Objective:To retrospectively analyze the clinical features and surgical efficacy of congenital cholesteatoma （CC） and acquired cholesteatoma （AC） in children. Methods:Clinical data of 169 children with middle ear cholesteatoma were reviewed in the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University from January 2010 to July 2020. The clinical characteristics, stages, surgical methods, and postoperative recurrence rates were analyzed and summarized. Results:The age distribution of enrolled children ranged from 2 to 14 years. The mean age of the CC group was （5.60±2.48） years compared with （6.45±2.48） years in the AC group, and the difference was statistically significant （P<0.05）. Preoperative hearing in the CC group was （40.06±13.52） dB HL, which was better than in the AC group at （48.40±13.84） dB HL （P<0.05）. The proportion of stage Ⅰ in the CC group was lower than that in the AC group according to EAONO/JOS staging （P<0.05）. The recurrence rate after primary surgery was 19.23% （10/52） in the CC group compared with 36.29% （45/124） in the AC group （P<0.05）. The mastoid retention rates after all operations were 28.85% （15/52） in the CC group and 5.65% （7/124） in the AC group （P<0.05）. Conclusion:Compared with congenital cholesteatoma, acquired cholesteatoma in children is more aggressive and has more complications, higher postoperative recurrence rate, and less possibility of mastoid retention. Early clinical detection and treatment are required, and canal wall-down tympanoplasty should be considered in surgery.
Humans ; Cholesteatoma, Middle Ear/congenital* ; Child ; Retrospective Studies ; Child, Preschool ; Adolescent ; Male ; Female ; Recurrence ; Cholesteatoma/congenital* ; Tympanoplasty ; Treatment Outcome

Objective　: To verify the feasibility of using a homemade lung phantom for quality control of Cyberknife by comparing the measurement results of the homemade lung phantom and CIRS dynamic phantom in E2E testing of Cyberknife lung tracking.  Methods　 : The patient treatment process was simulated, including CT positioning, plan design, irra- diation implementation, film scanning, and analysis using the homemade phantom and CIRS phantom. The two phantoms were measured five times using MLC under the S7 generation Cyberknife and five times using Iris under the M6 generation Cyberknife. The differences in measurement results between the two phantoms were analyzed using independent sample t-test. Results　: For the S7 generation Cyberknife, the statistical analysis of differences between the two phantoms in the detection values on the X-axis, Y-axis, Z-axis, and total deviation showed P values of 0.236, 0.175, 0.289, and 0.668, respect- ively. For the M6 generation Cyberknife, the statistical analysis showed P values of 0.880, 0.891, 0.573, and 0.433, respect- ively. The P values were all > 0.05. Therefore, there were no statistically significant differences in the detection results between the homemade lung phantom and the CIRS phantom under the S7 and M6 generation Cyberknife. The total deviation values were <1.5 mm. Conclusion　 The homemade lung phantom and CIRS phantom have consistent measurement results in the E2E testing of Cyberknife lung tracking and meet the requirements of Report of AAPM TG-135 and WS 667- 2019 standard. Therefore, the homemade lung phantom is feasible for clinical quality control of Cyberknife.

Objective To explore the feasibility of quartz glass for radiotherapy dosimetry through the experimental study of the thermoluminescence characteristics of synthetic quartz glass. Methods The thermoluminescence glow curves of quartz glass under different annealing conditions were analyzed, the thermoluminescence characteristics of quartz glass were studied, and the measurement parameters were optimized. Using the Co-60 reference radiation field in the National Secondary Standard Dosimetry Laboratory, the quartz glass samples under different annealing conditions were irradiated following the dose levels of radiotherapy, i.e., 0.5, 1.0, 2.0, 4.0, 6.0, 8.0, and 10.0 Gy, respectively. According to the relationship between the absorbed dose of quartz glass and the relative thermoluminescence signal intensity, the linearity and dispersion of the dose response of quartz glass were obtained, and the feasibility of quartz glass for radiotherapy dosimetry was analyzed. Results The linear correlation coefficient of dose response of quartz glass under annealing condition of 430℃ for 10 min was 0.9984, and the dose response dispersion was 0.97% at the absorbed dose of 2 Gy. The linear correlation coefficient of dose response of quartz glass under annealing condition of 600℃ for 1 h was 0.9911, and the dose response dispersion was 1.4% at the absorbed dose of 2 Gy. Conclusion Preliminary results suggest that quartz glass with annealing condition of 430℃ for 10 min has the potential to be used for radiotherapy dosimetry.

