Evaluation of Vertical Level Differences Between Left and Right Vocal Folds Using Artificial Intelligence System in Excised Canine Larynx

OBJECTIVES

This study aimed to establish an artificial intelligence (AI) system to classify vertical level differences between vocal folds during vocalization and to evaluate the accuracy of the classification.

METHODS

We designed models with different depths between the right and left vocal folds using an excised canine larynx. Video files for the data set were obtained using a high-speed camera system and a color complementary metal oxide semiconductor camera with global shutter. The data sets were divided into training, validation, and testing. We used 20,000 images for building the model and 8000 images for testing. To perform deep learning multiclass classification and to estimate the vertical level difference, we introduced DenseNet121-ConvLSTM.

RESULTS

The model was trained several times using different numbers of epochs. We achieved the most optimal results at 100 epochs, and the batch size used during training was 16. The proposed DenseNet121-ConvLSTM model achieved classification accuracies of 99.5% and 88.0% for training and testing, respectively. After verification using an external data set, the overall accuracy, precision, recall, and f1-score were 90.8%, 91.6%, 90.9%, and 91.2%, respectively.

CONCLUSIONS

The newly developed AI system may be an easy and accurate method for classifying superior and inferior vertical level differences between vocal folds. Thus, this AI system can be applied and may help in the assessment of vertical level differences in patients with unilateral vocal fold paralysis.

Diagnosis of Early Glottic Cancer Using Laryngeal Image and Voice Based on Ensemble Learning of Convolutional Neural Network Classifiers

OBJECTIVES

The purpose of study is to improve the classification accuracy by comparing the results obtained by applying decision tree ensemble learning, which is one of the methods to increase the classification accuracy for a relatively small dataset, with the results obtained by the convolutional neural network (CNN) algorithm for the diagnosis of glottal cancer.

METHODS

Pusan National University Hospital (PNUH) dataset were used to establish classifiers and Pusan National University Yangsan Hospital (PNUYH) dataset were used to verify the classifier's performance in the generated model. For the diagnosis of glottic cancer, deep learning-based CNN models were established and classified using laryngeal image and voice data. Classification accuracy was obtained by performing decision tree ensemble learning using probability through CNN classification algorithm. In this process, the classification and regression tree (CART) method was used. Then, we compared the classification accuracy of decision tree ensemble learning with CNN individual classifiers by fusing the laryngeal image with the voice decision tree classifier.

RESULTS

We obtained classification accuracy of 81.03 % and 99.18 % in the established laryngeal image and voice classification models using PNUH training dataset, respectively. However, the classification accuracy of CNN classifiers decreased to 73.88 % in voice and 68.92 % in laryngeal image when using an external dataset of PNUYH. To solve this problem, decision tree ensemble learning of laryngeal image and voice was used, and the classification accuracy was improved by integrating data of laryngeal image and voice of the same person. The classification accuracy was 87.88 % and 89.06 % for the individualized laryngeal image and voice decision tree model respectively, and the fusion of the laryngeal image and voice decision tree results represented a classification accuracy of 95.31 %.

CONCLUSION

The results of our study suggest that decision tree ensemble learning aimed at training multiple classifiers is useful to obtain an increased classification accuracy despite a small dataset. Although a large data amount is essential for AI analysis, when an integrated approach is taken by combining various input data high diagnostic classification accuracy can be expected.

Wernekinck Commissure Syndrome with Holmes Tremor: A Report of Two Cases and Review of Literature

Wernekinck commissure syndrome is a rare midbrain infarction, it consists of several symptoms including bilateral cerebellar ataxia, ophthalmoplegia, and palatal tremor. Holmes tremor is a rare clinical syndrome characterized by a combination of resting, postural, and action tremors. We describe two cases of Wernekinck commissure syndrome with Holmes tremor. To the best of our knowledge, it has been rarely reported in the literature to date. Both of the cases were presented with acute onset of bilateral cerebellar ataxia, dysarthria, and Holmes tremor. In the treatment, one patient was given "clonazepam and benheisol," the other was received acupuncture therapy, both of them showed a marked improvement in ataxia and tremor.

High accuracy measurement of the ground-state hyperfine splitting in a 113Cd+ microwave clock: erratum

We present an erratum to our Letter [Opt. Lett.40, 4249 (2015)OPLEDP0146-959210.1364/OL.40.004249]. This erratum corrects the nuclear Lande factor gI in Eq. (2). After correcting the error, the final ground-state hyperfine splitting frequency of the ¹¹³Cd⁺ ion is determined to be 15199862855.0287(10) Hz.

Spatiotemporal distribution, source apportionment and combined pollution of antibiotics in natural waters adjacent to mariculture areas in the Laizhou Bay, Bohai Sea

The spatiotemporal distribution, source apportionment and combined pollution of 14 antibiotics in natural waters adjacent to mariculture farms of Laizhou Bay in the Bohai Sea were studied. The contribution proportion and quantity of each potential pollution source to antibiotics in natural water bodies were quantitatively described. The correlations between heavy metals and antibiotics and their underlying mechanisms in natural and aquaculture water environment were analyzed. Fourteen antibiotics were detected in natural water and sediment in the coastal area of Laizhou Bay. The maximum concentrations of sulfamethazine and trimethoprim in water reached tens or even hundreds of μg/L in winter. Trimethoprim was the main antibiotic in natural water bodies in winter and summer, and enrofloxacin was the principal antibiotic in sediments. Enrofloxacin, ciprofloxacin and oxytetracycline were detected in all underground water samples; thus, control of these antibiotics needs to be made a priority to mitigate groundwater contamination. PCA-MLR revealed that the potential sources of antibiotics in natural waters of Laizhou Bay include the mariculture wastewater (18.3%), the domestic sewage (63.3%) and the livestock wastewater (18.4%). Therefore, the antibiotic burden of Laizhou Bay was principally from the domestic sewage. In natural water, the concentration of Cu was positively correlated with antibiotics, which might be related to the common sources, the competitive adsorption in sediments and the easy complexation characteristic of Cu and antibiotics. Positive correlations among antibiotics and heavy metals were observed in mariculture sediments, while negative relationships were observed in natural sediments.

Antibiotics in marine aquaculture farms surrounding Laizhou Bay, Bohai Sea: Distribution characteristics considering various culture modes and organism species

This study mainly investigated the distribution characteristics and risk assessment of 14 antibiotics in typical marine aquaculture farms surrounding the Bohai Sea. The effects of various culture modes (outdoor pond culture, recirculating water culture, greenhouse pond culture, raft culture, cage culture and bottom sowing culture), and diverse cultured organism species such as fish (grouper, bass, pike and turbot), mollusk (oyster, scallop, conch and mussel) and sea cucumber on the distribution of antibiotics in different mariculture pond matrices (seawater, sediment/biofilm and organism) were studied. In addition, antibiotic pollution levels in various matrices (water, sediment, organism and feed) from different mariculture areas surrounding the Bohai Sea and the Yellow Sea were compared. The biofilm on the inner wall of greenhouse pond was more capable of accumulating antibiotics than the biofilm attached to the rope for raft culture and net for cage culture, and other culture sediments. The antibiotic concentration level in the culture matrices (water, sediment/biofilm and organism) was the highest under greenhouse pond culture mode, and that under the industrial recirculating water culture mode was the lowest. Antibiotic concentration in culture matrices of fish ponds was higher than that of sea cucumber ponds and mollusk ponds. The levels of antibiotics in water and sediment from marine aquaculture farms in Laizhou (Bohai Sea coast) were higher than those in Haiyang and Jimo (Yellow Sea coast). Enrofloxacin in turbot might cause considerable harm to human health, and the risk of antibiotics in other seafood could be ignored. Antibiotic ecological risks and resistance risks were generally low in water. Fluoroquinolones posed medium to high ecological risks in the natural receiving water around the mariculture farm. Trimethoprim and enrofloxacin showed relatively high antibiotic resistance risks in mariculture water and natural water, which might exert selective pressure on the bacterial community in the environment.

