Objective:To evaluate the clinical efficacy of nasal pedicle tissue flap based on nasal blood supply in the reconstruction of nasal skull base defects.Methods:A retrospective analysis was conducted on 138 clinical cases of skull base tumors and cerebrospinal fluid rhinorrhea treated at the Department of Otolaryngology, Head and Neck Surgery at Xiangya Hospital of Central South University from March 2017 to March 2023. A total of 79 males and 59 females were enrolled, aged from 8 to 82 years, with a median age of 51 years, including 108 patients (78.3%) with skull base tumors and 30 patients (21.7%) with cerebrospinal fluid rhinorrhea (and/or meningoencephalocele). During the surgery, 88 cases (63.8%) were repaired with nasal septal mucosal flaps pedicled with the posterior nasal septal artery, 14 cases (10.1%) with mucosal flaps pedicled with the anterior ethmoidal artery on the lateral wall of the nasal cavity, 6 cases (4.3%) with mucosal flaps pedicled with the posterior lateral nasal artery on the lateral wall and nasal floor, 12 cases (8.7%) with mucosal flaps pedicled with the anterior ethmoidal artery and posterior ethmoidal artery, and 18 cases (13.0%) with nasal septal mucosal extension flaps pedicled with the sphenopalatine artery or internal maxillary artery. Patients were followed up for 12 to 72 months postoperatively. Endoscopic examination or skull base enhanced MRI was performed to assess the growth and tumor recurrence in the skull base repair area. The t-test was used for statistical analysis.Results:Among 138 patients, primary repair was successful in 133 patients (96.4%), while 5 patients (3.6%) experienced postoperative cerebrospinal fluid rhinorrhea. These 5 patients all underwent nasal septal mucosal flap repair with the posterior nasal septal artery as the pedicle. Complications included 1 case of mucosal flap necrosis, 1 case of mucosal flap central perforation, and 3 cases of mucosal flap survival peripheral leakage, of which were all successfully treated with a second repair.Conclusion:The use of nasal pedicle mucosal flap based on nasal blood supply is a reliable, safe, and effective technique for repairing skull base defects.

The many-banded krait, Bungarus multicinctus, has been recorded as the animal resource of JinQianBaiHuaShe in the Chinese Pharmacopoeia. Characterization of its venoms classified chief phyla of modern animal neurotoxins. However, the evolutionary origin and diversification of its neurotoxins as well as biosynthesis of its active compounds remain largely unknown due to the lack of its high-quality genome. Here, we present the 1.58 Gbp genome of B. multicinctus assembled into 18 chromosomes with contig/scaffold N50 of 7.53 Mbp/149.8 Mbp. Major bungarotoxin-coding genes were clustered within genome by family and found to be associated with ancient local duplications. The truncation of glycosylphosphatidylinositol anchor in the 3'-terminal of a LY6E paralog released modern three-finger toxins (3FTxs) from membrane tethering before the Colubroidea divergence. Subsequent expansion and mutations diversified and recruited these 3FTxs. After the cobra/krait divergence, the modern unit-B of β-bungarotoxin emerged with an extra cysteine residue. A subsequent point substitution in unit-A enabled the β-bungarotoxin covalent linkage. The B. multicinctus gene expression, chromatin topological organization, and histone modification characteristics were featured by transcriptome, proteome, chromatin conformation capture sequencing, and ChIP-seq. The results highlighted that venom production was under a sophisticated regulation. Our findings provide new insights into snake neurotoxin research, meanwhile will facilitate antivenom development, toxin-driven drug discovery and the quality control of JinQianBaiHuaShe.

