Objective: Endoscopic tympanoplasty includes various surgical methods, such as internal repair, interlayer repair, and external overlay. This technique requires autologous materials, allografts, and xenografts, which are used to repair tympanic membrane (TM) perforation. To obtain good results, appropriate surgical methods and repair materials should be selected. This study aims to assess the efficacy of repairing refractory TM perforations in the porcine small intestinal submucosa (SIS) during transcanal endoscopic type I tympanoplasty. Method: A retrospective chart review was performed on patients who underwent TM perforation repair with porcine SIS and tragus cartilage between January 2022 and September 2022 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Perforation size, tympanic status, pre- and postoperative symptoms, follow-up data, wound healing rates, and hearing improvement were analysed. Results: Of the 115 patients included in the study, 56 underwent interlayer repair with porcine SIS of the TM, and 59 patients underwent internal repair with tragus cartilage. No significant difference was found between the two groups at baseline in terms of age, sex, disease course, perforation side, tympanic status, underlying disease, or preoperative infection. The total postoperative effective rate of interlayer implantation with porcine SIS was 91.07% (51 patients), and that of internal implantation with tragus cartilage was 88.14% (52 patients). No significant difference was found in terms of the graft success rate between the two surgical methods (p = 0.887). Postoperative pure tone auditory (PTA) and air-bone gap (ABG) density significantly increased in both groups compared with before surgery (p < 0.05). However, the postoperative PTA and ABG density were not significantly different 3 months post-surgery between the two groups (p > 0.05). Compared to those in the internal implantation group, the patients in the interlayer group had a shorter operation duration (51.36 +/- 6.76 min vs. 59.71 +/- 7.45 min, t = 6.298, p < 0.001) and less blood loss (11.91 +/- 2.61 mL vs. 15.27 +/- 2.57 mL, t = 7.019, p < 0.001). Conclusions: Our study suggests that the porcine SIS, as well as the tragus cartilage, has a high success rate in repairing irreversible TM perforation. Endoscopic tympanoplasty via interlayer implantation with porcine SIS offers distinct advantages, including the absence of donor-site incision and scar formation, and ease of graft modification and manipulation. (c) 2024 Zhejiang University. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

Background: Laryngeal squamous cell carcinoma (LSCC) has poor prognosis, and the mechanism underlying the pathogenesis of LSCC remains unclear. Recently, study has shown that long nonprotein coding RNA ferritin heavy chain 1 pseudogene 3 (FTH1P3) plays a crucial role in tumor pathogenesis. This study aimed to explore the potential role of FTH1P3 in LSCC. Materials and Methods: The expression of E2F1 and FTH1P3 in LSCC was analyzed by quantitative real time-polymerase chain reaction assay. The direct targets of FTH1P3 and miR-377-3p were predicted, followed by functional validation. The functional role of FTH1P3 was investigated in AMC-HN-8 and TU686 cells using 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di-phenytetrazoliumromide assays and the measurement of glucose uptake and L-lactate production. Results: Their results found that overexpression of FTH1P3 promoted, but knockdown of FTH1P3 suppressed cell viability and glycolysis in LSCC cells. Besides, upregulated FTH1P3 was associated with increased E2F1 expression in LSCC patients. E2F1 was proved to induce FTH1P3 expression in LSCC cells. Mechanically, FTH1P3 modulated miR-377-3p expression by targeting miR-377-3p. Interestingly, LDHA was identified to be a target of miR-377-3p, and FTH1P3 promoted LDHA expression by suppressing miR-377-3p. In addition, knockdown of FTH1P3 mitigated E2F1-induced cell viability and glycolysis through miR-377-3p/LDHA in AMC-HN-8 cells. More importantly, knockdown of E2F1 inhibited tumor growth and FTH1P3 expression in vivo. Conclusion: In conclusion, these findings revealed that E2F1-induced FTH1P3 promoted cell viability and glycolysis through miR-377-3p/LDHA axis in LSCC, which could provide a promising novel strategy for LSCC treatment.

目的 分析总结胸部低剂量CT体检筛查冠状动脉钙化情况.方法 将2871例行低剂量胸部CT检查的体检人群按照年龄≤30岁、30 ～ 40岁、40～ 50岁、50～60岁和＞60岁和性别各分为5组.通过低剂量胸部CT图像判定各组人群的冠状动脉钙化斑块的阳性率、位置及累及支数(左前降支、回旋支、右冠状动脉).结果 冠状动脉钙化总阳性率10.6％,其中男性阳性率14.6％,女性5.3％.各组体检人群的冠状动脉钙化阳性率略随着年龄的增长逐渐提高.在男、女性冠状动脉钙化阳性人群中冠状动脉钙化斑块发生部位按照从高到低均分别为左前降支、右冠状动脉、回旋支、左主干、对角支、钝缘支.体检人群中,钙化斑块累及1支血管的比例最高,随着年龄的增长,累及2支血管和3支血管的比例逐渐提高.结论 低剂量胸部CT检查是一种简单有效的检查方法,有助于大规模筛选出本地区健康体检中冠状动脉钙化人群.

