Objective:The aim of this study was to present an institution's experience with cochlear reimplantation（CRI）, to assess surgical challenges and post-operative outcomes and to increase the success rate of CRI. Methods:We retrospectively evaluated data from 76 reimplantation cases treated in a tertiary center between 2001 and 2022. Clinical features include caused of CRI, type of failure, surgical issues, and auditory speech performance were analyzed. Categorical Auditory Performance （CAP） and Speech Intelligibility Rating （SIR） scores were used to evaluate pre-and post-CRI outcomes. Our center's consecutive cohort of 1 126 patients had seven patients, while 69 patients were from other cochlear implant centers. Device failure was the most common cause of CRI（68/76）, with the remaining cases including flap complications（3/76）, magnet displacement（3/76）, secondary meningitis（1/76）, and foreign bodies around the implant（1/76）. Postoperative auditory and speech outcome improved in 31.6%（24/76） of patients, remained unchanged in 63.2%（48/76）, and decreased in CAP and SIR scores in 5.2%（4/76） of patients. Postoperatively, the seven patients with cochlear ossification and fibrosis scored lower on the overall CAP and SIR scale than non-ossification individuals, which is a significant factor in surgical success rates and auditory-speech outcomes. Conclusion:CRI surgery is a challenging but relatively safe procedure, and most reimplanted patients experience favorable postoperative outcomes. Medical complications and intracochlear damage are the main causes of poor postoperative results. Therefore, minimally invasive CI has a positive significance for reducing the difficulty of CRI surgery and improving the CI performance.
Humans ; Cochlear Implantation/methods* ; Retrospective Studies ; Cochlear Implants ; Male ; Female ; Postoperative Period ; Treatment Outcome ; Adult ; Speech ; Middle Aged ; Postoperative Complications ; Replantation ; Cochlea/surgery*

Objective:To introduce a new design of super-micro flap for endoscopic ear surgery, and to evaluate the application effect of super-micro flap in endoscopic tympanoplasty. Methods:Between January, 2023 and March, 2024, 58 patients（64 ears） with tympanosclerosis underwent tympanoplasty with super-micro flap. Continuous irrigating mode endoscopic ear surgery（CIM-EES） was used to complete type Ⅱ or Ⅲ tympanoplasty with the tragus cartilage with followed up for 12 to 24 months. The operation time, postoperative efficacy and complications were statistically analyzed. Results:Of the 64 ears, 63 ears had primary healing of the tympanic membrane, and 1 ear had cartilage necrosis due to multi-drug resistant bacteria infection. The second operation was performed one year later, and the success rate of operation was 98.40%. The average operation time was （48.40±8.86） minutes. The average hearing threshold of 0.5 kHz to 4.0 kHz before operation was （59.63±10.62） dB HL, and the average air conduction threshold of 0.5 kHz to 4.0 kHz one year after operation was（38.79±10.91） dB HL, which was significantly improved compared with that before operation（P<0.01）. Bone conduction threshold also improved significantly （24.49±8.55） dB HL vs（21.88±7.58） dB HL（P<0.01）. No outer tympanic membrane healing and ear canal scar stenosis occurred. Conclusion:The design of super-micro flap can effectively solve the interference of flap floating during continuous irrigating mode in endoscopic ear surgery, relieve the difficulty of flap reposition, simplify the operation process, help to shorten the operation time, and reduce the possibility of circular scar stenosis of conventional free flap, which provides a new flap design option for endoscopic ear surgery.
Humans ; Tympanoplasty/methods* ; Endoscopy/methods* ; Surgical Flaps ; Male ; Female ; Adult ; Myringosclerosis/surgery* ; Middle Aged ; Treatment Outcome ; Tympanic Membrane/surgery* ; Adolescent ; Young Adult