Objective:To analyze the epidemiological and clinical characteristics of patients with imported corona virus disease 2019 (COVID-19) in Beijing City.Methods:A case-control study was performed to retrospectively analyze 69 cases of imported COVID-19 from abroad and 147 cases of domestic confirmed COVID-19 from China as a control group from January 20 to March 20, 2020 admitted to Beijing Ditan Hospital, Capital Medical University.The epidemiological and clinical characteristics were compared.Statistical analysis were performed by t test, Mann-Whitney U test, chi-square test and Fisher exact test. Results:The main sources of the cases in the import group were from the United Kingdom, Italy, Spain and other European countries, with 44.9%(31/69) of the overseas students entering the country by air. The age of the imported group (27(21, 40) years) was lower than the domestic group (43 (32, 59)years), the difference between the two groups was statistically significant ( U=2 828.500, P<0.01). Compared with the domestic group, the proportion of cases with contact history of confirmed cases in the imported group was lower (30.4%(21/69) vs 68.0%(100/147)), the interval between onset and admission ≤seven days was higher (81.2%(56/69) vs 66.0%(97/147)), the proportion of cases with underlying diseases was lower (21.7%(15/69) vs 44.2%(65/147)). The differences between the two groups were all statistically significant ( χ2=26.935, 5.233 and 10.175, respectively, all P<0.05). The proportion of mild cases in the imported group was higher than that in the domestic group (42.0%(29/69) vs 10.9%(16/147)). Seventeen cases with olfactory abnormality and 12 cases with taste abnormality were found in the imported group, while no olfactory and taste abnormality was found in the domestic group. The proportions of fever, weakness, muscle soreness and dyspnea were all lower than those of the domestic group, the differences between the two groups were all statistically significant ( χ2=13.851, 8.118, 9.730 and 16.255, respectively, all P<0.01). The proportions of cases with decreased lymphocyte absolute numbers (37.7%(26/69) vs 67.3%(99/147)) and increased C reactive protein level (15.9%(11/69) vs 51.8%(72/139)) were both lower than the domestic group, and the differences between the two groups were both statistically significant ( χ2=18.015 and 24.722, respectively, both P<0.01). The proportions of cases with ground glass shadow and consolidation of chest computed tomography were lower than those of the domestic group and the differences between the two groups were all statistically significant ( χ2=11.961 and 5.099, respectively, all P<0.05). In terms of complications, the proportions of cases with acute respiratory distress syndrome and acute myocardial injury were lower (2.9%(2/69) vs 10.9%(16/147) and 4.3%(3/69) vs 14.0%(16/114), respectively), and there were statistically significant differences between the two groups ( χ2=4.017 and 4.335, respectively, both P<0.05). There were no cases received mechanical ventilation and extracorporeal membrane oxygenation in the imported group, and the proportions of patients received oxygen therapy and antibiotic treatment were significantly lower than those in the domestic group (13.0%(9/69) vs 26.5%(39/147) and 13.0%(9/69) vs 39.5%(58/147), respectively) and the differences between the two groups were statistically significant ( χ2=4.942 and 15.797, respectively, both P<0.05). Conclusions:The majority of imported COVID-19 cases are mainly from European countries, mostly young and middle-aged, and mostly mild and ordinary types.The symptoms of olfactory and taste abnormality are found for the first time.

