Objective:To explore the application value of high-resolution temporal bone CT and DW-MRI fusion technology in achieving precise diagnosis and anatomical localization of middle ear cholesteatoma during endoscopic surgery. Methods:Eighteen patients initially diagnosed with middle ear cholesteatoma in the Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital, from January to June 2024 were enrolled.Preoperative high-resolution temporal bone CT and DW-MRI were performed, and rtStation software was used for image fusion to construct CT-MRI fused images. The involvement of cholesteatoma in six anatomical subregions of the temporal bone was evaluated. Using surgical pathology as the gold standard, and combining surgical videos and anatomical records, the sensitivity, specificity, and accuracy of pure CT, pure DW-MRI, and CT-MRI fused images in evaluating middle ear cholesteatoma lesions were compared. Results:A total of 18 patients were included, and 17 cases were pathologically confirmed as middle ear cholesteatoma postoperatively. The sensitivity of the preoperative of preoperative CT was 100%, but the specificity was only 44.44%, with an overall accuracy of 72.22%; the sensitivity and specificity of DW-MRI evaluation were 81.46% and 85.19%, the accuracy was 83.33%, respectively. In contrast, the sensitivity and specificity of CT-MRI fusion image to the spatial localization of cholesteatoma were higher than that of DW-MRI alone（92.59% vs 81.46%; 98.15% vs 85.19%）, and the diagnostic accuracy was also significantly improved（95.37% vs 83.33%）. The Kappa values for the agreement between HRCT, DW-MRI, and CT-MRI segmentation localization and pathological results were 0.444, 0.667, and 0.907 respectively. The chi-square paired t-test confirmed statistically significant diagnostic differences between groups（P<0.001）. Results demonstrated that CT-MRI significantly outperformed HRCT and DW-MRI in diagnostic efficacy for segmental localization of primary posterior congenital middle ear cholesteatoma. Conclusion:High-resolution temporal bone CT combined with DW-MRI fusion technology demonstrates higher sensitivity, specificity, and accuracy in the diagnosis and spatial localization of middle ear cholesteatoma than single imaging modalities. It can provide more precise evaluation of lesion scope for endoscopic surgery, showing important clinical application value.
Humans ; Cholesteatoma, Middle Ear/diagnostic imaging* ; Tomography, X-Ray Computed ; Temporal Bone/diagnostic imaging* ; Diffusion Magnetic Resonance Imaging ; Female ; Male ; Adult ; Sensitivity and Specificity ; Middle Aged ; Endoscopy

OBJECTIVE: Hepatocellular carcinoma (HCC) is a leading cause of mortality worldwide. Huachansu (Cinobufacini) is active extract isolated from the dry skin of Bufo Bufo gargarizans. It has now been widely used in clinical treatment of cancer, this study is to clarify the material basis of down-regulation of thymidylate synthase (TYMS) induced by Huachansu. METHODS: Our study utilized UPLC-MS/MS to identify major bioactive components from Huachansu. Cell Counting Kit 8 (CCK-8) assay and clone formation assay were used to examine the cell viability of tumor cells. TYMS and γ-H2AX level were detected by using quantitative real-time RT-PCR and/or western blotting. Small interfering RNA (siRNA) transfection was used to explore whether inhibition of TYMS could enhance the suppressive effect of Huachansu on cell growth of HCC cells. RESULTS: In our study, firstly, we identify 21 major bioactive components from Huachansu. CCK-8 assay results showed that Huachansu and its bioactive bufadienolides (Bufalin, Bufotalin, Cinobufotalin, Desacetylcinobufagin, Arenobufagin, Telocinobufagin, and Resibufogenin) significantly inhibited the proliferation of HepG2 and SK-HEP-1 cells in a dose- and time-dependent manner. Further molecular mechanistic investigation demonstrates that Huachansu significantly suppresses thymidylate synthase (TYMS), the enzyme which provides the sole de novo source of thymidylate for DNA synthesis. The inhibition of TYMS could lead to cell-cycle block and DNA damage of HCC cells. Furthermore, we identified that Huachansu markedly increased γ-H2AX expression, which indicated the presence of DNA damage. Moreover, we confirmed that transfection of cells with small interfering RNA specific to TYMS could increase the suppressive effects of Huachansu on the HCC cells proliferation. Quantitative RT-PCR analysis showed that Huachansu treatment had no effect on the transcription level of TYMS. Furthermore, proteasomal inhibitor MG132 could block TYMS inhibition induced by Huachansu, and concomitant administration of protein synthesis inhibitor cycloheximide (CHX) with Huachansu could further suppress the protein level of TYMS, indicating that Huachansu promotes proteasome-dependent degradation of TYMS in liver cancer cells. More importantly, the bioactive bufadienolides of Huachansu such as Bufalin, Bufotalin, Cinobufotalin, Desacetylcinobufagin, Arenobufagin, Telocinobufagin, and Resibufogenin could also significantly restrain the protein level of TYMS, revealing the material basis of inhibition of TYMS exposed to Huachansu. 5-Fluorouracil (5-FU) is a TYMS inhibitor, we also evaluate the effects of the combined treatment of Huachansu with 5-FU, the results show that interactions between Huachansu and 5-FU are synergistic or antagonistic. Thus, in clinical, attention should be paid to the dosage of Huachansu in combination with 5-FU. CONCLUSION Huachansu inhibits the growth and induces DNA damage of human HCC cells through proteasome-dependent degradation of TYMS, bioactive bufadienolides are the material basis of down-regulation of TYMS induced by Huachansu.

