OBJECTIVE Aimed at investigating whether reflux pharyngitis is an independent risk factor for the failure of type Ⅰ tympanoplasty for chronic otitis media.This is achieved by analyzing the relationship between the postoperative tympanic membrane healing in patients who underwent type Ⅰ tympanoplasty and pharyngolaryngeal reflux finding score(RFS).METHODS Patients who underwent type Ⅰ tympanoplasty in the Department of Otolaryngology Head and Neck Surgery,Nanshan People's Hospital,Shenzhen,China,from January 2023 to July 2024 were retrospectively included.All the patients received preoperative perfect nasal endoscopy,laryngoscopy,evaluation by the RFS questionnaire,preoperative otoscopy for tympanoplasty,pure tone hearing threshold,and temporal bone thin-layer CT examination.Postoperative otoscopic examination was performed to observe tympanic membrane healing and followed up for 3 months.The patients were divided into surgery success group and failure group based on the criterion of whether a complete tympanic membrane was formed by endoscopic examination within 3 months.The RFS scores of the two groups were statistically analyzed.RESULTS A total of 135 patients with an average age of 44.78 years(±12.22 years)took part in this study,with 60 males and 75 females included,and 68 left ears and 67 right ears involved.There were 120 patients in the surgery success group,and 15 patients in the failure group.Statistical analysis revealed that the RFS score of the patients in the tympanoplasty failure group was remarkably higher than that of the patients in the tympanoplasty success group.Moreover,there were significantly more cases with suspected reflux pharyngitis in the surgery failure group(P=0.007).Reflux-induced tympanic membrane lesion and reperforation mostly occurred in the central part of the tympanic membrane graft.CONCLUSION Reflux pharyngitis has been implicated with tympanoplasty failure,and thus may be a causative factor.Additionally,the RFS can be used to screen patients with chronic suppurative otitis media for suspected reflux pharyngitis.Findings from this work indicate that perioperative anti-reflux therapy,combined with dietary and lifestyle counselling for the patients who suffer from reflux pharyngitis and are about to undergo the tympanoplasty surgery may improve surgical success rate.

Objective:To investigate the clinicopathological features, immunophenotype, molecular characteristics, and differential diagnosis of primary intracranial DICER1-mutant sarcoma in order to better understand this tumor type.Methods:A retrospective analysis was conducted on 7 cases of primary intracranial DICER1-mutant sarcoma diagnosed in the Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China between 2021 and 2023 using next-generation sequencing. At the same time, 10 gliosarcomas, 4 intracranial FET::CREB fusion-positive mesenchymal tumors, 4 malignant meningiomas, 3 malignant solitary fibrous tumors, 3 malignant peripheral nerve sheath tumors, 3 synovial sarcomas and 3 rhabdomyosarcomas (total 30 cases) were selected as control.Results:Among the 7 patients with primary intracranial DICER1-mutant sarcoma, 6 were male and 1 was female, aged 10-32 years (median, 23 years). The tissue morphology was predominantly spindle or pleomorphic sarcoma-like, with 6 cases exhibiting eosinophilic globules, and 3 cases showing rhabdomyoblastic or rhabdomyosarcoma-like cell differentiation. Immunohistochemistry revealed focal desmin expression in 3 cases (3/7), ATRX loss in 3 cases (3/7), and p53 mutant pattern in 4 cases (4/7). Additionally, 4 cases (4/7) showed focal or diffuse SALL4 expression, whereas the control cases (30 cases) did not exhibit SALL4 protein expression, suggesting that SALL4 may possess certain auxiliary diagnostic value. Next-generation sequencing confirmed that all 7 cases of primary intracranial DICER1-mutant sarcoma harbored mutations in the DICER1 gene, with 5 cases having the mutation site at p.E1813D. Until May 2024, all 7 patients were alive.Conclusions:Primary intracranial DICER1-mutant sarcoma is a rare tumor. Understanding its morphological characteristics, immunohistochemical and molecular markers and differential diagnosis is crucial to avoid misdiagnosis and to improve diagnostic accuracy of this tumor.

