Objective:To investigate the clinical features, imaging characteristics, surgical strategies, and therapeutic outcomes of otitis media complicated with inflammatory response of local meninges.Methods:A retrospective analysis was conducted on the clinical data of 8 patients with chronic suppurative otitis media complicated with inflammatory response of local meninges, treated by the Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital from 2019 to 2023. Appropriate surgical strategies were selected based on the patient′s clinical manifestations, imaging characteristics, extent of lesions, and facial nerve function. Follow-up was performed postoperatively to assess the therapeutic outcomes.Results:Among the eight patients, there were six males and two females, with an average age of (55.9±12.6) years old. The primary clinical manifestations included otorrhea, hearing loss, facial paralysis, earache, headache, and fever. All patients had a history of chronic suppurative otitis media and tympanic membrane perforation, with varying degrees and types of hearing loss. Seven patients presented with peripheral facial palsy preoperatively, with the House-Brackmann (H-B) grading scale as follows: 4 cases (4/7) in grade Ⅳ, 1 case (1/7) in grade Ⅴ, and 2 cases (2/7) in grade Ⅵ. The mean duration of otorrhea and/or hearing loss was (24.68±12.18) years, while, the average duration of severe headache, aggravated otorrhea and facial paralysis was (2.73±3.92) months. Preoperative high-resolution CT scan of the temporal bone revealed soft tissue shadow in the middle ear and mastoid process, with partial defects in the mastoid cortex. Cranial MRI T1WI showed high signal in the meninges on the affected side, with contrast-enhanced MRI indicating localized meningeal thickening. Four patients (4/8) had diabetes mellitus, and 2 patients (2/8) had a history of middle ear/mastoid surgery. All patients underwent surgical treatment, including thorough removal of lesions, adequate drainage, and facial nerve decompression. Tympanoplasty and hearing reconstruction were performed when conditions permitted. Specifically, 5 patients underwent intact canal wall radical mastoidectomy with facial nerve decompression and tympanoplasty, 2 patients underwent canal wall down mastoidectomy with facial nerve exploration decompression, and 1 patient underwent modified radical mastoidectomy. Postoperatively, patients experienced significant relief and gradual disappearance of ear and head pain. The postoperative H-B grading scale of facial nerve function was as follows: 4 cases in grade Ⅰ (4/8, including 1 case without preoperatively facial palsy), 2 cases (2/8) in grade Ⅱ, and 2 cases (2/8) in grade Ⅲ. Postoperative cranial MRI showed a significant reduction in localized meningeal thickening on the affected side.Conclusions:Patients with long-term chronic suppurative otitis media and/or cholesteatoma who suddenly presented with headache, fever, aggravated otorrhea, and facial paralysis should be suspected of having inflammatory response of local meninges. High-resolution CT of temporal bone and cranial MRI provide crucial diagnostic information. Early surgical exploration and thorough lesion removal are effective treatment methods.

Objective: To analyze the risk factors of recurrence after transurethral resection of bladder tumor (TURBT) in patients with non-muscle-invasive bladder cancer (NMIBC)，and establish a risk prediction model，so as to optimize the clinical detection and management of NMIBC. Methods: A total of 174 patients with initial diagnosis of NMIBC who underwent TURBT in the First Affiliated Hospital of Xinjiang Medical University during Jan.2020 and Oct.2022 were followed up for 24 months，and were then divided into the recurrence group (n=74) and non-recurrence group (n=100).After univariate analysis and multivariate logistic regression，risk factors of recurrence were identified，a nomogram was established，and the calibration curve was plotted，which was verified with receiver operator characteristic (ROC) curve. Results: The 2-year recurrence rate was 42.53%.Logistic regression showed high body mass index (BMI)，poor differentiation，multiple tumors，and tumor diameter greater than 3 cm were risk factors of recurrence (P<0.05，OR≥1)，while immediate postoperative intravesical instillation was a protective factor (P<0.05).The C-index of the nomogram was 0.893 (95%CI:0.851-0.938)，the area of ROC curve (AUC) was 0.894 (95%CI：0.847-0.941)，the sensitivity was 82.4%，and the specificity was 83.0%. Conclusion: The prediction model based on BMI，tumor stage，grade，number，diameter，and immediate postoperative intravesical instillation fits well and can provide reference for predicting the risk of tumor recurrence.