Apolipoprotein D(APOD)is a protein that is widely present in animal tissues and is in-volved in the reproductive regulation of the body.In order to investigate the expression regularity of APOD in bactrian camel epididymis and its regulation effect on sperm maturation,this study took the epididymis of bactrian camel during estrus and anestrus as materials,and first cloned the complete sequence of APOD coding sequence(CDS)region.The physicochemical properties of AP-OD were analyzed by ProParam,SOPMA,SWISS-MODEL and MEGA7.0 software.Meanwhile,the expression and distribution of APOD in epididymis were detected by qRT-PCR,Western blot and IHC.The cloning results showed that:the length of the CDS region of APOD gene was 624 bp,encoding 207 amino acids.The APOD sequence of Bactrian camel was highly conserved with the nucleotide and amino acid sequence of alpaca,and the homology of APOD sequence with elk was the lowest.The results of qRT-PCR showed that the mRNA levels of APOD in the head,body and tail of epididymis in estrus were significantly higher than those in estrus(P＜0.01).Western blot results showed that the APOD protein expression and mRNA expression trend was similar in the head and body of the epididymis during anestrus,but the APOD expression level in the tail of the epididymis during anestrus was opposite to the mRNA expression level(P＜0.05).The results of H&E and IHC showed that there were significant differences in epididymal tissue between estrus and anestrus.In addition,APOD showed positive reactions in epididymal epithelial cells,smooth muscle cells,sperm and connective tissue to varying degrees,suggesting that APOD may be in-volved in the maturation of sperm during estrus and anestrus,providing evidence for further explo-ring the regulatory mechanism of APOD's involvement in seasonal estrus.

Objective:To investigate the risk factors for recurrence after modified Chevron osteotomy for hallux valgus.Methods:A total of 86 patients (102 feet) with hallux valgus who underwent modified Chevron operation in Beijing Jishuitan Hospital from December 2018 to February 2021 were retrospectively analyzed. There were 12 males (14 feet) and 74 females (88 feet), aged 50±15 years (range, 18-74 years). There were 36 cases on the right side, 34 on the left side, and 16 on the bilateral side. 4 feet were treated with Chevron osteotomy, 74 feet with modified McBride's osteotomy, 61 feet with Weil osteotomy, 24 feet with Akin osteotomy, and 23 feet with gastrocnemius aponeurotic release. At the last follow-up, hallux valgus angle (HVA) ≤15° was defined as the non-recurrence group after hallux valgus operation, and HVA>15° was defined as the recurrence group after hallux valgus operation. Compare the age, gender, preoperative HVA, the first and second intermetatarsal angles (IMA) before and after operation, the metatarsus adductus angles (MAA) before and after operation, the Meary angles before and after operation, the distal metatarsal articular angles (DMAA) before and after operation, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores before and after operation, and the rotation of the first metatarsal head between the two groups of patients. Include the indicators with statistically significant differences in the binary variable logistic regression analysis to screen for the risk factors of recurrence after modified Chevron operation for hallux valgus.Results:All patients successfully completed the operation and were followed up for 30.3±16.4 months (range, 12-52 months). Postoperative recurrence occurred in 21 feet, and the recurrence rate was 20.6% (21/102). The HVA at the last follow-up was 8.48°±4.52° in the non-recurrence group and 20.68°±3.61° in the recurrence group. In the non-recurrence group, the AOFAS ankle-hindfoot score increased from 60.31±16.62 points preoperatively to 86.89±12.79 points postoperatively ( t=-13.644, P<0.001). In the recurrent group, the AOFAS ankle-hindfoot score increased from 61.71±15.68 points preoperatively to 84.33±18.84 points postoperatively ( t=-6.082, P<0.001). The proportion of patients with preoperative Meary angle> 4° in the non-recurrence group was 52% (10/21), which was lower than 79% (64/81) in the recurrence group, and the difference was statistically significant (χ 2=6.077, P=0.014). The proportion of patients with square type of metatarsal rotation (type A) in the recurrence group was 58%(47/81), which was higher than 33%(7/21) in the non-recurrence group, and the difference was statistically significant (χ 2=4.081, P=0.043). There was no significant difference in gender, age, preoperative HVA, pre- and post-operative IMA, pre- and post-operative DMAA, pre- and post-operative MAA, or preoperative metatarsal rotation type between the two groups ( P>0.05). The results of the logistic regression analysis showed that a preoperative Meary angle ≤ 4° ( OR=3.299, P=0.024) and a non-type A metatarsal rotation pattern after operation ( OR=4.183, P=0.041) were independent risk factors for recurrence after modified Chevron operation for hallux valgus. Conclusion:Hallux valgus patients with a preoperative Meary angle ≤4° and non-type A metatarsal rotation after operation have an increased risk of recurrence following modified Chevron operation.

