Subclinical ptosis is a common congenital abnormality of bilateral upper eyelid development; the clinical manifestations are upper eyelid skin covering the upper corneal margin of more than 2 mm, upper eyelid bloat, narrow lid fissure, often accompanied by epicanthus and eyebrow elevation when the eyes are opened. Patients often present with a single eyelid, which can be easily missed and misdiagnosed. The cause of subclinical ptosis is an increase in the afterload of the levator muscle during contraction due to a variety of reasons, such as gravitational, volumetric, and tensile loads; the clinical manifestations and the normalisation of the levator muscle strength are the main basis for diagnosis and identification of true ptosis. Depending on the type of afterload, different surgical treatments are available, such as blepharoplasty, orbicularis oculi myotomy, upper eyelid tissue reduction, fibrous mesh band release, anterior displacement of the levator complex, and shortening of the levator complex.

Subclinical ptosis is a common congenital abnormality of bilateral upper eyelid development; the clinical manifestations are upper eyelid skin covering the upper corneal margin of more than 2 mm, upper eyelid bloat, narrow lid fissure, often accompanied by epicanthus and eyebrow elevation when the eyes are opened. Patients often present with a single eyelid, which can be easily missed and misdiagnosed. The cause of subclinical ptosis is an increase in the afterload of the levator muscle during contraction due to a variety of reasons, such as gravitational, volumetric, and tensile loads; the clinical manifestations and the normalisation of the levator muscle strength are the main basis for diagnosis and identification of true ptosis. Depending on the type of afterload, different surgical treatments are available, such as blepharoplasty, orbicularis oculi myotomy, upper eyelid tissue reduction, fibrous mesh band release, anterior displacement of the levator complex, and shortening of the levator complex.

Objective:To evaluate the application value of amplicon sequencing in identification of drug-contami-nating microbes in Chinese patent drugs.Methods:Both culturing method and Amplicon Sequencing technology were used to identify bacteria and fungi in 16 batches of Chinese patent drugs.The microbial colonies isolated by culturing medium were identified by 16srDNA/ITS sequencing and MALID-TOF-MS.The amplicon sequencing reads were clustered to OTU(Operational Taxonomic Units)by 97％similarity and BLAST in NCBI to get species taxonomy.Alpha and beta diversity index were used to analyze the microbial community composition in and between batches of drugs.Results:Fifteen species of bacteria and 3 species of fungi were isolated by culturing method,while 75 species of bacteria and 78 species of fungi were identified by amplicon sequencing.Between pre-cultured and non-cultured drug groups,the α diversity index and abundance of most dominant microbial genus were not changed significantly(P＞0.05).Beta diversity analysis showed that microbial diversity between different drugs are more than the same drugs between different pre-treated groups.Conclusion:This study revealed that amplicon sequencing method can provide more comprehensive information on the microbial community composition than tradi-tional culture method.It contributes great value to quick inspection and monitor for microbial contamination in chines patent drugs.

Objective:To evaluate the application value of amplicon sequencing in identification of drug-contami-nating microbes in Chinese patent drugs.Methods:Both culturing method and Amplicon Sequencing technology were used to identify bacteria and fungi in 16 batches of Chinese patent drugs.The microbial colonies isolated by culturing medium were identified by 16srDNA/ITS sequencing and MALID-TOF-MS.The amplicon sequencing reads were clustered to OTU(Operational Taxonomic Units)by 97％similarity and BLAST in NCBI to get species taxonomy.Alpha and beta diversity index were used to analyze the microbial community composition in and between batches of drugs.Results:Fifteen species of bacteria and 3 species of fungi were isolated by culturing method,while 75 species of bacteria and 78 species of fungi were identified by amplicon sequencing.Between pre-cultured and non-cultured drug groups,the α diversity index and abundance of most dominant microbial genus were not changed significantly(P＞0.05).Beta diversity analysis showed that microbial diversity between different drugs are more than the same drugs between different pre-treated groups.Conclusion:This study revealed that amplicon sequencing method can provide more comprehensive information on the microbial community composition than tradi-tional culture method.It contributes great value to quick inspection and monitor for microbial contamination in chines patent drugs.

