[Analysis of the influencing factors of short-term and long-term facial nerve function after vestibular schwannoma resection via suboccipital retrosigmoid approach]

Objective: To summarize the experience of facial nerve(FN) preservation in microsurgical treatment of vestibular schwannoma (VS) resection via suboccipital retrosigmoid approach and to analyze the influencing factors of facial function prognosis in short-term and long-term period. Methods: Patients with VS who underwent microsurgery via suboccipital retrosigmoid approach by the skull base surgery team in Huashan Hospital from January 2013 to February 2018 were enrolled. A total of 308 patients were included in this study, including 132 males and 176 females. The average age was 47.9 year-old (Range: 17-79 year-old). The patient's clinical data and FN function prognosis were recorded. Univariate and multivariate analysis by SPSS 23.0 statistical software were performed to evaluate the factors affecting facial function prognosis and its recovery. Results: Gross total resection was achieved in 304 cases, and subtotal resection was in 4 cases. The facial nerve preservation rate anatomically was 99.4%. The facial nerve of 2 cases was thin due to large tumor compression and severed, and a one-stage reconstruction was performed during surgery.Of the 308 patients, 300 cases were successfully followed up, and 8 cases were lost to follow-up. The mean follow-up time was 52 months. In short-term (2 weeks after surgery), satisfactory facial nerve function (House-Brackmann (H-B) grade Ⅰ-Ⅱ) was achieved in 96 cases, and 212 cases were unsatisfactory function (H-B grade Ⅲ-Ⅵ). After 1 year, 198 were satisfactory function and 97 were unsatisfactory. After 3 years, 219 were satisfactory function and 75 were unsatisfactory. Five years later, 155 were satisfactory function and 34 were unsatisfactory. According to the results of logistic regression analysis, the impact factors of FN function in short-term were tumor size (P=0.011) and stimulation threshold (ST) of EMG monitoring (P<0.001). The impact factors in long-term were tumor size (P=0.005), ST of EMG monitoring (P=0.005) and FN rehabilitation training. Conclusions: Tumor diameter is an independent factor related to FN function, and the larger the tumor, the worse the postoperative FN function. The ST of EMG (ST≤0.05 mA) can predict short-term and long-term FN function. The systematic facial rehabilitation training can effectively promote the recovery of FN after surgery.

[Application of nitrous oxide/oxygen inhalation comfort technique during tooth extraction of elderly hypertensive patients under electrocardiographic monitoring]

PURPOSE

To investigate the application value of nitrous oxide/oxygen inhalation comfort technique during tooth extraction in elderly patients with hypertension under electrocardiographic(ECG) monitoring.

METHODS

According to the inclusion and exclusion criteria, sixty elderly patients (over 65 years old) with hypertension for tooth extraction were randomly divided into 2 groups: the experimental group(nitrous oxide/oxygen inhalation combined with ECG monitoring group, n=30) and the control group (routine ECG monitoring group, n=30). Mean arterial pressure (MAP) and heart rate (HR) at T0 (baseline values before surgery), T1 (on local anesthesia), T2 (during operation) and T3(5 minutes after operation) were recorded. SPSS 25.0 software package was used for statistical analysis.

RESULTS

There was no significant difference in MAP and HR at each time point in the experimental group(P＞0.05). There was no significant difference in MAP and HR at T0 and T3 time points in the control group(P＞0.05). At other time points, MAP and HR were significantly different (P＜0.05). There was no significant differences in MAP and HR between the two groups at T0 and T3(P＞0.05). MAP and HR at T1 and T2 in the experimental group were significantly less than those in the control group(P＜0.05).

CONCLUSIONS

Nitrous oxide/oxygen inhalation comfort technology can stabilize patients' emotions and maintain stable blood pressure and heart rate in elderly patients with hypertension during tooth extraction, thus improving the safety of tooth extraction.

