[Clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers]

Objective: To explore the clinical efficacy of posterior femoral muscle flaps combined with posterior femoral cutaneous nerve nutrient vessel flap and closed lavage in the treatment of stage Ⅳ ischial tuberosity pressure ulcers. Methods: This study was a retrospective observational study. From March 2021 to March 2022, 15 patients with stage Ⅳ ischial tuberosity pressure ulcers who met the inclusion criteria were admitted to Dezhou Dongcheng Hospital, including 11 males and 4 females, aged 31 to 72 years. The pressure ulcer wound size ranged from 6.0 cm×4.5 cm to 10.0 cm×6.0 cm, with cavity diameters of 10-14 cm. Five cases were complicated with ischial tuberosity bone infection. After clearing the lesion, the biceps femoris long head muscle flap with an area of 10.0 cm×4.0 cm-18.0 cm×5.0 cm and the semitendinosus muscle flap with an area of 8.0 cm×4.0 cm-15.0 cm×5.0 cm combined with the posterior femoral cutaneous nerve nutrient vessel flap with an area of 6.5 cm×5.5 cm-10.5 cm×6.5 cm was transplanted to repair the pressure ulcer wound. The flap donor area was directly sutured, and the closed lavage with tubes inserted into the wound cavity was performed for 2-3 weeks. The postoperative survival of the muscle flaps and skin flaps, the wound healing of the donor and recipient areas were observed. The recurrence of pressure ulcers, the appearance and texture of flaps, and scar conditions of the donor and recipient areas were followed up. Results: All the muscle flaps and skin flaps in the 15 patients successfully survived after surgery. Two patients experienced incisional dehiscence at one week after surgery due to improper turning over, during which the incision in the recipient area was pressed on, and the wounds healed after dressing changes of 3 to 4 weeks; the wounds in the donor and recipient areas healed well in the other patients. All patients received follow-up after surgery. During the follow-up period of 6 to 12 months, none of the patients experienced pressure ulcer recurrence, and the texture, color, and thickness of the skin flaps closely resembled those of the surrounding skin at the recipient site, with only linear scar left in the donor and recipient areas. Conclusions: When using the posterior femoral muscle flaps combined with the posterior femoral cutaneous nerve nutrient vessel flap and closed lavage to treat stage Ⅳ ischial tuberosity pressure ulcers, the tissue flap can be used to fully fill in the dead space of the pressure ulcers. After treatment, the wound heals well, the appearance of the donor and recipient areas is better, and the pressure ulcers are less prone to reoccur.

[Research on the framework of biosafety standards for pathogenic microbial laboratories]

Developing and implementing biosafety standards for pathogenic microbiology laboratories is essential to achieving scientific, efficient, and standardized management and operation. This article analyzes the current standardization construction in biosafety in pathogenic microbiology laboratories domestically and internationally. It proposes a framework for the biosafety standard system of pathogenic microbiology laboratories, which mainly includes four parts: basic standards, management standards, technical standards, and industry applications. It provides a reference for the standardization work of pathogenic microbiology laboratories and helps to standardize the biosafety industry in China.

[Clinical application of retrosigmoid approach for BONEBRIDGE implantation after auricle reconstruction using expanded postauricular flap]

Objective: To explore the safety and reliability of retrosigmoid approach BONEBRIDGE implantation in patients with auricle reconstruction using skin expansion flap. Methods: A retrospective analysis was conducted on 43 congenital aural atresia cases (43 ears) who underwent BONEBRIDGE implantation from September 2019 to January 2023 in Beijing Tongren Hospital. 30 males and 13 females were included in this work. The implantation age was 9-36 years old (median age=10 y/o). All cases underwent auricle reconstruction surgery using the posterior ear flap expansion method, with 36 cases using the single expanded postauricular flap method and 7 cases using two-flap method. BONEBRIDGE implant surgery was performed during the third stage of auricle reconstruction or after all stages. The hearing improvements were evaluated by comparing the changes in pure tone hearing threshold and speech recognition rate of patients before and after BONEBRIDGE implantation. Routine follow-up was conducted to observe the hearing results and complications. SPSS 14.0 software was applied for data statistical analysis. Results: All 43 patients healed well and had no surgical complications when discharge. The average bone conduction hearing threshold after surgery was (8.2±6.6) dBHL, and there was no statistically significant difference compared to the preoperative [(8.1±5.7) dBHL] (P=0.95). After surgery, the threshold of hearing assistance with power on was significantly lower than that without hearing assistance [(32.8±4.6) dBHL vs (60.5±5.5) dBHL], and the difference was statistically significant (P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased to 72%, 84%, and 98% respectively. The differences were statistically significant (P<0.001). The speech recognition rate of monosyllabic words, disyllabic words, and short sentences in noise environment was significantly increased by 70%, 80%, and 92% respectively (P<0.001). After a follow-up of 4 to 47 months (median=24 months), the hearing results were stable and the aesthetic outcomes were satisfying. One patient had delayed hematoma around coil of the implant. After aspiration and compressed dressing for one week, hematoma was not recurrent. Conclusion: For patients after auricle reconstruction using expanded postauricular flap, the preference of retrosigmoid approach is a good choice in terms of safety and reliability of operation, as well as aesthetic appearance.

[Preparation and characterization of a recombinant poly-epitopic vaccine EgG1Y162-2 (4) against cystic echinococcosis based on the linker GSGGSG]

OBJECTIVE

To perform prokaryotic expression and preliminary characterization of the recombinant poly-epitope vaccine EgG1Y162-2 (4) against cystic echinococcosis.

