Objective:Multi-drug resistant bacterial infection（MRSA） complications occurring in cochlear implant recipients is rare and of serious consequence. This paper aimed to summarize the treatment experience of a patient with MRSA infection after cochlear implantation. A patient with nasopharyngeal malignant tumor after radiotherapy developed to severe sensorineural deafness. She suffered MRSA infection nine days after cochlear implantation. Since the wound failed to heal after weeks of topical and systemic sensitive antibiotic therapy, the patient underwent surgery for wound debridement. The stimulator-receiver and the electrode of the implant was removed, negative pressure wound therapy was applied, and systemic anti-infection treatment with sensitive antibiotics for weeks, the patients recovered and was discharged from hospital 69 days after infection.
Humans ; Cochlear Implantation/adverse effects* ; Female ; Drug Resistance, Multiple, Bacterial ; Staphylococcal Infections/therapy* ; Methicillin-Resistant Staphylococcus aureus ; Cochlear Implants ; Anti-Bacterial Agents/therapeutic use* ; Postoperative Complications ; Middle Aged

OBJECTIVES: We propose a sparse-view cone-beam CT reconstruction algorithm based on bidirectional flow field guided projection completion (BBC-Recon) to solve the ill-posed inverse problem in sparse-view cone-beam CT imaging. METHODS: The BBC-Recon method consists of two main modules: the projection completion module and the image restoration module. Based on flow field estimation, the projection completion module, through the designed bidirectional and multi-scale correlators, fully calculates the correlation information and redundant information among projections to precisely guide the generation of bidirectional flow fields and missing frames, thus achieving high-precision completion of missing projections and obtaining pseudo complete projections. The image restoration module reconstructs the obtained pseudo complete projections and then refines the image to remove the residual artifacts and further improve the image quality. RESULTS: The experimental results on the public datasets of Mayo Clinic and Guilin Medical University showed that in the case of a 4-fold sparse angle, compared with the suboptimal method, the BBC-Recon method increased the PSNR index by 1.80% and the SSIM index by 0.29%, and reduced the RMSE index by 4.12%; In the case of an 8-fold sparse angle, the BBC-Recon method increased the PSNR index by 1.43% and the SSIM index by 1.49%, and reduced the RMSE index by 0.77%. CONCLUSIONS The BBC-Recon algorithm fully exploits the correlation information between projections to allow effective removal of streak artifacts while preserving image structure information, and demonstrates significant advantages in maintaining inter-slice consistency.
Algorithms ; Cone-Beam Computed Tomography/methods* ; Image Processing, Computer-Assisted/methods* ; Humans

Therapeutic resistance in cancer is responsible for numerous cancer deaths in clinical practice. While target mutations are well recognized as the basis of genetic resistance to targeted therapy, nontarget mutation resistance (or nongenetic resistance) remains poorly characterized. Despite its complex and unintegrated mechanisms in the literature, nongenetic resistance is considered from our perspective to be a collective response of innate or acquired resistant subpopulations in heterogeneous tumors to therapy. These subpopulations, e.g., cancer stem-like cells, cancer cells with epithelial-to-mesenchymal transition, and drug-tolerant persisters, are protected by their resistance traits at cellular and molecular levels. This review summarizes recent advances in the research on resistant populations and their resistance traits. NOTCH signaling, as a central regulator of nongenetic resistance, is discussed with a special focus on its canonical maintenance of resistant cancer cells and noncanonical regulation of their resistance traits. This novel view of canonical and noncanonical NOTCH signaling pathways is translated into our proposal of reshaping therapeutic strategies targeting NOTCH signaling in resistant cancer cells. We hope that this review will lead researchers to study the canonical and noncanonical arms of NOTCH signaling as an integrated resistant mechanism, thus promoting the development of innovative therapeutic strategies.
Neoplasms/metabolism* ; Receptors, Notch/metabolism* ; Disease Resistance/physiology* ; Signal Transduction/physiology* ; Humans ; Drug Resistance, Neoplasm/physiology* ; Molecular Targeted Therapy/methods*

