar aprotic solvents with polyvinylpyrrolidone wrapping and dialysis in deionized H2O, which results in well-dispersed, neutralized SWNTs. The gelation of concentrated SWNT dispersion leads to the formation of hydrogels, which is subsequently transformed into SWNT aerogels through lyophilization. The prepared SWNT aerogels exhibit high-mass-sorption capacities for organic solvent absorption, paving the way towards harvesting the extraordinary properties of SWNTs.

Discovery of NLO Semiorganic (C5H6ON)+(H2PO4)-: Dipole Moment Modulation and Superior Synergy in Solar-Blind UV Region.

We herein report a novel semiorganic NLO material, (C5H6ON)+(H2PO4)-, 4HPP, showing promising excellent properties in the important solar-blind UV region where LAP and its deuterated form DLAP are the only commercialized semiorganic materials. For the first time, the 4-hydroxypyridine (4HP+, (C5H6ON)+) cation is identified as NLO active and how to eliminate the dipole-dipole interaction to avoid the unwanted center-symmetry-trap caused by the polar-induced susceptibility is well demonstrated. Remarkably, 4HPP exhibits competitive and even better properties compared with LAP that include better thermal stability (decomposition at 166 vs 112 °C of LAP); wider transparency range (0.26-1.50 µm); very strong SHG response (3 × KDP); a suitable large birefringence (Δncal = 0.25 vs 0.075 of LAP); and a high laser-induced damage threshold (2.2 × KDP). First-principles calculations show that the π-conjugated organic (4HP)+ cation governs the optical anisotropy, whereas the synergy of the organic and inorganic moieties dominates the SHG process. Our discovery points out a new path for the rational design of high performance semiorganic materials that require an acentric structure.

Grading system and surgical approaches for endolymphatic sac tumors.

PURPOSE: Endolymphatic sac tumors (ELSTs) are rare, low-grade adenocarcinomas arising from the endolymphatic sac. This study aims to present a novel grading system for ELSTs to determine the optimal management strategy. METHODS: We performed a retrospective analysis of 16 patients with 17 ELSTs. The tumor location and involved adjacent neurovascular structures on CT and MRI were selected to establish the grading system. RESULTS: Based on the novel grading system, grade III a tumors were most common (7/17), followed by grade I (4/17), grade II (3/17), and grade III b (3/17) tumors. Eight advanced ELSTs (grade III a and III b) received an infra-temporal fossa approach, while the other 6 early stage ELSTs (grade I and II) underwent either a retrolabyrinthine approach with posterior petrosectomy or a translabyrinthine approach combined with subtotal temporal bone resection. Hearing preservation was achieved in 2 grade I patients. Postoperative facial nerve function was HB II in 1 grade III a patient who underwent anterior facial nerve transposition and was HB III in 4 advanced patients who received facial nerve grafts with the great auricular nerve or facial-hypoglossal nerve anastomosis. The mean follow-up time was 35.1 months. Two grade III patients and 1 grade II patient had tumor recurrence during follow-up, among whom 1 grade III b patient had two cases of recurrence. CONCLUSION: A correct initial diagnosis was established in all patients after meticulous imaging studies. Surgical resection is still the first choice to manage patients with ELSTs. The novel grading system enables surgeons to select tailored surgical approaches. Long-term follow-up is necessary following surgical intervention.

Garbage Burning in South Asia: How Important Is It to Regional Air Quality?

Increasing air pollution in South Asia has serious consequences for air quality and human/ecosystem health within the region. South Asia, including India and Nepal, suffers from severe air pollution, including high concentrations of aerosols, as well as gaseous pollutants. One of the often-neglected sources contributing to the regional air pollution is garbage burning. It is mostly related to numerous yet small, open, uncontrolled fires burning diverse fuels, making it difficult to quantify activity and emissions. In this study, we attempted to quantify the total emissions due to garbage burning and its contribution to regional air quality, using new observational data, a new inventory, and a regional chemical transport model. We implemented the newly available emission factors (EFs) from a recent field campaign, Nepal Ambient Monitoring and Source Testing Experiment (NAMaSTE), which took place in April 2015. Using a chemical transport model-Weather Research and Forecasting model coupled with Chemistry version 3.5 (WRF-Chem)-and three emission scenarios, we assessed the impact of open garbage burning emissions on regional air quality. Our results show that garbage burning emissions could increase PM2.5 concentrations by nearly 30% in India and Nepal, and result in ∼300 000 premature deaths from chronic obstructive pulmonary disease in the two countries.

