OBJECTIVETo explore evaluation strategies for middle ear dysfunction in cleft palate patients, to optimize the diagnosis and treatment of this dysfunction, and ultimately to improve the comprehensive treatment of cleft palate.

METHODSThe relationship among abnormal tympanic types (B, C, and Anomaly), effusion rate, tympanic pressure, and hearing loss were analyzed. We collected relevant information on 469 ears of cleft palate patients and traced one-year longitudinal changes in the tympana of 124 ears from 62 patients with both cleft lip and cleft palate.

RESULTSThe effusion rates of cleft palate patients with type B, type C, and type Anomaly were 50.3% (97/193), 34.8% (8/23), and 20.9% (53/253), respectively. The tympanic pressure of the ears with and without effusion showed no significant difference (P>0.05). The hearing loss in type B cleft palate patients with middle ear effusion was worse than that in patients without effusion (P=0.001). However, the hearing loss in type Anomaly showed no difference (P>0.05). The constituent ratio of each tympanic type remained constant during the period between cheiloplasty and palatoplasty for cleft lip and palate patients (P>0.05).

CONCLUSIONCleft palate patients of all tympanic types may all suffer from middle ear effusion at different rates. Examination by centesis is suggested for ears with abnormal tympanic types. Early aggressive therapy is essential for type B cleft palate patients with middle ear effusion to avoid hearing loss. However, catheterization may be not necessary for type Anomaly patients, and conservative observation should be performed instead. Myringotomy with grommet insertion during palatoplasty does not delay treatment timing for patients with both cleft lip and cleft palateg.

Cleft Lip ; Cleft Palate ; Ear, Middle ; physiology ; Humans ; Middle Ear Ventilation ; Otitis Media with Effusion ; diagnosis ; epidemiology

Objective To investigate the mutation of type Ⅱ human hair basic keratin (hHb) gene in a family with monilethrix.Methods Scanning electron microscopy was used to observe the structure of hair shafts.With informed consent,blood samples were drawn from affected and unaffected membets in this family,as well as from 50 healthy controls.Genomic DNA was isolated from these samples.The exon 1 and exon 7 of hHb1,hHb3 and hHb6 were amplified by polymerase chain reaction (PCR).All the PCR products were sequenced directly using ABI3730 automated sequencer.DNA sequence alignment was carried out with BLAST software.Results A typical beaded appearance was observed in affected hairs by using scanning electron microscopy.There were obvious longitudinal ridges and sulcuses in hair node.and hair cuticles were irregularly shaped.Most cortex and medullary substance were absent in affected hairs of a patient.After sequence alignment,a G1289A point mutation in exon 7 of hHb6 gene,which led to a substitution of arginine for glutamide at codon 430,was detected in affected members of this family,but not in unaffected family members or 50 unrelated human controls.No mutation was observed in exon 1 or exon 7 of hHb1 and hHb3 gene or exon 1 of hHb6 gene.Conclusion The missense mutation of R430Q is a novel mutation.which may be associated with the pathogenesis of monilethrix in this pedigree.

Objective To investigate the effects on pelvic pseudocyst,ovarian function and symptoms of peri-menopausal period in patients with benign uterine disease undergoing simultaneous hysterectomy and bilateral salpingectomy.Methods From Jan.2000 to Dec.2006,1193 patients with benign uterine disease underwent total or subtotal hysterectomy,they were followed up for 48 months,334 patients lost follow-up,the other 859 patients were divided into 2 groups,including 348 patients undergoing simultaneous hysterectomy and bilateral salpingectomy in study group and 511 patients undergoing only hysterectomy in control group.The occurrence of pelvic pseudocyst and symptoms of peri-menopausal period and the changes of serum sexual hormone were observed.Results ( 1 ) The rate of pelvic pseudocyst was 1.7％ (6/348) in study group,which was significantly lower than 4.3％ (22/511) in control group (P =0.036).(2) There was an increasing trend of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and a decreasing trend of estradiol ( E2 ) at range of 6 - 48 months after surgery.At 3 months after surgery,LH in study group was significantly higher than that in control group [ (13.9 ±2.2) U/L vs.(12.6 ± 2.5 ) U/L,P =0.032 ]; FSH in study group at 6 months and 12 months after surgery were ( 17.6 ± 2.2) U/L and (26.7 ± 5.0) U/L,which were significantly higher than ( 16.2 ± 2.8 ) U/L and (24.3 ±3.1) U/L in control group (P=0.035 and P =0.031).At 12 months after surgery,LH in study group of (24.1 ±3.0) U/L was significantly higher than (22.5 ± 1.8) U/L in control group (P =0.017).E2 in control group of (97 ±22) pmol/L was significantly lower than ( 109 ± 17) pmol/L in control group at 24 months after surgery ( P =0.028) ; FSH in study group was lower than that in control group at 48 months after surgery [ (34.9 ± 6.7 ) U/L vs.(38.0 ± 4.8 ) U/L,P =0.043 ].There were no significant differences of FSH,LH,and E2 between two groups at the other time points (P ＞ 0.05 ).(3) At 6 months after surgery,the rate of perimenopausl systems of 21.8％ (76/348) in study group was significantly higher than 15.9％ (81/511 ) in control group ( P =0.026).However,at 24 months after surgery,the rate of perimenopausal symptoms of 54.4％ (278/511) in control group was significantly higher than 47.1％ (164/348) in study group (P =0.036).ConclusionSimultaneous hysterectomy and bilateral salpingectomy could decrease the occurrence of pelvic pseudocyst,and had similar effects on ovarian function and peri-menopausal symptoms compared with only hysterectomy in patients with benign uterine diseases.