METHODS

The recombinant poly-epitope vaccine EgG1Y162-2 (4) against Echinococcus granulosus based on the linker GSGGSG was subjected to structural three-dimensional (3D) modeling using immunoinformatics to analyze the structural changes and evaluate the antigenicity of the vaccine. The pET30a-EgG1Y162-2 (4) recombinant plasmid was generated using double digestion with EcoR I and Sal I, and then transformed into competent cells. Following protein induction with isopropyl-β-D-thiogalactoside (IPTG), the prokaryotic expression proteins were characterized using Western blotting, and the antigenicity of the recombinant protein was analyzed using sera from cystic echinococcosis patients and health volunteers.

RESULTS

The four EgG1Y162-2 proteins coupled by the 3D structure of the recombinant vaccine EgG1Y162-2 (4) presented independent and effective expression and good antigenicity. The highest protein expression was detected in the supernatant following induction of the recombinant plasmid pET30a-EgG1Y162-2 (4) by 0.2 mmol/L IPTG at 37 °C for 4 h, and a pure protein component was seen following elution with 60 mmol/L imidazole. Western blotting analysis of the recombinant multiepitope protein HIS-EgG1Y162-2 (4) showed a band at approximately 39 kDa, and this band was recognized by sera from cystic echinococcosis patients.

CONCLUSIONS

A recombinant poly-epitope vaccine EgG1Y162-2 (4) against cystic echinococcosis has been successfully constructed, which provides a preliminary basis for researches on recombinant multi-epitope vaccine against cystic echinococcosis.

[Evaluation of adhesive bone conduction hearing aid in pediatric patients with unilateral congenital aural atresia]

Objective: To evaluate the auditory efficacy and subjective satisfaction of adhesive bone conduction hearing aid in children with unilateral congenital aural atresia (UCAA). Methods: Ten subjects (5 males and 5 females) diagnosed with UCAA with an average age of 8.3 years old (ranged from 5 to 15) were included in Beijing Tongren Hospital, Capital Medical University from January to August 2019. The free sound field hearing threshold, word recognition score in quiet, speech reception threshold in noise and sound localization ability (results were measured by RMS error) tests were performed in unaided and aided situation, respectively. Subjective satisfaction questionnaires were also distributed to subjects. Paired t test and Wilcoxon signed rank test were used as statistical analysis methods. Results: The average hearing threshold in aided condition was improved by (21.9±4.4) dB (t=15.8，P<0.05). Speech recognition abilities were generally improved both under quiet and noise (P<0.05);however, when the binaural summation, squelch and head shadow effects were analyzed respectively, the binaural squelch effect was not statistically improved (P>0.05), while the other effects were improved in aided condition (P<0.05). In sound localization test, there was no significant difference of the RMS error value between the unaided and aided situation (P>0.05). The subjects got high satisfaction rates in three subjective questionnaires. Conclusion: The adhesive bone conduction hearing aid can provide significant audiological benefit for children with UCAA as well as raising the quality of their life.

[Effect of γ-secretase inhibitor on middle ear ultrastructures in ovalbumin-mediated otitis media with effusion in rats]

Objective: To study the effect of the inhibitor of Notch signaling pathway-γ-secretase inhibitor DAPT on the ultrastructures of middle ear in the ovalbumin (OVA)-mediated allergic OME in vivo. Methods: Male Sprague-Dawley (SD) rats, weighing 250-300 g, were completely and randomly divided into three groups (5 rats, 10 ears in each group):(1)Control group(2)OME group(3)OME+DAPT group. Rats in the OME group underwent systemic and local sensitization by intraperitoneal and intratympanic injection of ovalbumin to make the model of OVA-induced OME. Rats in the control group were sensitized with PBS. On the basis of establishing the OME model, OME+DAPT group were intraperitoneal injected with DAPT (10 mg/kg) for seven consecutive days and were administered before intratympanic injection of ovalbumin. After the model was successfully established, endoscopy,H&E staining and scanning electron microscopy were used to study the histology and mucous-ciliary ultrastructures of the non-ciliated and ciliated mucosa in the middle ear of each group. One-way ANOVA and Tukey methods were used for statistical analysis. Results: H&E staining showed that the three groups had statistically significant differences in submucosal thickness both in non-ciliated and ciliated regions (non-ciliated area:(6.83±1.47)μm, (38.58±9.57)μm, (32.17±11.89)μm, respectively. F=107.9;cilia area:(26.69±3.22)μm, (30.41±6.75)μm, (26.76±4.06)μm, respectively. F=5.62,both P<0.01). The thickness of the submucosa in the non-ciliated area and the cilia area of the OME group were significantly thicker than that of control group (F=42.08 and 4.40,both P<0.05); the thickness of the non-ciliated area and the ciliated area in OME+DAPT group were reduced compared to OME group(F=1.55 and 2.77,both P<0.05). Scanning electron microscopy showed that the array of cilia on the middle ear mucosa was disorderly arranged and inversed, this phenomenon was relieved in the OME+DAPT group. The number of goblet cells in the control group, OME group, and OME+DAPT group were 9.87±1.92; 15.67±5.77; 10.33±1.99 respectively and the difference between them was statistically significant (F=11.43, P<0.01). The number of goblet cells in the OME group were significantly higher than those in the control group (F=9.00,P<0.01) and the number of goblet cells in the OME+DAPT group were decreased compared to those of OME group (F=8.41, P<0.01). Conclusions: The study demonstrates the pathological changes of the ultrastructure in middle ear in OVA-induced OME and the effect of the γ-secretase inhibitor on it. In OME group, the cilia are disorderly arranged and inversed, the number of goblet cell is increased and they are swelled which suggest the hypersecretion of the mucus. DAPT can regulate OVA-induced allergic inflammation and relieve pathological changes of ultrastructure in middle ear mucociliary transport system through alleviating submucosal inflammation, reducing the hypersecretion of goblet cell and the morphological damage of cilia through the Notch signaling pathway.