Objective:To introduce a new technique of precise exposure and preservation of membranous semicircular canal under endoscope, and to evaluate the protective effect of this method on hearing preservation of semicircular canal occlusion.Methods:The study included three patients with unilateral refractory Meniere′s disease, including 1 male and 2 females, with hearing stage 4 in 2 cases and stage 3 in 1 case, the average hearing thresholds were 72.5, 82.5 and 48.8 dBHL, respectively. All of them were treated with triple semicircular canal occlusion under continuous irrigating mode of endoscopic ear surgery (CIM-EES) in RenMin Hospital of WuHan University. The surgical procedure involved the following key steps: the bony walls of the three semicircular canals near the ampullae were gradually thinned to expose the blue line. The endoscope was positioned as close as possible to the operating area to obtain a clear, magnified view. A micro hook needle was used to create a window on the bony semicircular canals. The hook needle progressively removed the bony material while preserving the membranous canals, which were clearly visible during the procedure. The bone dust was removed out of the surgical area by the continuous exchanged insuline without the help of suction that can avoid the damage of the membranous semicircular canals caused by aspiration and the open bony canals were precisely filled with bone wax and covered with bone powder to ensure complete occlusion of the three semicircular canals. Postoperative follow-up included regular assessments of vertigo control and hearing preservation.Results:All the 3 patients obtained complete hearing preservation at 6 months after surgery, and the hearing preservation rate was 100%. The average hearing thresholds at 6 months postoperatively were 66.3, 81.3, and 50.0 dBHL, respectively. Postoperatively, all patients experienced horizontal spontaneous nystagmus toward the healthy side on the day of surgery and the first day after surgery. One patient reported complete disappearance of tinnitus, while the other two patients showed no change in tinnitus severity. Postoperative MRI revealed complete occlusion of the three semicircular canals with normal vestibular imaging. At 6 months postoperatively, none of the patients experienced any vertigo attacks, suggesting effective control of vertigo symptoms.Conclusions:Precise Semicircular canal occlusion under CIM-EES is a promising technique for the treatment of intractable vertigo in patients with refractory Meniere′s disease. This method provides clear visualization of the membranous canals, reducing the risk of inner ear damage and preserving hearing function of the patients.

Objective:To investigate the related factors of hyperuricemia(HUA)in adolescents with bipolar disorder.Methods:Fifty-nine adolescent patients with bipolar disorder and 60 normal controls were select-ed.General demographic and clinical data were collected.Serum uric acid(UA),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FPG),fructosamine(FA)and other physiological indices were detected.The Hamilton Depression Scale 17(HAMD-17)and Bech-Rafaelsen Mania Scale(BRMS)were used to evaluate the emotional symptoms of the patients.Results:The detection rate of HUA was higher in the adolescent patients with bipolar disorder than in the normal control group(30.5％vs.18.3％,P＜0.05),and was higher in manic episode than in depressive episode(48.2％vs.20.8％,P＜0.05).Unconditioned logistic regression analysis showed that high level of TG and high BMI were risk factors for hyperuricemia in adolescents with bipolar disorder(OR=2.51,1.34).Conclusion:This study shows that adolescents with bipolar disorder may have a higher risk of HUA than normal controls,and its oc-currence is associated with high TG level and BMI.