Objective To introduce the application scene,operating steps and preliminary clinical effect of tibial bone mass preservation technique in medial unicompartmental knee arthroplasty(MUKA).Methods A total of 15 patients with antero-medial knee osteoarthritis(AMOA)treated in this hospital from May 2022 to May 2023 were selected as the study subjects.The tibial bone mass preservation technique was a-dopted to complete MUKA(fixed platform prosthesis).The operating time,intraoperative bleeding volume,hospitalization duration and operation complications were recorded.The VAS score before operation and in last follow up,range of motion(ROM)of knee joint,Knee Society Score(KSS),hip and knee stomping angle(HKA)of lower extremity in the operation side and image results were recorded to evaluate the clinical effect.Results The operations in 15 cases were successfully completed.The average operation time was(82.73±9.97)min,mean intraoperative bleeding volume was(21.00±9.49)mL and average hospital stay was(4.9±1.4)d.There was no intraoperative nerve,vascular and medial collateral ligament injury,no iatro-genic fracture,and no postoperative surgical site infection.All patients were followed up for average(5.87±2.77)months.The VAS score of knee joint,ROM,KSS and HKA angle of lower limb in the operated side were significantly improved compared with before operation(P<0.05).There was no prosthesis loosening,displacement or fragmentation,and no obvious degeneration aggravation of the lateral compartment of the knee joint.Conclusion The tibial bone mass preservation technique is a simple,effective and reliable method to deal with the slightly tight flexion space after tibial osteotomy during MUKA,and the postoperative clinical efficacy and imaging results are excellent.

Objective To observe the value of quantitative parameters of synthetic MRI(syMRI)and multiplexed sensitivity encoding diffusion weighted imaging(MUSE-DWI)for predicting pathological characteristics of endometrial cancer(EC).Methods Totally 125 patients with single EC were retrospectively collected.Quantitative parameters of EC,including T1,T2,proton density(PD)and apparent diffusion coefficient(ADC)values were measured based on preoperative syMRI and MUSE-DWI.Univariate analysis and multivariate logistic regression were performed to explore quantitative parameters of EC in order to screen independent predictors of EC with different pathologic characteristics for establishing combined models.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated to evaluate the predictive efficacy of models.Results Among 125 cases,type Ⅰ(estrogen-dependent type)and type Ⅱ(non-estrogen-dependent type)EC were found in 109 and 16 cases,respectively,including 94 cases of medium-low grade(31 of grade G1+63 of grade G2)and 31 cases of high grade(grade G3)EC,93 low-risk type(grade G1-2 type Ⅰ EC)and 32 high-risk type(grade G3 type Ⅰ EC+type Ⅱ EC),with muscular invasion＜1/2 in 84 cases and≥1/2 in 41 cases.Meanwhile,vascular infiltration was found in 41 cases.Lymph node invasion was detected in 18 cases but not in 105 cases,which remained unclear in 2 cases.T2 value of type Ⅰ EC was higher than that of type Ⅱ EC(P＜0.05).T2 and ADC values of high grade or high-risk type EC were lower than those of medium-low grade or low-risk type EC(all P＜0.05).T1,PD and ADC values of EC with muscular invasion≥1/2 were all lower than of those with muscular invasion＜1/2(all P＜0.05).No significant difference of other quantitative MRI parameters was observed among EC with different pathological features(all P＞0.05).ADC value was independent predictor of EC grade and risk type,PD and ADC values were both independent predictors of EC muscular invasion(all P＜0.05).The AUC of PD+ADC model for predicting muscular invasion depth of EC was 0.739,which was not significantly different with that of single PD and ADC models(0.692 and 0.707)(both P＞0.05).Conclusion Quantitative parameters of syMRI and MUSE-DWI could be used in clinical prediction of pathological characteristics of EC.