Phosphorus acquisition strategies of wheat are related to biochar types added in cadmium-contaminated soil: Evidence from soil zymography and root morphology

Biochar application for the remediation of cadmium (Cd)-contaminated soils may result in a relative deficiency of phosphorus (P) due to the disruption of soil nutrient balance. However, the P acquisition strategies of plants in such situation are still unclear. In this study, analyses on soil zymography and root morphology were combined for the first time to investigate the effects of pristine and P-modified biochars from apple tree branches on the P acquisition strategies of wheat under Cd stress. The results show that the application of pristine biochar exacerbated the soil's relative P deficiency. Wheat was forced to improve foraging for P by forming longer and thinner roots (average diameter 0.284 mm) as well as releasing more phosphatase to promote P mobilization in the soil. Moreover, bioavailable Cd affected the P acquisition strategies of wheat through stimulating the release of phosphatase from roots. The P-modified biochar maintained high levels of Olsen-P (>100 mg kg^-1) in the soil over time by slow release, avoiding the creation of relative P deficiency in the soil; and increased the average root diameter (0.338 mm) and growth performance index, which promoted shoot growth (length and biomass). Furthermore, the P-modified biochar reduced DTPA-extracted Cd concentration in soils by 79.8 % (pristine biochar by 26.9 %), and decreased the Cd translocation factor from root to shoot as well as Cd concentration in the shoots. Therefore, P-modified biochar has a great potential to regulate the soil element balance (carbon, nitrogen, and P), promote wheat growth, and remediate the Cd-contaminated soil.

Evaluation of the learning curve of laser peripheral iridectomy: the 20th case reaches the turning point

AIM: To explore the learning curve for ophthalmologists at the start of laser peripheral iridectomy (LPI) training. METHODS: The learning curve of 4 doctor groups without previous LPI experience was studied. Three main parameters of LPI were reviewed: total energy, argon energy and neodymium-doped yttrium aluminum garnet (Nd:YAG) energy. Procedures were evaluated in cohorts of 20 cases to identify the turning points of the three variables. RESULTS: There was no significant difference in terms of age or eye among the 4 doctor groups. There were stable trends on the learning curve for the Doctor A and C groups regarding total energy and argon energy. In addition, the turning points on the learning curve were determined after the 20th procedure for the Doctor B and D groups regarding total energy and argon energy. Moreover, the Nd:YAG energy was relatively stable since the first procedure. CONCLUSION: It requires approximately 20 procedures for a beginner to reach a turning point on the learning curve regarding LPI. It can serve as a point of reference or guideline for training beginners to perform LPI.

Geniposide attenuates spermatogenic dysfunction via inhibiting endoplasmic reticulum stress in male mice

BACKGROUND

Spermatogenesis dysfunction is common in clinically infertile patients. Geniposide (GP) is one of the important active ingredients extracted from Eucommia ulmoides. However, the protective effect and mechanism of GP in the treatment of spermatogenic dysfunction is not known yet.

METHODS

After cyclophosphamide-induced spermatogenic dysfunction was established in male mice, we gavaged GP for 4 weeks to evaluate spermatogenic function and anti-apoptotic effects by fertility, testicular weight, sperm quality, endoplasmic reticulum stress (ER stress), comet assay and serum testosterone level.

RESULTS

GP can improve the damage of fertility and reproductive organs induced by cyclophosphamide and increase the number and activity of sperm. In comet assay, it was found that GP administration could alleviate sperm DNA damage induced by cyclophosphamide. In addition, GP treatment can significantly reduce ThT fluorescence intensity and improve endoplasmic reticulum stress induced by cyclophosphamide. Besides, TUNEL staining and WB showed that GP could inhibit the excessive apoptosis of cells and protect testis. (p < 0.05, p < 0.01, p < 0.001).

CONCLUSION

The protective effect of Geniposide on cyclophosphamide-induced spermatogenic dysfunction in mice is related to the inhibition of endoplasmic reticulum stress.

Recognition efficiency of atypical cardiovascular readings on ECG devices through fogged goggles

In their continuing battle against the COVID-19 pandemic, medical workers in hospitals worldwide need to wear safety glasses and goggles to protect their eyes from the possible transmission of the virus. However, they work for long hours and need to wear a mask and other personal protective equipment, which causes their protective eye wear to fog up. This fogging up of eye wear, in turn, has a substantial impact in the speed and accuracy of reading information on the interface of electrocardiogram (ECG) machines. To gain a better understanding of the extent of the impact, this study experimentally simulates the fogging of protective goggles when viewing the interface with three variables: the degree of fogging of the goggles, brightness of the screen, and color of the font of the cardiovascular readings. This experimental study on the target recognition of digital font is carried out by simulating the interface of an ECG machine and readability of the ECG machine with fogged eye wear. The experimental results indicate that the fogging of the lenses has a significant impact on the recognition speed and the degree of fogging has a significant correlation with the font color and brightness of the screen. With a reduction in screen brightness, its influence on recognition speed shows a v-shaped trend, and the response time is the shortest when the screen brightness is 150 cd/m2. When eyewear is fogged, yellow and green font colors allow a quicker response with a higher accuracy. On the whole, the subjects show a better performance with the use of green font, but there are inconsistencies. In terms of the interaction among the three variables, the same results are also found and the same conclusion can be made accordingly. This research study can act as a reference for the interface design of medical equipment in events where medical staff wear protective eyewear for a long period of time.