Objective:To explore the application value and initial clinical experience of fluorescence-enhanced laparoscopy combined with indocyanine green in radical cystectomy with pelvic lymphadenectomy.Methods:A retrospective analysis was performed on the clinical data of a total of 8 patients admitted from May 2018 to August 2019 who underwent laparoscopic radical cystectomy with pelvic lymphadenectomy for muscle-invasive bladder cancer using the fluorescent laparoscopy system.There were 6 males and 2 females; aged 58 to 71 years, with an average of 65.8 years. The preoperative pathology was urothelial carcinoma, with 2 cases in T 2a stage, 4 cases in T 2b stage, and 2 cases in T 3a stage. The patient was injected a total of 2 ml of 2.5 mg/ml of indocyanine green through a rigid cystoscope using a 18 gauge cystoscope injection needle before surgery. The PINPOINT endoscopic fluorescence camera system performed surgery in real-time. A systematic examination of the surgical area under near-infrared fluorescence was performed every 5 minutes. Observation and recording of indocyanine green combined with fluorescence laparoscopy to mark the bladder tumor area and identify the sentinel drainage. Results:Eight cases were successfully completed under the fluorescence laparoscopic system.In terms of tumor markers, cystoscopy with indocyanine green allowed 7 of the 8 patients to successfully identify the tumor area under fluorescent laparoscopy. Six of the 8 patients with sentinel lymph nodes identified by indocyanine green lymphangiography were also successful, of which 3 were positive for lymph nodes. At the same time, intravenous indocyanine green was used to observe that the blood supply to the bladder and the end of the ureter was good. The operation time was 190-310 minutes, with an average of 235 minutes; the bleeding volume was 150-380 ml, with an average of 180 ml; the postoperative hospital stay was 10-22 days, with an average of 14.5 days. Postoperative pathological staging 2 cases in T 2a stage, 3 cases in T 2b stage, 3 cases in T 3a stage, with total number of lymph nodes 8-14, average 10. The 8 cases were followed-up for 4-12 months, average 5.5 months, without indocyanine green related complications. Conclusions:Indocyanine green fluorescent laparoscopy can accurately locate and identify the bladder tumor area and pelvic lymph nodes during radical cystectomy, which can reduce positive margins and unnecessary enlarged lymph node dissection.

Objective To evaluate the efficacy and safety of single flexible ureteroscope vs.flexible ureteroscope combined with intraoperative ultrasonography guided in the endogenous renal cyst incision and drainage.Methods Retrospective analysis of case data of 64 patients with endogenous renal cysts admitted from January 2015 to December 2017.All the patients undrwent contrast-enhanced CT,urinary tract imaging,ultrasound B to confirm bosniak classification Ⅰ and Ⅱ renal cyst.The patients (38 males,26 females) were divided into single flexible ureteroscope group [group A,32 cases of patients,average age (54.2 ±6.6) years,unilateral or bilateral cystic patients:19 cases/ 13cases,simple cyst of kidney or polycystic kidney:24 cases/8 cases,average maximum diameter of the renal cyst (5.4 ± 1.3) cm,combined with renal calculus:8 cases,combined with hydronephrosis:7 cases,1 case who had the history of laparoscopic renal cyst decapitation,1 case who had the history of percutaneous renal cyst puncture] and flexible ureteroscope group combined with intraoperative ultrasonography guided [group B,32 cases of patients,average age (52.3 ± 9.3) years,unilateral or bilateral cystic patients:21 cases/11 cases,simple cyst of kidney or polycystic kidney:25 cases/7 cases.Average maximum diameter of the renal cyst (5.3 ±1.2) cm,combined with renal calculus:9 cases,combined with hydronephrosis:8 cases,2 case who had the history of laparoscopic renal cyst decapitation,1 case who had the history of percutaneous renal cyst puncture].The double J stent was placed two weeks before the surgery into the body of patients.During the operation,the surgical procedure were used by the electronic flexible ureteroscope and holmium laser (0.8 J,20 Hz),combined with ultrasound B in the monitoring,to find the suitable incision position.It would be defined as the successful result if we could put the head of flexible ureteroscope into the inside of renal cyst and see the image of mist in the screen of ultrasound B.According to the standard,the result of operation wound be defined compared to before operation (success:shrink more than 80％ or maximum diameter was smaller than 1 cm;improvement:shrink about 50％-79％;ordinary result:shrink about 30％-49％;failure:shrink smaller than 30％).Effective rate =(success cases + improvement cases)/total cases.We compared the differences of two groups in the time,efficacy,safety and complication of surgery.Results Compared the results of single flexible ureteroscope groups vs flexible ureteroscope group combined with intraoperative ultrasonography guided in the success cases of surgery,after 8-30 months following-up,total operative complication rate was [8 cases(25％)vs.1 case(3.1％)],success rate of operation in 6 month later [(20 cases (62.5％) vs.28 cases (87.5％)].Flexible ureteroscope group combined with intraoperative ultrasonography guided had advantages statistically (P ＜ 0.05).However,there was no statistical difference for the two groups in the time of operation [(33.4 ± 6.7) min vs.(35.1 ± 8.6) min],single operative complication (intraoperative wounding bleeding:3 cases vs.1 case,postoperative urinary infection:3 cases vs.0 case,perinephric space effusion:2 cases vs.0 case,renal function impairment:1 case vs.0 case)(P ＞0.05).Conclusions Flexible ureteroscope combined with intraoperative ultrasonography guided can help the urologist can improve the success rate of surgery and reduce the chance of surgical injury intraoperatively.