Objective:To investigate the clinical features, imaging characteristics, surgical strategies, and therapeutic outcomes of otitis media complicated with inflammatory response of local meninges.Methods:A retrospective analysis was conducted on the clinical data of 8 patients with chronic suppurative otitis media complicated with inflammatory response of local meninges, treated by the Department of Otolaryngology, Head and Neck Surgery, PLA General Hospital from 2019 to 2023. Appropriate surgical strategies were selected based on the patient′s clinical manifestations, imaging characteristics, extent of lesions, and facial nerve function. Follow-up was performed postoperatively to assess the therapeutic outcomes.Results:Among the eight patients, there were six males and two females, with an average age of (55.9±12.6) years old. The primary clinical manifestations included otorrhea, hearing loss, facial paralysis, earache, headache, and fever. All patients had a history of chronic suppurative otitis media and tympanic membrane perforation, with varying degrees and types of hearing loss. Seven patients presented with peripheral facial palsy preoperatively, with the House-Brackmann (H-B) grading scale as follows: 4 cases (4/7) in grade Ⅳ, 1 case (1/7) in grade Ⅴ, and 2 cases (2/7) in grade Ⅵ. The mean duration of otorrhea and/or hearing loss was (24.68±12.18) years, while, the average duration of severe headache, aggravated otorrhea and facial paralysis was (2.73±3.92) months. Preoperative high-resolution CT scan of the temporal bone revealed soft tissue shadow in the middle ear and mastoid process, with partial defects in the mastoid cortex. Cranial MRI T1WI showed high signal in the meninges on the affected side, with contrast-enhanced MRI indicating localized meningeal thickening. Four patients (4/8) had diabetes mellitus, and 2 patients (2/8) had a history of middle ear/mastoid surgery. All patients underwent surgical treatment, including thorough removal of lesions, adequate drainage, and facial nerve decompression. Tympanoplasty and hearing reconstruction were performed when conditions permitted. Specifically, 5 patients underwent intact canal wall radical mastoidectomy with facial nerve decompression and tympanoplasty, 2 patients underwent canal wall down mastoidectomy with facial nerve exploration decompression, and 1 patient underwent modified radical mastoidectomy. Postoperatively, patients experienced significant relief and gradual disappearance of ear and head pain. The postoperative H-B grading scale of facial nerve function was as follows: 4 cases in grade Ⅰ (4/8, including 1 case without preoperatively facial palsy), 2 cases (2/8) in grade Ⅱ, and 2 cases (2/8) in grade Ⅲ. Postoperative cranial MRI showed a significant reduction in localized meningeal thickening on the affected side.Conclusions:Patients with long-term chronic suppurative otitis media and/or cholesteatoma who suddenly presented with headache, fever, aggravated otorrhea, and facial paralysis should be suspected of having inflammatory response of local meninges. High-resolution CT of temporal bone and cranial MRI provide crucial diagnostic information. Early surgical exploration and thorough lesion removal are effective treatment methods.

Humans ; Urinary Bladder Neoplasms/pathology* ; Carcinoma, Transitional Cell/pathology* ; Genetic Markers ; Biomarkers, Tumor/genetics* ; Urothelium/pathology*

Mild autonomous cortisol secretion (MACS) is a condition indicated by biochemical testing for autonomous cortisol secretion, yet it lacks the classical signs of Cushing's Syndrome, such as moon face, buffalo hump, plethoric appearance, and purple striae. It is predominantly observed in middle-aged women and is commonly associated with adrenal incidentalomas. Due to the lack of significant clinical signs, the diagnosis of MACS primarily relies on hormonal testing. Patients with MACS often present with comorbidities such as hypertension, diabetes, and osteoporosis. For those with comorbid conditions, surgical treatment is the principal therapeutic approach. This article summarizes recent national and international guidelines and research to elucidate the updates to the diagnostic criteria for MACS, with a particular focus on the interpretation of the 1 mg overnight dexamethasone suppression test results. It also details the treatment and follow-up strategies for MACS. Furthermore, the article highlights the urgent need for more extensive prospective studies to refine the existing diagnostic criteria and to develop surgical guidelines for a wider range of patients with MACS.