Protective Effects of Sesamin on Cytoxan-Induced Spermatogenesis Dysfunction by Regulating RNF8-ubH2A/ubH2B Pathways in Male Mice

Most of the clinically infertile patients show spermatogenesis dysfunction. Cyclophosphamide, as an anticancer drug, can induce spermatogenesis dysfunction. Sesamin is the main bioactive component of natural lignans in sesame. It is abundant in sesame oil and has strong biological activities such as antioxidant, antibacterial, and hypoglycemic properties. By establishing the model of spermatogenic dysfunction induced by cyclophosphamide in male mice and then feeding sesamin (50, 100, and 200 mg/kg) for 2 weeks, we proved that sesamin can improve the reproductive organ damage induced by cyclophosphamide and increase the number and activity of sperms. Sesamin can resist cyclophosphamide-induced sperm nuclear maturity and DNA damage by increasing the expression levels of histones H2A and H2B in the testis. In addition, sesamin can improve the ubiquitination of histones regulated by RNF8 to protect the testis. In conclusion, these results suggest that sesamin can improve spermatogenic dysfunction induced by cyclophosphamide, which may be mediated by ubiquitination of histones.

Assessing risk factors for SARS-CoV-2 infection in patients presenting with symptoms in Shanghai, China: a multicentre, observational cohort study

Background

The outbreak of COVID-19 has led to international concern. We aimed to establish an effective screening strategy in Shanghai, China, to aid early identification of patients with COVID-19.

Methods

We did a multicentre, observational cohort study in fever clinics of 25 hospitals in 16 districts of Shanghai. All patients visiting the clinics within the study period were included. A strategy for COVID-19 screening was presented and then suspected cases were monitored and analysed until they were confirmed as cases or excluded. Logistic regression was used to determine the risk factors of COVID-19.

Findings

We enrolled patients visiting fever clinics from Jan 17 to Feb 16, 2020. Among 53 617 patients visiting fever clinics, 1004 (1·9%) were considered as suspected cases, with 188 (0·4% of all patients, 18·7% of suspected cases) eventually diagnosed as confirmed cases. 154 patients with missing data were excluded from the analysis. Exposure history (odds ratio [OR] 4·16, 95% CI 2·74-6·33; p<0·0001), fatigue (OR 1·56, 1·01-2·41; p=0·043), white blood cell count less than 4 × 10⁹ per L (OR 2·44, 1·28-4·64; p=0·0066), lymphocyte count less than 0·8 × 10⁹ per L (OR 1·82, 1·00-3·31; p=0·049), ground glass opacity (OR 1·95, 1·32-2·89; p=0·0009), and having both lungs affected (OR 1·54, 1·04-2·28; p=0·032) were independent risk factors for confirmed COVID-19.

Interpretation

The screening strategy was effective for confirming or excluding COVID-19 during the spread of this contagious disease. Relevant independent risk factors identified in this study might be helpful for early recognition of the disease.

Funding

National Natural Science Foundation of China.

A novel frameshift mutation in the cylindromatosis (CYLD) gene in a Chinese family with multiple familial trichoepithelioma

Multiple familial trichoepithelioma (MFT) (OMIM: 601606) is an autosomal dominantly inherited disorder characterized by numerous, skin-colored papules and nodules with pilar differentiation. Recently, several mutations in the cylindromatosis (CYLD) gene have been reported in MFT. In this study, a mutation analysis of the CYLD was conducted in a Chinese pedigree of typical MFT. Affected individuals were identified through probands from Shanxi Province, China. Lesional skin biopsy of the proband revealed the typical histopathological characteristics of trichoepithelioma. Individuals belonging to five consecutive generations were similarly affected, which indicated an autosomal dominant inheritance pattern. Genomic DNA was extracted from peripheral blood lymphocytes using standard phenol/chloroform extraction method. All the coding exons (4-20) and exon-intron boundaries of the CYLD gene were amplified by polymerase chain reaction (PCR). Direct sequencing of all PCR products amplified from the complete coding regions of the CYLD gene was performed to identify mutations. Sequencing of the CYLD gene was performed in a further 100 unrelated, unaffected control individuals to exclude the possibility of polymorphism. A novel heterozygous frameshift mutation c.1169_1170delCA (p.Thr390Argfs) was identified in exon 10 of the CYLD gene in the affected family members. This mutation was also detected in unaffected family members, but not in the unrelated, healthy individuals who were also analyzed. Our study expands the database on the CYLD gene mutations in MFT and should be useful in providing genetic counseling and prenatal diagnosis for families affected by MFT.