Objective:To analyze the antimicrobial resistance and genomic characteristics of Salmonella typhimurium and its monophasic variants isolated from human and food sources in Hangzhou. Methods:A total of 186 Salmonella typhimurium and its monophasic variants isolated in Hangzhou during the period from 2017 to 2021 were subjected to antimicrobial susceptibility testing and whole-genome sequencing, and the genomes from public databases were downloaded. Multilocus sequence typing and the identification of antimicrobial resistance (AMR) genes were performed using the sequencing data. Phylogenetic tree based on the single nucleotide polymorphism (SNP) sites in the genomes from Hangzhou and public databases was constructed. Results:The multidrug resistance (MDR) rate of the monophasic variant strains in Hangzhou was 95.4% (103/108). The MDR strains harbored ≥3 classes of AMR genes simultaneously and the most common resistance genotype was blaTEM-1B- tet( B)- sul2- aac(6′)- Ia (44.7%, 46/103). The MDR rate of Salmonella typhimurium strains was 75.6% (59/78), and 52.5% (31/59) of the MDR strains harbored ≥10 AMR genes simultaneously, with the most common resistance genotype being blaTEM-1B- qnrS1- tet( A)- tet( M)- cmlA1- floR- dfrA12- sul2- sul3- aac(6′)- Iaa (40.7%, 24/59). All of the 186 strains were positive for AMR gene aac (6 ′)- Iaa, and three monophasic variant strains which were resistant to polymyxin E was positive for mcr-1.1. ST19 accounted for 91.0% of the 78 Salmonella typhimurium strains (except for two strains belonging to ST34, two strains belonging to ST1544, and three strains untyped), and ST34 accounted for 96.3% of the 108 monophasic variant strains (except for four strains untyped). The phylogenetic tree showed that the ST19 strains dominated by serotype typhimurium and the ST34 strains dominated by monophasic variants were divided into two clades. In the ST19 clade, strains from Hangzhou were mainly clustered with the strains from other cities in Zhejiang Province as well as other provinces and cities in China, such as Jiangxi, Shanghai, and Shandong. Strains isolated from pig, duck, and chicken were the ones that were clustered with clinical strains. In the ST34 clade, most strains from Hangzhou were clustered together, and some strains were clustered with those isolated from other cities in Zhejiang Province as well as Beijing, Guangdong, Shanghai, etc. Strains isolated from pig and chicken were the ones that were clustered with clinical strains. Conclusions:The MDR rate of monophasic variant strains is higher than that of Salmonella typhimurium strains, and the latter is prominent by its harboring multiple AMR genes. The epidemic of Salmonella typhimurium and its monophasic variants in Hangzhou is mainly caused by the spread of ST19 and ST34 strains, respectively, and the clinical infection may be closely related to the consumption of pork and poultry meat. While transmitting locally, cross-region transmission of the two serovars in Zhejiang Province and cross-province transmission in China may also occur.

Objective:To analyze the antimicrobial resistance and genomic characteristics of Salmonella typhimurium and its monophasic variants isolated from human and food sources in Hangzhou. Methods:A total of 186 Salmonella typhimurium and its monophasic variants isolated in Hangzhou during the period from 2017 to 2021 were subjected to antimicrobial susceptibility testing and whole-genome sequencing, and the genomes from public databases were downloaded. Multilocus sequence typing and the identification of antimicrobial resistance (AMR) genes were performed using the sequencing data. Phylogenetic tree based on the single nucleotide polymorphism (SNP) sites in the genomes from Hangzhou and public databases was constructed. Results:The multidrug resistance (MDR) rate of the monophasic variant strains in Hangzhou was 95.4% (103/108). The MDR strains harbored ≥3 classes of AMR genes simultaneously and the most common resistance genotype was blaTEM-1B- tet( B)- sul2- aac(6′)- Ia (44.7%, 46/103). The MDR rate of Salmonella typhimurium strains was 75.6% (59/78), and 52.5% (31/59) of the MDR strains harbored ≥10 AMR genes simultaneously, with the most common resistance genotype being blaTEM-1B- qnrS1- tet( A)- tet( M)- cmlA1- floR- dfrA12- sul2- sul3- aac(6′)- Iaa (40.7%, 24/59). All of the 186 strains were positive for AMR gene aac (6 ′)- Iaa, and three monophasic variant strains which were resistant to polymyxin E was positive for mcr-1.1. ST19 accounted for 91.0% of the 78 Salmonella typhimurium strains (except for two strains belonging to ST34, two strains belonging to ST1544, and three strains untyped), and ST34 accounted for 96.3% of the 108 monophasic variant strains (except for four strains untyped). The phylogenetic tree showed that the ST19 strains dominated by serotype typhimurium and the ST34 strains dominated by monophasic variants were divided into two clades. In the ST19 clade, strains from Hangzhou were mainly clustered with the strains from other cities in Zhejiang Province as well as other provinces and cities in China, such as Jiangxi, Shanghai, and Shandong. Strains isolated from pig, duck, and chicken were the ones that were clustered with clinical strains. In the ST34 clade, most strains from Hangzhou were clustered together, and some strains were clustered with those isolated from other cities in Zhejiang Province as well as Beijing, Guangdong, Shanghai, etc. Strains isolated from pig and chicken were the ones that were clustered with clinical strains. Conclusions:The MDR rate of monophasic variant strains is higher than that of Salmonella typhimurium strains, and the latter is prominent by its harboring multiple AMR genes. The epidemic of Salmonella typhimurium and its monophasic variants in Hangzhou is mainly caused by the spread of ST19 and ST34 strains, respectively, and the clinical infection may be closely related to the consumption of pork and poultry meat. While transmitting locally, cross-region transmission of the two serovars in Zhejiang Province and cross-province transmission in China may also occur.