Inner ear diseases are common in the field of otolaryngology,including hearing loss,tinnitus and peripheral vestibular dysfunction.Their pathogenesis is relatively complex,which is one of the hot spots in current research.A large number of studies have demonstrated that sleep disorder is an important inducement of inner ear diseases.This paper reviews the impact of sleep deprivation on inner ear diseases in order to pro-vide a theoretical basis for the mechanisms of sleep deprivation on inner ear diseases.

Objective:To explore the clinical phenotypic features and genetic variation characteristics of children with epilepsy-aphasia spectrum due to GRIN2A gene variants confirmed by second-generation sequencing. Methods:The clinical data of 5 children with epilepsy-aphasia spectrum with epileptic onset diagnosed in the Department of Neurology, Children′s Hospital Affiliated to Zhengzhou University, from February 2019 to November 2022 were retrospectively analyzed. Whole-exome genome sequencing of the probands using a second-generation sequencing method confirmed that all 5 cases were children with the GRIN2A gene variant. The characteristics of the GRIN2A gene variants were analyzed. Results:Among the 5 children diagnosed with epileptic aphasia spectrum due to GRIN2A gene variants, the male-to-female ratio was 4∶1, and the age range of onset was 1.5-4.4 years. The clinical phenotype included seizures in all cases, language and intellectual developmental deficits in 4 cases, and attention deficit hyperactivity disorder in 3 cases. The seizures were manifested as focal seizures or secondary generalized seizures, and were effectively controlled with antiepileptic drugs. Among the 5 children, gene variant of case 1 was originated from a paternal heterozygous variant, and cases 2-5 had de novo variants, which were c.2107C>T (p.Gln703 *) nonsense variant, c.2284G>A (p.Gly762Arg) missense variant, c.2197del (p.Ala733Glnfs *3) shifted coding variant, c.2511G>A (p.Trp837 *) nonsense variant, and c.1651+1G>C shear site variant, respectively. None of the 5 loci were reported in the literature. Conclusions:Epilepsy-aphasia spectrum is an epilepsy syndrome with a complex onset, and may have different phenotypes at different genetic variant loci, with focal seizures or secondary generalized seizures, which can be effectively controlled with anti-seizure medication. The GRIN2A gene variant is the genetic etiology of the epileptic aphasia spectrum.

Background Currently,the diagnosis of depressive disorder relies on symptomatology,which is greatly influenced by subjective factors such as clinicians' experience.Finding more accurate and reliable quantitative diagnostic methods is currently an urgent problem.Objective To explore the value of Fisher discriminant function based on inflammatory cytokines in the diagnosis of depressive disorder,so as to provide references for clinical diagnosis.Methods A total of 136 patients diagnosed with depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-5)criteria,who underwent inpatient treatment at Hebei Mental Health Center from April 2020 to November 2020,were enrolled as study group.67 healthy participants matched for age and gender,was recruited during the same period.Serum levels of inflammatory cytokine were measured using enzyme-linked immunosorbent assay(ELISA).Fisher discriminant model was employed to establish a discriminant function for inflammatory cytokines exhibiting significant statistical differences between study group and control group,which was then validated.Results The levels of pro-inflammatory cytokines interleukin-1β(IL-1β),interleukin-6(IL-6),interferon-γ(INF-γ)and tumor necrosis factor-α(TNF-α)were higher in the study group compared with control group,with statistically significant differences(U=9.115,5.239,4.431,5.428,P<0.01).Conversely,the levels of anti-inflammatory cytokines interleukin-4(IL-4),interleukin-10(IL-10)and interleukin-13(IL-13)were lower in the study group compared with control group,with statistically significant differences(U=7.398,7.331,7.614,P<0.01).The retrospective test in Fisher discriminant function achieved a correct discrimination rate of 89.66%,and the cross validation achieved a correct discrimination rate of 88.67%.Conclusion The Fisher discriminant function developed in this study may serve as a valuable auxiliary method in the diagnosis of depressive disorder.