BACKGROUND: Postoperative cholangitis is a common but severe complication after Kasai portoenterostomy for biliary atresia (BA). This study aimed to identify its prognostic factors. METHODS: Two sets of liver paraffin-embedded tissue samples were collected from BA patients who received Kasai portoenterostomy (n = 25 and n = 31, respectively). Patients were divided into non-cholangitis and cholangitis groups. The infiltration of CD4+, CD8+, CD45RO+, CD68+ cells and expression of Beclin1 were quantitatively evaluated in immunohistochemical analysis. RESULTS: Cholangitis group had a significantly lower CD8+ T cell infiltration but a higher CD45RO+ cell infiltration, and a lower Beclin1 level than non-cholangitis group (all P < 0.01). Multivariate logistic regression analysis indicated that infiltration of CD8+ cells (odds ratio [OR], 0.112; 95% confidence interval [CI], 0.022–0.577) and CD45RO+ cells (OR, 3.88; 95% CI, 1.37–11.03), and Beclin1 level (OR, 0.088; 95% CI, 0.018–0.452) were independent influence factors for early postoperative cholangitis. Receiver operating characteristic (ROC) analysis showed that area under ROC curve (AUROC) values for CD8+ cells, CD45RO+ cells and Beclin1 were 0.857, 0.738 and 0.900, respectively. CONCLUSION: Our findings demonstrated the CD8+ cells, CD45RO+ cells and Beclin1 level possessed the prognostic value for early postoperative cholangitis following Kasai operation, which may be helpful to develop new prevention and treatment strategies for postoperative cholangitis.
Biliary Atresia* ; Cholangitis* ; Humans ; Liver ; Logistic Models ; ROC Curve ; T-Lymphocytes*

Objective To investigate the clinical efficacy of the laparoscopic radical resection and the conventional laparotomy for colorectal cancer. Methods The clinical data of 106 patients with colorectal cancer treated by surgery from March 2011 to January 2016 were retrospectively analyzed, including 55 patients receiving laparoscopic surgery (laparoscopic group) and 51 patients treated by traditional surgery (conventional laparotomy group). The clinical effects of both groups were compared. Results The operation time in conventional laparotomy group was shorter than that in laparoscopic group [(141.2 ±40.6) min vs. (192.0±32.5) min, t=7.136, P<0.05]. The blood loss of the laparoscopic operation group was lower than that of conventional laparotomy group [(81.2 ±16.5) ml vs. (168.0 ±36.2) ml, t= 16.077, P< 0.05]. The recovery time of gastrointestinal function and hospital stay time in laparoscopic surgery group were significantly shorter than those in the laparotomy group (t= 12.236, t= 9.524, all P< 0.05). There were no statistical differences in the number of captured lymph nodes, complications and the length of bowel resection between two groups (all P>0.05). There were no severe complications and death case in both groups. Patients were followed up for 10-60 months, and there were no significant differences on recurrence and metastasis between two groups (P> 0.05). Conclusion Compared with the conventional laparotomy, laparoscopic radical resection is an effective method for the treatment of colorectal cancer with small trauma, less bleeding and fast recovery, which is worthy of clinical application.