Evaluation of efficacy and recurrence for anti-vascular endothelial growth factor therapy in idiopathic choroidal neovascularization.

BACKGROUND: This study aimed to evaluate the visual and morphological outcomes of intravitreal anti-VEGF therapy and the recurrence for idiopathic choroidal neovascularization (ICNV). METHODS: This retrospective study included 35 patients (35 eyes) with ICNV from July 2012 to October 2017. All patients received 1 intravitreal anti-VEGF injection followed by pro re nata injections until there was no sign of ICNV activity. This was defined as the first follow-up period. To evaluate ICNV recurrence, we continued to follow-up 27 of the 35 patients for at least 2 years after the initial diagnosis, and the longest follow-up period was 5 years. Additional injection was performed when ICNV recurred. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were recorded and morphological improvement in optical coherence tomography (OCT) was assessed. Parameters that affect prognosis and recurrence were analysed. RESULTS: The mean follow-up period was 168.0 ± 34.82 weeks. Mean BCVA improved from 56.20 ± 14.13 letters at baseline to 73.31 ± 12.57 letters (P<0.01); Mean CRT decreased from 353.6 ± 98.70 µm at baseline to 273.1 ± 53.56 µm (P < 0.001) at the end of the first follow-up period. Better baseline BCVA indicated a better morphological improvement (P = 0.026) in OCT: the lesion had completely subsided with recovery of the foveal contour. Those with high baseline BCVA (more than 60 letters) showed significant resolution of CNV lesions (P = 0.036). ICNV recurred in six patients (22.2%), 1 of whom experienced 2 recurrences. The mean timing of recurrence was 90.83 ± 49.02 weeks after diagnosis. There was no significant correlation between ICNV recurrence and the morphological improvement (P = 0.633). The final BCVA in patients with recurrence did not differ from that in patients without recurrence (P = 0.065). CONCLUSIONS: Intravitreal anti-VEGF therapy on a pro re nata basis was effective for treating ICNV. High baseline BCVA indicated a better prognosis. Re-treatment with anti-VEGF could effectively lead to resolution of recurrent ICNV. Disease recurrence had no significant effect on final visual prognosis and had no correlation with the morphological improvement during treatment, suggesting that follow-up for subsequent monitoring should be performed in all ICNV patients.

Rotational slit-beam marking: an advanced manual corneal astigmatic marking method for toric intraocular lens implantation.

PURPOSE: To evaluate the accuracy of an advanced manual corneal astigmatic marking method for toric intraocular lens (IOL) implantation. METHODS: From 52 patients, 52 eyes with cataracts and corneal astigmatism were included. The target axis of the toric IOL was marked with the new manual marking method preoperatively and with the Zeiss CALLISTO Eye image-guided system intraoperatively. For the manual method, a slit-lamp with a minimum rotation angle of 5 degrees was used and rotated to the meridian of the toric IOL and incision axes. The relative rotational and vertical deviation of the IOL and incision axes were measured using the digital marker as a reference. RESULTS: There was no significant difference between the manually marked IOL axis (100.9° ± 65.62°) and the digital mark (100.8° ± 65.76°; P = 0.771). The absolute values of the relative rotational and vertical deviations of the manually marked IOL axis were small, at 2.03° ± 1.44° and 0.46 ± 0.43 mm, respectively. There was no significant difference between the manually marked corneal incision and the digital meridian (P = 0.179). Then, patients were classified into three groups based on the type of astigmatism they had. There was no significant difference in mean absolute deviation among the groups (P = 0.112). The manual incision mark had a relative rotational deviation of 1.65° ± 1.44°. The vertical misalignment of the manually marked incision axis was 0.27 ± 0.30 mm. CONCLUSION: Rotational slit-beam marking could be an effective and convenient marking method for toric IOL implantation. This method could be a potential alternative in underdeveloped areas where digital image-guided systems are not available.