Objective:To evaluate the radiation shielding performance for a novel self-shielded ZAP-X radiotherapy system used for intra-cranial and neck treatments. The present evaluation was performed according to the relevant Chinese national standards and the clinical placement of the radiotherapy system in an unshielded treatment room.Methods:The radiation source of the ZAP-X was a 3 MV linear accelerator. A total of 33 detection sites were selected surrounding the self-shielded system at 1.3, 2.3 and 3.3 m away from the periphery of the equipment. The maximum ambient dose equivalent rate in each irradiation condition was measured accordingly. A commonly used clinical treatment plan was selected to simulate the treatment process. During the delivery of this treatment plan, the cumulative doses of these 33 sites were measured, separately. The applicable current radiation protection standard for radiotherapy in China was chosen to evaluate the radiation shielding performance of the system.Results:According to the measurement result of the ambient dose equivalent rates along the aforementioned perimeter lines, a suggestion was put forward to redefine the existing 1 m controlled area by determining the distance at which the instantaneous dose rate of 10 μSv/h will not be exceeded. This is to meet the requirements of the Chinese standard GBZ 121-2020.Conclusions:According to the existing Chinese national radiation protection standards, the self-shielded radiotherapy system in the unshielded treatment room has the clinical applicability in China. But for such a novel self-shielded system, the corresponding performance testing and radiation protection standards shall be formulated.

Objective:To investigate the emergency surgical effect of ruptured intracranial dural arteriovenous fistula (DAVF).Methods:Patients with ruptured intracranial DAVF underwent microsurgery in the Department of Neurosurgery, Nanping First Hospital Affiliated to Fujian Medical University from May 2013 to July 2022 were retrospectively included. The clinical, imaging and follow-up data were collected, and the clinical characteristics, selection of surgical methods and treatment effects of patients were summarized.Results:A total of 8 patients with DAVF were enrolled. Their age ranged from 11 to 60 years (average, 48 years). There were 7 males and 1 female. All 8 patients suffered from intracranial hemorrhage, manifested as headache and vomiting in 2 cases, simple conscious disturbance in 2 cases, conscious disturbance with cerebral hernia in 3 cases, and conscious disturbance with limb paralysis in 1 case. The fistula was located in the anterior fossa in 4 cases (including 2 cases with aneurysms), the middle fossa in 2 cases (including 1 case with moyamoya disease), the transverse sinus in 1 case, and the anterior 1/3 area of the sagittal sinus in 1 case. Cognard classification: 7 patients were type Ⅲ and 1 was type Ⅳ. After admission, all patients underwent emergency craniotomy and microsurgery to remove hematoma. Among them, 4 patients underwent decompressive craniectomy at the same time, 1 patient with moyamoya disease underwent dural turnover and temporalis muscle application at the same time, and 2 patients with aneurysms at the same location were clipped at the same time. Postoperative re-examination of head CT showed that the hematoma was cleared satisfactorily and the midline was no shift in all 8 patients. CT angiography (CTA) showed that the fistula disappeared within 2 weeks. Seven patients were followed up within 1-12 months after operation. CTA or digital subtraction angiography showed no recurrence of DAVF. Two patients with aneurysms did not have residual or recurrent aneurysms. All patients had no new neurological symptoms, and the Glasgow Outcome Scale score in 2 patients increased by 1 compared with that at discharge.Conclusion:Emergency microsurgery is an effective method for the treatment of ruptured intracranial DAVF, especially for patients with special parts or complicated hematoma, cerebral hernia, and other vascular diseases.

Objective: To discuss the feasibility of applying home-made auto quality assurance (AQA) phantom in Cyberknife AQA test. Methods: The same treatment plan for AQA test was designed in the Cyberknife treatment planning system. The AQA tests were performed under the same conditions using the home-made AQA phantom and the AQA phantom in the fourth-generation (G4) Cyberknife mode and the fifth-generation (VSI) Cyberknife mode, respectively, and each measurement was repeated five times to analyze and compare the differences in test results between the two phantoms. Results: The total deviations of the home-made AQA phantom and the AQA phantom in the AQA test under the G4 Cy- berknife mode were (0.28 ± 0.12) mm and (0.28 ± 0.15) mm, respectively (P > 0.05); the test results under the VSI Cy- berknife mode were (0.46 ± 0.19) mm and (0.50 ± 0.07) mm, respectively (P > 0.05); the total deviations of all test results were smaller than 1.0 mm, which met the requirements of WS 667—2019 Specification for Testing of Quality Control in Ro- botic Arm Radiotherapy Device. Conclusion The test results of the home-made AQA phantom and the AQA phantom are consistent in the AQA test, and the home-made AQA phantom can be used for Cyberknife quality control.