[Bonebridge implantation combined with simultaneous bilateral auricle reconstruction for bilateral congenital aural atresia]

Objective: To investigate the feasibility and safety of auricle reconstruction combined with Bonebridge implantation for bilateral aural atresia patients. Methods: A retrospective analysis was conducted for 36 cases(72 ears) who underwent Bonebridge implantation combined with bilateral auricle reconstruction from February 1, 2017 to January 15, 2020. All cases were bilateral congenital aural atresia and underwent Nagata auricle reconstruction for both sides simultaneously. Bonebridge implantations were performed during the second stage of auricle reconstruction. Results: All 36 patients healed well and had no surgical complications when discharged. The preoperative average bone conduction threshold of the patients was(8.5±5.8) dB HL and postoperative bone conduction threshold was (8.4±5.2) dB HL. There was no significant change after the implantation (P=0.724). The preoperative average air conduction threshold of was(64.9±7.4)dB HL and postoperative air conduction threshold was (24.0±5.3) dB HL, which had a significant change after the implantation (P<0.001). The hearing threshold with Bonebridge significantly decreased by 40.9 dB HL compared with the preoperative air conduction threshold(P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased by 62.5%, 63.5% and 72.2% respectively. The differences were statistically significant (P<0.001). The speech recognition rate of monosyllabic words, disyllabic words and short sentences in noise environment were significantly increased by 55.9%, 58.9% and 69.9% respectively (P<0.001). After a follow-up of 18.3 months in average, the hearing results were stable and the aesthetic outcomes were satisfied. One patient had implant rupture and healed after revision surgery. Conclusions: With an integrated surgical procedure, patients with bilateral congenital aural atresia can complete bilateral auricle reconstruction and hearing implantation within six months. This integrated surgical procedure is safe and efficient, with a stable hearing improvement and good appearance.

[Effects of Astragaloside Ⅳ on exosome secretion and its microRNA-126 expression in human endothelial progenitor cells]

Objective: To investigate the effects of Astragaloside Ⅳ on the secretion of exosomes in human endothelial progenitor cells (EPCs) and the expression of microRNA (miRNA)-126 in exosomes. Methods: The umbilical cord blood from one healthy full-term newborn from the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine in 2019 was harvested for isolating mononuclear cells by density gradient centrifugation and cultured for 7 days. Morphological observation was performed during this period. Cells of the third passage were collected for identification by CD31 immunomagnetic bead sorting and double fluorescence staining. According to the random number table, the identified EPCs were divided into Astragaloside Ⅳ group and phosphate buffer solution (PBS) group. The cells in Astragaloside Ⅳ group were cultured with Astragaloside Ⅳ in final mass concentration of 100 mg/L for 24 hours, and the cells in PBS group were cultured with the same volume of PBS for 24 hours. After culture, the exosomes from the cell culture supernatant of the two groups were collected, and the expressions of characteristic markers of exosomes CD9, CD63, and CD81 were detected by Western blotting, the morphology of EPC exosomes (EPC-Exos) was observed under transmission electron microscope, and the particle size of EPC-Exos was detected by nanoparticle tracking analysis technique. The concentration of EPC-Exos was determined by dioctyl butyric acid method (the sample number was 3), and the expressions of miRNA-126-3p and miRNA-126-5p related to angiogenesis in EPC-Exos were determined by reverse transcription polymerase chain reaction (the sample number was 3). Data were statistically analyzed with independent sample t test. Results: (1) On the 4th day of culture, the cells began to adhere to the wall, and the multi-forms such as circle, fusiform, and strip appeared at the same time. On the 7th day of culture, the edge of the cells was clear and arranged like a paving stone, the central cells were round, and the surrounding cells were fusiform. (2) CD31 immunomagnetic beads sorting method identification showed that the membrane was stained with green fluorescence and the nucleus was stained with blue fluorescence. Double fluorescence staining method showed that the cells were orange-yellow. The cells were identified as EPCs. (3) After 24 hours of culture, the expressions of CD9, CD63, and CD81 in EPC-Exos were all positive, confirming that EPC-Exos were extracted successfully in this experiment. (4) After 24 hours of culture, the EPC-Exos of the two groups showed round membrane vesicles, and there was no significant difference in morphology. (5) After 24 hours of culture, the particle size of 98.7% EPC-Exos in Astragaloside Ⅳ group was 84.7 to 143.1 nm, and that of 98.0% EPC-Exos in PBS group was 88.7 to 123.5 nm. (6) After 24 hours of culture, the mass concentration of EPC-Exos in Astragaloside Ⅳ group was (310±5) μg/mL, which was significantly higher than (257±5) μg/mL in PBS group, t=13.369, P<0.01. (7) After 24 hours of culture, there were more miRNA-126-3p (t=16.062, P<0.01) and miRNA-126-5p (t=3.252, P<0.05) in EPC-Exos of Astragaloside Ⅳ group than in PBS group. Conclusions: Astragaloside Ⅳ can improve the function of human EPC secretory exosomes, and the secreted exosomes are loaded with miRNA-126.

Comparison of Three Frailty Scales for Prediction of Adverse Outcomes among Older Adults: A Prospective Cohort Study

OBJECTIVES

To compare the ability of Frailty Phenotype (FP), FRAIL and Frailty Index (FI) to predict adverse outcomes.

DESIGN

A prospective cohort study.

SETTING

A senior community in Beijing, China.

PARTICIPANTS

A total of 188 older adults aged 65 years or older (mean age 84.0 ± 4.4 years, 58.5% female).

MEASUREMENTS

Frailty was evaluated by FP, FRAIL and FI. The agreement between scales was assessed by Cohen kappa coefficient. The predictive value of the three scales for adverse outcomes during one-year follow-up period were analyzed using decision curve analysis(DCA) and receiver operating characteristic curve (ROC) analysis.