Evaluation of Voice and Vocal Fold Vibration after Thyroidectomy Using Two-Dimensional Scanning Digital Kymography and High-Speed Videolaryngoscopy

OBJECTIVE

Vocal dysfunction is one of the major factors that affect the health-related quality of life of patients after thyroidectomy. Conventionally, voice changes after thyroidectomy have been evaluated by videostroboscopy and acoustic analysis. Recently, two-dimensional scanning digital kymography (2D DKG) and high-speed videolaryngoscopy (HSV) have been developed and have shown usefulness in accurately evaluating vocal fold vibration. This study aimed to evaluate changes of vocal fold vibration and voice after thyroidectomy using 2D DKG and HSV.

MATERIALS AND METHODS

We evaluated the voice and vocal fold movement of 24 female patients who underwent thyroidectomy in a single tertiary hospital from December 2018 to October 2019. We obtained serial 2D DKG and HSV data one day before thyroidectomy, and 1 week and 1 month after surgery. We analyzed the peak glottal area of HSV, amplitude symmetry index, phase symmetry index, and open quotient using the 2D DKG data. The parameters were calculated at three levels of the vocal fold (line 1=anterior, line 2=middle, line 3=posterior). In the same period, we performed a voice analysis evaluating voice frequency, jitter, shimmer, and noise to harmonic ratio. We also assessed maximum phonation time and subjective voice changes with voice handicap index-10 questionnaires.

RESULTS

Highest frequency (F-high), frequency range (F-range), and fundamental frequency (F0) decreased at 1 week and 1 month after thyroidectomy compared with preoperative values (P = 0.003, 0.004, <0.001 and P = 0.002, 0.015, 0.001 at 1 week and 1 month, respectively). The open quotient of 2D DKG in lines 1 and 2 increased at 1 week after thyroidectomy (P = 0.011, 0.006) and recovered to preoperative levels at 1 month postoperatively (P = 0.189, 0.153). Other quantitative measures by 2D DKG and HSV did not show significant changes between the preoperative and postoperative periods. In a correlation analysis between vocal parameters from the acoustic analysis and the values obtained from 2D DKG and HSV, significant negative correlations were observed between peak glottal area and three factors (F-high, F-range, and F0) at 1 month after surgery (r = -0.589, -0.529, -0.708; P = 0.002, 0.008, <0.001, respectively). There were positive correlations between phase symmetry indexes in lines 1 and 2 and shimmer at 1 week after thyroidectomy (r = 0.489, 0.425; P = 0.015, 0.038, respectively). Phase symmetry index in line 3 showed a significant negative correlation with maximum phonation time at both 1 week and 1 month after surgery (r = -0.497, -0.439; P = 0.013, 0.032, respectively). However, there was no correlation between total score on the voice handicap index-10 questionnaires and quantitative measurements of vocal fold vibration.

CONCLUSION

2D DKG and HSV may provide important information on vocal fold vibratory patterns after thyroidectomy, and measurements made with them were correlated with maximal phonation time and acoustic parameters such as F-high, F-range, F0, shimmer.

Clinical epidemiology and outcome of HIV-associated talaromycosis in Guangdong, China, during 2011-2017

OBJECTIVES

Talaromycosis is an invasive mycosis endemic to Southeast Asia. This study aimed to investigate the epidemiology, clinical features and prognostic factors of HIV-associated talaromycosis in Guangdong, China.

METHODS

We retrospectively evaluated HIV patients hospitalized with histopathology- or culture-confirmed talaromycosis between 2011 and 2017. Factors associated with poor prognosis were identified using logistic regression.

RESULTS

Overall, 1079 patients with HIV-associated talaromycosis were evaluated. Both the number and prevalence of talaromycosis among HIV admissions increased from 125 and 15.7% in 2011 to 253 and 18.8% in 2017, respectively, reflecting the increase in HIV admissions. Annual admissions peaked during the rainy season between March and August. Common clinical manifestations included fever (85.6%), peripheral lymphadenopathy (72.3%), respiratory symptoms (60.8%), weight loss (49.8%), skin lesions (44.5%) and gastrointestinal symptoms (44.3%). Common laboratory abnormalities were hypoalbuminaemia (98.6%), anaemia (95.6%), elevated aspartate aminotransferase level (AST) (76.9%), elevated alkaline phosphatase level (55.8%) and thrombocytopenia (53.7%). The median CD4 count was 9 cells/μL. Talaromyces marneffei was isolated from blood and bone marrow cultures of 66.6% and 74.5% of patients, respectively. The rate increased to 86.6% when both cultures were performed concurrently. At discharge, 14% of patients showed worsening conditions or died. Leucocytosis, thrombocytopenia, elevated AST, total bilirubin, creatinine and azole monotherapy independently predicted poor prognosis.

CONCLUSIONS

The incidence of HIV-associated talaromycosis has increased in Guangdong with the high HIV burden in China. Skin lesions were seen in less than half of patients. Induction therapy with azole alone is associated with higher mortality. Findings from this study should help to improve treatment of the disease.

[Long-term oncological outcomes of laparoscopic versus abdominal surgery in stage Ⅰa1 （LVSI+）-Ⅰb1 cervical cancer patients with different tumor size: a big database in China]

Objective: To compare the long-term oncological outcomes between laparoscopic and abdominal surgery in stage Ⅰa1 （lymph-vascular space invasion-positive, LVSI⁺）- Ⅰb1 cervical cancer patients with different tumor sizes. Methods: Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China (1538 project database), patients with stage Ⅰa1 （LVSI⁺）-Ⅰb1 cervical cancer who treated by laparoscopic or abdominal surgery were included. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) between the two surgical approaches were compared under 1∶1 propensity score matching (PSM) in different tumor diameter stratification. Results: (1) A total of 4 891 patients with stage Ⅰa1 （LVSI⁺）-Ⅰb1 cervical cancer who underwent laparoscopy or laparotomy from January 1, 2009 to December 31, 2016 were included in the 1538 project database. Among them, 1 926 cases in the laparoscopic group and 2 965 cases in the abdominal group. There were no difference in 5-year OS and 5-year DFS between the two groups before matching. Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.367, 95%CI: 1.105-1.690, P=0.004). After 1∶1 PSM matching, 1 864 patients were included in each group, and there was no difference in 5-year OS between the two groups （94.1% vs 95.4%, P=0.151）. While, the inferior 5-year DFS was observed in the laparoscopic group (89.0% vs 92.3%, P=0.004). And the laparoscopic surgery was associated with lower 5-year DFS (HR=1.420, 95%CI: 1.109-1.818, P=0.006). (2) In stratification analysis of different tumor sizes, and there were no difference in 5-year OS and 5-year DFS between the laparoscopic group and abdominal group in tumor size ≤1 cm, >1-2 cm and >2-3 cm stratification (all P>0.05). Cox multivariate analysis showed that laparoscopic surgery were not related to 5-year OS and 5-year DFS (P>0.05). In the stratification of tumor size >3-4 cm, there was no difference in 5-year OS between the two groups (P>0.05). The 5-year DFS in the laparoscopic group was worse than that in the abdominal group (75.7% vs 85.8%, P=0.025). Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS (HR=1.705, 95%CI: 1.088-2.674, P=0.020). Conclusions: For patients with stage Ⅰa1 （LVSI⁺）-Ⅰb1 cervical cancer, laparoscopic surgery is associated with lower 5-year DFS, and the adverse effect of laparoscopic surgery on oncology prognosis is mainly reflected in patients with tumor size >3-4 cm. For patients with tumor sizes ≤1 cm, >1-2 cm and >2-3 cm, there are no difference in oncological prognosis between the two surgical approaches.

