ObjectiveTo investigate MR imaging features of endolymphatic sac and vestibular aqueduct in patients with large vestibular aqueduct syndrome (LVAS) and its correlation with hearing loss.MethodsMR imaging findings of LVAS were analyzed in 31 cases (62 ears) retrospectively.MR imaging features were grouped into 4 types.In the first type,the signals of endolymphatic and vesitibular aqueduct were hypointense without any hyperintense area.In the second type,the signals of endolymphatic sac and vestibular were hyperintense which were confined within vestibular fissure.In the third type,the area from vestibular aqueduct backward out of the edge of the petrous bone was hyperintense,but its lower boundary was above posterior semicircular.In the fourth type the area which was hyperintense was below the posterior semicircular.To avoid errors in visual inspection,the hyperintense and hypointense area of endolymphatic and the signal intensity of vestibular aqueduct and cerebrospinal fluid (CSF)were measured.The differences of signal intensity among the vestibular endolymphatic sac between the high-signal areas and lowsignal areas were compared with paired t-test.The correlation of the endolymphatic sac MRI classification and degree of hearing losswasanalyzedby correctedChi-squaretestandSpearmancorrelation analysis.ResultTen ears belonged to type Ⅰ (moderate hearing loss in 1 ear,severe in 4 ears,profound in 5 ears),17 ears belonged to type Ⅱ ( moderate hearing loss in 1 ear; severe in 5 ears,profound in 11 ears),23 ears to type Ⅲ (moderate hearing loss in 3 ear,severe in 5 ears,profound in 15 ears) and 12 ears belonged to Ⅳ(mild hearing loss in 1 ear,moderate in 1 ear,severe 3 ear,profound in 7 ears).The boundary between hyperintense and hypointense area was clear,and the signal intensity ratios was 2.02 ± 0.06.The signal ratios of hyperintense and hypointense area to vestibular and CSF were 0.95 ±0.12,0.49 ±0.10,0.99 ± 0.08 respecitively.So there was statistical significant difference between hyperintense and hypointense area ( t =- 24.966,P ＜ 0.05 ),but there was no statistical significant difference between hyperintense area and vesitbular( t =-24.966,P ＞ 0.05).There was no difference of hearing loss between different MRI types ( likelihood ratio =5.02,P ＞ 0.05 ).Conclusions Not only endolymphatic sac enlarged but also perilymph herniated into skeletal fissures of vestibular aqueduct in patients with LVAS.The signal intensity of the endolymphatic sac did not show significant correlation with degree of hearing loss.

The aquatic therapy is a part of comprehensive rehabilitation. Aquatic therapy may benefit the social interaction, stereotyp-ing and motor learning of children with autism, which may associate with the physical and mental mechanism. The programs applied for the autism include game in water, swimming, physical fitness training in water, etc. The assessment tools include scales and video, and so on.

OBJECTIVETo investigate the effect of kirenol on bovine type II collagen (CII)-specific lymphocytes in vivo and in vitro, and explore the mechanism of kirenol-induced immunosuppression in antigen-specific lymphocytes.

METHODSTwenty-four Wistar rats were randomized into control group, collagen-induced arthritis (CIA) model group, kirenol group (2 mg/kg), and prednisolone group (2 mg/kg). After CII injection, the rats in the latter two groups received intragastric administration of kirenol and prednisolone for 30 days, and the spleens and draining lymph nodes of the rats were harvested to prepare single cell suspensions for measurement of the cytokine levels using ELISA. In the in vitro experiment, the lymphocytes from the control rats, with or without 20 µg/ml CII treatment in the presence of 0-80 µg/ml kirenol, were evaluated for cell proliferation and apoptosis using [(3)H]-thymidine incorporation and flow cytometry, respectively.

RESULTSCompared with those in CIA group, IFN-γ and TNF-α production was significantly reduced in splenocyte culture supernatant of kirenol group (P<0.05 and P<0.01, respectively), and the level of IL-10 and IL-4 was up-regulated (P<0.05 and P<0.01, respectively); IFN-γ and TNF-α secretion by the cultured lymph node cells (LNCs) significantly decreased (P<0.05 and P<0.001, respectively) and IL-10 and IL-4 production increased (P<0.05, P<0.001) in kirenol group. In the in vitro experiment, kirenol treatment caused obvious suppression of CII-induced LNC proliferation and dose-dependently induced antigen-specific apoptosis of the splenocytes and LNCs.