Objective:To evaluate the surgical management and clinical efficacy of endoscopic operation for tympanosclerosis (TS).Methods:A retrospective analysis was conducted on 228 patients with TS who underwent endoscopic surgery at Shaanxi Provincial People′s Hospital between January 2019 and December 2023. There were 79 males and 149 females, aged 18-68 years (median 50 years). Surgical management, perforation healing rate, pre-and post-operate hearing characteristics, and complications were analyzed. The air conduction threshold values at 500 Hz, 1 000 Hz, 2 000 Hz and 4 000 Hz, average air conduction pure tune audiometry (AC-PTA), and air-bone conduction (ABG) pre-and post-operation were compared. Statistical analysis was performed using SPSS 25.0.Results:All 132 cases of type Ⅰ tympanosclerosis underwent myringoplasty. Among 55 cases with type Ⅱ tympanosclerosis, 33 (60.0%) received typeⅠand 22 (40.0%) received type Ⅱ tympanoplasty. Of 16 cases with type Ⅲ tympanosclerosis, 10 (62.5%) underwent type Ⅰand 6 (37.5%) underwent type Ⅱtympanoplasty. Among 25 cases with type Ⅳ, 5 (20.0%) underwent type Ⅰ, 13 (52.0%) type Ⅱ, and 3 (12.0%) type Ⅲ tympanoplasty, while, 4 (16.0%) underwent tympanoplasty with autologous cartilage. The average follow-up period was 8.2 months (6 months to 3 years); The overall healing rate of the tympanic perforation was (97.8%)223/228. All cases exhibited improved air conduction hearing threshold at all frequencies, AC-PTA and ABG postoperatively. The differences between types Ⅰ, Ⅱ at 500 Hz, 1 000 Hz, 2 000 Hz, 4 000 Hz, AC-PTA and ABG were statistically significant (all P<0.001 for type Ⅰ, all P<0.05 for type Ⅱ). In type Ⅲ, improvements were significant for all tested parameters except at 4 000 Hz (all P<0.05) and no statistically significant difference were found in type Ⅳ. No severe complications such as profound sensorineural hearing loss or facial nerve paralysis were encountered. Conclusion:Totally, endoscopic transcanal surgery is an effective management for tympanosclerosis, providing favorable short-term hearing outcomes with an acceptable safety profile.

Objective:To evaluate the surgical management and clinical efficacy of endoscopic operation for tympanosclerosis (TS).Methods:A retrospective analysis was conducted on 228 patients with TS who underwent endoscopic surgery at Shaanxi Provincial People′s Hospital between January 2019 and December 2023. There were 79 males and 149 females, aged 18-68 years (median 50 years). Surgical management, perforation healing rate, pre-and post-operate hearing characteristics, and complications were analyzed. The air conduction threshold values at 500 Hz, 1 000 Hz, 2 000 Hz and 4 000 Hz, average air conduction pure tune audiometry (AC-PTA), and air-bone conduction (ABG) pre-and post-operation were compared. Statistical analysis was performed using SPSS 25.0.Results:All 132 cases of type Ⅰ tympanosclerosis underwent myringoplasty. Among 55 cases with type Ⅱ tympanosclerosis, 33 (60.0%) received typeⅠand 22 (40.0%) received type Ⅱ tympanoplasty. Of 16 cases with type Ⅲ tympanosclerosis, 10 (62.5%) underwent type Ⅰand 6 (37.5%) underwent type Ⅱtympanoplasty. Among 25 cases with type Ⅳ, 5 (20.0%) underwent type Ⅰ, 13 (52.0%) type Ⅱ, and 3 (12.0%) type Ⅲ tympanoplasty, while, 4 (16.0%) underwent tympanoplasty with autologous cartilage. The average follow-up period was 8.2 months (6 months to 3 years); The overall healing rate of the tympanic perforation was (97.8%)223/228. All cases exhibited improved air conduction hearing threshold at all frequencies, AC-PTA and ABG postoperatively. The differences between types Ⅰ, Ⅱ at 500 Hz, 1 000 Hz, 2 000 Hz, 4 000 Hz, AC-PTA and ABG were statistically significant (all P<0.001 for type Ⅰ, all P<0.05 for type Ⅱ). In type Ⅲ, improvements were significant for all tested parameters except at 4 000 Hz (all P<0.05) and no statistically significant difference were found in type Ⅳ. No severe complications such as profound sensorineural hearing loss or facial nerve paralysis were encountered. Conclusion:Totally, endoscopic transcanal surgery is an effective management for tympanosclerosis, providing favorable short-term hearing outcomes with an acceptable safety profile.