Distribution, combined pollution and risk assessment of antibiotics in typical marine aquaculture farms surrounding the Yellow Sea, North China

This study focused on the distribution, combined pollution, potential source and risk assessment of 17 antibiotics in an aquaculture ecosystem surrounding the Yellow sea, North China. Antibiotics were detected in various matrices (seawater, sediment/biofilm, organism and feed) in different aquaculture modes (greenhouse and outdoor aquaculture) during the wet and dry seasons in coastal areas of Shandong province. The innovation points of the study were as follows: (1) To the best of our knowledge, this study was one of the few to investigate the occurrence and distribution of antibiotics in mariculture environments along the Yellow Sea coast; (2) Biofilms, a focus of the study, might act as a sink for antibiotics in the aquaculture ecosystem; and (3) The correlation of heavy metals and antibiotic concentrations was proved, which could correspondingly be used as an indicator for antibiotic concentrations in the studied area. The levels of antibiotics in water were observed to be relatively low, at the ng/L level. Trimethoprim was the most prevalent antibiotic, and was detected in all water samples. Oxytetracycline was detected at high concentrations in biofilms (up to 1478.29 ng/g). Moreover, biofilms exhibited a higher antibiotic accumulation capacity compared to sediments. Concentrations of oxytetracycline and doxycycline were high in feed, while other antibiotics were almost undetected. Tetracycline was widely detected and the concentration of enrofloxacin was highest in organisms. Correlation analysis demonstrated that environmental parameters and other coexisting contaminants (e.g. heavy metals) significantly affected antibiotic concentrations. In addition, the concentration of Zn was significantly correlated with the total antibiotic concentration and was proportional to several antibiotics in water and sediment (biofilm) samples (p < 0.01). High Mn concentrations were closely related to total and individual (e.g. sulfadiazine, sulfamethazine and enrofloxacin) antibiotic levels, which may result in the combined contamination of the environment. Antibiotics in estuaries and groundwater generally originated from aquaculture wastewater and untreated/treated domestic sewage. Most of the detected antibiotics posed no risk to the environment. Ciprofloxacin and enrofloxacin found in water may present high ecological and resistance risks, while the two antibiotics observed to accumulate in fish may pose a considerable risk to human health through diet consumption. All antibiotics detected in seafood were lower than the respective maximum residue limits. This study can act as a reference for the government for the determination of antibiotic discharge standards in aquaculture wastewater and the establishment of a standardized antibiotic monitoring and management system.

Structural features associated with multiferroic behavior in the RX3(BO3)4 system

The magnetoelectric effect in the RX₃(BO₃)₄ system (R  =  Ho, Eu, Sm, Nd, Gd; X  =  Fe, Al) varies significantly with the cation R despite very similar structural arrangements. Our structural studies reveal a symmetry reducing tilting of the BO₃ planes and of the FeO₆ polyhedra in the systems exhibiting low magnetic field induced electric polarization. Neutron scattering measurements reveal a lack of magnetic ordering indicating the primary importance of the atomic structure in the multiferroic behavior of this system.

Schwannoma of the Tonsil

Between 25 and 48% of schwannomas have been reported to occur in the head and neck region; the acoustic nerve is involved in most cases. Schwannomas arising in the tonsil are extremely uncommon. We report a case of tonsillar schwannoma in a 23-year-old woman. We also review the literature on this rare entity.

Extratympanic Observation of Middle and Inner Ear Structures in Rodents Using Optical Coherence Tomography

Objectives

This study aimed to investigate whether optical coherence tomography (OCT) provides useful information about the microstructures of the middle and inner ear via extratympanic approach and thereby could be utilized as an alternative diagnostic technology in ear imaging.

Methods

Five rats and mice were included, and the swept-source OCT system was applied to confirm the extent of visibility of the middle and inner ear and measure the length or thickness of the microstructures in the ear. The cochlea was subsequently dissected following OCT and histologically evaluated to compare with the OCT images.

Results

The middle ear microstructures such as ossicles, stapedial artery and oval window through the tympanic membrane with the OCT could be confirmed in both rats and mice. It was also possible to obtain the inner ear images such as each compartment of the cochlea in the mice, but the bone covering bulla needed to be removed to visualize the inner ear structures in the rats which had thicker bulla. The bony thickness covering the cochlea could be measured, which showed no significant differences between OCT and histologic image at all turns of cochlea.

Conclusion

OCT has been shown a promising technology to assess real-time middle and inner ear microstructures noninvasively with a high-resolution in the animal model. Therefore, OCT could be utilized to provide additional diagnostic information about the diseases of the middle and inner ear.

Ground-to-satellite time and frequency synchronization link with active carrier phase compensation

In this paper, a synchronization link between one ground station and one geostationary satellite is established. The ground station receives retransmitted signals from the satellite, measures phase delay along the propagation route, and actively compensates back to its sending signals, realizing real-time phase fluctuation compensation. The transmitted signal contains two frequencies to eliminate common-mode phase noise. The difference between their carrier phase delays is measured. Different modes of carrier phase variation are separated and compensated, achieving a remaining time jitter of ±200 ps. Major sources of error are analyzed, and potential methods for improvement are discussed. The proposed ground-to-satellite link and active compensation method has potential applications in frequency standard dissemination to remote receivers (including ground stations or satellites). These potential applications justify further study of this system.

Clinical Application of Two-Dimensional Scanning Digital Kymography in Discrimination of Diplophonia

Purpose The purpose of this study was to investigate the characteristics of diplophonia using an auditory perception and multimodal simultaneous examination, which included sound waveform analysis, electroglottography (EGG), digital kymography (DKG), and 2-dimensional scanning digital kymography (2D DKG). Additionally, we compared the diagnostic accuracy of each method using a binary classifier in confusion matrix and convenience of discrimination, based on the time required for interpretation. Method One normophonic male, 12 patients with diplophonia, and 12 dysphonia patients without diplophonia were enrolled. A multimodal simultaneous evaluation was used to analyze the vibration pattern of diplophonia. Sensitivity, specificity, accuracy, area under the curve, and interpretation time were used to compare the various diagnostic methods. Discrimination was determined by 3 raters. Results There are 3 types of asymmetric vibratory patterns in diplophonia. The types are based on the oscillators vibrating at different frequencies: asymmetry of the left and right cords (6 subjects with unilateral palsy and 1 subject with vocal polyps), asymmetry of anterior and posterior cords (2 subjects with vocal polyps), and asymmetry of true and false cords (3 subjects with muscle tension dysphonia). All evaluation methods were useful as diagnostic tools, with all areas under the curve > .70. The diagnostic accuracy was highest with DKG (95.83%), followed by 2D DKG (83.33%), EGG (81.94%), auditory-perceptual evaluation (80.56%), and sound waveform (77.78%). The interpretation time was the shortest for auditory-perceptual evaluation (6.07 ± 1.34 s), followed by 2D DKG (10.04 ± 3.00 s), EGG (12.49 ± 2.76 s), and DKG (13.53 ± 2.60 s). Conclusions Auditory-perceptual judgment was the easiest and fastest method for experienced raters, but its diagnostic accuracy was lower than that of DKG or 2D DKG. The diagnostic accuracy of DKG was the highest, but 2D DKG allowed rapid interpretation and showed relatively high diagnostic accuracy, except in cases with space-occupying lesions. Supplemental Material https://doi.org/10.23641/asha.9911786.

Direct observation of magnetic contrast obtained by photoemission electron microscopy with deep ultra-violet laser excitation

Magnetic circular dichroism (MCD) and magnetic linear dichroism (MLD) have been investigated in a photoemission electron microscopy (PEEM) system excited by a deep ultra-violet (DUV) laser (with λ = 177.3 nm and hυ = 7.0 eV) for the first time. High resolution PEEM magnetic images (down to 43.2 nm) were directly obtained on a (001)-oriented magnetic FePt film surface with a circularly-polarized light under normal incidence. Furthermore, a stepped Cr seeding layer was applied to induce the formation of large-area epitaxial FePt films with (001) and (111) two orientations, where MLD with large asymmetry was observed in the transition area of two phases. It demonstrates that DUV laser can be a powerful source for high resolution magnetic imaging in the laboratory in absence of synchrotron facilities.