CONCLUSIONKirenol treatment reduces pro-inflammatory cytokine secretion, increases anti-inflammatory cytokine production, inhibits cell proliferation and induces apoptosis of CII-specific lymphocytes in vitro, suggesting the potential of kirenol as an immunosuppressant.

Animals ; Anti-Inflammatory Agents ; pharmacology ; therapeutic use ; Apoptosis ; drug effects ; Arthritis, Rheumatoid ; chemically induced ; drug therapy ; immunology ; Cattle ; Cell Proliferation ; Cells, Cultured ; Collagen Type II ; immunology ; Cytokines ; immunology ; Diterpenes ; pharmacology ; therapeutic use ; Female ; Immunosuppressive Agents ; pharmacology ; therapeutic use ; Lymphocytes ; cytology ; drug effects ; immunology ; Rats ; Rats, Wistar

On the basis of the existing appointment process, artificial intelligence and Internet of things technologies were introduced to optimize such process. Thanks to the all appointment process management empowered by AI and IoT, patient waiting time is cut short and patient satisfaction enhanced as a result.

Objective:To introduce a new surgical procedure for harvesting an iliac bone flap with deep iliac circumflex vessels—"retrograde anatomical method", and report the effect of preliminary application with this procedure.Methods:From June 2018 to May 2021, 15 patients who admitted in the Department of Hand and Microsurgery, Xiangya Hospital of Central South University received surgeries of iliac bone flap with deep iliac circumflex artery by "retrograde anatomical method". During the surgery, appropriate cutaneous perforators or muscular branches were found near the medial side of the iliac bone of iliac tubercle. The branches were dissected from surface inwards to the starting point of deep circumflex iliac blood vessel with microsurgery and micro Schlieren forceps. The iliac bone flap was chiselled out, inserted into femoral head, and then anastomosed with the transverse branches of deep circumflex iliac blood vessel and lateral circumflex femoral blood vessel. All patients were included in the postoperative follow-up at the outpatient clinic to evaluate the preliminary effect of this procedure. Harris scores before and after surgery were assessed with paired t test. P<0.05 was considered statistically significant. Results:The length of iliac bone flap was at 3.0-5.0(4.0±0.5) cm, and the length of vascular pedicle was at 4.0-7.0(5.3±1.0) cm. The time of iliac bone flap harvest was 35-55(45.0±6.1) minutes. During the operation, the success rate of harvesting iliac bone flap with deep iliac circumflex artery was 100%, and blood had oozed out of bone surface before the pedicle of all iliac bone flaps was cut-off. The volume of intraoperative autologous blood transfusion was 100-400(226.7±78.2) ml. One patient suffered from traction injury of lateral femoral cutaneous nerve in the operation. The numbness of anterolateral thigh area occurred on the 1st day after the surgery, and relieved 4 months later. Other 14 patients did not suffer from postoperative numbness in the area of anterolateral thigh. The amount of drainage from donor site for the iliac bone flap was 50-70 ml[(62.7±7.5) ml in average] after surgery. Incisions at the donor sites of iliac bone flap healed in stage I. Postoperative follow-up lasted between 3 months and 3 years. There was no incision hernia and other complication in the donor sites of the iliac bone flap. There was a significant difference in Harris scores between at 9, 12 and 18 months after surgery and that before the surgery, respectively( P<0.05). After 18 months, Harris score were at a better level. Conclusion:The "retrograde anatomical method" can quickly determine the nutrient vessels of an iliac bone flap with deep circumflex iliac vessels. The surgical procedure is relatively simple with safe and reliable anatomy. Donor site damage and postoperative complications are greatly minimised. This surgical technique can be considered to be applied clinically.