The clinical data, laboratory test, and gene mutations were collected from a family with pseudohypoaldosteronism type II(PHA2). The proband, aged 1 year and 7 months, presented with hyperkalemia(6.69 mmol/L; reference range 3.5-5.3 mmol/L), blood pressure of 110/68 mmHg(normal<106/61 mmHg, 1 mmHg=0.133 kPa), blood chloride of 111.5 mmol/L(reference 99-110 mmol/L), blood HCO 3- of 17.1 mmol/L(reference 22-29 mmol/L), estimated glomerular filtration rate of 128.5 mL·min -1·(1.73 m 2) -1[>90 mL·min -1·(1.73 m 2) -1], and blood renin concentration of 0.30 μIU/mL(reference 4.2-45.6 μIU/mL). The mother and maternal grandfather also exhibited normal renal function with hyperkalemia, hypertension, hyperchloremia, metabolic acidosis, and low renin. Genetic testing revealed a heterozygous missense mutation(c.1685A>G, p. E562G) in exon 7 of the no-lysine kinase 4(WNK4) gene. Treatment with hydrochlorothiazide was effective. Literature review comparing this E562G pedigree with other WNK4 variants suggested clinical heterogeneity of WNK4 mutations. For unexplained hyperkalemia, especially with concurrent hypertension, PHA2 should be considered early for genetic screening to prevent misdiagnosis or delayed diagnosis.

Objective:To systematically evaluate the clinical efficacy of oral ginger capsule or ginger powder in chemotherapy-induced nausea and vomiting in cancer patients.Methods:Computers searched Chinese Journal Full-text Database (CNKI), China Biomedical Literature Database (CBM), Wanfang Database, PubMed, EMbase, Web of Science, and Cochrane Library about oral chemotherapy in patients with cancer ginger correlation clinical curative effect of nausea and vomiting randomized controlled trial, supplemented by other search methods, the time range was built until July 2019. Quality evaluation and data extraction were performed independently by two investigators, and Meta analysis was performed by RevMan5.3 software.Results:A total of 12 articles and 13 studies were included, with a total of 1 105 patients. Meta-analysis showed that oral ginger capsule or ginger powder reduced the incidence of acute vomiting (risk ratio value was 0.76, 95% confidence interval was 0.59-0.98, P<0.05) and the severity of vomiting (mean difference value was-0.79, 95% confidence interval was-1.36--0.23, P<0.01), including the severity of acute vomiting (mean difference value was-1.39, 95% confidence interval was-2.72--0.06, P<0.05) and the severity of delayed vomiting (mean difference value was-0.46, 95% confidence interval was-0.82--0.10, P<0.05). However, there was no significant difference between the two groups in the incidence and severity of acute and delayed nausea ( P>0.05). Conclusions:This study demonstrates that oral ginger capsule or ginger powder is a complementary treatment for chemotherapy-induced nausea and vomiting in cancer patients, and more high-quality studies are needed to validate its clinical efficacy in the future.

OBJECTIVE：To isolate and purify baicalin metabolites from rat bile ，and to study its effect on the proliferation of liver cancer HepG 2 cells. METHODS ：Totally of 6 SD rats were collected ，anesthetized and then intubated with bile ducts. They were given baicalin （168 mg/kg）intragastrically after the rats were awake as well as the bile sample 1 was collected during 24 h after intragastric administration. After processed ，bile sample 1 was preliminarily analyzed by HPLC. Another 5 SD rats were anesthetized and intubated in the same way as above ，and then given baicalin intragastrically （400 mg/kg）. The bile sample 2 was collected during 48 h after intragastric administration. After processed ，the bile sample 2 was isolated and purified by semi-preparative HPLC. The isolated metabolites were identified by using UV ，IR，MS and NMR ，as well as based on physical and chemical properties. MTT method combined with high content cell imaging analysis system was used to study the effect of the metabolites on the proliferation of HepG 2 cells. RESULTS ：Baicalin was mainly metabolized into metabolite 1 and metabolite 2 through bile. After isolation and purification ， they were identified as oroxylin A- 7-O-β-D-glucuronide and 2726719792@qq.com baicalein 6-O-β-D-glucuronide. The results of MTT assay showed that the metabolite 2 had a significant inhibitory effect 分析。E-mail：gaoxl@gmc.edu.cn on the proliferation of HepG 2 cells，and its IC 50 was 90 µg/mL；the results of high content cell imaging analysis showed that at a certain concentration metabolite 2 may inhibit proliferation by changing the mitochondrial distribution and membrane permeability of HepG 2 cells（studies on the pharmacological activities of metabolism 1 had been reported ，it was skipped in this study ）. CONCLUSIONS ：In this study ，two baicalin bile metabolites were successfully isolated and identified ，of which baicalein 6-O-β-D-glucuronide has a significant inhibitory effect on the proliferation of HepG 2 cells.

