Cartilage ; transplantation ; Ear, Middle ; surgery ; Humans ; Otologic Surgical Procedures ; methods

Humans ; Tinnitus ; diagnosis ; therapy

B and T lymphocyte attenuator (BTLA) is an immune checkpoint discovered in the early 21st century. BTLA is a typeⅠtransmembrane protein that belongs to Ig super family. The ligand for BTLA is herpesvirus-entry mediator (HVEM), a TNF receptor family protein. BTLA regulates the homeostasis of γδ T cells and innate lymphocytes (ILCs), promotes the survival of effector T cells and helps them differentiate into memory T cells. BTLA also plays an important role in maintaining the homeostasis of dendritic cells (DCs). Studies have shown that BTLA knockout mice have increased susceptibility to autoimmune diseases. Recent studies showed that BTLA also plays a crucial role in allergic diseases (such as allergic conjunctivitis and allergic rhinitis) and autoimmune diseases (such as systemic lupus erythematosus and ankylosing spondylitis). This article makes a systematic review about recent researches of BTLA in immune diseases.

Objective　To obtain staphylococcal enterotoxin B (SEB) mutant with normal antigenicity but low toxicity. Methods　Using PCR technique, normal SEB (SEB-N) gene which was amplified from S. aureus S6B. SEB mutant gene (SEB-M) was prepared from the same strain, but one nucleotide in SEB gene was changed from asparagine (N23) to serine (S23). SEB-N and SEB-M were cloned into procaryotic expression vector pTrc99A then and transferred into E. coli JM109. SEB-N and SEB-M which were cloned into plasmid were sequenced directly by dideoxynucleotide method. The crude expressed proteins were identified by double agar immunodiffusion. The level of IL-2 in supernatants of mouse splenocytes stimulated by crude expressed proteins was determined by ELISA. Results　SEB-N and SEB-M were obtained through PCR. The sequence of SEB-N was changed with non site-directed mutagenesis, threonine at the residue 150 of SEB-N was replaced with alanine (ACT→GCT, T150A). As being expected, at the residue 23 of SEB-M, serine substituted for asparagine (AAT→AGT, N23S) with site-directed mutagenesis. Double agar immunodiffusion showed obvious precipitin line with anti-SEB by both crude SEB-N and SEB-M mutant proteins could produce, but not by non-recombinant strain. ELISA demonstrated that the level of IL-2 in supernatant of mouse splenocytes stimulated by natural SEB protein (containing equal amount of JM109P crude protein) was 40 times as much as that stimulated by SEB-M and 12.5 times as much as that stimulated by SEB-N. Conclusions　We obtained two recombinant strains which produced T150A and N23S mutant SEB protein. The mutant proteins showed binding ability to anti-SEB as the normal protein. However, their biological activity as superantigen decreased sharply. We consider that it is promising for further study of molecular adjuvant or superantigen vaccine.

Objective To explore the common influencing factors on the severity of Reinke's edema of the vo-cal cord and to analyze the factors of recurrence.Methods To analyze the relationships among the degrees and smoking,voice overuse,and laryngopharyngeal reflux for 85 patients with Reinke's edema of the vocal cord,and an-alyze the risk factors of recurrence.ResuIts 84.7% of the patients were male with the mean age of 51.35 years. There were statistical differences among smoking history of more than 25 years (P<0.001),laryngopharyngeal re-flux (P<0.01),and voice overuse (P<0.01).Follow ups lasted 1 year and 7 patients showed recurrence.ConcIu-sion Reinke's edema was related to long - term smoking and common in senior male patients.The degree of Reinke's edema was positive correlation with smoking,laryngopharyngeal reflux and voice overuse.The most impor-tant factor is smoking history of more than 25 years.The longer smoking history,the more severe Reinke's edema.