Objective To explore the efficacy and safety of intravenous infusion of tirofiban after mechanical thrombectomy in elderly patients with acute anterior circulation intracranial athero-sclerotic stenosis-related large vessel occlusion(ICAS-LVO).Methods A retrospective analysis was conducted on 106 elderly patients with acute anterior circulation ICAS-LVO undergoing me-chanical thrombectomy in our hospital from June 2021 to August 2023.After operation,38 pa-tients receiving 48-hour intravenous infusion of tirofiban at a drip rate of 0.1 μg/(kg·min)were assigned into experimental group,while the other 68 patients undergoing the infusion for only 24 h served as the control group.The indicators related to efficacy(90-day good prognosis rate)and to safety[intracerebral hemorrhage(ICH),symptomatic intracerebral hemorrhage(sICH),and 90-day mortality rate]were compared between the 2 groups.Multivariate logistic regression model was employed to analyze the influencing factors for good prognosis.Results The experimental group exhibited a significantly higher rate of 90-day favorable prognosis than the control group(52.6％vs 29.4％,P=0.018),but no significant differences were observed in the rates of ICH,sICH,and 90-day mortality between the 2 groups(P＞0.05).Multivariate logistic regression anal-ysis indicated that intravenous tirofiban administration for 48 h(OR=2.554,95％CI:1.067-6.116,P=0.034)and NIHSS score at admission(OR=0.887,95％CI:0.822-0.957,P=0.001)were independent influencing factors for 90-day prognosis in elderly patients undergoing mechani-cal thrombectomy due to acute anterior circulation ICAS-LVO.Conclusion In elderly acute ante-rior circulation ICAS-LVO patients receiving mechanical thrombectomy,postoperative intrave-nous tirofiban infusion for 48 h shows better improvement for 90-day prognosis than for 24 h,and has no effect on increasing the risk of sICH.

Objective To investigate the role of TLR4/NF-κB signaling pathway in mediating sleep depriva-tion induced endolymphatic hydrops.Methods A total of 30 healthy sprague-dawley(SD)rats were randomly di-vided into the control group、big platform control group,and 2 w,3 w,4 w sleep deprivation group,with 6 rats in each group.Modified multiple platform method was adopted to establish the rat sleep deprivation model.Before and after the experiment,the open field and acoustic brain-stem response(ABR)was conducted to evaluate the behavior and hearing level.After ABR test,blood samples were collected from abdominal aorta,and serum levels of TNF-αand MCP-1 were detected by ELISA.The cochlea was dissected,the severity of endolymphatic hydrops was as-sessed by calculating the ratio of the cross sectional area of the membranous cochlear duct(SM)to that of the mem-branous cochlear duct+scale vestibuli(SM+SV).Positive expression of IL-1β,TNF-α,MCP-1,TLR4,NF-κB P65 in rat cochlear tissues was detected via immunohistochemical staining.After the experiment,the changes of hearing level,the severity of endolymphatic hydrops and TLR4/NF-κB signaling pathway related proteins and down-stream inflammatory factors expression level were observed.The correlation between TLR4/NF-κB signaling path-way and hearing level and endolymphatic hydropsin rats was analyzed.Results ABR results showed an increased threshold of wave Ⅱ in the sleep deprivation group compared to those of the control group and big platform control group(P＜0.05).The rate of hydrops was 0％in control and big platform control groups,16.67％in 2w sleep deprivation group and 25％in 3 w and 4 w sleep deprivation group.The concentrations of TNF-αand MCP-1 in ser-um of rats in sleep deprivation groups were higher than those in control and big platform control groups,and the 4w sleep deprivation group were statistically significant compared with control and big platform control groups.The ex-pressions of IL-1β,TNF-α,MCP-1,TLR4 and NF-κB P65 in the cochlear spiral ganglion,spiral canal,stria vascu-laris and spiral ligament of rats in sleep deprivation groups were higher than those in control and big platform control groups.Conclusion Sleep deprivation may induce endolymphatic hydrops by the TLR4/NF-κB signaling pathway.