Extracts from Radix Astragali and Radix Rehmanniae promote keratinocyte proliferation by regulating expression of growth factor receptors

Chinese herbal medicine has long been used as a treatment for wounds. However, the underlying cellular and molecular mechanisms remain largely unknown. In this study it was shown that the proliferation of keratinocytes, which is known to play an important role in wound healing as the major cell type in the epidermis, was promoted by three herbal extracts/natural compounds: NF3 (an extract from the mixture of Radix Astragali (RA) and Radix Rehmanniae (RR) in the ratio of 2:1), stachyose (an isolated compound from Radix Rehmanniae) and extract P2-2 (a sub-fraction from the extract of Radix Astragali). The effect of the herbal extracts/natural compounds on the growth of keratinocytes was not influenced by a high glucose level, a condition similar to diabetic patients who usually suffer from diabetic foot ulcers. Real time RT-PCR results showed that the expression of epidermal growth factor (EGF) receptor, but not transforming growth factor-β (TGF-β) receptor, was up-regulated by NF3. Moreover, treatments with the EGF receptor kinase inhibitor AG1478 and the MEK inhibitor U0126 resulted in the diminishment of the effect of the three herbal extracts/natural compounds on keratinocyte proliferation, indicating that EGF receptor might have a significant role in this action. This study has further elucidated the molecular mechanism under which herbal extracts/natural compounds exert their effects on the wound healing process.

Applied anatomy of the V-shaped fibular osteomyocutaneous flap in reconstruction of the hindfoot

To establish the applied anatomy of the V-shaped fibular osteomyocutaneous flap pedicled on the peroneal vessels, cadaver dissections were made in 60 lower limbs and 40 calcanei were examined to sum up the features of calcaneal biomechanics on the stability of the foot and the blood supply of the fibular osteomyocutaneous flap. There were four anastomoses and large communicating branches between the lower segment of the peroneal artery and the anterior and posterior tibial arteries. The flap was well supplied by a retrograde circulation through these anastomoses. A suitable length of pedicle was 20 cm. In the sagittal section of the calcaneus passing through the center of the articular surface for the cuboid bone, the arrangement of the trabeculae formed a triangular zone. The V-shaped flap corresponds nicely with the calculated lines of stress evoked by the weight of the body. The procedure may provide a new method for hindfoot reconstruction. This flap meets the criteria outlined for composite tissue reconstruction of defects of the extremities and biomechanics of the hindfoot, especially for calcaneal and cuboid defects.

[Studies on immobilization of suspension cells of peltate yam (Dioscorea zingiberensis C.H. Wright)]

The suspension cells of D. zingiberensis were immobilized with 3% sodium alginate, and then cultured in MS+2, 4-D1.0 + 6-BA 0.1 at 25 degrees C for a long period of time. The culture fluid free from cells was extracted and analyzed by TLC. The result showed that the immobilized cells could secrete the main component of D. zingiberensis--diosgenin, but not consecutively.

The sartorius myocutaneous island flap

The vascular supply to the distal part of sartorius m. was studied in 37 limbs by dissection under magnification and after black ink and latex injections. The muscle or myocutaneous island flap pedicled on the saphenous artery (SA) is supplied by a retrograde circulation through anastomoses of the SA with the perforating branches of the posterior tibial artery and the medial inferior genicular artery. Three different vascular patterns were defined. Retrograde injection also showed good perfusion of the SA. The flap is useful for covering around the knee, the proximal and middle thirds of the lower leg, and the end of the amputation stump. Raising of the flap has not resulted in any functional or cosmetic defect. Eighteen operations have so far been performed, six using the muscle island flap and twelve using the myocutaneous island flap, and all survived completely.