Objective To analyze the relationship between pain sensation, emotion and recognition in three dimensions. Methods By using questionnaires which contained general information questionnaire, Cancer Pain Questionnaire, Self-reporting Inventory (SCL-90), Pain Beliefs and Perceptions Inventory (PBPI) to investigate pain sensation, emotion and recognition of 46 patients with cancer pain. Results There were 13(28.3%) cases sufferd from mild pain,17 (37.0%) cases were moderate pain, 16 (34.8% )cases were severe pain.As to the result of SCL- 90,patients showed obvious symptom in somatization, depression, anxiety and hostility.They holded deep belief of that pain was very mysterious. There was a significant correlation between pain severity and depression(rs=0.377) , anxiety(rs=0.388) on the condition that confidence level was 0.01;there was also a significant correlation between pain degree and interpersonal sensitivity(rs=0.308), hostility(rs=0.320) on the condition that confidence level was 0.05. As to pain beliefs, pain degree had a significant correlation with it in the dimension of pain as mystery (rs=0.529) and pain was persistent(rs=0.680) on the condition that confidence level was 0.01. Conclusions The survey shows a positive correlation between pain severity,emotion of pain(such as anxiety,depression, hostility and interpersonal sensitivity)and beliefs about pain as mystery or permanent.

Objective To investigate whether the effects of rapamycin on promoting oral squamous cancer cell apoptosis is related with inhibiting TLR4 expression and inflammatory factor IL-6 and PGE2 expression.Methods Human oral squamous carcinoma SCC-15 cell line was cultured and interfered by rapamycin.Then the activity of SCC-15 cells was detected by CCK 8,the SCC-15 cells apoptosis was detected by the Hochest33342/PI double staining,the invasion ability was determined by the transwell method.The TLR4 protein expression level was detected by Western blot and IL-6 and PGE2 expressions were detected by ELISA.Results Rapamycin could promote cell apoptosis,the invasion ability of SCC-15 cells was significantly decreased.After rapamycin intervention,the TLR4 protein expression was decreased and expression levels of IL-6 and PGE2 were reduced,showing statistical difference as compared with the negative group (P＜0.05).Conclusion Rapamycin promotes oral squamous cancer SCC-15 cell apoptosis,which may be related with inhibiting TLR4,IL-6 and PGE2 expression.

OBJECTIVE: To analyze the role and significance of pepsin and pepsinogen in the pathogenesis of OME in children. METHOD: Pediatric patients with otitis media aged 2-8 years who enrolled in our department of the hospital from May of 2012 to December of 2012 were set as experimental group (38 cases, 48 ears) which should be underwent tympanic membrane puncture/tube insertion. Meanwhile, pediatric patients waiting for cochlear implant without otitis media (10 ears), were set as control group. Middle ear lavage fluid and plasma samples from the two groups were collected and detected using enzyme-linked immune method for pepsin and pepsinogen. RESULT: The concentrations of pepsin and pepsinogen in the middle ear lavage fluid of OME group [(48.8 ± 415.99) ng/ml and 676.32 ± 336.71)ng/ml] were significantly higher than those in the control group [(8.20 ± 4.59)ng/ml and (77.27 ± 50.33) ng/ml] (P < 0.01). Meanwhile, the concentration of pepsinogen in the middle ear lavage of OME patients was significantly higher than that of plasma (P < 0.01). The concentration of pepsin in the middle ear lavage fluid from the dry ear subgroup was lower than those in the serum ear and mucous ear subgroups (P < 0.01), but there was no significant difference about concentrations of pepsinogen among the dry ear, serum ear and mucous ear subgroups (P > 0.05). CONCLUSION Pepsin and pepsinogen in the middle ear cavity of OME patients maybe originated from laryngopharyngeal reflux (LPR), indicating that LPR is associated with the pathogenesis of OME in children.
Child ; Child, Preschool ; Ear, Middle ; metabolism ; Enzyme-Linked Immunosorbent Assay ; Humans ; Laryngopharyngeal Reflux ; physiopathology ; Otitis Media with Effusion ; metabolism ; Pepsin A ; metabolism ; Pepsinogen A ; metabolism ; Tympanic Membrane ; surgery