Objective This study aims to explore the efficacy and complication rates of the transcranial approach(TCA)and extended endoscopic endonasal approach(EEEA)for the treatment of craniopharyngiomas based on the QST classification,providing a scientific reference for clinical decision-making on surgical approach.Methods A total of 151 patients who underwent craniopharyngioma surgery at our center from January 2018 to December 2023 were enrolled.The patients were categorized into Q-CP(suprasellar type),S-CP(infundibular type),and T-CP(tuberal type)according to the QST classification.Systematic collection and analysis were performed on the outcomes of TCA and EEEA treatments,respectively.The differences in effectiveness between the two approaches were evaluated based on the QST classification.Results The improvement rate of visual symptoms was overall higher in the EEEA group than in the TCA group(59.1%vs.36.5%,P=0.006),and the visual deterioration rate was lower(3.0%vs.14.1%,P=0.006).However,the incidence of cerebrospinal fluid leakage was higher in the EEEA group(15.2%vs.3.5%,χ2=4.986,P=0.026).The incidence of postoperative seizures(8.2%vs.0,P=0.019),brain contusions(10.6%vs.0,P=0.005),and subdural hematoma(9.4%vs.0%,P=0.01)was higher in the TCA group.For patients with Q-CP type,the EEEA group had a higher rate of total tumor resection(92.9%vs.65.2%,P=0.025)and a lower recurrence rate(3.6%vs.21.7%,P=0.047),with shorter hospital stays and lower postoperative costs.The TCA group had higher intraoperative blood loss in this type(300 mL vs.200 mL,Z=-2.261,P=0.024).For S-CP type patients,the EEEA group showed a higher rate of total tumor resection(91.3%vs.74.2%)and a lower recurrence rate(0 vs.12.9%,P=0.031),with lower postoperative hospital costs.In T-CP type,due to the deeper location,EEEA showed limitations in protecting hypothalamic function and the TCA group had a better postoperative hypothalamic function score(P=0.035).Conclusion Based on QST classification,EEEA has advantages in Q-CP and S-CP types and is recommended as the preferred surgical procedure;In the T-CP type,TCA surgery is more helpful in protecting hypothalamic function.

Adeno-associated virus(AAV)is a small virus that relies on other helper viruses to replicate.In recent years,with the rapid development of gene therapy,AAV has been widely used as a vector for gene therapy due to its low immunogenicity and wide host range.Many studies have shown that AAV in a variety of autoimmune diseases in animal models showed promising therapeutic effect,such as multiple sclerosis,type 1 diabetes,rheumatoid arthritis,etc,it was proved that AAV gene therapy can slow down the disease progression and reduce its severity.Transmission of autoimmune disease-related genes through AAV may become a new strategy to treat autoimmune diseases.This review will discuss the application and efficacy of AAV in autoimmune diseases based on the latest research progress.

Adeno-associated virus(AAV)is a small virus that relies on other helper viruses to replicate.In recent years,with the rapid development of gene therapy,AAV has been widely used as a vector for gene therapy due to its low immunogenicity and wide host range.Many studies have shown that AAV in a variety of autoimmune diseases in animal models showed promising therapeutic effect,such as multiple sclerosis,type 1 diabetes,rheumatoid arthritis,etc,it was proved that AAV gene therapy can slow down the disease progression and reduce its severity.Transmission of autoimmune disease-related genes through AAV may become a new strategy to treat autoimmune diseases.This review will discuss the application and efficacy of AAV in autoimmune diseases based on the latest research progress.