[Clinical investigation of ultrasound-guided percutaneous nephrolithotomy accessed by SVOF-principle and two-step puncture techniques]

Objective: To evaluate the safety and effectiveness of ultrasound-guided percutaneous nephrolithotomy (PCNL) accessed by SVOF-principle and two-step puncture techniques. Methods: A total of 838 cases with upper urinary stones underwent percutaneous nephrolithotomy successfully accessed by ultrasound-guided between June 2007 and December 2015 at Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Of all cases were divided in two groups: hydronephrosis calyces puncture group include 425 cases and SVOF-principle puncture group include 413 cases. The access establishment time, operation time, stone free rate (SFR), postoperative complications, and postoperative hospitalization time between the two groups we compared by t test or χ² test. Results: Statistically significant differences were observed between hydronephrosis calyces puncture group and SVOF-principle puncturegroup in the first access establishment time ((16.5±8.4) minutes vs. (11.2±5.9) minutes, t=3.931, P=0.013), one-stage SFR (74.3% vs. 85.7%, χ²=16.868, P=0.000), postoperative hospitalization time ((6.4±2.1) days vs. (4.8±1.8)days, t=4.574, P=0.000), transfusion rate (7.1% vs. 2.9%, χ²=8.027, P=0.006), and embolization rate (3.3% vs. 1.0%, χ²=5.390, P=0.020). There were no statistically significant differences in operation time, total SFR, postoperative fever and sever infection between these two groups (all P>0.05). In both two groups, no serious complications such as peripheral organ injury and death occurred. Conclusions: PCNL accessed guided by ultrasound with SVOF-principle and two-step puncture techniques has advantages of quick puncture location, high stone free rate, fewer complications and fast recovery. This technique is an effective and safe treatment option for upper urinary stones and deserved promotion and application in clinic.

Preoperative serum VEGF-C but not VEGF-A level is correlated with lateral neck metastasis in papillary thyroid carcinoma

BACKGROUND

This study aimed to investigate the relationships between serum vascular endothelial growth factor (VEGF)-A or VEGF-C levels and lymph node metastasis (LNM) status in patients with papillary thyroid carcinoma (PTC).

METHODS

The study enrolled 150 patients with pathologically proven PTC who underwent surgery: PTC without LNM, PTC with central neck metastasis, and PTC with lateral neck metastasis.

RESULTS

Preoperative serum VEGF-A levels were 300.12 ± 80.80 pg/mL overall and were not correlated with the presence of LNM. Preoperative serum VEGF-C levels were 132.41 ± 48.48 pg/mL overall and were significantly correlated with the presence of LNM. Serum VEGF-C levels were further increased in patients with lateral neck metastasis and positively correlated with the number of metastatic LNs (rho = 0.252, P = 0.002). Serum VEGF-C, but not VEGF-A, was identified as a significant predictor of lateral neck metastasis.

CONCLUSION

Serum VEGF-C might be a clinically relevant biomarker of lateral neck metastasis in patients with PTC.

Voice Recovery in a Patient with Inhaled Laryngeal Burns

INTRODUCTION

Laryngeal burns cause long-term voice disorders due to mucosal changes of the vocal folds. Inhalation injuries affect voice production and result in changes in the mucosal thickness and voice quality.

CASE REPORT

A 47-year-old woman was transferred to our department with laryngeal burns sustained during a house fire. On laryngoscopic examination, mucosal waves of both vocal folds were not visualized due to the injury caused by inhalation of high-temperature toxic smoke. Hence, voice analysis, laryngoscopic examinations, and high-speed videoendoscopy (HSV) were performed to evaluate vocal fold vibrations. An absence of mucosal waves and a breathy and strained voice with a severe grade were noted. We report that voice quality was recovered to close to the normal state through multiple treatments such as medication, voice therapy, and counseling.

CONCLUSION

This paper presents the unique case of a patient with laryngeal burns, in which vibrations of the vocal folds were observed using laryngoscopic examination and HSV. Voice samples before and after treatment were also analyzed. By observing the vibration pattern of the injured vocal fold, it is expected that appropriate diagnosis and treatment planning can be established in clinical practice.

[Effect of rapamycin and chloroquine on osteosarcoma]

Objective: To investigate the combination effect of anti-tumor agent rapamycin and anti-autophagy agent chloroquine on osteosarcoma. Methods: The inhibition effect of rapamycin or chloroquine and combination of both on human osteosarcoma cell line 143B measured with CCK-8 box.The combination index at different concentration was calculated, and the synergism effect range was analysed.The effect of combined therapy on cell cycle and apoptosis via flow cytometric was analyzted.Setting up murine subcutaneous xenograft model, the combination effect of antitumor in vivo observed. Results: Either of them, rapamycin or chloroquine had an antitumor effect in vitro (RAPA: IC50=1.5 nmol/L; CQ: IC50=400 μmol/L). When the inhibition rate 40%<fa<70%, the combination had synergism effect (CI<1) at different concentration.Moreover, when CQ at 200 μmol/L, the synergism effect was the most obvious, CI(min)=0.255.The flow cytometric analysis display rapamycin at 1.5 nmol/L had slightly promote apoptosis effect (16.1%±4.4%), and had distinct cell cycle arrest, mainly blocked at G0/G1 phase (73.5%±10.6%; control group: 46.7%±7.7%; P<0.001). While combined with chloroquine, the apoptosis cell obviously increased (21.3%±6.8%; P<0.05). The xenograft model also confirmed that rapamycin combined with chloroquine had a better antitumor effect than single usage (relative tumor proliferation rate; T/C%.CQ: 98.4%±11.6%; RAPA: 65.5%±7.5%; CQ+ RAPA: 42.0%±3.4%). Conclusion: Rapamycin combine with chloroquine can increase the antitumor efficacy, and the combination therapy maybe a potential therapeutic regimen.

Regulatory functions of trehalose-6-phosphate synthase in the chitin biosynthesis pathway in Tribolium castaneum (Coleoptera: Tenebrionidae) revealed by RNA interference

RNA interference (RNAi) is a very effective technique for studying gene function and may be an efficient method for controlling pests. Trehalose-6-phosphate synthase (TPS), which plays a key role in the synthesis of trehalose and insect development, was cloned in Tribolium castaneum (Herbst) (TcTPS) and the putative functions were studied using RNAi via the injection of double-stranded RNA (dsRNA) corresponding to conserved TPS and trehalose-6-phosphate phosphatase domains. Expression analyses show that TcTPS is expressed higher in the fat body, while quantitative real-time polymerase chain reaction results show that the expression of four trehalase isoforms was significantly suppressed by dsTPS injection. Additionally, the expression of six chitin synthesis-related genes, such as hexokinase 2 and glutamine-fructose-6-phosphate aminotransferase, was suppressed at 48 and 72 h post-dsTPS-1 and dsTPS-2 RNA injection, which were two dsTPS fragments that had been designed for two different locations in TcTPS open reading frame, and that trehalose content and trehalase 1 activity decreased significantly at 72 h post-dsRNA injection. Furthermore, T. castaneum injected with dsTPS-1 and dsTPS-2 RNA displayed significantly lower levels of chitin and could not complete the molting process from larvae to pupae, revealing abnormal molting phenotypes. These results demonstrate that silencing TPS gene leads to molting deformities and high mortality rates via regulation of gene expression in the chitin biosynthetic pathway, and may be a promising approach for pest control in the future.

Acoustic Characteristics in Epiglottic Cyst

OBJECTIVE

The purpose of this study was to analyze the acoustic characteristics associated with alternation deformation of the vocal tract due to large epiglottic cyst, and to confirm the relation between the anatomical change and resonant function of the vocal tract.

METHODS

Eight men with epiglottic cyst were enrolled in this study. The jitter, shimmer, noise-to-harmonic ratio, and first two formants were analyzed in vowels /a:/, /e:/, /i:/, /o:/, and /u:/. These values were analyzed before and after laryngeal microsurgery.