How To Maximize Birefringence and Nonlinearity of π-Conjugated Cyanurates.

Materials with large birefringence (Δn) are highly needed by fiber-optic isolators, whereas crystals showing strong second-order harmonic generation (SHG) are the key component for all-solid-state laser devices. Cyanurate constructed by the planar π-conjugated ring (C3N3O3, CY) is a class of fascinating materials exhibiting not only very large Δn (larger than that of calcite) but also strong SHG (2 times that of ß-BaB2O4, BBO). Here, we report five new cyanurates (I-V) and their single-crystal structures; among them, II realizes a Δn = 0.4, the maximum in the cyanurate family, and IV realizes a d33 = 6.69 pm/V, one of the highest values in the cyanurate family. We discover a dependence between Δn and the coplanarity of the CY rings that is explicitly described by a Boltzmann function, in which the coplanarity is defined by the dihedral angle (γ) between the CY plane and the principal optical axes XY plane. II realizes the maximum Δn due to its zero γ that indicates perfect coplanarity. Such a Δn-γ dependence also allows the Δn prediction of cyanurates. Furthermore, we uncover that the SHG intensity of cyanurates increases monotonically as the angle (θ) between the maximum hyperpolarizability (ßmax) vector and the crystal 21 polar axis decreases. We predict the dij to extend well beyond such a value and to maximize at θ = 0°. Our results have significant implications for the future rational design and discovery of high-performance materials of π-conjugated and other related systems.

Advance in Close-Edged Graphene Nanoribbon: Property Investigation and Structure Fabrication.

The absence of dangling bonds in close-edged graphene nanoribbons (CEGNRs) confers upon them a series of fascinating properties, especially when compared with cylindrical carbon nanotubes and open-edged GNRs. Here, the configuration of CEGNRs is described, followed by the structure-related properties, including mechanical, thermal, electrical, optical, and magnetic properties. Based on the unique structures and extraordinary properties, their potential applications in a variety of fields, such as field-effect transistors, energy suppliers, nanoactuators, and fibers, are discussed. Remarkably, the strategies applied for generating CEGNRs, mainly from the collapse of carbon nanotubes and graphene tubes, are depicted in detail. Finally, the prospects in the research area of CEGNRs are proposed.

Clinical features and management of Meniere's disease patients with drop attacks.

PURPOSE: The aims of the present study are to investigate the variations in clinical features, including medical history, hearing function, vestibular function, and degree of endolymphatic hydrops (EH), in Meniere's disease (MD) patients with and without drop attacks (DAs), and to examine the efficacy of intratympanic gentamicin (ITG) treatment in alleviating DAs. METHODS: In total, 177 unilateral definite MD patients, including 16 patients with DAs and 161 patients without DAs, were enrolled. The results of hearing test, vestibular-evoked myogenic potentials (VEMPs), and magnetic resonance imaging (MRI) were analyzed. Thirteen patients with DAs received a single ITG treatment and were followed up. RESULTS: The disease course of MD in the DA group was significantly longer than that in the control group (p = 0.007). MD patients with DAs had significantly greater hearing loss and worse EH than MD patients without DAs (p < 0.05). However, there was no between-group difference in vestibular function. In the study, 92.31% of refractory definite MD patients with DAs achieved satisfactory control of DAs after ITG treatment. CONCLUSIONS: MD patients with DAs tend to suffer from severe hearing loss and a significant degree of EH in the inner ear. However, the vestibular function of MD patients with DAs may not be completely abolished, but be sensitive to stimulating signals. ITG treatment, which helps to decrease vestibular sensitivity, was an effective treatment to control DAs.