Objective:To investigate the effect of intravenous application of furosemide on occurrence of cardiac surgery-associated acute kidney injury (CSA-AKI) in patients after cardiac surgery.Methods:The electronic medical records of patients undergoing cardiac surgery in Linyi People′s Hospital from January 2014 to December 2022 were collected and retrospectively analyzed. According to whether CSA-AKI occurred after surgery, the patients were divided into AKI group and non-AKI group and the clinical characteristics between the 2 groups were compared. Multivariate logistic regression was used to analyze the influencing factors of CSA-AKI, and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. Results:A total of 2 633 patients were enrolled in the analysis, including 1 601 males (60.8%) and 1 032 females (39.2%). The age was (62.8±8.9) years, ranging from 18 to 85 years. Among the 2 633 patients, 491 (18.6%) developed CSA-AKI. Multivariate logistic regression analysis showed that after adjusting for factors such as the type of operation, intraoperative cardiopulmonary bypass, hypertension, diabetes mellitus, hypoalbuminemia, NYHA cardiac function class Ⅲ/Ⅳ, intraoperative/postoperative aortic balloon counterpulsation, preoperative serum creatinine level, operation duration, and the number of vasoactive drugs used after the operation, postoperative intravenous application of furosemide was still independently associated with the occurrence of CSA-AKI ( OR=2.161, 95 %CI: 1.720-2.715, P<0.001). Conclusions:The incidence of CSA-AKI in patients enrolled in this study was 18.6%. Intravenous use of furosemide after cardiac surgery can increase the risk of CSA-AKI.

Objective:To investigate the effect of intravenous application of furosemide on occurrence of cardiac surgery-associated acute kidney injury (CSA-AKI) in patients after cardiac surgery.Methods:The electronic medical records of patients undergoing cardiac surgery in Linyi People′s Hospital from January 2014 to December 2022 were collected and retrospectively analyzed. According to whether CSA-AKI occurred after surgery, the patients were divided into AKI group and non-AKI group and the clinical characteristics between the 2 groups were compared. Multivariate logistic regression was used to analyze the influencing factors of CSA-AKI, and the odds ratio ( OR) and its 95% confidence interval ( CI) were calculated. Results:A total of 2 633 patients were enrolled in the analysis, including 1 601 males (60.8%) and 1 032 females (39.2%). The age was (62.8±8.9) years, ranging from 18 to 85 years. Among the 2 633 patients, 491 (18.6%) developed CSA-AKI. Multivariate logistic regression analysis showed that after adjusting for factors such as the type of operation, intraoperative cardiopulmonary bypass, hypertension, diabetes mellitus, hypoalbuminemia, NYHA cardiac function class Ⅲ/Ⅳ, intraoperative/postoperative aortic balloon counterpulsation, preoperative serum creatinine level, operation duration, and the number of vasoactive drugs used after the operation, postoperative intravenous application of furosemide was still independently associated with the occurrence of CSA-AKI ( OR=2.161, 95 %CI: 1.720-2.715, P<0.001). Conclusions:The incidence of CSA-AKI in patients enrolled in this study was 18.6%. Intravenous use of furosemide after cardiac surgery can increase the risk of CSA-AKI.

Objective To analyze the transcription factor binding sites(TFBS)in the promoter region of E3 ubiquitin protein ligase 1(MIB1)gene in zebrafish,the types of MIB1 interacting genes and proteins and their roles in signaling pathways,and to investigate the regulatory mode and potential function of MIB1 gene.Methods Non-coding RNA(ncRNA)was predicted by National Genomics Data Center(NGDC).Alggen and AnimalTFDB online software were used to predict the TFBS types of MIB1 gene.GeneMANIA and STRING were used to analyze the interacting genes and proteins of MIB1.The related data were obtained through DA-VID website,and gene ontology(GO)visual analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)metabolic pathway analysis were performed.Results ncRNA could be transcribed from the promot-er region and 5'untranslated region of MIB1 gene.A total of 121 TFBS were obtained by prediction.P53 tran-scription factor could bind to the promoter region of MIB1 gene and interact with MIB1 protein.A total of 6 co-expressed genes of MIB1 were predicted online,and 20 interacting genes were screened.GO visual analysis showed that MIB1 and its interaction genes had functions in regulating the growth and differentiation of cells,tissues and organs and regulating the NOTCH signaling pathway in the biological process,and were mainly enriched in the cytoplasmic perinuclear region,cell membrane,postsynaptic dense area and so on.It had molec-ular functions such as binding NOTCH proteins and PDZ domain proteins.KEGG metabolic pathway analysis showed that MIB1 and its interacting genes were involved in 4 metabolic pathways.Conclusion MIB1 con-tains a variety of TFBS,and affects a variety of biological processes such as cell carcinogenesis and immune regulation by interacting with specific transcription factors.MIB1 may also play an important role in cell growth regulation,hematopoietic stem cell differentiation,embryonic development and neuronal information transmission through the mediation of its interacting genes and proteins.