BackgroundPoor adherence to sublingual immunotherapy (SLIT) has become a major cause of unsatisfactory clinical efficacy for patients with allergic rhinitis (AR). This study was designed to identify the effect of different first prescription lengths on the adherence to SLIT.MethodsThe clinical data of 306 patients with AR who started SLIT between January 2017 and June 2018 were retrospectively reviewed. Patients were divided into 3 groups according to the length of their first prescription (group A: less than 3 months, group B: 3 to 6 months, group C: more than 6 months). The numbers of adherent or nonadherent patients in each group and the main reasons of nonadherence were analyzed.ResultsGroups A, B, and C included 102, 161, and 43 patients, respectively. The average lengths of the first prescription for group A, B, and C were 62.52 ± 17.63, 102.21 ± 9.22, and 189.07 ± 17.97 days. There were significance differences among the 3 groups (p < 0.05). There were 42 (41.18%), 112 (69.57%), and 37 (86.05%) adherent patients in group A, B, and C. There were 60 (58.82%), 49 (30.43%), and 6 (13.95%) nonadherent patients in group A, B, and C. There were significant differences in the proportions of adherent and nonadherent patients among the 3 groups (p < 0.05). The following reasons were cited for nonadherence to SLIT: the long course of SLIT; inconvenience of getting the prescription; ineffectiveness; side effects; and other reasons.ConclusionUnder certain conditions, 6 months is recommended as the standard length for the first prescription, which can significantly improve adherence to SLIT in patients with AR.

Objective To screen the hot-spot deafness gene mutation in children with non-syndromic hearing loss (NSHL) in Ningbo region.Methods One hundred and sixty eight NSHL children were enrolled from Ningbo Special Education Center for the study.The screening of 29 hot-spot mutations of 4 deafness genes was performed by multiple ARMS capillary electrophoresis using AGCU genetic deafness gene detection kit.Results Among 168 children,the deafness gene mutations were detected in 58 cases (34.52％),including 43 cases with single hotspot mutation in GJB2 gene,9 with hotspot mutations in single SLC26A4 gene,and 3 with GJB2 gene and SLC26A4 gene mutation,and 3 with 12S rRNA gene mutation.The total hot spot mutation rate of GJB2 gene was 27.38％,that of SLC26A4 gene was 7.14％,and that of 12S rRNA gene was 1.79％.The mutation rate of GJB2 235delC was the highest (23.21％),followed by GJB2 299 del AT (5.36％) in all hotspots.Conclusion GJB2 and SLC26A4 are the main genes associated with non-syndromic deafness patients in Ningbo area,and GJB2 235delC is the most common mutation site.

Objective To evaluate the risk factors of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic carcinoma (HCC).Methods Retrospective analysis was made on 21 patients complicating bile duct injury among 483 cases undergoing TACE for HCC.Results 21 patients were found to suffer from bile duct injury,the average interval between bile duct injury and TACE was 3.9 ± 2.7 months (9 cases of intrahepatic bile ducts dilation,1 case of biloma,3 cases of hepatic bile duct stricture combined with intrahepatic bile ducts dilation,5 cases of biloma combined with intrahepatic bile ducts dilation,3 cases with a triplex of intrahepatic bile ducts dilation,biloma and intrahepatic bile ducts dilation).Bile duct injury was accompanied by elevation of alanine aminotransferase (ALT),aspertate aminotransferase (AST),alkaline phosphatase (ALP)and gamma glutamyl transpeptidase (GGT) (respectively t =-2.721,-2.674,-3.079,-3.377,all P ＜ 0.05).Among those 21 patients TACE was given after hepatectomy in 16 cases.Conclusions Bile duct injury complicating TACE has a causal relationship with intraarterial embolism of the hepatic artery branches.Pre-TACE hepatectomy was a risk factor for TACE related bile duct injury.

Objective To evaluate the voice improvement after the suspend laryngoscope surgery combined with micro-suture techniques in vocal fold polyps. Methods The epithelial defects and micro-flaps of all 33 vocal fold polyps pa-tients who underwent resection of vocal fold polyps through suspend laryngoscope under microscope were sutured and fixed with 8-0 absorbable suture. All the patients underwent evaluation of vocal function included the perceptual grade, rough-ness, breathness, aesthenia, GRBAS and objective voice analysis pre-operation and post-operation. Results Two weeks after post-operative, the GRBAS and objective acoustic parameters were improved significantly compared with the pre-op-erative (t=5.51,3.87,4.87,6.56,5.34,8.66,P<0.05). The vocal cords were slightly congested, vibration amplitude and mucosa wave of the vocal cords mildly decreased at two weeks after post-operative. The vocal form kept well, vocal fold vibration amplitude and mucous wave returned to normal values at 1 months after post-operative, and jitter and shimmer were improved significantly (t=2.97,4.54,P<0.05),but there was no significantly difference of the other acoustic parame-ters (t=1.73,1.46,1.01,1.62,P>0.05). Conclusions The suspend laryngoscope surgery combined with micro-suture techniques on vocal fold polyps can promote the recovery and improve voice quality.