Apolipoprotein D(APOD)is a protein that is widely present in animal tissues and is in-volved in the reproductive regulation of the body.In order to investigate the expression regularity of APOD in bactrian camel epididymis and its regulation effect on sperm maturation,this study took the epididymis of bactrian camel during estrus and anestrus as materials,and first cloned the complete sequence of APOD coding sequence(CDS)region.The physicochemical properties of AP-OD were analyzed by ProParam,SOPMA,SWISS-MODEL and MEGA7.0 software.Meanwhile,the expression and distribution of APOD in epididymis were detected by qRT-PCR,Western blot and IHC.The cloning results showed that:the length of the CDS region of APOD gene was 624 bp,encoding 207 amino acids.The APOD sequence of Bactrian camel was highly conserved with the nucleotide and amino acid sequence of alpaca,and the homology of APOD sequence with elk was the lowest.The results of qRT-PCR showed that the mRNA levels of APOD in the head,body and tail of epididymis in estrus were significantly higher than those in estrus(P＜0.01).Western blot results showed that the APOD protein expression and mRNA expression trend was similar in the head and body of the epididymis during anestrus,but the APOD expression level in the tail of the epididymis during anestrus was opposite to the mRNA expression level(P＜0.05).The results of H&E and IHC showed that there were significant differences in epididymal tissue between estrus and anestrus.In addition,APOD showed positive reactions in epididymal epithelial cells,smooth muscle cells,sperm and connective tissue to varying degrees,suggesting that APOD may be in-volved in the maturation of sperm during estrus and anestrus,providing evidence for further explo-ring the regulatory mechanism of APOD's involvement in seasonal estrus.

Objective To investigate the effect and mechanism of benserazide on bleomycin-induced pulmonary fibrosis in mice.Methods Male C57BL/6 mice were randomly divided into normal control group,model control group,pirfenidone group(50 mg·kg-1),and low-dose and high-dose benserazide groups(300 and 600 mg·kg-1),with 6 mice in each group.Except for normal control group,the other groups were given bleomycin(3.5 mg·kg-1)by non-invasive tracheal instillation to establish a mouse model of pulmonary fibrosis.Seven days after modeling,pirfenidone group and low-dose and high-dose benserazide groups were intragastrically administered the corresponding doses of drugs for 14 consecutive days.After the drug administration,the mice in each group were sacrificed.The pathological morphology of the lung tissue in each group was observed by hematoxylin-eosin(HE)staining and Masson staining.The content of hydroxyproline(HYP)in the lung tissue of mice,the content of lactic acid in the lung tissue and serum,and the activity of hexokinase(HK)in the lung tissue were detected by using kits.The expression levels of Collagen I and Fibronectin in the lung tissue of mice in each group were detected by immunohistochemistry.The expression levels of α-SMA,TGF-β1,Smad2,p-Smad2,TNF-α and IL-6 proteins in the lung tissue of mice in each group were detected by Western blotting.Results Compared with normal control group,the lung tissue structure of model control group mice was damaged,with thickened alveolar septa and fibrotic changes such as collagen accumulation.The content of HYP and lactic acid and the activity of HK in the lung tissue increased significantly,and the expression levels of Collagen I,Fibronectin,α-SMA,TGF-β1,Smad2,p-Smad2,TNF-α,and IL-6 proteins were significantly increased.Compared with model control group,treatment with benserazide significantly alleviated the pathological damage of lung tissue in mice,significantly reduced the content of HYP,lactic acid and HK activity in lung tissue,and significantly decreased the expression levels of Collagen I,Fibronectin,α-SMA,TGF-β1,Smad2,p-Smad2,TNF-α and IL-6 proteins.Conclusion Benserazide ameliorates bleomycin-induced pulmonary fibrosis in mice by modulating the HK2-mediated glycolysis pathway.