The roles of teacher and parental support on adolescent cyber-bystander behaviors: a path analysis.

Introduction: The role of bystanders in cyberbullying situations is critical, with the potential to significantly influence outcomes. Bystanders who demonstrate positive behaviors-such as reporting incidents or supporting victims-can help to mitigate the damaging effects of cyberbullying. Based on the Social Cognitive Theory, this study seeks to address the psychosocial mechanisms that underlie positive cyber-bystander behaviors. Methods: A total of 1,716 students in Grades 8-12 from three secondary schools in China participated in this study. Path analysis was utilized to delineate the relationships between internet self-efficacy, empathy, teacher and parental support, and cyber-bystander behaviors. Results: Adolescents who received greater support from teachers were more likely to demonstrate increased internet self-efficacy and empathy. In contrast, higher levels of parental warmth were associated with lower levels of internet self-efficacy. Teacher support and parental warmth exerted an indirect effect on positive bystander behaviors through empathy. Discussion: The importance of parental warmth paired with Internet self-efficacy in preventing online interpersonal violence and motivate active bystander behaviors is considerable. We recommend adopting a nuanced approach that differentiates between empathy and internet self-efficacy in cyber-bystander research.

The coupling coordination and spatiotemporal evolution of industrial water-energy-CO2 in the Yellow River Basin.

The Yellow River Basin (YRB) is an important energy, chemical, raw material, and basic industrial base in China. With economic growth, water and energy consumption in industrial industries increasing dramatically, huge pressure for CO2 emission reduction has generated. This paper constructed an industrial water-energy-CO2 (WEC) evaluation index system, analyzed the comprehensive evaluation level, coupling status and coupling coordination status, by using the comprehensive evaluation method, coupling degree model and coupling coordination degree model and used the spatial autocorrelation analysis to study the spatiotemporal evolution from 1999 to 2019 in the YRB. The results demonstrated that the integrated development level of the basin's industrial WEC system and subsystems had been improving. The basin was at a high coupling and the level of coupling had been increasing as a whole, and the industrial energy-CO2 coupling degree was bigger than the industrial water-energy and industrial water-CO2 coupling degrees in the YRB. The coupling coordination status had transitioned from forced coordination to good coordination. Spatially, the coupling coordination didn't appear a significant correlation and showed a random distribution. Accordingly, the suggestions were made to improve the level of industrial development in the basin, strengthen integrated resource management, and enhance intra-basin cooperation.

The Role of Parotid Gland Invasion in Adenoid Cystic Carcinoma of the External Auditory Canal.

OBJECTIVE: This study aimed to investigate the significance of parotid gland invasion in predicting distant metastasis of adenoid cystic carcinoma in the external auditory canal. STUDY DESIGN: Single-institution retrospective cohort study. METHODS: A retrospective review of patients with adenoid cystic carcinoma of the external auditory canal who underwent surgery was performed. Information on patient demographics, parotid gland invasion, tumor stage, perineural invasion, lymphovascular invasion, and follow-up data were collected and analyzed. RESULTS: One hundred twenty-nine patients were identified for review. Parotid gland invasion was noted in 45 patients (34.9%). Parotid gland invasion was significantly associated with tumor stage, perineural invasion, distant metastasis, and postoperative adjuvant therapy. Distant metastasis was noted in 30 patients (23.3%). Multivariate Cox proportional hazards analysis identified parotid gland invasion as an independent risk factor for predicting distant metastasis. The 5-year distant metastasis-free survival rate was 83.6% for patients without parotid gland invasion and 61.8% for patients with parotid gland invasion (p = 0.010). CONCLUSIONS: The parotid gland invasion rate is relatively high in adenoid cystic carcinoma of the external auditory canal and is significantly related to tumor stage. Parotid gland invasion is associated with worse distant metastasis-free survival. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:419-425, 2024.

