Objective:To explore the clinical characteristics and treatment methods of middle ear cholesteatoma with intracranial and extracranial complications as the first diagnosis. Methods:A total of 244 patients were initially diagnosed with intracranial and/or extracranial complications associated with middle ear cholesteatoma at the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2022, and medical records were collected and retrospectively analyzed. Results:Among 244 patients with intracranial and extracranial complications of middle ear cholesteatoma, 203 cases had one complication, 34 cases had 2 complications, and 7 cases had 3 or more complications. One hundred and eighty-six cases presented labyrinthitis, 41 cases had peripheral facial paralysis, 27 cases had periauricular abscess, 12 cases had meningitis, 10 cases had brain abscess, 7 cases had sigmoid sinus lesions, 6 cases had epidural abscess, and 4 cases demonstrated hydrocephalus. Conclusion:The destructive nature of middle ear cholesteatoma can lead to intracranial and extracranial complications. The incidence rate of extracranial complications is highest for labyrinthitis. Patients with otitis media who complained dizziness should raise clinical suspicion for potential labyrinthitis. The second most prevalent extracranial complication is peripheral facial paralysis, and early facial nerve decompression surgery is critical for better recovery of facial paralysis symptoms. Brain abscess is the most common intracranial complications, which has the highest fatality rate. Clinicians should be alert to otogenic brain abscess. Otolaryngology and neurosurgery teams should cooperate and evaluate patients' middle ear lesions and brain abscess, and jointly develop personalized treatment plans.
Humans ; Cholesteatoma, Middle Ear/surgery* ; Retrospective Studies ; Facial Paralysis/etiology* ; Brain Abscess/diagnosis* ; Male ; Female ; Otitis Media/complications* ; Meningitis/etiology* ; Labyrinthitis/etiology* ; Adult ; Middle Aged ; Young Adult

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To observe the clinical efficacy of Huangqi Danggui Compound Decoction(mainly composed of Astragali Radix,Angelicae Sinensis Radix,etc.)combined with Shi's Acupuncture Therapy in the treatment of postpartum low back pain due of qi and blood depletion type.Methods A total of 138 patients diagnosed with postpartum low back pain from March 2021 to February 2024 in the outpatient and inpatient departments of the Second Affiliated Hospital of Hebei University of Chinese Medicine were selected as the study subjects.The patients were randomly divided into an observation group and a control group using a random number table,with 69 cases in each group.The control group was treated with Ibuprofen Sustained-Release Capsules combined with Shi's Acupuncture Therapy,while the observation group was additionally treated with Astragalus and Angelica Compound Decoction on the basis of the control group's treatment.Both groups were treated for 4 weeks.After treatment,the clinical efficacy of the two groups was evaluated.The changes in Oswestry Disability Index(ODI)and Visual Analogue Scale(VAS)scores before and after treatment,as well as the SF-36 Quality of Life Scale scores,were observed.The changes in follicle-stimulating hormone(FSH),luteinizing hormone(LH),and estradiol(E2)levels were compared before and after treatment,and the safety and incidence of adverse reactions in the two groups were evaluated.Results(1)The total effective rate in the observation group was 92.75%(64/69),while it was 79.71%(55/69)in the control group.The efficacy of the observation group was superior to that of the control group,with a statistically significant difference(P＜0.05).(2)After treatment,the ODI and VAS scores of both groups were significantly improved(P＜0.05),and the observation group showed significantly better improvement in ODI and VAS scores compared to the control group,with a statistically significant difference(P＜0.05).(3)After treatment,the SF-36 Quality of Life Scale scores of both groups improved significantly(P＜0.05),and the observation group showed significantly better improvement in SF-36 scores compared to the control group,with a statistically significant difference(P＜0.05).(4)After treatment,the FSH,LH,and E2 levels in the observation group were significantly improved(P＜0.05),and the observation group showed significantly better improvement in FSH,LH,and E2 levels compared to the control group,with a statistically significant difference(P＜0.05).In the control group,the FSH,LH,and E2 levels improved slightly,but there was no statistically significant difference compared to before treatment(P＞0.05).(5)There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group(P＞0.05).Conclusion Huangqi Danggui Compound Decoction combined with Shi's Acupuncture Therapy in the treatment of postpartum low back pain due to qi and blood depletion can significantly alleviate pain symptoms,improve lumbar function,regulate sex hormone levels,and enhance the quality of life of patients,with significant efficacy and good safety.