RESULTS

Frailty ranged from 25% (FRAIL) to 42.6% (FI). The agreement between scales was moderate to good (Cohen's kappa coefficient 0.44~0.61). DCA showed though the curves of the scales overlapped across all relevant risk thresholds, clinical treating had a higher net benefit than "treat all" and "treat none" when risk of unplanned hospital visits ≥30%, risk of functional decline or falls ≥15%. The three scales had similar predictive value for unplanned hospital visits (area under ROC, AUC 0.63, 0.64 and 0.69). FRAIL and FI had similar predictive value for functional decline (AUC 0.63,0.65). FI had predictive value for falls (AUC 0.65).

CONCLUSIONS

All three scales showed clinical utility but FRAIL may be best in practice because it is simple. Multidimensional measures of frailty are better than unidimensional for prediction of adverse outcomes among older adults.

[A preliminary study of the first Chinese-translated Ophthalmology book Treatise on Diseases of the Eye in Modern times]

Treatise on Diseases of the Eye is the first western medical ophthalmology book published in modern times. This book introduced clinical diagnosis technology, some related equipment, specific disease knowledge and treatment methods of western ophthalmology systematically.Not only its content is valuable; the way of expression is easy to understand for its readers. Compilation of this book has a vital role in treating patients and training students, especially for high incidence areas of eye diseases. It opens a door for Chinese to accept and disseminate western ophthalmology knowledge.

Advances in Neuropathologic Research of Hypoglycemic Brain Damage Caused by Insulin Overdose

Abstract

The number of death from insulin overdose, including accidental poisoning, suicide and homicide, is increasing these years. The forensic diagnosis of death from insulin overdose is a tough task. Glucose is the main energy source of the brain. Therefore, hypoglycemic brain damage is considered to be the main reason of death from insulin overdose. Recently, research of hypoglycemic brain damage caused by insulin overdose is gradually being paid attention in the field of forensic medicine. This paper summarizes the neuropathologic changes, pathophysiologic process and potential neural molecular markers of hypoglycemic brain damage caused by insulin overdose in terms of forensic neuropathology, providing reference for the research and practice in forensic medicine related fields.

Trial of Chloroquines in the Treatment of COVID-19 and Its Research Progress in Forensic Toxicology

Abstract

Chloroquines are the long-established prescription drug, which are often used clinically to treat malaria and connective tissue diseases. Since December 2019, corona virus disease 2019 （COVID-19） outbreaks caused by 2019 novel coronavirus （2019-nCoV） has occurred in China and many countries around the world. Due to the lack of drugs against COVID-19, the disease spreads rapidly and the mortality rate is relatively high. Therefore, specific drugs against 2019-nCoV need to be quickly screened. The antimalarial drug chloroquine phosphate which has already been approved is confirmed to have an anti-2019-nCoV effect and has been included in diagnostic and therapeutic guidelines. However, awareness of the risk of chloroquine phosphate causing acute poisoning or even death should be strengthened. The current dosage recommended in clinical treatment is larger than that in previous treatment of malaria and the period of treatment is longer. Many provinces have required close clinical monitoring of adverse reactions. This paper reviews the pharmacological effects, poisoning and toxicological mechanisms, in vivo metabolism and distribution, and forensic issues of chloroquine drugs, in order to provide help to forensic practice and clinical work.

[Diagnostic value of serum alpha-fetoprotein, alpha-fetoprotein variant and abnormal prothrombin in primary hepatocellular carcinoma]

Objective: To explore the diagnostic value of single or combined detection of serum tumor markers alpha-fetoprotein (AFP), α-fetoprotein (AFP)-L3 and abnormal clotting (PIVKA-II) in the primary hepatic carcinoma. Methods: Serum AFP, AFP-L3 and PIVKA-II of 56 cases with primary hepatic carcinoma, 46 cases with cirrhosis, 45 cases with other liver disease and 41 healthy persons (control group) were examined by chemiluminescence method, and the differences in the levels of AFP, AFP-L3 and PIVKA-II in each group were compared. Results: Serum level of AFP, AFP-L3 and PIVKA-II in patients with primary liver cancer was significantly higher than that of the cirrhosis, other liver disease and control groups, and the difference was statistically significant (P < 0.05). The receiver operating characteristic curve analysis showed that the areas under the curve for the diagnosis of primary hepatic carcinoma by AFP, AFP-L3 and PIVKA-II were 0.887, 0.846 and 0.885, respectively. The combined use of the three tumor markers for the diagnosis of primary hepatic carcinoma increased the area under the curve to 0.899. Among the single detection, AFP had the highest sensitivity of 91.07% and PIVKA-II had the highest specificity at 88.63%. In the combined detection, AFP/PIVKA-II combination had the highest sensitivity of 94.64 %, while the AFP + AFP-L3 + PIVKA-II combination had the highest specificity at 98.48%. Conclusion: Combined detection of AFP, AFP-L3 and PIVKA-II could improve the diagnostic specificity and the sensitivity of primary hepatic carcinoma; thereby make up the deficiency of single detection and improve the early diagnosis rate.

[Congenital microtia with aural atresia or stenosis accompany with first branchial cleft anomaly: report of 5 cases]

Objective: To summarize the experience of the diagnosis, treatment and effects of the cases with coexistence of first branchial cleft anomaly(FBCA) and microtia with congenital aural atresia or stenosis(external auditory canal stenosis, EACS). Method: This was a retrospective study. The clinical data of 5 patients with microtia and EACS in Beijing Tongren Hospital of Capital Medical University from October 2015 to March 2018 were collected, including 3 males and 2 females, aged from 5 to 28 years. The clinical characteristics, imaging findings, treatment methods and effects of 5 patients were analyzed. Result: The 5 cases were all coexistence of EACS and FBCA, three of who associated with cholesteatoma of external auditory canal. CT showed external auditory canal stenosis with soft tissue shadow, sometimes gas or bone septum found inside, filling in the external auditory canal, combined with canal bone destruction irregularly. All patients underwent surgical resection of FBCA, 3 patients accompanied by cholesteatoma resection and canalplasty. The postoperative follow-up ranged from 10 to 39 months, and no recurrence of infection was observed. Conclusions: EACS and FBCA both result from maldevelopment of the first branchial cleft. These two malformations, FBCA and EACS with or without cholesteatoma, can occur simultaneously, in which situation CT shows external auditory canal stenosis with soft tissue shadow inside. These patients underwent surgical resection of FBCA combined with cholesteatoma resection with good result.