Objective:To explore the feasibility and clinical effect of modified tibial transverse transport (TTT) technique in treatment of severe diabetic foot.Methods:The research was carried out from November 2015 to November 2017 at the Department of Hand Microsurgery, Xiangya Hospital of Central South University. Red latex was used to perfuse 10 adult lower limb specimens through femoral artery. The study observed the occurrence rate of osteofascial cutaneous branches from the inner and posterior edge of tibia within 6.0 to 10.0 cm distal from the tibial tubercle, as well as the number, distribution, outer diameter and other indicators of the perforating cutaneous branches and periosteal branches. Combined with findings in the anatomical observation, a chimeric flap with a vessel of posterior medial tibial osteofascial cutaneous branch was designed to improve TTT in the treatment of diabetic foot. From February 2016 to November 2018, 12 patients with Wagner’s Grades Ⅲ and Ⅳ diabetic feet were treated. All the patients were treated with a modified TTT, with a piece of designed tibial bone flap at 10.0 cm × 2.5 cm in size. After surgery, 5 patients with gangrenous toes received various toe stump reconstruction surgery for removal of the external fixator for bone transport. Two patients had arch stone flap reconstructions for the wounds of heel and sole, 3 patients had the wounds self-healed, and 2 patients with Wagner’s Grade IV diabetic feet had proximal calf amputations. Postoperative follow-ups were run through visits of outpatient clinic, and meanwhile the preliminary effects of the surgical procedure were observed and summarised.Results:Among the 10 specimens, it was found that a total of 11 osteofascial cutaneous branches(2 branches in 1 case and 1 branch in 9 cases) branched out from the posterior edge of tibia within 6-10 cm distal to the tibial tubercle. The distance to the tibial tubercle was 9.23 cm± 0.62 cm, with an outer diameter at 1.10 mm ± 0.10 mm. After penetrating the deep fascia, the osteofascial cutaneous branch further branched out a skin branch with an outer diameter of 0.59 mm± 0.09 mm, and delivered blood supply to the medial skin of calf. Meanwhile, it also branched out a periosteal branch with an outer diameter of 0.85 mm ± 0.10 mm, and supplied blood to the medial periosteum of tibia. All surgery went smoothly. A significant increase of temperature in foot skin and a significant decrease in postoperative Visual Analogue Scale(VAS) score were found in comparison with what before the surgery( P<0.05). The follow-up time of 12 patients was 24-36(29.33 months ± 4.36 months). After surgery, the symptoms of pain and numbness in the affected limbs were significantly improved or even disappeared and the wounds in foot were completely healed in 10 patients. The wounds of TTT in the calf were all healed in stage-I. The segments of tibial bone transport were all completely healed with healing time of 6.17 months ± 0.83 months. The wounds of the 2 amputees healed well. Conclusion:Modified TTT bone graft can effectively promote wound healing and reduce complications by covering the wound with a posterior tibial medial fascia flap in the treatment of severe diabetic foot. Further studies are required to confirm the benefits to the patients from this modified surgical procedure.

Objective To review the clinical characteristics of urethral prolapse in female children and summarize our experience of treatment.Methods A retrospective analysis of the clinical characteristics of 102 patients with urethral prolapse from January 2007 to December 2017 was conducted at The Children's Hospital of Zhejiang University School of Medicine.The age of the patients ranged from 8-156 months with an median of 80 months.The presenting symptoms in the 102 girls were:bleeding in 57 patients (55.9％),mass in 31 patients (30.4％),and dysuria/urinary frequency,urgent and pain in 14 patients (13.4％).In all,58 patients were managed conservatively with Sitz baths as their masses were small,39 underwent prolapse reduction under topical anesthesia and Sitz baths because their mass were large,and 5 patients were treated by excision of the prolapsed urethral mucosa with four-quadrant excisional technique because thrombosed urethral prolapse at first visit.Results A total of 89 patients were cured after conservative treatment (87.3％),8 patients were converted to surgical treatment because frequent recurrence with conservative treatment.No urethral stricture,active hemorrhage and recurrent were found in 13 patients after operation.Conclusions The most common clinical manifestations of urethral prolapse are urethral mass and bleeding.Most patients can be cured by conservative treatment.The patients whose symptoms were severe or suffered from frequent recurrence of urethral prolapse should be managed with surgical excision.