Objective To compare the clinical effect of tympanoplasty with and without eustachian tube bal-loon dilatation(ETBD)in the treatment of adhesive otitis media(AOM).Methods A total of 43 patients with AOM and eustachian tube dysfunction(ETD)were retrospectively analyzed,and were divided into the experimental group(n=22)who underwent tympanoplasty combined with ETBD and the control group(n=21)who underwent tympanoplasty alone.The changes of average air conduction hearing thresholds,pure-tone air-bone gap(ABG)and eustachian tube score(ETS)were compared between the two groups before and after surgery at 6 months and 2 years.Results There were no significant differences between the experimental group and the control group in air conduction hearing thresholds,ABG and ETS before operation(P＞0.05).Comparison within both the two groups after operation:air conduction hearing thresholds and ABG in both groups were significantly reduced(P＜0.05),and ETS in the experimental group was significantly higher than that before surgery(P＜0.05).Comparison be-tween two groups after operation:there were no statistically significant differences in the air conduction hearing thresholds and ABG at 6 months after surgery(P＞0.05),while there was statistically significant difference in ETS(P＜0.05).At 2 years,there were statistically significant differences in the air conduction hearing thresholds,ABG and ETS between the two groups(P＜0.05)with the experimental group showing better outcomes.Conclusion Tympanoplasty can significantly improve the postoperative hearing of AOM.Tympanoplasty combined with ETBD not only effectively improves the eustachian tube function,but also shows better long-term follow-up hearing im-provement,making it an effective treatment for AOM patients.

Objectives:To investigate the effect of interferon-γ(IFN-γ)on the repair of dental pulp injury.Methods:hDPSCs were isolated and cultured,and the hDPSCs were divided into control group,0.05 ng/mL IFN-γ group,0.5 ng/mL IFN-γ group,5 ng/mL IFN-γ group and 0.5 ng/mL IFN-γ+PDTC group.Transwell was used to detect the effect of IFN-γ on the migration abil-ity of human dental pulp stem cells,alizarin red staining was used to evaluated the influence of IFN-γ on the osteogenic differentia-tion of hDPSCs,and the expression of protein related to Wnt/β-catenin signaling pathway in cells was detected by Western blot.The rat dental pulp mechanical injury model was established,and the 3D cultured hDPSCs cell mass and hDPSCs cell mass with 0.5 ng/mL IFN-γ were placed in the cavity of the established rat dental pulp injury model.The cavity was filled with glass ionomer,and HE staining was used to compare the repair of dental pulp tissue in each group of rats.Results:The number of migrating cells in dif-ferent concentrations of IFN-γ groups was significantly higher than that in the control group,and the difference was statistically signif-icant(P＜0.05),and the number of migrated cells in the 0.5 ng/mL IFN-γ group was more than that in the 0.05 ng/mL IFN-γgroup and the 5 ng/mL IFN-γ group(P＜0.05).Compared with the control group,the mineralized nodules and osteoblastic differ entiation of hDPSCs in different concentrations IFN-γgroups were significantly inhibited(P＜0.05).Compared with the 0.5 ng/mL IFN-γ group,the mineralized nodule formation and osteogenic differentiation of hDPSCs in the 0.5 ng/mL IFN-γ+PDTC group were enhanced(P＜0.05).Compared with the control group,the ALP activity of IFN-γ group and IFN-γ+PDTC group was significantly lower(P＜0.05),and the ALP activity of IFN-γ+PDTC group was higher than that of IFN-γgroup,and the difference between groups was statistically significant(P＜0.05).Compared with the control group,the protein ex-pression levels of Wnt1,β-catenin,RUNX2,CyclinD1 and OCN in the IFN-γ group and IFN-γ+PDTC group were significantly decreased,while the GSK-3β and p-GSK-3β had increased,and the difference between the groups was statistically significant(P＜0.05),the protein expressions of Wnt1,β-catenin,RUNX2,CyclinD1 and OCN in the IFN-γ+PDTC group were significantly higher than those in the IFN-γ group,while the protein expression levels of p-GSK-3β and GSK-3β were lower than those in the IFN-γ group,and the differences between the groups were statistically significant(P＜0.05).Compared with the control group,the inflammatory response in the dental pulp mechanical injury model of the IFN-γ group was aggravated,and the dentin formation was significantly inhibited.Conclusion:IFN-γ can promote the migration of hDPSCs and inhibit the osteogenic differentiation of hDP-SCs,and IFN-γ has an inhibitory effect on the formation of restorative dentin after pulp injury,which may be related to the expres-sion regulation of Wnt signaling pathway.