[The implantation of Bonebridge in bilateral congenital malformation of external and middle ear]

Objective: To evaluate the auditory efficacy of Bonebridge implantation in patients with bilateral congenital malformation of external and middle ear. Methods: Eleven cases (6 males and 5 females) had unilateral Bonebridge implantation. The age ranged from 8 to 26 and the average age was 16.9. Seven to ten days after operation, the first fitting was undergone. In acoustic sound field, the average auditory thresholds were respectively measured for unaided ears and Bonebridge implanted ears by pure tone auditory (PTA, 0.25, 0.5, 1, 2 and 4 kHz). For the group over 12-year-old, MSTM was applied to evaluate speech discrimination score (SDS). For the other cases, MLNT was used as the test material. The auditory efficacy post Bonebridge implantation would be analyzed and evaluated by comparing the differences between unaided ears and Bonebridge implanted ears. Results: The bone conduction audibility threshold after Bonebridge implantation was as well as the preoperative. The auditory threshold with Bonebridge aided was improved to 25-35 dB HL, when compared to that of the unaided ears in the sound field. The SDS in the group over 12-year-old was improved about 50%; the efficacy was slightly limited for the other two cases (both less than 12 years old). Statistical analysis showed that there were significant differences between unaided ears and Bonebridge implanted ears in the sound field and SDS(P<0.05). Conclusions: The auditory efficacy of Bonebridge is significant and noticeable in patients with bilateral congenital malformation of external and middle ear. Bonebridge provides a new and effective way for patient with congenital malformation of external and middle ear to reconstruct hearing.

[The treatment efficiency of a new ear moding device in the infants with congenital ear abnormalities]

Objective:To observe the nonsurgical treatment effciency of a new ear moding device on congenital auricle deformities in order to promote clinical application. Method:Twenty-nine patients (38 ears) from Beijing Tongren Hospital Outpatient received ear molding treatment using the EarWell Infant Ear Correction System. We keep regular follow-up and close observation during the moding period. The treatment effciency was judged by the otologist, plastic surgeons and parents based on the preprocedure and postprocedure photographs and divided into 3 grades: excellent, good and poor. Result:Twenty-nine patients (38 ears) including prominent ear, 2 ears; cup ear,7 ears; lidding/lop ear deformities, 4 ears; Stahl's ear, 4 ears; helical rim abnormalities, 4 ears; conchal crus ear, 3 ears, mixed ear deformities 4 ears; cryptotia, 5 ears; ear malformation, 5 ears, 2 patients (2 ears) stop moding after 3 days treatment due to the low compliance of the infants, the remaining 36 ears received ear molding all have improved. The success rate of the EarWell Infant Ear Correction System is more than 94% (good to excellent). Conclusion:EarWell Infant Ear Correction System have a significant moding effect and can achieve satisfactory results in early time. EarWell system has a high success rate in the treatment of neonatal auricle deformations and mild auricle malformations, depending on the severity of the deformations and the initiation of treatment time. The sooner the noninvasive moding begins (especially within one week after birth), the better effect and the shorter treatment time the patients will achieve.

[Vibrant soundbridge implantation of congenital atresia of oval window(with summary of nine cases]

Objective:To investigate the surgical effects of round window implantation of vibrant soundbridge(VSB)for patients with congenital oval window atresia.Method:Retrospectively analyze the clinical information of 9 cases of congenital oval window atresia as well as the pre-and post-operative hearing and speech results. Three of them had undergone or attempted the vestibulotomy but obtained poor results. All cases underwent round window implantation of VSB. Result:All patients obtained an improvement of 21-33 dBHL after implantation. In the speech recognition rate test, the average increase of disyllabic words was 62%, and 60% in the sentence test. During the follow-up of 51 months in average, 2 cases had a decline of auditory benefit and finally 1 case regained the improvement after reoperation. Conclusion:Round window implantation can get a fairly good result in congenital oval windows atresia cases.

[The efficacy of bone anchored hearing aid application in patients with bilateral congenital aural atresia]

Objective:To evaluate the efficacy of Bone anchored hearing aid(Baha) application in patients with bilateral congenital aural atresia.Method: Prospective study of 18 patients with bilateral congenital aural atresia received unilateral Baha implanted. Aided and unaided hearing was assessed using pure tone audiometry(PTA)，Speech Recognition in quiet and noisy circumstances and the abbreviated profile of hearing and benefit(APHAB) questionnaire.Result:The average decline in pure-tone threshold was(31.06±14.32)dB HL for those with implanted Baha. The average improvement in Mandarin speech test was(62.4±31.1)%, and the average improvement in hearing in noise test（HINT) was (34.3±10.8)%．In the APHAB questionnaire survey, the mean Baha scores of ease of communication（EC）, backgroud noise and revereration were decreased by 59.3± 14.5，46.7±10.1，58.8±8.1 compared to the unaided scores, and the Baha score of aversiveness was (66.4±11.9) higher than the unaided score. After the mean 9.6 months's follow-up，no serious complications were recorded.Conclusion:Baha can significantly improve hearing ability and quality of life of patients with bilateral congenital aural atresia. It has been one of the most reliable methods of auditory rehabilitation.