Objective To observe the value of quantitative parameters of synthetic MRI(syMRI)and multiplexed sensitivity encoding diffusion weighted imaging(MUSE-DWI)for predicting pathological characteristics of endometrial cancer(EC).Methods Totally 125 patients with single EC were retrospectively collected.Quantitative parameters of EC,including T1,T2,proton density(PD)and apparent diffusion coefficient(ADC)values were measured based on preoperative syMRI and MUSE-DWI.Univariate analysis and multivariate logistic regression were performed to explore quantitative parameters of EC in order to screen independent predictors of EC with different pathologic characteristics for establishing combined models.Receiver operating characteristic curves were drawn,the area under the curves(AUC)were calculated to evaluate the predictive efficacy of models.Results Among 125 cases,type Ⅰ(estrogen-dependent type)and type Ⅱ(non-estrogen-dependent type)EC were found in 109 and 16 cases,respectively,including 94 cases of medium-low grade(31 of grade G1+63 of grade G2)and 31 cases of high grade(grade G3)EC,93 low-risk type(grade G1-2 type Ⅰ EC)and 32 high-risk type(grade G3 type Ⅰ EC+type Ⅱ EC),with muscular invasion＜1/2 in 84 cases and≥1/2 in 41 cases.Meanwhile,vascular infiltration was found in 41 cases.Lymph node invasion was detected in 18 cases but not in 105 cases,which remained unclear in 2 cases.T2 value of type Ⅰ EC was higher than that of type Ⅱ EC(P＜0.05).T2 and ADC values of high grade or high-risk type EC were lower than those of medium-low grade or low-risk type EC(all P＜0.05).T1,PD and ADC values of EC with muscular invasion≥1/2 were all lower than of those with muscular invasion＜1/2(all P＜0.05).No significant difference of other quantitative MRI parameters was observed among EC with different pathological features(all P＞0.05).ADC value was independent predictor of EC grade and risk type,PD and ADC values were both independent predictors of EC muscular invasion(all P＜0.05).The AUC of PD+ADC model for predicting muscular invasion depth of EC was 0.739,which was not significantly different with that of single PD and ADC models(0.692 and 0.707)(both P＞0.05).Conclusion Quantitative parameters of syMRI and MUSE-DWI could be used in clinical prediction of pathological characteristics of EC.

Objective This study aims to explore the efficacy and complication rates of the transcranial approach(TCA)and extended endoscopic endonasal approach(EEEA)for the treatment of craniopharyngiomas based on the QST classification,providing a scientific reference for clinical decision-making on surgical approach.Methods A total of 151 patients who underwent craniopharyngioma surgery at our center from January 2018 to December 2023 were enrolled.The patients were categorized into Q-CP(suprasellar type),S-CP(infundibular type),and T-CP(tuberal type)according to the QST classification.Systematic collection and analysis were performed on the outcomes of TCA and EEEA treatments,respectively.The differences in effectiveness between the two approaches were evaluated based on the QST classification.Results The improvement rate of visual symptoms was overall higher in the EEEA group than in the TCA group(59.1%vs.36.5%,P=0.006),and the visual deterioration rate was lower(3.0%vs.14.1%,P=0.006).However,the incidence of cerebrospinal fluid leakage was higher in the EEEA group(15.2%vs.3.5%,χ2=4.986,P=0.026).The incidence of postoperative seizures(8.2%vs.0,P=0.019),brain contusions(10.6%vs.0,P=0.005),and subdural hematoma(9.4%vs.0%,P=0.01)was higher in the TCA group.For patients with Q-CP type,the EEEA group had a higher rate of total tumor resection(92.9%vs.65.2%,P=0.025)and a lower recurrence rate(3.6%vs.21.7%,P=0.047),with shorter hospital stays and lower postoperative costs.The TCA group had higher intraoperative blood loss in this type(300 mL vs.200 mL,Z=-2.261,P=0.024).For S-CP type patients,the EEEA group showed a higher rate of total tumor resection(91.3%vs.74.2%)and a lower recurrence rate(0 vs.12.9%,P=0.031),with lower postoperative hospital costs.In T-CP type,due to the deeper location,EEEA showed limitations in protecting hypothalamic function and the TCA group had a better postoperative hypothalamic function score(P=0.035).Conclusion Based on QST classification,EEEA has advantages in Q-CP and S-CP types and is recommended as the preferred surgical procedure;In the T-CP type,TCA surgery is more helpful in protecting hypothalamic function.