Disrupted mitochondrial transcription factor A expression promotes mitochondrial dysfunction and enhances ocular surface inflammation by activating the absent in melanoma 2 inflammasome.

PURPOSE: Severe dry eye disease causes ocular surface damage, which is highly associated with mitochondrial dysfunction. Mitochondrial transcription factor A (TFAM) is essential for packaging mitochondrial DNA (mtDNA) and is crucial for maintaining mitochondrial function. Herein, we aimed to explore the effect of a decreased TFAM expression on ocular surface damage. METHODS: Female C57BL/6 mice were induced ocular surface injury by topical administrating benzalkonium chloride (BAC). Immortalized human corneal epithelial cells (HCECs) were stimulated by tert-butyl hydroperoxide (t-BHP) to create oxidative stress damage. HCECs with TFAM knockdown were established. RNA sequencing was employed to analyze the whole-genome expression. Mitochondrial changes were measured by transmission electron microscopy, Seahorse metabolic flux analysis, mitochondrial membrane potential, and mtDNA copy number. TFAM expression and inflammatory cytokines were determined using RT-qPCR, immunohistochemistry, immunofluorescence, and immunoblotting. RESULTS: In both the corneas of BAC-treated mice and t-BHP-induced HCECs, we observed impaired TFAM expression, accompanied by mitochondrial structure and function defects. TFAM downregulation in HCECs suppressed mitochondrial respiratory capacity, reduced mtDNA content, induced mtDNA leakage into the cytoplasm, and led to inflammation. RNA sequencing revealed the absent in melanoma 2 (AIM2) inflammasome was activated in the corneas of BAC-treated mice. The AIM2 inflammasome activation was confirmed in TFAM knockdown HCECs. TFAM knockdown in t-BHP-stimulated HCECs aggravated mitochondrial dysfunction and the AIM2 inflammasome activation, thereby further triggering the secretion of inflammatory factors such as interleukin (IL) -1ß and IL-18. CONCLUSIONS: TFAM reduction impaired mitochondrial function, activated AIM2 inflammasome and promoted ocular surface inflammation, revealing an underlying molecular mechanism for ocular surface disorders.

An efficient approach toward production of near-zigzag single-chirality carbon nanotubes.

Synthesizing single-walled carbon nanotubes (SWCNTs) with a narrow chirality distribution is essential for obtaining pure chirality materials through postgrowth sorting techniques. Using carbon monoxide chemical vapor deposition, we devise a ruthenium (Ru) catalyst supported by silica for the bulk production of SWCNTs containing only a few (n, m) species. The result is attributed to the limited carbon dissociation on the supported Ru clusters, favoring the growth of only small-diameter SWCNTs at comparable growth rates. The resulting materials expedite high-purity single chirality separation using gel chromatography, leading to unprecedented yields of 3.5% for (9, 1) and 5.2% for (9, 2) nanotubes, which surpass those separated from HiPco SWCNTs by two orders of magnitude. This work sheds light on the large-quantity synthesis of SWCNTs with enriched species beyond near-armchair ones for their high-yield separation.

[A case report of middle ear cholesteatoma complicated with labyrinthine fistulaand delayed endolymphatic hydrops].

Delayed endolymphatic hydrops （DEH） is a rare disease that causes vertigo and is often misdiagnosed as other vertigo diseases. This article reports on a patient with vertigo who was easily misdiagnosed. The patient was a middle ear cholesteatoma complicated by labyrinthine fistula （LF）; however, his vertigo was episodic vertigo, which could not be explained solely by LF causing labyrinthitis. The possibility of endolymphatic hydrops was suspected, which was confirmed by inner ear magnetic resonance gadolinium imaging. This is the first reported case of middle ear cholesteatoma complicated by LF and DEH. The patient underwent surgical resection of the cholesteatoma and three semicircular canal obstructions at the same time. During two years postoperative follow-up, the patient did not experience a recurrence of vertigo. When diagnosing vertigo diseases, a careful history of vertigo is of utmost importance.