RESULTS

The F1 value of /a:/ was significantly raised after surgery. Significant differences of formant frequencies in other vowels, jitter, shimmer, and noise-to-harmonic ratio were not presented.

CONCLUSION

The results of this study could be used to analyze changes in the resonance of vocal tracts due to the epiglottic cysts.

Note: An atomic self-sustaining magnetic gradiometer with a 1/τ uncertainty property based on Larmor precession

We demonstrate an atomic magnetic gradiometer based on self-sustaining Larmor precession. By coherent optical pumping, we measure the phase of the Larmor precession directly and observe that the gradiometer shows a 1/τ improvement in magnetic field gradient uncertainty over time τ. Since the measurement gives frequency signals, the gradiometer can be easily implemented by mixing and filtering the different frequency signals from two adjacent magnetometers. A gradient sensitivity of 186 fT/Hz/cm^-1) is realized, which is close to the shot-noise limit. In a noisy environment, the gradiometer can still maintain its 1/τ behavior by suppressing 90% of the common-mode noise. This method should be widely applicable to the measurement of magnetic field gradients owing to its simplicity and outstanding performance.

[Clinical application of combined hepatic artery resection and reconstruction in surgical treatment for hilar cholangiocarcinoma]

Objective: To clarify whether the surgical treatment for hilar cholangiocarcinoma combined with artery reconstruction is optimistic to the patients with hilar cholangiocarcinoma with hepatic artery invasion. Methods: There were 384 patients who received treatment in the First Affiliated Hospital to Army Medical University from January 2008 to January 2016 analyzed retrospectively. There were 27 patients underwent palliative operation, 245 patients underwent radical operation, radical resection account for 63.8%. Patients were divided into four groups according to different operation method: routine radical resection group(n=174), portal vein reconstruction group (n=47), hepatic artery reconstruction group (n=24), palliative group(n=27). General information of patients who underwent radical operation treatment was analyzed by chi-square test and analysis of variance. The period of operation time, blood loss, the length of hospital stay and hospitalization expenses of the radical operation patients were analyzed by one-way ANOVA. Comparison among groups was analyzed by LSD-t test. Results: The follow-up ended up in June first, 2016. Each of patients followed for 6 to 60 months, the median follow-up period was 24 months. 1-, 3-, and 5-year survival rates were 81.3%, 44.9% and 13.5% of routine radical operation group, and were 83.0%, 44.7% and 15.1% of portal vein reconstruction group, and were 70.8%, 27.7% and 6.9% of hepatic artery reconstruction group, respectively. And 1-, 3-, and 5-year survival rates of hepatic artery reconstruction group was lower than routine radical group and portal vein reconstruction group significantly (P<0.05). However, the rate of postoperative complications of the hepatic artery reconstruction group and the routine radical operation group and the portal vein reconstruction group were 62.5%(15/24), 55.3%(96/174) and 51.5%(24/47), respectively. There was no significant difference among them (P>0.05). The data shows that the ratio of lymphatic metastasis in hepatic artery reconstruction group (70.8%) is much higher than them in routine radical operation group (20.1%) and portal vein reconstruction group (19.1%) significantly (P<0.05). The presented data also indicate that hepatic artery resection prolongs survival time comparing with patients undergoing palliative therapy for hilar cholangiocarcinoma. Cox regression analysis indicate that hepatic artery resection and reconstruction is a protective factor compare with palliative therapy (RR=0.38, 95%CI: 0.22-0.67). The significant reason for shorter survival time is a positive correlation between hepatic artery invasion and lymph node metastasis. Conclusion: Hepatic artery resection and reconstruction has beneficial impact on oncologic long-term outcome in patients with advanced stage hilar cholangiocarcinoma.

Prognostic implication of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with recurrent papillary thyroid cancer

BACKGROUND

Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (¹⁸ F-FDG PET/CT) has been widely accepted as an effective method for detecting recurrent papillary thyroid cancer (PTC) in patients with increased serum thyroglobulin (Tg) or Tg antibody (TgAb) levels and negative whole-body scintigraphy (WBS) results. The role of WBS as a diagnostic tool in detecting recurrence has relatively decreased recently. However, only a few studies have examined the usefulness of ¹⁸ F-FDG PET/CT for evaluating patients with recurrent PTC, regardless of the WBS results. The purpose of this analysis was to evaluate the diagnostic value and prognostic role of ¹⁸ F-FDG PET/CT for patients with recurrent PTC, irrespective of their WBS results.

METHODS

Sixty-six patients with locoregional recurrent PTC who underwent ¹⁸ F-FDG PET/CT and neck CT within 6 months before surgical treatment were included in this retrospective analysis. Imaging findings were compared with postoperative histopathologic results. The diagnostic values of ¹⁸ F-FDG PET/CT and neck CT were compared according to the serum Tg and TgAb levels and cervical levels. Each patient's status at the last follow-up was also reviewed, and survival probabilities were estimated using the Kaplan-Meier plot.

RESULTS

The sensitivity, specificity, and diagnostic accuracy of ¹⁸ F-FDG PET/CT for the entire patient group were 38.5%, 90.2%, and 58.3%, respectively. The corresponding neck CT values were 55.0%, 85.7%, and 66.7%, respectively. According to the serum Tg and TgAb levels, except for the specificity, most diagnostic values of ¹⁸ F-FDG PET/CT were worse than those of the neck CTs, with or without statistical significance. For the high maximum standardized uptake value (SUVmax) group (SUVmax >10) and the low SUVmax group, the median locoregional disease-free survival times were 33.3 months and 81.8 months, respectively (P < .001).

CONCLUSION

The diagnostic value of ¹⁸ F-FDG PET/CT for localizing recurrent lesions was worse than that of the neck CT, irrespective of the WBS results. However, patients with a higher SUVmax showed a significantly worse prognosis than did those with a lower SUVmax. Therefore, we suggest that, in patients with recurrent PTC, ¹⁸ F-FDG PET/CT should be considered for prognostication rather than diagnosis.

Differential Prognostic Value of Metabolic Heterogeneity of Primary Tumor and Metastatic Lymph Nodes in Patients with Pharyngeal Cancer

BACKGROUND/AIM

We aimed to explore the prognostic value of metabolic heterogeneity of ¹⁸F-FDG uptake in chemoradiotherapy-treated pharyngeal cancer patients.

PATIENTS AND METHODS

This study included 52 consecutive patients with pharyngeal cancer who underwent ¹⁸F-FDG PET/CT before definitive chemoradiotherapy. The heterogeneity factor (HF) was defined as the derivative (dV/dT) of a volume-threshold function for primary tumors and metastatic lymph nodes. The relationships between clinical parameters and HFs of primary tumors (pHF) and metastatic lymph nodes (nHF) were analyzed.

RESULTS

The pHF (range=∓1.367 - -0.027; median=-0.152) was significantly correlated with the maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis. Induction chemotherapy response was not correlated with HF, whereas response to radiotherapy was significantly better in patients with high pHF (low heterogeneity). Consistently, the 2-year locoregional recurrence-free survival was significantly better in patients with high pHF (82.9% for pHF>-0.152 vs. 30.5% for pHF<-0.152, log-rank p=0.009). The nHF (range=-1.067 - -0.039; median=-0.160) was not correlated with response to radiotherapy and locoregional recurrences.

CONCLUSION

pHF, but not nHF, was a significant predictor of response to radiotherapy and locoregional recurrence in pharyngeal cancer. Thus, HF use can prevent unnecessary treatment and surgical delays.