Objective:To investigate risk factors for decompressive craniectomy (DC) after endovascular therapy (EVT) in patients with acute anterior circulation ischemic stroke.Methods:Patients underwent EVT due to acute anterior circulation large vessel occlusion in Liaocheng Brain Hospital from January 2018 to January 2020 were retrospectively included. They were divided into DC group and non-DC group. Univariate and multivariate logistic regression analyses were used to determine risk factors for DC after EVT. Results:A total of 207 patients were enrolled, 126 were male (60.87%), and their age was 66.22±11.24 years old. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 19.84±9.20, and the Alberta Stroke Program Early CT Score (ASPECTS) was 7.98±0.66. The immediate postoperative modified Treatment In Cerebral Ischemia (mTICI) blood flow grade in seven patients (5.80%) was ≤2a, 30 (14.49%) experienced hemorrhagic transformation (HT) after procedure, and 28 (13.5%) received DC. There were statistically significant differences between the DC group and the non-DC group in terms of past stroke history, preoperative NIHSS score and ASPECTS, vascular occlusion site, EVT time, immediate postoperative mTICI ≤2a, and HT (all P<0.05). Multivariate logistic regression analysis showed that atrial fibrillation (odds ratio [ OR] 3.202, 95% confidence interval [ CI] 1.335-9.796; P=0.011), previous stroke history ( OR 2.655, 95% CI 1.016-6.938; P=0.046), high preoperative NIHSS score ( OR 1.074, 95% CI 1.026-1.124; P=0.002), internal carotid artery occlusion ( OR 4.268, 95% CI 1.399-13.024; P=0.011), longer EVT time ( OR 1.010, 95% CI 1.003-1.016; P=0.003), mTICI grade ≤2a ( OR 5.342, 95% CI 1.565-18.227; P=0.007) and postoperative HT ( OR 3.036, 95% CI 1.024-9.004; P=0.045) were independent risk factors for DC. Conclusions:It is not uncommon for patients with acute anterior circulation ischemic stroke to need DC after EVT. Previous stroke history, atrial fibrillation, high baseline NIHSS score, internal carotid artery occlusion, prolonged blood EVT time, mTICI grade ≤2a and postoperative HT are independent predictors of needing DC after EVT.

Objective:To investigate the clinical manifestation and management strategy of intraparotid facial nerve schwannoma.Methods:The clinical data of 12 patients with parotid schwannoma treated in Henan Cancer Hospital from January 2009 to January 2019 were analyzed retrospectively, including 5 males and 7 females, aged from 23 to 72 years. All the 12 patients complained of a mass in the parotid region, of whom 4 patients had local discomfort and pain, and 6 patients had varying degrees of pain during palpation. Ultrasound examination showed solid mass in parotid region in 8 cases and mixed mass in 4 cases. The treatment methods, the relationship between tumor and facial nerve, the modes of treatments and the nerve functions before and after operation were analyzed and summarized with House-Brackmann grade.Results:All 12 patients received surgical treatment: 8 patients underwent tumor resection plus partial or total superficial parotidectomy, 1 patient underwent tumor resection and total parotidectomy, and 3 patients underwent tumor resection, with 1 patient in whom tumor could not be removed completely due to tumor extention to the skull base. In 9 cases, the tumor occurred in the trunk or main branch of the facial nerve, and there was no facial nerve injury occurred after surgery; in 1 case, the tumor occurred in the terminal branch of the facial nerve, and part of the severe small branches of adhesion were cut off during the operation; in 1 case, the total trunk of the facial nerve was not found and the broken end of the nerve could not be found during the operation, so the nerve transplantation was not performed. In 1 case, nerve grafting was performed after nerve transection because it was impossible to separate the trunk of the facial nerve from the tumor during the operation. Preoperatively, House-Brackmann grade (H-B)Ⅰfacial nerve function was shown in 10 patients, H-BⅡ in 1 patient and H-B Ⅴin 1 patient. Postoperatively, the facial nerve function recovered to H-B Ⅰfor 7 patients, H-B Ⅱfor 2 patients, H-B Ⅲ for 1 patient, grade Ⅳ for 1 patient with nerve transplantation, and H-B Ⅴfor 1 patient with a revised surgery due to tumor recurrence.Conclusions:The intraparotid facial nerve schwannoma is rare, and it is easy to be misdiagnosed before operation. Surgery is a main treatment for intraparotid facial nerve schwannoma. Attention should be paid to the protection of facial nerve during operation.

Objective To study the clinical diagnosis and preoperative management of carotid body tumor.Methods A total of 24 cases with carotid body tumors underwent surgery from 2003 to 2013 were reviewed.The clinical and imaging features,treatment and prognosis were retrospectively evaluated.Five of the 24 patients were males and 19 were females.Twenty-three cases were benign and one case was malignant.Seven of the 24 patients had bilateral tumors.Results Nineteen of twenty-four patients underwent digital subtraction angiography (DSA) and temporary balloon occlusion (TBO) test,and one case of them was positive in the test.Twenty-three benign case were treated with operation.The malignant one treat with biopsy.Three cases underwent resection of tumors with both the internal and external carotid arteries without carotid reconstruction,and none of the three patients died or presented with hemiplegia after operation.Twenty-three benign cases were followed up for 6-122 months,the median was 75 months.The malignant patient died 6 months after operation.Conclusion TBO and DSA are reliable and practical methods to determine the safety of carotid ligation and can be used as routine preoperative examinations.