With the rapid development of modern biotechnology, fermentation process is increasingly important in industrial production. To guarantee the stability of products, fermentation process should be elaborately monitored and controlled. Biomass is an important parameter for on-line monitoring in bioprocesses because biomass can reflect cell growth in a bioreactor directly. In-situ microscope, a non-invasive and image-analysis based technology, can real-time monitor cells in biological process. This review summarizes the development and application of in-situ microscopy in biomass monitoring.
Biomass ; Bioreactors ; Biotechnology ; Fermentation ; Microscopy

OBJECTIVE: To evaluate the application of femtosecond laser technology in the management of subluxated lens. METHODS: We retrospectively analyzed the data of the patients with subluxated lens undergoing femtosecond laser- assisted surgery at the Cataract Center of Guangzhou Aier Eye Hospital between March, 2017 and May, 2019. The LenSx femtosecond laser-assisted cataract surgery system was used to perform capsulotomy and lens fragmentation. According to the patients' eye condition, anterior vitrectomy was performed and capsular retractors was used. After phacoemulsification, I/A and insertion of the tension rings, the intraocular lens (IOL) was implanted into the capsular bag. The perioperative data, complications, visual acuity and intraocular pressure after the operation were recorded, and the stability of the capsular bag and IOLs were assessed. RESULTS: We analyzed the data of 25 cases (29 eyes) of subluxated lens, including 16 (16 eyes; 55.17%) as the result of traumatic lens subluxation, 5 (9 eyes; 31.03%) of Mafan syndromes, 1 case (1 eye; 3.45%) of high myopia and 3 cases (3 eyes; 10.34%) of unknown causes. Thirteen 13 eyes (44.83%) showed mild subluxation, 7 (24.14%) had moderate subluxation, and 9 (31.03%) had severe subluxation. Femtosecond laser- assisted capsulorhexis, lens fragmentation and phacoemulsification were successfully completed for 29 eyes, of which 28 eyes (96.55%) retained the complete capsular bag and with successful implantation of the capsular tension devices and IOLs. Nine eyes (31.03%) were treated with anterior segment vitrectomy; iris hooks were used for 2 eyes (6.90%) and capsular bag hooks for 9 eyes (31.03%). The best corrected visual acuity was significantly improved in 29 eyes after operation ( < 0.05). At 1 month after the surgery, 26 eyes (89.66%) showed stably centered IOLs, 2 eyes (6.90%) showed slight tilt of the IOLs, and 3 eyes (10.34%) had anterior capsular contraction. The intraoperative complications included subconjunctival hemorrhage (75.87%), incomplete capsulotomy (17.24%) and contracted pupils (13.79%). CONCLUSIONS The application of femtosecond laser assisted technology enhances the surgical safety and effectiveness for subluxated lens, facilitates the choice of individualized surgical options, and promotes maximum recovery of the patients' visual function.
Humans ; Laser Therapy ; Lens Implantation, Intraocular ; Lens Subluxation ; surgery ; Lenses, Intraocular ; Phacoemulsification ; Retrospective Studies

Objective: To identify the pathophysiological characteristics of cortical stroke survivors′ swallowing. Methods: Sixty cortical stroke survivors with dysphagia and cognitive impairment were enrolled into the observation group, while another 16 with dysphagia but without cognitive impairment formed the unimpaired control group and 16 healthy counterparts were selected for a normal control group. Each subject was recorded videofluoroscopically while swallowing 5ml of a liquid of medium consistency. The occurrence of refusing to eat, mouth opening difficulty, incomplete oral closure, residue in the oral cavity, residue in the pharyngeal cavity, leakage and aspiration were observed. Each subject′s swallowing time and kinematic parameters were analyzed from the fluoroscopic videos. Results: The incidence of refusing to eat (37.5%) and/or incomplete mouth closure (68.75%) were significantly higher in the observation group than in the other two groups. The incidence of difficulty in opening the mouth (37.5%), residue in the oral cavity (81.25%), residue in the pharyngeal cavity (56.25%), leakage (56.25%) and aspiration (50%) of the observation group were significantly higher in the observation group than among the normal controls, but were not significantly different from those incidences among the group without cognitive impairment. The average oral transit time and soft palate elevation time of the observation group were significantly longer than those of the other two groups. The observation group′s average hyoid movement time was significantly longer than that of the normal control group, but not significantly different from that of the group without cognitive impairment. There were no significant differences among the groups in average upper esophageal sphincter opening time, larynx closure time or the kinematic parameters. Conclusions Stroke survivors with dysphagia and cognitive impairment present dysphagia characteristic of oral phase swallowing difficulties.