Primary investigation of the optical limiting performance of cyclo[8]pyrrole with a wide optical limiting window

Cyclo[8]pyrrole (CP) was prepared and its UV/vis spectral and optical limiting properties for ns light pulse were investigated withZ-scan technical.

Current-pulse-induced enhancement of transient photodetective effect in tilted manganite film

A current-pulse-induced enhancement effect of transient photovoltage has been discovered in tilted manganite La(2/3)Ca(1/3)MnO(3) film at room temperature. Here, by applying a pulsed current stimulus before pulse laser irradiation, we observed a significant enhancement of more than 50% in photovoltaic sensitivity. The current-pulse-induced photovoltaic enhancement can be tuned not only by the stimulating current value but also by the stimulating time. Such enhancement is time-sensitive and reproducible. This electrically induced effect, observed at room temperature, has both the benefit of a discovery in materials properties and the promise of applications for thin film manganites in photodetectors.

High-sensitivity photovoltaic responses in manganite-based heterojunctions on Si substrates for weak light detection

We have fabricated and characterized a weak light photodetector in a heterojunction composed of manganite La0.4Ca0.6MnO3 and n-type Si. High-sensitivity photoresponse properties were investigated. The responsivities of open-circuit photovoltage and short-circuit photocurrent reach ∼1000  V/mJ and ∼30  A/mJ, respectively, without any amplification bias under irradiation by 20-ps-wide and 355, 532, and 1064-nm-wavelength laser pulses in nanojoule to microjoule order. The present results demonstrate that the manganite-based heterojunction on Si substrate has potential applications in weak light detection from ultraviolet to near-infrared light.

11C-PD153035 PET/CT molecular imaging of EGFR for evaluation of advanced non-small cell lung cancer (NSCLC) to EGFR-targeted therapy

7576

Background: Our previous study suggests that 11C-PD153035, a specific and potent inhibitor of EGFR tyrosine kinase (EGFR-TKI), is a novel PET radiotracer and 11C-PD153035 PET/CT is a promising non-invasive method for in vitro and vivo imaging of EGFR in NSCLC. We report a pilot study evaluating the efficacy of 11C-PD153035 PET/CT imaging as a “molecular fingerprint” to the EGFR-TKI in advanced NSCLC (stage IIIB/IV). Methods: Patients with pathologically proved advanced NSCLC were enrolled. 11C-PD153035 PET/CT was performed before (PET/CT 1) and 4 weeks after (PET/CT 2) received EGFR-targeted therapy (erlotinib) with assessment of maximum standardized uptake values (SUVmax) for correlation with response. Treatment response was also expressed as CT results on the basis of traditional Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Image fusion and calculation of tumor subvolumes was performed on Xeleris workstation. Radioactivity concentrations, derived from regions of interest, were analyzed to the SUVmax. Results: 12 patients (5 men, 7 women; age range, 60–79 years) have been enrolled in this study from August 2008, including 3 cases of squamous cell carcinoma, 1 case of large cell carcinoma, and the other of adenocarcinoma. Tumor uptake of 11C-PD153035 before received therapy was observed in 8 patients and SUVmax ranged from 3.1 to 5.9. There was significant difference in SUVmax (p < 0.01) between tumor and normal tissue. Tumor/lung ratio at 20 min was 4.14 ± 1.80. The SUVmax did not correlate with tumor marker before therapy in our limited data. After 4 weeks therapy, a total of 7 patients underwent the 11C-PD153035 PET /CT again and 5 patients only received CT scanning. Tumor responders had a higher baseline pre-therapy SUVmax than nonresponders (p < 0.01). However, there was no significant difference between pre- and post-therapy SUVmax among 7 patients (p > 0.05). Conclusions: Our data indicated that 11C-PD153035 PET/CT before therapy may play a vital role for identification of patients that could be suitable for EGFR targeted therapies. Thus, it offers opportunities to individualize and optimize target therapy for NSCLC patients.

No significant financial relationships to disclose.

[Analysis of soybean lecithin by supercritical fluid chromatography]

Separation of six phospholipids, phosphatidyl choline (PC), phosphatidyl-ethanolamine (PE), phosphatidyl-serine(PS), phosphatidyl-inositol(PI), phosphotidic acid(PA), lyso-phosphatidyl-choline(lyso-PC), in soybean lecithin with supercritical fluid chromatography was achieved within 15 min. C18 column was used and carbon dioxide modified by ethanol containing 0.05% (V/V) triethylamine was chosen as the mobile phase. Effects of the composition of mobile phase, temperature and pressure were studied. The quantitative analysis of PC has been achieved with external standard method. The calibration curve for PC was linear in the range between 0.020 g/L-0.075 g/L and the detection limit was 0.2 microgram. This method has been applied to the analysis of PC in soybean lecithin.

[Observation of deaf-mute students' audition examine and otacoustic effect]

OBJECTIVE

To explore the state of the remnant hearing of deaf-mute students and to check the effect of hearing aids to them.

METHOD

38 cases of deaf and dumb students were examined with the pure tone auditometry, acoustic immitance test, auditory brainstem response, and the environmental sound discrimination test.

RESULT

In 17 cases, the average threshold of air conduction of speech frequency is below 89 dB HL; In 18 cases, it is between 90 dB and 110 dB; In 3 cases, it is above 110 dB. 33 cases have model A curve and 5 cases have model B curve. When 123 dB peSPL was presented, 24 cases generated the waveform but the others didn't. 16 cases could discriminate the environmental sound and the other 22 cases could not, but if the patients weared the hearing aids, the number of the persons who could discriminate the environmental sound increased to 24, only 14 cases had no effect by this means.