Ménière disease(MD)is a complex inner ear disorder with an uncertain cause and multiple contrib-uting factors.Affective disorders,such as anxiety,depression,insomnia,and other mood disorders,are common mental illnesses characterized by mood instability.There is a reciprocal relationship between affective disorders and MD,leading to a vicious cycle that worsens the progression of MD.This paper provides a comprehensive summary of the mechanisms linking affective disorders to MD,including changes in hormone levels and tissue damage caused by inflammation.It also explores how affective disorders influence MD through their effects on hormones and in-flammation.Additionally,the feasibility and effectiveness of psychotherapy in treating MD are discussed,with the aim of offering potential avenues for future MD treatment.

Objective:To introduce the application of highly selective arterial indocyanine green angiography (hereinafter referred to as highly selective arterial angiography) in the design of anterolateral thigh free flap.Methods:This study was a retrospective observational study. From November 2023 to April 2024, 29 patients with wounds in extremities which were repaired by anterolateral thigh free flaps designed under the assistance of highly selective arterial angiography and met the inclusion criteria were admitted to the Department of Hand Surgery and Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital, including 26 males and 3 females, aged 16 to 71 years. The wound area after debridement ranged from 8.0 cm×4.5 cm to 27.0 cm×16.0 cm. During the surgery, highly selective arterial angiography was used to assist in flap design. The fluorescence development range of the source arteries or perforators of flaps was observed. The blood supply range of the source arteries or perforators of flaps was determined based on the fluorescence development of the skin, and the excision position of the flap was adjusted. The flap incision area ranged from 9.0 cm×6.0 cm to 29.0 cm×16.0 cm. During the surgery, the number of highly selective arterial angiography, the type of source artery of perforators for puncture, and changes in the excision position of flaps were observed and recorded. After surgery, the blood supply and survival of flaps, the healing of wounds and the survival of skin grafts in the flap donor sites, and the angiography-related complications were observed.Results:All the 32 flaps of 29 patients were successfully excised. The highly selective arterial angiography was performed 37 times, including 13 cases of puncture of the oblique branch of the lateral circumflex femoral artery, 6 cases of puncture of the descending branch, 8 cases of double puncture of the oblique and descending branches, and 2 cases of puncture of arteries from other branches. During the surgery, the excision position of 28 flaps did not change, the excision position of 3 flaps moved towards proximal extremity of the thigh, and the excision position of 1 flap moved towards distal extremity of the thigh. All the flaps survived successfully after the surgery, and there was no partial necrosis of the flaps at the proximal or distal ends. The wounds in the flap donor sites healed, and all skin grafts survived. No angiography-related complications occurred.Conclusions:Highly selective arterial angiography can be used to determine the blood supply range of the source artery and perforators of the anterolateral thigh free flaps during the surgery. It can evaluate the blood supply of flaps more intuitively and objectively. Its application in assisting flap design can avoid partial flap necrosis caused by unreasonable preoperative design to a certain extent, and it is safe and reliable.

Objective:To investigate the effectiveness and safety of endovascular therapy for patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion with early neurological deterioration (END).Methods:Patients with AIS due to anterior circulation large vessel occlusion with END underwent endovascular therapy under the multimodal imaging guidance in the Department of Neurology, Huai'an First Hospital Affiliated to Nanjing Medical University from June 2019 to April 2023 were collected retrospectively. The modified Thrombolysis in Cerebral Infarction (mTICI) grading was used to evaluate the vascular recanalization, and grade 2b or 3 was defined as successful recanalization. At 90 days after onset, the modified Rankin Scale (mRS) was used to evaluate the functional outcome, and 0-2 was defined as a good outcome. The patients with onset to femoral artery puncture time ≤24 hours and >24 hours were compared.Results:A total of 19 patients were enrolled, including 13 males, aged 61.16±11.75 years. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was 4 (interquartile range, 2-5), and the median NIHSS score at END was 13 (interquartile range, 10-20). Twelve patients (63.2%) received intravenous thrombolysis before END. Median baseline Alberta Stroke Project Early CT Score (ASPECTS) was 8 (interquartile range, 7-9); 18 patients (94.7%) achieved successful recanalization, and 2 (10.5%) experienced symptomatic intracranial hemorrhage (sICH). At 90 days after onset, the mRS scores: 0-2 in 12 cases (63.2%), 3 in 4 cases (21.1%), 5 in 1 case (5.2%), and 6 (death) in 2 cases (10.5%). There were 10 patients (52.6%) in the group with onset time to femoral artery puncture ≤24 hours, and 9 patients (47.4%) in the group with onset time >24 hours. There was significant difference between the two groups only in the ASPECTS ( P=0.035), but there were no significant differences in the postprocedural recanalization rate, sICH incidence rate, and good outcome rate at 90 days. Conclusion:Endovascular therapy under the guidance of multimodal imaging is safe and feasible for AIS patients with END due to anterior circulation occlusion.