AIM:To study the improvement effect and possible mechanism of Shufeng Jiedu capsules(SFJDC)on viral pneumonia.METHODS:Forty-eight BALB/c mice were used to establish a viral pneumo-nia model by intranasal administration of influenza A virus H1N1.They were randomly divided into 4 groups,with twelve mice in each group.Except for the Model group,the treatment group was given oseltamivir(OSTW),low and high dose groups of Shufeng Jiedu capsules(SFJDC-L,SFJD-H)by gavage,take another 12 mice as the normal group,continu-ously administered for 7 days.The physical signs of each group of mice were observed during the ad-ministration process,and the daily body weight change rate and disease activity index was calculat-ed;After administration,lung,intestinal tissue,and intestinal contents were taken,and the pathological changes in mouse lung tissue were detected using hematoxylin eosin(HE)staining method,Alisin blue staining was used to detect goblet cells in the intes-tinal wall;RT-qPCR method for detecting viral load influenza(infA)and the expression of tumor necro-sis factor-a(TNF-α)and interleukin-6(IL-6)mRNA in mouse lung tissue;Detection of mouse gut mi-crobiota using 16S rRNA high-throughput sequenc-ing;ELISA method for detecting lipopolysaccharide(LPS),TNF-α and IL-6 level in mouse serum;The ex-pression of cyclic GMP AMP synthase(cGAS),inter-feron gene stimulating protein(STING),phospho-STING(p-STING),nuclear factor-κB(NF-κB)phos-pho-nuclear factor-κB(p-NF-κB)in lung tissue and ZO-1,Occludin in small small intestine was detected by Western Blotting.RESULTS:Compared with the model group,the lung index and viral load of mice in the Shufeng Jiedu capsules group were signifi-cantly reduced(P＜0.01);significant reduction in lung tissue inflammation accompanied by TNF-α;The expression level of IL-6 mRNA decreased(P＜0.01);The abundance of Firmicutes and Lachnospi-raceae in the intestine significantly increased(P＜0.01),while the abundance of Bacteroidetes and Bacteroidaceae communities significantly de-creased(P＜0.05 or 0.01);The number of goblet cells in the small intestine epithelium significantly increased(P＜0.01);the levels of serum LPS and TNF-α,IL-6 were significantly reduced(P＜0.01);The protein expression level of cGAS,p-STING,p-NF-κB significantly decreased in lung tissue(P＜0.05 or 0.01),ZO-1,Occludin significantly decreased in small intestine(P＜0.05).CONCLUSION:Shufeng Jie-du capsules reduces the inflammatory response of mice lung tissue,and its mechanism may be relat-ed to its regulation of intestinal flora,protection of intestinal mucosal barrier,and reduction the activa-tion of cGAS/STING/NF-κB signaling pathway ac-tived by LPS leakaging from the intestine.

AIM:To study the improvement effect and possible mechanism of Shufeng Jiedu capsules(SFJDC)on viral pneumonia.METHODS:Forty-eight BALB/c mice were used to establish a viral pneumo-nia model by intranasal administration of influenza A virus H1N1.They were randomly divided into 4 groups,with twelve mice in each group.Except for the Model group,the treatment group was given oseltamivir(OSTW),low and high dose groups of Shufeng Jiedu capsules(SFJDC-L,SFJD-H)by gavage,take another 12 mice as the normal group,continu-ously administered for 7 days.The physical signs of each group of mice were observed during the ad-ministration process,and the daily body weight change rate and disease activity index was calculat-ed;After administration,lung,intestinal tissue,and intestinal contents were taken,and the pathological changes in mouse lung tissue were detected using hematoxylin eosin(HE)staining method,Alisin blue staining was used to detect goblet cells in the intes-tinal wall;RT-qPCR method for detecting viral load influenza(infA)and the expression of tumor necro-sis factor-a(TNF-α)and interleukin-6(IL-6)mRNA in mouse lung tissue;Detection of mouse gut mi-crobiota using 16S rRNA high-throughput sequenc-ing;ELISA method for detecting lipopolysaccharide(LPS),TNF-α and IL-6 level in mouse serum;The ex-pression of cyclic GMP AMP synthase(cGAS),inter-feron gene stimulating protein(STING),phospho-STING(p-STING),nuclear factor-κB(NF-κB)phos-pho-nuclear factor-κB(p-NF-κB)in lung tissue and ZO-1,Occludin in small small intestine was detected by Western Blotting.RESULTS:Compared with the model group,the lung index and viral load of mice in the Shufeng Jiedu capsules group were signifi-cantly reduced(P＜0.01);significant reduction in lung tissue inflammation accompanied by TNF-α;The expression level of IL-6 mRNA decreased(P＜0.01);The abundance of Firmicutes and Lachnospi-raceae in the intestine significantly increased(P＜0.01),while the abundance of Bacteroidetes and Bacteroidaceae communities significantly de-creased(P＜0.05 or 0.01);The number of goblet cells in the small intestine epithelium significantly increased(P＜0.01);the levels of serum LPS and TNF-α,IL-6 were significantly reduced(P＜0.01);The protein expression level of cGAS,p-STING,p-NF-κB significantly decreased in lung tissue(P＜0.05 or 0.01),ZO-1,Occludin significantly decreased in small intestine(P＜0.05).CONCLUSION:Shufeng Jie-du capsules reduces the inflammatory response of mice lung tissue,and its mechanism may be relat-ed to its regulation of intestinal flora,protection of intestinal mucosal barrier,and reduction the activa-tion of cGAS/STING/NF-κB signaling pathway ac-tived by LPS leakaging from the intestine.