Determination of the Spin and Parity of the Z_{c}(3900)

The spin and parity of the Z_{c}(3900)^{±} state are determined to be J^{P}=1^{+} with a statistical significance larger than 7σ over other quantum numbers in a partial wave analysis of the process e^{+}e^{-}→π^{+}π^{-}J/ψ. We use a data sample of 1.92  fb^{-1} accumulated at sqrt[s]=4.23 and 4.26 GeV with the BESIII experiment. When parametrizing the Z_{c}(3900)^{±} with a Flatté-like formula, we determine its pole mass M_{pole}=(3881.2±4.2_{stat}±52.7_{syst})  MeV/c^{2} and pole width Γ_{pole}=(51.8±4.6_{stat}±36.0_{syst})  MeV. We also measure cross sections for the process e^{+}e^{-}→Z_{c}(3900)^{+}π^{-}+c.c.→J/ψπ^{+}π^{-} and determine an upper limit at the 90% confidence level for the process e^{+}e^{-}→Z_{c}(4020)^{+}π^{-}+c.c.→J/ψπ^{+}π^{-}.

Connexin36 localization to pinealocytes in the pineal gland of mouse and rat

Several cell types in the pineal gland are known to establish intercellular gap junctions, but the connexin constituents of those junctions have not been fully characterized. Specifically, the expression of connexin36 (Cx36) protein and mRNA has been examined in the pineal, but the identity of cells that produce Cx36 and that form Cx36-containing gap junctions has not been determined. We used immunofluorescence and freeze fracture replica immunogold labelling (FRIL) of Cx36 to investigate the cellular and subcellular localization of Cx36 in the pineal gland of adult mouse and rat. Immunofluorescence labelling of Cx36 was visualized exclusively as puncta or short immunopositive strands that were distributed throughout the pineal, and which were absent in pineal sections from Cx36 null mice. By double immunofluorescence labelling, Cx36 was localized to tryptophan hydroxylase-positive and 5-hydroxytryptamine-positive pinealocyte cell bodies and their large initial processes, including at intersections of those processes and at sites displaying a confluence of processes. Labelling for the cell junction marker zonula occludens-1 (ZO-1) either overlapped or was closely associated with labelling for Cx36. Pinealocytes thus form Cx36-containing gap junctions that also incorporate the scaffolding protein ZO-1. FRIL revealed labelling of Cx36 at ultrastructurally defined gap junctions between pinealocytes, most of which was at gap junctions having reticular, ribbon or string configurations. The results suggest that the endocrine functions of pinealocytes and their secretion of melatonin is supported by their intercellular communication via Cx36-containing gap junctions, which may now be tested by the use of Cx36 null mice.

Immunofluorescence reveals unusual patterns of labelling for connexin43 localized to calbindin-D28K-positive interstitial cells in the pineal gland

Gap junctions between cells in the pineal gland have been described ultrastructurally, but their connexin constituents have not been fully characterized. We used immunofluorescence in combination with markers of pineal cells to document the cellular localization of connexin43 (Cx43). Immunofluorescence labelling of Cx43 with several different antibodies was widely distributed throughout the pineal, whereas another connexin examined, connexin26, was not found in pineal but only in surrounding leptomeninges. Labelling apparently associated with plasma membranes was visualized either as fine Cx43-puncta (1-2 μm) or as unusually large pools of Cx43 ranging up to 4-7 μm in diameter or length. These puncta and pools were highly concentrated in perivascular spaces, where they were associated with numerous cells devoid of labelling for markers of pinealocytes (e.g. tryptophan hydroxylase and serotonin), and where they were minimally associated with blood vessels and lacked association with resident macrophages. Astrocytes labelled for glial fibrillary acidic protein were largely restricted to the anterior pole of the pineal gland, where they displayed only fine and sparse Cx43-puncta along their processes. Labelling for Cx43 was localized largely though not exclusively to the somata and long processes of a subpopulation of perivascular interstitial cells that were immunopositive for calbindin-D28K. These cells were often located among dense bundles or termination areas of sympathetic fibres labelled for tyrosine hydroxylase or serotonin. The results indicate that interstitial cells form abundant gap junctions composed of Cx43, and suggest that gap junction-mediated intracellular communication by these cells supports the activities of pinealocytes.

Effects of mutant TDP-43 on the Nrf2/ARE pathway and protein expression of MafK and JDP2 in NSC-34 cells

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects motor neurons and lacks an effective treatment. The disease pathogenesis has not been clarified at present. Pathological transactive response DNA-binding protein 43 (TDP-43) plays an important role in the pathogenesis of ALS. Nuclear translocation of nuclear factor erythroid 2 (NF-E2)-related factor 2 (Nrf2) is found in a mutant TDP-43 transgenic cell model, but its downstream antioxidant enzyme expression is decreased. To elucidate the specific mechanism of Nrf2/ARE (antioxidant responsive element) signaling dysfunction, we constructed an ALS cell model with human mutant TDP-43 using the NSC-34 cell line to evaluate the impact of the TDP-43 mutation on the Nrf2/ARE pathway. We found the nuclear translocation of Nrf2, but the expression of total Nrf2, cytoplasmic Nrf2, and downstream phase II detoxifying enzyme (NQO1) was decreased in NSC-34 cells transfected with the TDP-43-M337V plasmid. Besides, TDP-43-M337V plasmid-transfected NSC-34 cells were rounded with reduced neurites, shortened axons, increased levels of intracellular lipid peroxidation products, and decreased viability, which suggests that the TDP-43-M337V plasmid weakened the antioxidant capacity of NSC-34 cells and increased their susceptibility to oxidative damage. We further showed that expression of the MafK protein and the Jun dimerization protein 2 (JDP2) was reduced in TDP-43-M337V plasmid-transfected NSC-34 cells, which might cause accumulation of Nrf2 in nuclei but a decrease in NQO1 expression. Taken together, our results confirmed that TDP-43-M337V impaired the Nrf2/ARE pathway by reducing the expression of MafK and JDP2 proteins, and provided information for further research on the molecular mechanisms of TDP-43-M337V in ALS.

Some posterior branches of extralaryngeal recurrent laryngeal nerves have motor fibers

OBJECTIVES/HYPOTHESIS

Anatomical variations of the recurrent laryngeal nerve (RLN), such as extralaryngeal branching, are a well-known risk factor for RLN injury during thyroid surgery. This study aimed to analyze the surgical anatomy and to investigate the existence of posterior branch motor fibers of extralaryngeal RLNs.

STUDY DESIGN

Prospective consecutive observational study.

METHODS

This was a prospective cohort study of 366 patients between January 2014 and February 2016. Operative data included the type of operation, incidence of nerve bifurcation, the distances among anatomical landmarks. The motor fibers were evaluated using neurostimulation with laryngeal palpation.

RESULTS

A total of 667 RLNs at risk were analyzed in this study, and of these 103 (14.5%) nerves were bifurcated or trifurcated before the laryngeal entry point (LEP). More extralaryngeal branched RLNs were observed on the right side than on the left (17.5% vs. 13.3%, P = .294). The mean distance of the LEP point of division was longer on the left side (16.2 ± 6.7 mm) than on the right (14.7 ± 5.9 mm, P = .132). All branched RLNs had a palpable laryngeal twitch when stimulating anterior branches. When stimulating posterior branches, 28.2%(29/103) of branched RLNs showed palpable laryngeal twitch. Overall incidence of posterior motor branch in total RLNs was 4.3% (29/667).

CONCLUSIONS

The motor fibers of the RLN are all located in the anterior branch, whereas some posterior branches have motor function. Identification of all of the branches of the RLN may be mandatory to decrease the risk of postoperative nerve injury.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:2678-2685, 2017.