Mismatch negativity (MMN) is an endogenous component of event-related potential that occurs with deviation stimulus. It has been widely used as a biomarker in schizophrenia-related researh. Studies have shown that MMN is correlated with early diagnosis of mental illness, cognitive impairment, and social-behavioral dysfunction in psychiatric patients. Further studies on relevant mechanisms would be conducive to understand the electrophysiological, cognitive, and behavioral changes of mental diseases and provide a new treatment strategy. This review introduces the latest progress in basic research and clinical application of MMN in schizophrenia, discusses the future research direction of MMN, and provides evidence for further research.

Mismatch negativity (MMN) is an endogenous component of event-related potential that occurs with deviation stimulus. It has been widely used as a biomarker in schizophrenia-related researh. Studies have shown that MMN is correlated with early diagnosis of mental illness, cognitive impairment, and social-behavioral dysfunction in psychiatric patients. Further studies on relevant mechanisms would be conducive to understand the electrophysiological, cognitive, and behavioral changes of mental diseases and provide a new treatment strategy. This review introduces the latest progress in basic research and clinical application of MMN in schizophrenia, discusses the future research direction of MMN, and provides evidence for further research.

To investigate the clinical effect of repairing the electrical wound of upper limbs by using the perforator flap pedicled with the descending branch of lateral circumflex femoral artery. Methods From August, 2014 to July, 2018, the perforator flap pedicled with the descending branch of lateral circumflex femoral artery was used to repair the electrical wound of the upper limbs in 10 cases (11 sides), which were 9 cases (10 sides) in males, 1 case (1 side) in female. Three cases in the left side, 6 cases in the right side, and 1 case in both sides. The area of the flap was 12 cm ×6 cm-26 cm×11 cm.The arterial, venous and cutaneous nerves of the perforator flap were anastomosed with those of the recipient area, respectively. The patients were followed-up in outpatient depat-ment, including flap survival, texture, appearance, sensory recovery, donor site healing and scar hyperplasia. Results All the flaps survived without vascular crisis. Infection occurred in 1 case (1 side). The wound was healed 19 d after the operation by using effective antibiotics and dressing change. All cases were followed-up for 4-24 months after the operation. The blood supply of the flaps was good, the texture was similar to that of the recipient area, and the ap-pearance was satisfactory. There was no obvious bloat, and no ulceration of the flap was found. The anterolateral femoral cutaneous nerve was retained in the flap and anastomosed with the cutaneous nerve in the recipient area. The sensory recover to S3 in 3 flaps, S2 in 7 flaps, S1 in 1 flap. The donor site of the flap was sewn up with aesthetic treat-ment.After the operation, the donor sites presented a linear scar with a concealed position and no occurrence of oste-ofascial compartment syndrome. Conclusion The perforator flap pedicled with the descending branch of lateral cir-cumflex femoral artery has a constant anatomical position of perforator vessel, a wide excision range, abundant blood supply, a good appearance and a hidden donor site, which is a good choice for repairing the electrical wound.

OBJECTIVE:To understand the rationality of proton pump inhibitors (PPI) in our hospital during perioperative period,in order to provide reference for rational use of drugs in clinical practice. METHODS:Through randomly collecting discharge cases of surgical system of May and Dec. in 2015 from Hospital Information System,the use of PPI during perioperative period was investigated retrospectively,and the rationality of drug use was evaluated. RESULTS:Among 522 cases,418 cases were given PPI for preventing stress ulcer during perioperative period,with utilization rate of 80.1%. Among them,the top three were neurosurgery,orthopedics and general surgery (100%,92.6% and 92.3% respectively). Pantoprazole and lansoprazole (72.5%,14.8%,respectively) were the top two categories of the use of PPI. The irrational utilization rate of PPI was 70.8%during perioperative period. In the top three,the number of drugs was exceeded,the drug was not used,course of treatment was too long (73.7%,64.1% and 62.4% respectively). CONCLUSIONS:The utilization rate of PPI prevention is higher in the department in our hospital during perioperative period,and there is unreasonable situation in some preventive drugs,and the measures need to be implemented and strengthened.