Objective To investigate the correlation between histone deacetylase 9 gene ( HDAC9 ) single nucleotide polymorphisms and ischemic stroke ( IS) subtypes. Methods A total of 202 patients with IS were enrolled prospectively. According to the Trial of Org 10172 in Acute Stroke Treatment ( TOAST) classification,the patients with IS were divided into large artery atherosclerotic stroke group (LAA,n=149) and the small-artery occlusive stroke group (SAO,n=53). A total of 201 age- and sex-matched healthy subjects over the same period were enrolled as the control group. Polymerase chain reaction-ligase detection reaction ( PCR-LDR ) was used to perform genotyping for HDAC9 gene rs11984041 and rs2107595 loci in all subjects. The correlation between genotype and IS was analyzed with multivariate logistic regression analysis. Results ( 1 ) In all the subjects detected, the genotype detected from rs11984041 loci was type CC,and 3 genotypes including CC,CT,and TT were detected from rs2107595 loci. (2) There were significant differences in dominance model (CT+TT,CC) genotypes and allele frequencies among the LAA, SAO, and control group dominance model ( CT +TT, CC ) and (χ2 =8. 635,P=0. 013, χ2 =10. 309,P=0. 006);and there were no significant differences in dominance model (CT+TT,CC) and allele frequencies among the 3 groups (after adjustment all P>0. 017). Compared with the control group,there were significant differences in the CC,CT,and TT genotypes and allele frequencies in the LAA group (χ2 =7. 446;P=0. 006). In the dominance models (CT+TT),there was significant difference in genotype frequencies between the LAA group ( 65. 1%,97/149 ) and the control group (52. 2%,105/201) (χ2 =5. 800;P=0. 016). (3) Multivariate logistic regression analysis showed that in addition to gender,hypertension,smoking,and high level of low-density lipoprotein,the dominance model CT+TT genotype was associated with the LAA type IS ( CT+TT genotype:OR,1. 909,95% CI 1. 055-3. 454,P =0. 033). Conclusion In addition to the risk factors for cerebrovascular disease such as gender,hypertension,smoking,and high level of low-density lipoprotein,HDAC9 gene polymorphisms may be associated with the LAA type IS. rs2107595 locus CT + TT genotype may be an independent risk factor for LAA type IS.

Thirty-five patients with perioperative pulmonary embolism during January 2000 and October 2006 were analyzed retrospectively.Disease diagnosis and treatment outcomes were assessed.Of the 35 patients,2 died without any management,and 33 received conventional anti-coagulation and thrombolysis.including 3 percutaneous catheterization.Disease improvement Was seen in 29.Four deaths occurred after no response to the treatment.Thus,early diagnosis and treatment,which miight depend on further understanding of pulmonary embolism,could play an important role in reduced adverse events.Prevention is crucial to avoid perioperative occurrence of pulmonary embolism.

OBJECTIVE: To investigate the accuracy and clinical application of multi-slice spiral CT imaging on optic canal area. METHOD: Forty intact specimens of human corpse head were tested with three dimensional reconstruction of multi-slice spiral CT imaging. The results of radiology and anatomy were compared on adjacent structures of optic canal interior wall and its developmental relationship with sphenoid sinus. RESULT: (1) The high spatial resolution of integrity could be obtained with dimensional processing technique. The anatomical structure of optic canal and its surrounding area could be demonstrated clearly. (2) With the technique of virtual endoscopy, the interior reconstruction of optic canal could demonstrate the inner topography of optic canal, the reconstruction image of which was identical to that of the control subjects. (3) There was no significant difference between the data of multi-slice spiral CT imaging and that of anatomy (P > 0.05). CONCLUSION Associated application of dimensional processing technique and virtual endoscopy, not only can the subtle structures of optic canal be demonstrated and measured, but also the detailed information on spatial relationships of optic canal area can be provided for operation.
Adult ; Asian Continental Ancestry Group ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Optic Nerve ; anatomy & histology ; diagnostic imaging ; Tomography, Spiral Computed