[Clinical effects of different methods of the proximal fusion for long segmental lumbar vertebrae fusion in treatment of degenerative lumbar scoliosis]

Objective: To explored the clinical effects of different methods of the proximal fusion for long segmental lumbar vertebrae fusion in treatment of degenerative lumbar scoliosis(DLS). Methods: From January 2007 to March 2014 fifty-five cases of DLS treated by the posterior proximal fusion of long segmental lumbar vertebrae fusion were analyzed in Department of Orthopaedics, Shanghai general Hospital of Nanjing Medical University (35)HuaiAn The First Hospital Affiliated to Nanjing Medical University(20). According to various upper instrumented vertebra(UIV) the patients were divided into Group A(upper horizontal vertebra, UHV, n=17), Group B (upper natural vertebra, UNV n=18 ), and Group C(upper end vertebra, UEV, n=20). The VAS, ODI, spinal balance parameters and postoperative complications in each group were assessed. Results: Except for 1 case death of serious lung infection in early postoperative, 54 cases were received 2-4 years follow-up. No statistical differences in improvements and fusion rates were found among 3 groups (P>0.05). The improvements of the coronal Cobb's angle in the A group were significantly more than the C group (75.8%±12.8%, 69.6%±11.8%, 63.4%±15.3%, P<0.05). The incidences of early postoperative complications in A group were the highest, next in B group, and lowest C group (52.9%, 22.0%, 15.0%, P<0.05). The incidences of proximal ASD in the C group were significantly more than the A group (12.5%, 22.2%, 50.0%, P=0.045). Conclusion: UHV, UNV and UEV had similar clinical outcomes for treatment of degenerative lumbar scoliosis in short term. Correction of the coronal deformity of UHV was superior to UEV. UEV was beneficial to reduce early complications, but more likely to happen proximal adjacent segment degeneration in the long run.

A stabilized laser continuously tunable over a range of 1.5 GHz

We demonstrate a method to stabilize laser frequency which can be continuously tuned over a range of 1.5 GHz. It is based on saturated absorption spectroscopy (SAS) generated by an external-cavity diode laser (ECDL) which is modulated by an electro-optic amplitude modulator (EO-AM). The spectra consist of not only the original peaks corresponding to resonant and crossover lines of ¹³³Cs D₂ line, but also signals introduced by sidebands from an EO-AM. Thus, the laser frequency can be locked to any point within the range of the spectra. Furthermore, the tuning range of the laser can be doubled compared to the coverage of common SAS by fixing the frequency of the pumping laser. The best stability of the locked laser induced by the EO-AM is 1.27 × 10^-11 over an integrating time of 125 s. This method may be applied for more precise and flexible manipulation of atoms and molecules.

Observation of an Anomalous Line Shape of the η^{'}π^{+}π^{-} Mass Spectrum near the pp[over ¯] Mass Threshold in J/ψ→γη^{'}π^{+}π^{-}

Using 1.09×10^{9} J/ψ events collected by the BESIII experiment in 2012, we study the J/ψ→γη^{'}π^{+}π^{-} process and observe a significant abrupt change in the slope of the η^{'}π^{+}π^{-} invariant mass distribution at the proton-antiproton (pp[over ¯]) mass threshold. We use two models to characterize the η^{'}π^{+}π^{-} line shape around 1.85  GeV/c^{2}: one that explicitly incorporates the opening of a decay threshold in the mass spectrum (Flatté formula), and another that is the coherent sum of two resonant amplitudes. Both fits show almost equally good agreement with data, and suggest the existence of either a broad state around 1.85  GeV/c^{2} with strong couplings to the pp[over ¯] final states or a narrow state just below the pp[over ¯] mass threshold. Although we cannot distinguish between the fits, either one supports the existence of a pp[over ¯] moleculelike state or bound state with greater than 7σ significance.

Role of Fibroblast Growth Factor-5 on the Proliferation of Human Tonsil-Derived Mesenchymal Stem Cells

Human mesenchymal stem cells (MSCs) are a promising tool for therapeutic applications in cell-based therapy and regenerative medicine, and MSCs from the human palatine tonsils have recently been used as a new tissue source. However, the understanding of the proliferation and differentiation capacity of tonsil-derived MSCs (T-MSCs) is limited. In this study, we compared the proliferative potential of T-MSCs with those of bone marrow MSCs (BM-MSCs) and adipose tissue-derived MSCs (A-MSCs). Additionally, we investigated the underlying mechanism of T-MSC function. We showed that T-MSCs proliferated faster than A-MSCs and BM-MSCs in methylthiazolyl diphenyl-tetrazolium (MTT) assays, cell count assays, and cell cycle distribution analyses. DNA microarray and real-time PCR analyses revealed that the expression of fibroblast growth factor-5 (FGF5) was significantly elevated in T-MSCs compared with those in A-MSCs and BM-MSCs. Cell growth curves showed a difference in cell growth between untreated cells and siFGF5-treated T-MSCs. The administration of recombinant human FGF5 (rhFGF5) to the cells transfected with siFGF5 led to a significant increase in the proliferation rates. The administration of rhFGF5 to T-MSCs led to an increase in the levels of phosphorylated ERK1/2. However, treatment with siFGF5 resulted in an overall decrease in the level of phosphorylated ERK1/2. The osteogenic differentiation of T-MSCs was reduced following siFGF5 transfection, and it recovered to near-normal levels when rhFGF5 was added. These findings indicate that T-MSCs show significantly higher proliferative potential compared with those of BM-MSCs and A-MSCs. FGF5 facilitates cell proliferation through ERK1/2 activation, and it influences the osteogenic differentiation of T-MSCs.

[Mechanism of RhoA/Rho-kinase signal pathway-induced erectile dysfunction in hyperlipidemic rats]

OBJECTIVE

To investigate the expression of RhoA/Rho-kinase (ROCK) in penile corpus cavernosum smooth muscles in rats of hyperlipidemia-induced erectile dysfunction and its molecular mechanism.

METHODS

Forty male Sprague-Dawley rats were randomly divided into control and experimental groups using a random number table. Rats in the control group (n=20) were fed with regular diet for 24 weeks and those in the experimental group (n=20) with high-fat diet for the same period of time. The serum lipids profile was detected before and after the diet treatment. The ratio of intracavernosal pressure (ΔICP)/mean arterial pressure (MAP) was measured, and Western blot was used to detect the expression of total RhoA, ROCK1, and ROCK2 in penile corpus cavernosum smooth muscles, and RhoA protein in cell membrane and cytoplasm of smooth muscles after 24 weeks.

RESULTS

After 24 weeks, the levels of cholesterol, triglyceride, and low-density lipoprotein were significantly higher in the experimental group compared with those before diet treatment and the control group (all P<0.01). ΔICP/MAP in the experimental group was greatly lower than in the control group (P<0.01). The protein expression of ROCK2 in penile corpus cavernosum smooth muscles was higher in the experimental group than in the control group (0.77±0.10 vs 0.27±0.08, P<0.01) after 24 weeks, while no statistically significant differences were observed in total RhoA and ROCK 1 protein expression between the two groups (both P>0.05). RhoA expression in cytoplasm was lower in the experimental than in the control group (1.66±0.09 vs 1.79±0.15, P<0.05). The ratio of RhoA expression in menmbrane/cytoplasm was higher in the experimental than in the control group (0.33±0.09 vs 0.26±0.07, P<0.05).

CONCLUSION

Up-regulation of RhoA/ROCK may be involved in hyperlipidemia-induced erectile dysfunction in rats.

Factors Associated with Postoperative Delirium after Major Head and Neck Surgery

Postoperative delirium (POD) is an acute change in cognitive status characterized by fluctuating consciousness and is associated with high incidences of morbidity, high complication rates, and long hospitalizations. This study was performed to determine the incidence of POD and the perioperative risk factors in order to predict which patients have an increased risk and thus to prevent POD after major head and neck surgery. The authors retrospectively evaluated 341 patients who underwent laryngectomy or the Commando (combined operation of mouth, mandible, and neck dissection) procedure at Pusan National University Hospital from January 1986 through July 2001. Postoperative delirium developed in 13.8% of the patients who underwent laryngectomy (42 of 304) and 13.5% of the patients who underwent the Commando procedure (5 of 37). A multivariate analysis showed that older age, hypertension, low postoperative 02 saturation, and decreased postoperative hemoglobin levels were risk factors for POD (p < .05). Postoperative delirium is preventable, and its incidence can be decreased by predicting these risk factors during the preoperative and postoperative periods.