Objective:To observe the clinical efficacy of auricular needle-embedding therapy for treating primary insomnia. Methods:A total of 63 patients were randomly divided into a conventional acupuncture group and an auricular needle-embedding group.The conventional acupuncture group received acupuncture at meridian points,while the auricular needle-embedding group received acupuncture at auricular points.Treatments were given once a day for 6 consecutive days,followed by a 1-day break,as a course of treatment.Both groups were treated for 2 courses.Before treatment,and after 1 course and 2 courses of treatment,the Pittsburgh sleep quality index(PSQI)score was assessed,and the efficacy was evaluated. Results:The cured and markedly effective rate and total effective rate of the auricular needle-embedding group were higher than those of the conventional acupuncture group,but there was no significant difference between the two groups(P>0.05).After 1 course of treatment,the PSQI global score and the scores of subjective sleep quality,sleep latency,sleep duration,habitual sleep efficiency,and daytime dysfunction of both groups decreased compared with those before treatment(P<0.01);there was no statistical significance in comparing the PSQI global score and individual component scores between the two groups(P>0.05).After 2 courses of treatment,the PSQI global score and the scores of sleep latency and habitual sleep efficiency of the auricular needle-embedding group decreased compared with those after 1 course of treatment(P<0.01 or P<0.05),while only the score of sleep latency of the conventional acupuncture group decreased compared with that after 1 course of treatment(P<0.05);the PSQI global score and the scores of subjective sleep quality and sleep latency of the auricular needle-embedding group were lower than those of the conventional acupuncture group(P<0.05). Conclusion:Both therapies can improve insomnia.Compared to conventional acupuncture,auricular needle-embedding therapy demonstrates a therapeutic advantage in improving sleep latency and sleep quality,making it worthy of clinical promotion.

Background: Biofilms, such as those from Staphylococcus epidermidis, are generally insensitive to traditional antimicrobial agents, making it difficult to inhibit their formation. Although quercetin has excellent antibiofilm effects, its clinical applications are limited by the lack of sustained and targeted release at the site of S. epidermidis infection. Objectives: Polyethylene glycol-quercetin nanoparticles (PQ-NPs)-loaded gelatin-N,Ocarboxymethyl chitosan (N,O-CMCS) composite nanogels were prepared and assessed for the on-demand release potential for reducing S. epidermidis biofilm formation. Methods: The formation mechanism, physicochemical characterization, and antibiofilm activity of PQ-nanogels against S. epidermidis were studied. Results: Physicochemical characterization confirmed that PQ-nanogels had been prepared by the electrostatic interactions between gelatin and N,O-CMCS with sodium tripolyphosphate. The PQ-nanogels exhibited obvious pH and gelatinase-responsive to achieve on-demand release in the micro-environment (pH 5.5 and gelatinase) of S. epidermidis.In addition, PQ-nanogels had excellent antibiofilm activity, and the potential antibiofilm mechanism may enhance its antibiofilm activity by reducing its relative biofilm formation, surface hydrophobicity, exopolysaccharides production, and eDNA production. Conclusions This study will guide the development of the dual responsiveness (pH and gelatinase) of nanogels to achieve on-demand release for reducing S. epidermidis biofilm formation.