Objective To compare the clinical effect of tympanoplasty with and without eustachian tube bal-loon dilatation(ETBD)in the treatment of adhesive otitis media(AOM).Methods A total of 43 patients with AOM and eustachian tube dysfunction(ETD)were retrospectively analyzed,and were divided into the experimental group(n=22)who underwent tympanoplasty combined with ETBD and the control group(n=21)who underwent tympanoplasty alone.The changes of average air conduction hearing thresholds,pure-tone air-bone gap(ABG)and eustachian tube score(ETS)were compared between the two groups before and after surgery at 6 months and 2 years.Results There were no significant differences between the experimental group and the control group in air conduction hearing thresholds,ABG and ETS before operation(P＞0.05).Comparison within both the two groups after operation:air conduction hearing thresholds and ABG in both groups were significantly reduced(P＜0.05),and ETS in the experimental group was significantly higher than that before surgery(P＜0.05).Comparison be-tween two groups after operation:there were no statistically significant differences in the air conduction hearing thresholds and ABG at 6 months after surgery(P＞0.05),while there was statistically significant difference in ETS(P＜0.05).At 2 years,there were statistically significant differences in the air conduction hearing thresholds,ABG and ETS between the two groups(P＜0.05)with the experimental group showing better outcomes.Conclusion Tympanoplasty can significantly improve the postoperative hearing of AOM.Tympanoplasty combined with ETBD not only effectively improves the eustachian tube function,but also shows better long-term follow-up hearing im-provement,making it an effective treatment for AOM patients.

Objectives:To investigate the effect of interferon-γ(IFN-γ)on the repair of dental pulp injury.Methods:hDPSCs were isolated and cultured,and the hDPSCs were divided into control group,0.05 ng/mL IFN-γ group,0.5 ng/mL IFN-γ group,5 ng/mL IFN-γ group and 0.5 ng/mL IFN-γ+PDTC group.Transwell was used to detect the effect of IFN-γ on the migration abil-ity of human dental pulp stem cells,alizarin red staining was used to evaluated the influence of IFN-γ on the osteogenic differentia-tion of hDPSCs,and the expression of protein related to Wnt/β-catenin signaling pathway in cells was detected by Western blot.The rat dental pulp mechanical injury model was established,and the 3D cultured hDPSCs cell mass and hDPSCs cell mass with 0.5 ng/mL IFN-γ were placed in the cavity of the established rat dental pulp injury model.The cavity was filled with glass ionomer,and HE staining was used to compare the repair of dental pulp tissue in each group of rats.Results:The number of migrating cells in dif-ferent concentrations of IFN-γ groups was significantly higher than that in the control group,and the difference was statistically signif-icant(P＜0.05),and the number of migrated cells in the 0.5 ng/mL IFN-γ group was more than that in the 0.05 ng/mL IFN-γgroup and the 5 ng/mL IFN-γ group(P＜0.05).Compared with the control group,the mineralized nodules and osteoblastic differ entiation of hDPSCs in different concentrations IFN-γgroups were significantly inhibited(P＜0.05).Compared with the 0.5 ng/mL IFN-γ group,the mineralized nodule formation and osteogenic differentiation of hDPSCs in the 0.5 ng/mL IFN-γ+PDTC group were enhanced(P＜0.05).Compared with the control group,the ALP activity of IFN-γ group and IFN-γ+PDTC group was significantly lower(P＜0.05),and the ALP activity of IFN-γ+PDTC group was higher than that of IFN-γgroup,and the difference between groups was statistically significant(P＜0.05).Compared with the control group,the protein ex-pression levels of Wnt1,β-catenin,RUNX2,CyclinD1 and OCN in the IFN-γ group and IFN-γ+PDTC group were significantly decreased,while the GSK-3β and p-GSK-3β had increased,and the difference between the groups was statistically significant(P＜0.05),the protein expressions of Wnt1,β-catenin,RUNX2,CyclinD1 and OCN in the IFN-γ+PDTC group were significantly higher than those in the IFN-γ group,while the protein expression levels of p-GSK-3β and GSK-3β were lower than those in the IFN-γ group,and the differences between the groups were statistically significant(P＜0.05).Compared with the control group,the inflammatory response in the dental pulp mechanical injury model of the IFN-γ group was aggravated,and the dentin formation was significantly inhibited.Conclusion:IFN-γ can promote the migration of hDPSCs and inhibit the osteogenic differentiation of hDP-SCs,and IFN-γ has an inhibitory effect on the formation of restorative dentin after pulp injury,which may be related to the expres-sion regulation of Wnt signaling pathway.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.