OBJECTIVE To measure the dexamethasone concentration in the cochlear tissue after postaurical and intramuscular administration. METHODS After bilateral adrenalectomy,animals were divided into three groups:postaurical injection group,intramuscular injection group,and physiological saline injected blank control group.At 0.25,0.5, 2.5,5,12,24,72 h after injection(1mg/100g), cochleae together with the intact endolymphatic sac were removed and homogenated.After that, the dexamethasone was detected by enzymelinked immunosorbent assay(ELISA).RESULTS The dexamethasone levels in the cochlear tissue in postaurical injection group were significantly higher than that in the intramuscular injection group.In the postaurical administration group,a mean peak cochlear tissue concentration of(175.2?36.0) ng/ml was detected at 0.25 h after injection,then declined obviously 12 h and was below detection limits by 24h.While in the intramuscular administration group, a mean peak concentration was observed 2.5 h at the concentration of(141.1?8.9) ng/ml,then rapidly declined from 5h and beyond detection by 24 h.CONCLUSION Compared with intramuscular administration,the dexamethasone levels in the postaurical injection group were significantly higher, with peak concentration reached earlier,and last longer.

Objective To investigate plasma pharmacokinetics profiles of compound betameth in guinea pig after postaurieal and systemic administrations,and to explore the possible pathway for postaurical injection. Methods 1 ml compound-betameth was injected postaurieally and intramuscularly into the guinea pig. Blood were samples obtained 0. 5,1,1.5,2,3,5,7 h and 1,2,4 w after the administration of contralateral sigmoid sinus blood and circulatory blood respectively. High performance liquid chromatography was used to dectet compound betameth in the samlowing postaurieal administration. The Cmax(peak concentration) in sigmoid sinus of postaurieal group was 2.56 and 3.03 higher than those in the contralateral and the systemic group. The AUC((area under the ct curve) was 2.41 postaurieal administration. The Cmax and AUC in postaurieal group were 0. 13 and 0. 32 higher than systemic group. Conclusion The postaurieal injection reached a higher concentration of drugs in the sigmoid sinus blood, and remained a lower concentration in circulatory blood.

Objective To study the correlation between dopamine and glutamate receptor NMDA NR_1 and NMDA NR_(2A),and to share the understanding of the mechanism of dopamine in the synaptic complex of inner hair cells.Methods Forty guinea pigs were divided randomly into four groups and the whole intacochlear perfusions were performed.The perfused cochleas were taken out as preparations 2 hours after perfusing,the contralateral cochleas were also taken out as the normal control group in the group perfused with artifical perilymph solutions.All the preparations were divided into 5 groups:①normal control cochleas;②perfused with artificial perilymph solutions;③perfused with artifical perilymph solutions containing 10 mmol/L dopamine；④perfused with artificial perilymph so lutions containing 30 mmol/L dopamine；⑤perfused with artifical perilymph solutions containing 50 mmol/L dopa mine.The semi-quantitive RT-PCR was used to observe the difference in the amount of glutamate receptor NMDA NR_1、NMDA NR_(2A).Results Dopamine inhibited the compound action potential(CAP),the increase of CAP threshold was observed and correlated with the contentration of dopamine in the perfusion solution.Regarding the amount of glutamate receptor NMDA NR_1 mRNA,there was no significant difference between group ① and group ② (P＞0.05).But a significant difference was observed the other 3 groups when compared to group ①(P＜0.05).No significant difference was detected among the 5 groups in the amount of glutamate receptor NMDA NR_(2A) (P＞0.05).Conclusion Dopamine may inhibit the cochlear auditory afferent nerve.The significant correlation between dopamine and glutamate receptor NMDA NR_1 was observed,the amount of glutamate receptor NMDA NR_1 decreased along with the increasing of the contentration of dopamine in the perfusion solution.And there was no significant correlation between dopamine and glutamate receptor NMDA NR_(2A).