Objective To investigate the impact factors of real-time shear wave elastography ( SWE) by using the ultrasound phantoms . Methods The noduled phantoms with different densities and viscosities and background phantoms with three textures ( soft ,medium ,and hard) were prepared by using gelatin as the main ingredient . Nodule phantoms were embedded in background phantom in different depths . The elasticity ( Emax ) was measured by SWE . Factorial designed was used to evaluate the effects of various factors ,including density ,viscosity and depth of nodule phantom and texture of background phantom on Emax of nodule phantom . Binary Logistic regression was used to analysis the effects of various factors , including density ,viscosity ,diameter ,depth of nodule phantom and texture of background phantom on the window phenomenon . Results The density ,viscosity and the Emax of nodule phantoms increased as the gelatin ratio increased . The Emax of nodule phantoms in shallow position ( depth < 3 .0 cm ) were higher than those in deep position ( depth ≥ 3 .0 cm) . In hard-background phantoms ,the Emax of nodule phantoms was maximal ,soft-background phantoms was minimal . Main effects of the density ,viscosity ,depth of nodule phantoms and texture of background phantoms on Emax of nodule phantoms were different ,and all of the factors had interactive effects ( P < 0 .05 ) . The density ,viscosity ,diameter and depth of nodule phantoms were independent risk factors of the windowphenomenon ( P < 0 .05 ) . According to OR ( 23 .846 ,0 .093 ,and 0 .003 ,respectively) ,reduced density and viscosity ,or increased diameter and depth of nodule phantoms ,could increase the incidence of the window phenomenon . Conclusions The density and viscosity of self-making ultrasound phantoms can be easily and flexibly controlled .Density ,viscosity , diameter ,depth of nodule and texture of background are the impact factors of shear wave elastography .

OBJECTIVETo study the expression of Toll-like receptors (TLRs) mRNA in human trophoblast HTR-8/SVneo cells and the changes in indoleamine 2,3-dioxygenase (IDO) mRNA expression in response to TLR ligand stimulation.

METHODSThe expressions of TLRs and IDO mRNA in human HTR-8/SVneo cells were tested by RT-PCR, and the changes in IDO mRNA levels after exposure to TLR3, TLR4, TLR7/8, and TLR9 ligands were quantitatively analyzed with real-time PCR.

RESULTSIDO and TLR1-10 mRNAs were expressed in HTR-8/SVneo cells. As the cell culture time extended, IDO mRNA expression level tended to increase within 48 h. After stimulation with the TLR ligands, the expression of TLR-3 mRNA was down-regulated while the expression of TLR-4, 7, 8, and 9 mRNA up-regulated. Stimulation of the cells with poly(I:C) lowered the expression of IDO mRNA while IFN-γ increased its expression.

CONCLUSIONSThe expression of IDO mRNA is associated with the nutrition of the maternal-fetal interface. Stimulation with the TLR ligands affects the expression of IDO and TLR mRNA expressions in the cells, which verifies the functional activity of TLRs and suggests a role of IDO in TLR pathway-dependent antiviral immunity.

Cell Line ; Female ; Humans ; Indoleamine-Pyrrole 2,3,-Dioxygenase ; genetics ; metabolism ; Interferon-gamma ; pharmacology ; Ligands ; Poly I-C ; pharmacology ; RNA, Messenger ; metabolism ; Toll-Like Receptors ; genetics ; metabolism ; Trophoblasts ; cytology ; metabolism

We report the induced labor of conjoined twins in the second trimester in a woman with a history of two previous cesarean sections, the last one of which was performed in 2017. This 25-year-old patient was found to have thoracolumbar conjoined fetuses with one heart and polyhydramnios through the routine ultrasound examination at 19 +5 gestational weeks and was admitted at 20 +1 gestational weeks. After a full assessment of the fetal and maternal condition through multidisciplinary consultation, it was determined to attempt a vaginal delivery as no absolute contraindication for induction of labor. The patient was given 300 mg mifepristone orally plus an amniotic cavity injection of 100 mg ethacridine lactate. Regular contractions occurred 28 hours after medication. The patient delivered a pair of dead female conjoined twins at 20 +6 gestational weeks following successful induction of labor, with an assisted vaginal breech delivery. There was no soft tissue damage in the birth canal, and the estimated blood loss was 150 ml. Pathological examination and autopsy showed thoracolumbar conjoined deformity twins with a common heart and liver. Adequate prenatal evaluation, a detailed understanding of the indications for induction of labor and vaginal delivery, closed monitoring during labor, and preparation for emergency cesarean section, are essential safety measures for induced labor of conjoined twins in women with a scarred uterus in the second trimester.

We report the diagnosis and treatment of a rare case of epidural analgesia failure followed by postpartum subdural hematoma. The patient underwent vaginal delivery under epidural analgesia at 32 +6 gestational weeks due to threatened premature labor, during which an unexpected dural rupture occurred. She gave no history of headache and there was no obvious abnormality during the pregnancy. However, on postpartum day 4, the patient complained of headache that could not be relieved when supine, but without any other neurological symptoms. A prompt cranial CT examination showed a left frontotemporal subdural hematoma. After conservative management with intravenous drip of mannitol, re-examination of cranial CT showed that the left frontotemporal subdural hematoma was mostly absorbed and the patient was discharged on postpartum day 18. The patient was healthy during follow up. Intracranial subdural hematoma after dural puncture is a rare and serious complication that requires early recognition and treatment.