CONCLUSION

Examination of deaf-mutes audition can find persons with residual audition. If they wear the hearing aids and go into hearing rehabilitation training at the same time as early as possible, it will improve the environmental sound discrimination rate.

Speech evaluation of partially implantable piezoelectric middle ear implants in vivo

OBJECTIVE

Cochlear microphonic responses (CMs) were measured in a rabbit model in the intact ear (CM1) and in ears with a partially implantable piezoelectric middle ear implant (P-MEI) (CM2) to investigate the characteristics of speech transmission of the P-MEI in vivo.

DESIGN

The spectra of pure tones, voices, and elicited CM1 and CM2 obtained from the round window before and after the implantation of a P-MEI device were calculated by using fast Fourier transform. Frequency response functions of CM1 and CM2 were used to demonstrate the functional similarity between the implanted P-MEI and the normal ossicular chain. The coherence functions between the voices and CM1 and between CM1 and CM2 were evaluated to characterize speech transmission of the P-MEI in vivo. Ten rabbit ears were used in this study. Pure tones, six Chinese vowels, and six Chinese characters were the acoustic stimuli. The CMs elicited by a list of bisyllabic words were tape-recorded and then recognized by subjects with normal hearing.

RESULTS

Using pure tones at the same intensity of 90 dB SPL, frequency response functions of the CMs between the two states (the intact ear with normal hearing and ears with a P-MEI device at the medium volume) were calculated showing great resemblance in shape. Compared with that at 1 kHz, gain factors were 10 and 20 dB, respectively, at higher frequencies. The correlation and spectral analyses of the vocalizations, CM1 and CM2, demonstrated that the harmonics of CM1 were approximately identical as those of the voices between 0.5 and 5.0 kHz with coherence functions of about 0.7 to approximately 1 at the formants' frequencies, whereas the harmonics of CM2 between 0.5 and 2.5 kHz were enhanced with the coherences near to unity at the formants' frequencies, and others <0.5 kHz and >2.5 kHz were attenuated. The recognition score of the CMs elicited by a list of bisyllabic words was >90% using subjects with normal hearing.

CONCLUSIONS

Data from this study suggest that cochlear microphonic potentials can be used as an important tool to evaluate objectively whether the implantation of a P-MEI device is successful and whether the quality in speech transmission of the P-MEI is satisfactory. Thus, the method would be of significance to clinically ascertain the performance of the device in vivo.

[Analysis on voice acoustic parameters and electroglottographic parameters in normal children of Han, Naxi, Bai nationality]

OBJECTIVE

To explore the normal vocal acoustic parameters and electroglottographic (EGG) parameters and their differences in normal children of the Han, the Naxi, the Bai nationality.

METHOD

By using computer and Dr. speech software, We studied six parameters of voice acoustic and the E.G.G. in 951 children (Han 342, Naxi 224, Bai 385), aged 4-8 years old. We also examined 30 cases who suffered from vocal nodule and local proliferation.

RESULT

The major parameters 1. Jitter, 2. Shimmer, 3. Mean F0, 4. SD F0, 5. NNE) of the voice acoustic and E.G.G. of the three nationality.

CONCLUSION

1. All parameters in Han nationality school-age children and preschool children were not different in years old. But Naxi and Bai nationality school-age children's Mean F0 and SD F0 were different from preschool children. The parameters(Mean F0, SD F0) of school-age children in Han, Naxi and Bai nationality were significant different. 2. The tested parameters were significant different between normal children of the Han nationality and the vocal nodule patients.

[Overproduction of cholera toxin B subunit by recombinant Escherichia coli MM2 in lactate-containing medium]

The expression of ctb gene in recombinant E. coli MM2 strain is affected by temperature, pH and carbon source. High level production of cholera toxin B subunit (CTB) was investigated in lactate-containing medium which designed by experiments of orthogonal test. Upshifting temperature from 30 degrees C to 37 degrees C could increase the production of CTB by 4 fold, upshifting pH value from 7.2 to 8.4 at the later culture stage could increase the specific expression level of CTB by 2.14 fold, and adding sodium acetate increased the production of CTB by 65%. In 5 L fermentor the cell density was reached at OD600 30, and the 186.7 mg/L of CTB was obtained. The CTB in the culture supernatants was in the form of polymer like the native CTB from Sigma, and also possessed the same antigenity.

[Hemangioma of external ear: an analysis of 8 cases]

OBJECTIVE

To investigate approaches of diagnosis and therapy to hemangioma of external ear and improve the effects of diagnosis and therapy.

METHOD

Eight cases of hemangioma of external ear were analyzed retrospectively. All patients were unilateral hemangioma. 5 were performed digital subtraction angiography (DSA) before operation, of which 3 were performed embolization simultaneously. 7 were operated, 1 was not done. Racemose hemangioma was 5 and cavernous hemangioma was 2 according to pathologic diagnosis.

RESULT

All patients have followed up 1 to 5 years, 5 were healed, 2 were controlled, and 1 was not treated.

CONCLUSION

Surgery was effective approach to hemangioma of adults. It suggested that it was the key of controlling bleeding during operation that DSA and embolization before operation or ligating artery of blood supply during operation.