Observation of h_{c} Radiative Decay h_{c}→γη^{'} and Evidence for h_{c}→γη

A search for radiative decays of the P-wave spin singlet charmonium resonance h_{c} is performed based on 4.48×10^{8} ψ^{'} events collected with the BESIII detector operating at the BEPCII storage ring. Events of the reaction channels h_{c}→γη^{'} and γη are observed with a statistical significance of 8.4σ and 4.0σ, respectively, for the first time. The branching fractions of h_{c}→γη^{'} and h_{c}→γη are measured to be B(h_{c}→γη^{'})=(1.52±0.27±0.29)×10^{-3} and B(h_{c}→γη)=(4.7±1.5±1.4)×10^{-4}, respectively, where the first errors are statistical and the second are systematic uncertainties.

[Intervention of systolic pressure and left ventricular hypertrophy in rats under cold stress]

OBJECTIVE

To investigate the effects of different drugs on systolic blood pressure (SBP) and left ventricular hypertrophy (LVH) in spontaneously hypertensive rats under cold stress.

METHODS

A total of 40 male spontaneously hypertensive rats aged 10 weeks (160~200 g) were given adaptive feeding for 7 days at a temperature of 20±1°C and then randomly divided into control group, cold stress group, metoprolol group, amlodipine group, and benazepril group, with 8 rats in each group. SBP, body weight, and heart rate were measured once a week. After the rats were sacrificed by exsanguination, left ventricular weight (LVW) was measured, and left ventricular weight index (LVWI; mg/g) was calculated. Radioimmunoassay was used to measure the concentrations of endothelin-1 (ET-1) and angiotensin-II (Ang-II) in plasma and myocardium, and the chemical method was used to measure the concentrations of nitric oxide (NO) in plasma and myocardium. RT-PCR was used to measure the mRNA expression of endothelin-A receptor.

RESULTS

Compared with the cold stress group, all medication groups showed significant reductions in SBP since week 5 (P<0.05). The cold stress group showed a significant increase in LVWI compared with the control group (3.38±0.27 mg/g vs 2.89±0.19 mg/g, P<0.05). The amlodipine group showed a significant reduction in LVWI compared with the cold stress group (2.98±0.28 mg/g vs 3.38±0.27 mg/g, P<0.05). The cold stress group showed a significant reduction in plasma NO concentration compared with the control group (104.9±19.5 μmol/L vs 129.3±17.8 μmol/L, P<0.05) ; compared with the cold stress group, all the medication groups showed significant increases in blood NO concentration (P<0.05). The cold stress group showed a significant increase in myocardial ET-1 concentration compared with the control group (6.3±1.5 pg/100 mg vs 4.5±1.9 pg/100 mg, P<0.05) ; compared with the cold stress group, the amlodipine group showed a significant reduction in myocardial ET-1 concentration (4.4±1.0 pg/100 mg vs 6.3±1.5 pg/100 mg, P<0.05). The cold stress group had significantly higher mRNA expression of endothelin-A receptor than the control group (0.86±0.23 vs 0.45±0.16, P<0.01) ; compared with the cold stress group, the amlodipine group showed a significant reduction in the mRNA expression of endothelin-A receptor (0.41±0.14 vs 0.86±0.23, P<0.01).

CONCLUSION

Amlodipine can reduce the increase in SBP and inhibit LVH in spontaneously hypertensive rats under cold stress.

Histopathologic Evaluations of the Lingual Artery in Healthy Tongue of Adult Cadaver

Objectives.

To clarify the anatomical distribution of the lingual artery in normal adult subjects through histopathologic evaluations.

Methods.

Eighteen healthy cadaveric tongues were used to produce 8 paraffin-embedded tissue sections each. Length from midline raphe, depth from dorsum of tongue and the whole transverse length tongue were measured. The lateral distance, depth, and proportion of lateral distance of deep lingual artery were determined from tip to base of tongue gradually. Lateral distance is length from median raphe to the center of deep lingual artery lumen. Depth is vertical distance from dorsal surface of tongue to the center of deep lingual artery. Proportion of lateral distance is obtained by dividing lateral distance with transverse length from median raphe to lateral border of tongue. The degree of symmetry between right and left sides and the difference between selected spots were evaluated.

Results.

Right and left sides of the lingual artery were symmetric. The lingual artery was lateralized as it run posterior. The lingual artery runs gradually deeper from the surface as it goes near the base of tongue. Both length and depth of the lingual artery gradually increased between 0%–75% of the mobile tongue, but 75%–100% zone of the lingual artery showed no significant difference. There was no anastomosis between right and left side of the lingual arteries. The lingual artery was located within 50% of the transverse length of tongue from median raphe.

Conclusion.

The present study reveals 3-dimensional information on the anatomical distributions of the lingual artery in normal adult subjects. These findings gives us beneficial information about the handling of the lingual artery during oral and base of tongue-related surgery.

Intracordal Injection of Autologous Auricular Cartilage in the Paralyzed Canine Vocal Fold

OBJECTIVE: Vocal fold augmentation by injectable material under direct visual control is an easy and simple operation. However, when autologous fat or bovine collagen is used, resorption creates a problem. And autologous fascia is debating about absorption now days. This study is to evaluate the histology of minced and injected autologous auricular cartilage and fat graft in the augmentation of unilateral vocal fold paralysis using a canine model.

METHOD: Nine dogs were operated. At first, a piece of auricular cartilage was harvested from ear and minced into tiny chips with a scalpel, and a piece of fat tissue was harvested from inguinal area and minced into tiny chips with a scalpel. Cutting off a section of the recurrent nerve paralyzed the right vocal fold. The minced cartilage and fat-paste (0.2 mL) was injected using a pressure syringe into the paralyzed thyroarytenoid muscle under direct laryngoscopy. Two animals were sacrificed at 3 days, three at 3 weeks, two at 3 months, one at 6 months, and one at 12 months. Each dog underwent laryngectomy and serial coronal sections of paraffin blocks from the posterior part of the vocal fold were made.

RESULTS: There was no significant complication perioperatively and during follow-up. There was acute inflammatory findings in the graft at 3 days and 3 weeks. The injected cartilage remained in the larynx until 12 months.

CONCLUSION: The autologous auricular cartilage graft is well tolerated and may be very effective material for volumetric augmentation on paralyzed vocal cord.

Histologic Evaluation of Intracordal Autologous Cartilage Injection in the Paralyzed Canine Vocal Fold at Two and Three Years

OBJECTIVE: Intracordal injection for vocal fold augmentation is easy and simple and does not require a cervical skin incision. We reported previously on the 1-year results of injected autologous auricular cartilage for volumetric augmentation in paralyzed canine vocal cord. This study evaluates the long-term histomorphologic results of injected autologous auricular cartilage for the augmentation of the paralyzed canine vocal fold at 2 and 3 years.

STUDY DESIGN AND SETTING: A prospective trial of autologous cartilage augmentation of vocal cord in animal model. Five dogs were operated on. A piece of auricular cartilage was harvested from the ear and minced into tiny chips with a scalpel. Fat was harvested from inguinal area and minced with a scalpel. The minced cartilage and fat-paste (0.2 ml) was injected using a pressure syringe into the paralyzed thyroarytenoid muscle using direct laryngoscopy. Three animals were sacrificed at 2 years, two at 3 years. Each subject underwent laryngectomy and serial coronal sections of paraffin blocks from the posterior vocal fold were made.

RESULTS: There was no significant complications perioperatively or postoperatively. The injected cartilage that seemed to have lost viability existed in the vocalis muscles until 36 months. Fibrotic change was exhibited in the surrounding injected cartilage. There were no differences between 2 and 3 years in histomorphologic results of the injected cartilage.

CONCLUSION: The autologous auricular cartilage graft is well tolerated and may be a very effective material for long-term volumetric augmentation in the paralyzed vocal cord.