目的：探讨老年慢性鼻-鼻窦炎及伴鼻息肉患者与支气管哮喘和肺功能的相关性。方法134例老年慢性鼻窦炎患者根据是否有鼻息肉将所有患者分为单纯慢性鼻窦炎（ CRS）组和CRS伴息肉组，观察并记录两组患者变应性鼻炎和支气管哮喘发生率，Spearman相关分析慢性鼻窦炎不同病变范围、鼻息肉不同分级与合并支气管哮喘肺功能的相关性。结果 CRS组和CRS伴息肉组不同病变范围和分级间变应性鼻炎和支气管哮喘发生率比较差异无统计学意义（P＞0.05）；CRS病变范围与肺功能呈显著正相关（P＜0.05），CRS伴息肉不同分级与肺功能无相关性（P＞0.05）。结论老年CRS、CRS伴鼻息肉病变程度与支气管哮喘肺功能阻塞程度存在正相关关系。

恶性肿瘤是当今威胁人类健康和生命的主要疾病之一，头颈癌占全身恶性肿瘤的5%左右，国外报道其发病率位居全身第6位[1]，但其发病部位和病理类型之多，居肿瘤全身肿瘤之首。肿瘤异常蛋白（tumor abnormal protein，TAP）是细胞中癌基因和抑癌基因突变后表达的产物，是癌细胞在异常增生过程中的共同特征[2]。近年来，TAP已被广泛应用于消化系统、肺癌、乳腺癌等的早期筛查或临床治疗后效果评估。本研究通过检测头颈部恶性肿瘤患者手指末梢血TAP表达水平，探讨TAP与肿瘤病理类型、发病部位及临床分期的相关性。

患者男,62岁,因右耳痒、痛11d,口角歪斜、步态不稳、吞咽困难、嗜睡3d于2011年6月20日急诊来我院.家属述患者既往有10余年糖尿病史,未经正规治疗.查体:意识不清,右外耳道皮肤红肿,右侧周围性面神经麻痹.实验室检查:血钾6.26 mmol/L,血糖27.6 mmol/L,血pH值7.275,血清碳酸氢盐28.0 mmol/L,β-羟丁酸8.5 mmol/L,剩余碱-9.7 mmol/L,C反应蛋白67.6 mg/L,白细胞22.0×109个/L,中性粒细胞比例93％,尿酮体(2+).腰穿脑脊液常规检查,未发现颅内感染.急诊以糖尿病酮症酸中毒合并Ramsay Hunt氏综合征收入我院内分泌科治疗.

Gastric cancer is one of the most common malignant tumors in digestive tract, functional MRI can represent the functional changes of the tumor. DWI not only provides a new way to diagnosis the gastric cancer, but also reflect the pathology changes of the tumor, which has great value to predict the therapeutic effect and prognosis of the tumor. MRS is the only method to test the chemical composition of tissues in live without injury, which has great value in the early diagnosis of gastric tumor and in the research of tumor mechanism. This review is mainly focused on the status and development of functional MRI in gastric cancer.

患者 男,62岁,因右耳痒、痛11d,口角歪斜、步态不稳、吞咽困难、嗜睡3d于2011年6月20日急诊来我院.家属述患者既往有10余年糖尿病史,未经正规治疗.查体：意识不清,右外耳道皮肤红肿,右侧周围性面神经麻痹.实验室检查：血钾6.26 mmol/L,血糖27.6 mmol/L,血pH值7.275,血清碳酸氢盐28.0 mmol/L,β-羟丁酸8.5 mmol/L,剩余碱-9.7 mmol/L,C反应蛋白67.6 mg/L,白细胞22.0×109个/L,中性粒细胞比例93%,尿酮体（2＋）.腰穿脑脊液常规检查,未发现颅内感染.急诊以糖尿病酮症酸中毒合并Ramsay Hunt氏综合征收入我院内分泌科治疗.