Phenotypic heterogeneity of mutational changes at a conserved nucleotide in 16 S ribosomal RNA

RNA sites that contain unpaired or mismatched nucleotides can be interaction sites for other macromolecules. C1054, a virtually universally conserved nucleotide in the 16 S (small subunit) ribosomal RNA of Escherichia coli, is part of a highly conserved bulge in helix 34, which has been located at the decoding site of the ribosome. This helix has been implicated in several translational events, including peptide chain termination and decoding accuracy. Here, we observed interesting differences in phenotype associated with the three base substitutions at, and the deletion of, nucleotide C1054. The phenotypes examined include suppression of nonsense codons on different media and at different temperatures, lethality conditioned by temperature and level of expression of the mutant rRNA, ribosome profiles upon centrifugation through sucrose density gradients, association of mutant 30 S subunits with 50 S subunits, and effects on the action of tRNA suppressor mutants. Some of our findings contradict previously reported properties of individual mutants. Particularly notable is our finding that the first reported 16 S rRNA suppressor of UGA mutations was not a C1054 deletion but rather the base substitution C1054A. After constructing deltaC1054 by site-directed mutagenesis, we observed, among other differences, that it does not suppress any of the trpA mutations previously reported to be suppressed by the original UGA suppressor. In general, our results are consistent with the suggestion that the termination codon readthrough effects of mutations at nucleotide 1054 are the result of defects in peptide chain termination rather than of decreases in general translational accuracy. The phenotypic heterogeneity associated with different mutations at this one nucleotide position may be related to the mechanisms of involvement of this nucleotide, the two-nucleotide bulge, and/or helix 34 in particular translational events. In particular, previous indications from other laboratories of conformational changes associated with this region are consistent with differential effects of 1054 mutations on RNA-RNA or RNA-protein interactions. Finally, the association of a variety of phenotypes with different changes at the same nucleotide may eventually shed light on speculations about the coevolution of parts of ribosomal RNA with other translational macromolecules.

Variety of nonsense suppressor phenotypes associated with mutational changes at conserved sites in Escherichia coli ribosomal RNA

To screen for ribosomal RNA mutants defective in peptide chain termination, we have been looking for rRNA mutants that exhibit different patterns of suppression of nonsense mutations and that do not suppress missense mutations at the same positions in the same reporter gene. The rRNA mutations were induced by segment-directed randomly mutagenic PCR treatment of a cloned rrnB operon, followed by subcloning of the mutagenesis products and transformation of strains containing different nonsense mutations in the Escherichia coli trpA gene. To date, we have repeatedly obtained only two small sets of mutations, one in the 3' domain of 16S rRNA, at five nucleotides out of the 610 mutagenized (two in helix 34 and three in helix 44), and the other in 23S rRNA at only four neighboring nucleotide positions (in a highly conserved hexanucleotide loop) within the 1.4 kb mutagenized segment. There is variety, however, in the suppression patterns of the mutants, ranging from suppression of UAG or UGA, through suppression of UAG and UGA, but not UAA, to suppression of all three termination codons. The two helices in 16S rRNA have previously been associated both physically and functionally with the decoding center of the ribosome. The 23S region is part of the binding site for the large subunit protein L11 and the antibiotic thiostrepton, both of which have been shown to affect peptide chain termination. Finally, we have demonstrated that the 23S mutant A1093, which suppresses trpA UGA mutations very efficiently, is lethal at temperatures above 36 degrees C (when highly expressed). This lethality is overcome by secondary 23S rRNA mutations in domain V. Our results suggest that specific regions of 16S and 23S rRNA are involved in peptide chain termination, that the lethality of A1093 is caused by high-level UGA suppression, and that intramolecular interaction between domains II and V of 23S rRNA may play a role in peptide chain termination at the UGA stop codon.

[The modifications in the evaluation of standard of hand function]

On the basis of the international evaluation of impairment of hand function, we propose five improvements: (1) For the evaluation of the impairment of thumb opposition and adduction, calculating the ratio of two distances takes the place of measuring a pure distance. (2) Hand sensory impairment evaluation is based upon both results of a sensory examination and a two-point discrimination test. (3) On the evaluation of amputation percentages related to whole hand, measuring loss of length is replaced by measuring loss of area. (4) On the evaluation of a joint, we correlated the combined angular measurement with the loss of length. (5) In the international evaluation of impairment of hand function, the sensory or amputation of the palm and back of the hand is not counted. But they are counted in our paper. Besides above-mentioned works, we have made a software with these improvements. You may obtain definite impairment percentages related to whole hand, so long as you input the results of examination of hand function.

["Separation delay" on random flap: an experimental and clinical practice on delayed flap]

A new technique of delayed flap, that is called "Separation delay" by the authors, has succeeded in animal experiment and clinical practice. In the years of 1985-1989, 11 cases of random skin flaps on the patients had been performed with the new method. All the flaps look like table tennis rackets. It's pedicle is very narrow, simultaneously, the flap itself is very large. So it is quite suitable for repairing a neighbouring wound surface. It can be rotated 180 degrees. "The Separation delay" is a handy way without microsurgical technique. It is also an useful and reliable technique for resurfacing wound on plastic and reconstructive surgery.

[Relationship between bacterial envelope barrier and resistance of E. coli, S. aureus to rifamdine]

The Rifamdine (RFD) resistant strains were obtained from wild types of S. aureus NCTC 6571, E. coli NCTC 10418 and Proteus vulgaris by drug concentration gradient plate. The experiment indicated that the growth inhibition of resistant cells induced by synergism of EDTA acting with RFD. Such results did not occur effectively if EDTA or RFD was added separately. The amount of 3H-RFD incorporated into cells of susceptible and resistant strains of E. coli and S. aureus was compared. The amount of 3H-RFD incorporated into susceptible cells was much greater than that of the resistant strains in E. coli cells. Ultrastructure comparison of sensitive and resistant cells showed that the surface of resistant cells was coarser and shorter, the outer membrane thickened and electron density increased. These results have shown that there is a close relationship between the resistance of bacteria induced by RFD and the decrease in the permeability of cell envelope barrier to the drug.

[Studies on the introduction and cultivation of Kaempferia galanga L]

This paper reports a systematic survey of the biological character istics of K. galanga. As a result of investigations on plant density, planting season, fertilization, storage of maternal tubers in winter and qualitative analysis of tubers, etc, cultural measures have been brought forth that suit the local climatic conditions and thus give high yield and quality of products.