Objective:To explore the basic rules of hemodynamics of the multi-territory flap in the early stage.Methods:In this paper, based on the prototype of the free flaps and vascularized pedicled transpositional flaps. The angiosome theory was applied as a basis to systematically analyze the blood flow pathway, the resistance network, and the series or parallel connection mode between each resistance network within the flap, according to the knowledge of fluid mechanics and current pathway, and finally the mathematical model was used for deduction.Results:Based on the model, it can be concluded that a dynamic flow balance can be achieved in the arteries and veins of the multi-territory flap in the early stage and the flap could be divided into four areas: the effective microcirculation zone, the venous stasis zone, the relative ischemic zone and the absolute ischemic zone. And the following inferences can be drawn: (1) The blood supply to the vascular pedicle is constant by pressure rather than by flow. (2) The resistance of the flap varies by the position or the relative position of the arterial vascular pedicle and venous vascular pedicle. (3) The flow velocity decrease gradually from the pedicle to the distal end. (4) The main factors that lead to distal flap necrosis vary depending on the region in which they are located: the venous stasis zone is mainly due to obstructed venous return, and the relative and absolute ischemic zones are mainly due to insufficient arterial blood supply.Conclusions:The basic rules and characteristics of hemodynamics of the multi-territory flap in the early stage can be well explained by this theoretical model, the pedicled artery and vein of the flap can achieve a dynamic balance of flow, and the blood flow gradually decreases from the pedicle to the distal end. The survival range of the flap depends on the pressure difference between the artery and vein as well as the resistance of the blood flow path in the flaps. The distal necrotic area of the flap can be divided into venous stasis area and arterial insufficiency area.

Objective:To explore the basic rules of hemodynamics of the multi-territory flap in the early stage.Methods:In this paper, based on the prototype of the free flaps and vascularized pedicled transpositional flaps. The angiosome theory was applied as a basis to systematically analyze the blood flow pathway, the resistance network, and the series or parallel connection mode between each resistance network within the flap, according to the knowledge of fluid mechanics and current pathway, and finally the mathematical model was used for deduction.Results:Based on the model, it can be concluded that a dynamic flow balance can be achieved in the arteries and veins of the multi-territory flap in the early stage and the flap could be divided into four areas: the effective microcirculation zone, the venous stasis zone, the relative ischemic zone and the absolute ischemic zone. And the following inferences can be drawn: (1) The blood supply to the vascular pedicle is constant by pressure rather than by flow. (2) The resistance of the flap varies by the position or the relative position of the arterial vascular pedicle and venous vascular pedicle. (3) The flow velocity decrease gradually from the pedicle to the distal end. (4) The main factors that lead to distal flap necrosis vary depending on the region in which they are located: the venous stasis zone is mainly due to obstructed venous return, and the relative and absolute ischemic zones are mainly due to insufficient arterial blood supply.Conclusions:The basic rules and characteristics of hemodynamics of the multi-territory flap in the early stage can be well explained by this theoretical model, the pedicled artery and vein of the flap can achieve a dynamic balance of flow, and the blood flow gradually decreases from the pedicle to the distal end. The survival range of the flap depends on the pressure difference between the artery and vein as well as the resistance of the blood flow path in the flaps. The distal necrotic area of the flap can be divided into venous stasis area and arterial insufficiency area.