Objective To explore the causes and managements of peritoneal laceration in the laparoscopic totally extraperitoneal (TEP) hernia repair during learning curve.Methods The retrospective cross-sectional study was conducted.The clinical data of 120 patients with inguinal hernia who underwent laparoscopic TEP hernia repair in the Third Affiliated Hospital of Anhui Medical University (98 patients) and Anhui Provincial Hospital (22 patients) during surgeons' learning curve between February 2012 and January 2017 were collected.Patients underwent laparoscopic TEP hernia repair,meshes were intraoperatively placed and then fixed by medical glue.Observation indicators:(1) intraoperative situations:surgical procedure,operation time,using of mesh,intraoperative peritoneal laceration;(2) postoperative situations:time to anal exsufflation,time for fluid diet intake,occurrence of complications,duration of hospital stay;(3) follow-up:number of patients receiving follow-up,follow-up time,recurrence of hernia during follow-up,pain in inguinal region,intestinal adhesion and obstruction induced abdominal pain,incisional infection.Follow-up using outpatient examination and telephone interview within 10 days postoperatively and using telephone interview at 10 days postoperatively was performed to detect the recurrence of inguinal hernia,pain in inguinal region,intestinal adhesion and obstruction induced abdominal pain and incisional infection up to May 2017.Measurement data with normal distribution were represented as （x）±s.Results (1) Intraoperative situations:of 120 patients,112 underwent laparoscopic TEP hernia repair,5 converted to laparoscopic transabdominal preperitoneal hernia repair and 3 converted to open surgery due to adhesion between hernial sac and surrounding tissues induced bleeding of separation.Total operation time of 120 patients was (71 ± 13) minutes,including (63± 7) minutes in 106 patients with unilateral hernia and (79 ± 11)minutes in 14 patients with bilateral hernia.All the patients used intraoperatively meshes of 10.0 cm×15.0 cm and 16.0 cm× 10.8 cm.Forty-eight patients had intraoperative peritoneal laceration,peritoneal laceration occurred for reconstruction of preperitoneal space in 10 patients,separation of anterolateral preperitoneal space in 11 patients and improperly operating equipment or hernial sac in 27 patients.Of 48 patients with peritoneal laceration,40 continued to finish operation through acupuncturing into the abdominal cavity for exsufflation and then received peritoneal suture and repair,including 5 with recurrence of indirect inguinal hernia (receiving tissue repair) undergoing peritoneal repair through opening hernial sac,and 8 intraoperatively converted to other or open surgery.(2) Postoperative situations:time to anal exsufflation and time for fluid diet intake in 120 patients were (18± 4) hours and (15±6) hours.Of 120 patients,14 had postoperative complications,scrotal emphysema of 6 patients disappeared in 24 hours anti inguinal and scrotal seroma of 8 patients disappeared after puncture treatment.All the patients were discharged from hospital in 2 days postoperatively.(3) Follow-up:112 of 120 patients were followed up for 3-65 months,with a median time of 31 months.During follow-up,there was no occurrence of recurrence of hernia,pain in inguinal region,intestinal adhesion and obstruction induced abdominal pain and incisional infection.Conclusion During surgeons' learning curve,identifying anatomy of the groin clearly,a right way to treat the hernia sac and broken peritoneum in the operation can ensure the smooth completion of the laparoscopic TEP hernia repair.

OBJECTIVE To analyze 1000 Hz probe tone tympanometry of middle ear with different volume of fluid, and to evaluate the role of 1000 Hz probe tone tympanometry in the diagnosis of presence of fluid in tympanic cavity. METHODS Tympanometries with 1000 Hz or 226 Hz probe tone were obtained from all the guinea pigs with different volume of fluid in tympanic cavity using GSI33 analyzer and tympanometry curves were analyzed. RESULTS There was a significant difference of the peak pressure of 1000 Hz tympanometry among all test groups and control group. The peak pressure decreased with the increasing of fluid volume in tympanic cavity. CONCLUSION Tympanometry with 1000 Hz probe tone can be used in the diagnosis of fluid in tympanic cavity, and it can be an indicator of volume of fluid in tympanic cavity.