Objective To investigate the effect and mechanism of benserazide on bleomycin-induced pulmonary fibrosis in mice.Methods Male C57BL/6 mice were randomly divided into normal control group,model control group,pirfenidone group(50 mg·kg-1),and low-dose and high-dose benserazide groups(300 and 600 mg·kg-1),with 6 mice in each group.Except for normal control group,the other groups were given bleomycin(3.5 mg·kg-1)by non-invasive tracheal instillation to establish a mouse model of pulmonary fibrosis.Seven days after modeling,pirfenidone group and low-dose and high-dose benserazide groups were intragastrically administered the corresponding doses of drugs for 14 consecutive days.After the drug administration,the mice in each group were sacrificed.The pathological morphology of the lung tissue in each group was observed by hematoxylin-eosin(HE)staining and Masson staining.The content of hydroxyproline(HYP)in the lung tissue of mice,the content of lactic acid in the lung tissue and serum,and the activity of hexokinase(HK)in the lung tissue were detected by using kits.The expression levels of Collagen I and Fibronectin in the lung tissue of mice in each group were detected by immunohistochemistry.The expression levels of α-SMA,TGF-β1,Smad2,p-Smad2,TNF-α and IL-6 proteins in the lung tissue of mice in each group were detected by Western blotting.Results Compared with normal control group,the lung tissue structure of model control group mice was damaged,with thickened alveolar septa and fibrotic changes such as collagen accumulation.The content of HYP and lactic acid and the activity of HK in the lung tissue increased significantly,and the expression levels of Collagen I,Fibronectin,α-SMA,TGF-β1,Smad2,p-Smad2,TNF-α,and IL-6 proteins were significantly increased.Compared with model control group,treatment with benserazide significantly alleviated the pathological damage of lung tissue in mice,significantly reduced the content of HYP,lactic acid and HK activity in lung tissue,and significantly decreased the expression levels of Collagen I,Fibronectin,α-SMA,TGF-β1,Smad2,p-Smad2,TNF-α and IL-6 proteins.Conclusion Benserazide ameliorates bleomycin-induced pulmonary fibrosis in mice by modulating the HK2-mediated glycolysis pathway.

Objective:To analyze the functional outcomes of arthrodesis for the first metatarsophalangeal joint.Methods:A retrospective study was conducted to analyze the 21 patients who had undergone arthrodesis for the first metatarsophalangeal joint at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital from August 2013 to October 2019. The cohort included 6 males and 15 females. One patient underwent bilateral surgery, 10 cases the left side surgery and 10 cases the right side surgery. Their ages averaged (63.1±9.2) years. There were 12 cases of simple hallux valgus, 5 cases of rheumatoid arthritis combined with hallux valgus, and 4 cases of gout combined with hallux valgus. The visual analog scale (VAS) pain score, American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score, foot function index (FFI) score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were compared between preoperation and the last follow-up. The proximal phalangeal inclination angle (PPIA) was measured postoperatively. Postoperative satisfaction was evaluated using the Coughlin rating scale. Complications were documented.Results:All patients were followed up for 71.0 (69.8, 75.0) months. In all patients at the last follow-up, VAS [1(0, 3) points], FFI [4.8 (1.6, 8.6) points], HVA [23.4° (14.3°, 28.5°)], and IMA (9.6°±3.2°) were significantly lower than the preoperative values [4 (3, 7) points, 30.4 (16.7, 46.8) points, 43.5° (31.5°, 48.2°), and 13.0°±4.5°], and the AOFAS forefoot score [80.0 (70.8, 90.0) points] was significantly higher than the preoperative one [46.0 (32.8, 55.3) points] ( P<0.05). The postoperative PPIA was 7.7°±10.1°. According to the Coughlin rating scale, 12 cases were rated as excellent, 5 as good, 2 as fair, and 3 as poor. All patients reported relief from painful plantar calluses, most ones experienced complete resolution of plantar calluses, and some ones had stiffness of the metatarsophalangeal joint after fusion. Conclusion:Arthrodesis for the first metatarsophalangeal joint is a reliable treatment for degenerative changes in the metatarsophalangeal joint, because it can well restore the postoperative foot function, significantly relieve pain, and lead to high patient satisfaction.