BACKGROUND:The tumor suppressor TP53 and its negative regulator MDM2 play crucial roles in carcinogenesis. Previous case-control studies also revealed TP53 72Arg>Pro and MDM2 309T>G polymorphisms contribute to the risk of common cancers. However, the relationship between these two functional polymorphisms and nasopharyngeal carcinoma (NPC) susceptibility has not been explored.METHODS:In this study, we performed a case-control study between 522 NPC patients and 722 healthy controls in a Chinese population by using PCR-RFLP.RESULTS:We found an increased NPC risk associated with the MDM2 GG (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 2.08-3.96) and TG (OR = 1.49, 95% CI = 1.16-2.06) genotypes. An increased risk was also associated with the TP53 Pro/Pro genotype (OR = 2.22, 95% CI = 1.58-3.10) compared to the Arg/Arg genotype. The gene-gene interaction of MDM2 and TP53 polymorphisms increased adult NPC risk in a more than multiplicative manner (OR for the presence of both MDM2 GG and TP53 Pro/Pro genotypes = 7.75, 95% CI = 3.53-17.58).CONCLUSION:The findings suggest that polymorphisms of MDM2 and TP53 genes may be genetic modifier for developing NPC.

目的讨论螺旋CT在咽喉部滞留鱼刺的诊断作用。方法对10例咽喉部鱼刺滞留15 d以上的患者作颈部螺旋CT扫描,并经多层面重建后清晰显示异物及其所在位置,然后进行手术探查,证实为鱼刺并取出。结果手术取出鱼刺的直径1～4 mm,长度15～28 mm。鱼刺横跨颈总动脉后方平第三气管环1例,位于舌骨水平内侧下颌舌骨肌群内1例,梨状窝2例,气管食管沟5例,食管入口1例。结论螺旋CT对咽喉部鱼刺异物敏感性高,定位准确,对咽喉部滞留鱼刺的诊断有重要价值,对手术有指导意义。

随着磁共振设备及序列的不断发展,磁共振功能成像在腹部脏器的应用成为现实。肾脏的磁共振功能成像近年来发展迅速,就其研究现状、存在的问题及其发展方向予以综述。

ABSTRACT We isolated an Mg ATG1 gene encoding a serine/threonine protein kinase from the rice blast fungus Magnaporthe grisea . In the ΔMg atg1 mutant, in which the Mg ATG1 gene had been deleted, autophagy was blocked; the mutant also showed fewer lipid droplets in its conidia, lower turgor pressure of the appressorium, and such defects in morphogenesis as delayed initiation and slower germination of conidia. As a result of lower turgor pressure of the appressorium, the ΔMg atg1 mutant lost its ability to penetrate and infect the two host plants, namely, rice and barley. However, normal values of the parameters and infective abilities were restored on reintroducing an intact copy of the Mg ATG1 gene into the mutant. Autophagy is thus necessary for turnover of organic matter during the formation of conidia and appressoria and for normal development and pathogenicity in M. grisea .

任克间隙(Reinke's space)是位于声带上皮下与声韧带之间的一个柔软、含有无定形物质的潜在间隙,其形态和张力决定了声带的振动特点[1].此间隙内组织液缓慢聚集增多形成任克水肿(Reinke's edema),它是引发嗓音改变的常见声带疾病.吸烟、嗓音滥用和食管反流被视为最常见的病因,具体病理机制尚不十分明确.本文对近年来有关任克间隙的细胞生理学、任克水肿的病理生理学、治疗方法的最新进展综述如下.

OBJECTIVE:To research the value of frozen section examination for intraoperation diagnosis of thyroid nodule and determination of extent of thyroidectomy.METHOD:A retrospective evaluation of a group of 1 057 patients with thyroid nodular disease was analyzed. The group was divided into frozen section examination group (FS group) and non-frozen section examination group (NFS group).RESULT:There were 750 cases in FS group. The diagnosis made by frozen section examination was carcinoma in 117; benign lesion in 626. Diagnosis was deferred in 7 patients. The final pathology diagnosis was carcinoma in 127; benign lesion in 623. The sensitivity, specificity, accuracy and disaccord rate of frozen section examination were 95. 9%, 100. 0%, and 98. 4%, and 1. 6%, respectively. There were 307 cases in NFS group, and the final pathology diagnosis was carcinoma in 30; benign lesion in 277. The disaccord rate with clinical diagnosis was 9. 77%. The binomial distribution analysis indicate that the difference of disaccord rate between the FS group and the NFS group was remarkable ( P <0. 01).CONCLUSION:Frozen section examination has value in diagnosing the thyroid nodular, and is capable of determination of the extent of thyroidectomy.

>我国《医疗事故处理条例》、《执业医师法》、《医疗机构管理条例》和《医疗机构管理条例实施细则》都明确规定了医生在术前的告知义务。手术知情同意书作为医疗行为的有效证据,体现了患者及家属对医生的信任和对手术风险的认同及分担,是医患双方获取自我保护、预防医疗纠纷的关键步骤之一。我院耳鼻咽喉-头颈外科、骨科、头颈-整形外科、妇