Two cases of Tullio phenomenon in which oval and round window reinforcement surgery was effective

AimTo report the effect of oval and round window reinforcement surgery performed in two patients with the Tullio phenomenon. Case 1: A male with bilateral superior canal dehiscence syndrome. Downbeat nystagmus with leftward horizontal eye movement was recorded in an electronystagmogram using a pure-tone sound of 110 dB at 2000 or 4000 Hz in the right ear. Case 2: A female who had undergone stapes surgery. Computed tomography revealed an ossicular prosthesis in the vestibule. An audiogram indicated mild to moderate hearing impairment in the right ear. Leftward horizontal nystagmus was recorded in an electronystagmogram using a pure-tone sound of 110 dB at 500 or 1000 Hz in the right ear. Surgical findings indicated that the prosthesis was inserted deep into the oval window, which was closed with thin connective tissue.OutcomesAfter oval and round window reinforcement surgery was performed in the right ear, and loud, pure-tone sounds elicited neither nystagmus nor dizziness in either patient.     

Single-incision for breast-conserving surgery through round block technique

Aims and objectivesThe purpose of this study was to assess the feasibility of using the single-incision round block technique in breast-conserving surgery with sentinel lymph node (SLN) retrieval for breast cancer without compromising oncological safety.Materials and methodsA retrospective observational case-control study was conducted from January 2017 to October 2021. The study population consisted of two groups. In both groups, breast-conserving surgery was carried out through the round-block technique. In group A, SLN retrieval was performed using the round-block incision (study group), while in group B, SLN retrieval was conducted through a second skin incision in the axilla (control group). The study was approved by the local ethics committee Zurich (BASEC-Nr. 2020–02857), and written informed consent was obtained from all participants.ResultsOverall, 134 patients met the inclusion criteria, of whom 86 women underwent breast-conserving surgery and SLN retrieval using the single-incision approach (group A), and 48 women underwent conventional surgery, using two independent incisions for tumour resection and SLN retrieval (group B). The overall success rate in group A regarding SLN retrieval was 97.7%, whereas most tumours were located in the upper outer (47.7%) and upper inner quadrant (27.9%). Although the technique was equally successful in the other quadrants, the share of tumours in the lower outer, and the lower inner quadrant, and the retroareolar region was smaller, representing 17.4%, 3.5% and 3.5%, respectively. The median number of dissected lymph nodes was two, with a positivity rate of 24.4%. The occurrence of axillary neuralgia and axillary skin retraction was significantly higher in group B along with tendentially more axillary seroma formation. There were no significant differences regarding reintervention rates, in terms of complications, resection margins, locoregional recurrences, or deaths with a mean follow-up of 11 months.ConclusionsThe single-incision method through the round block technique is as safe and effective as the standard two-incision approach regarding nodal staging and resection margins, and seems to be applicable for tumours in all breast quadrants.     

Evaluation of key parameters in a potentiostatic corrosion test for dental amalgam

OBJECTIVES: Participation in a Round Robin study of potentiostatic corrosion test guidelines for dental amalgam was undertaken for the purpose of developing an accurate set of draft guidelines. METHODS: Dispersalloy, sybraloy, aristalloy, phasealloy, and tytin were used as the amalgam specimens. They were prepared following the guidelines, then coupled to a copper wire, cemented into glass tubes, and polished to a 600-grit finish. A corrosion cell was prepared using a carbon counter-electrode, a standard calomel electrode (SCE) as the reference electrode, and amalgam as the working electrode. A 37 degrees C solution of 10 g/l NaCl with a minimum volume of 300 ml was used. Within 5 min of polishing, the open circuit potential (OCP) was recorded for 10 min. Next, the specimen was polarized to 0 mV versus SCE, and the currents were recorded for a 24-h time period. Corrosion results were analyzed statistically with one-way ANOVA (p < 0.05) and the multiple comparisons Student-Newman-Keuls post-hoc test. RESULTS: Problems that occurred with evaporation, beaker size, carbon electrode length, SCE cap removal, glass tube fracture, polishing technique, and fresh electrolyte are easily avoidable with further explanation or reminder notes. Observations made concerning starting time, initial OCP recording, millivoltage, and solution temperature were determined to be necessary for the accuracy of test results. Analysis of results should include clarification of units, and graph interpretations. Finally, the number of specimens per amalgam should be increased from one to three so that statistical analysis can be performed. Using three specimens per amalgam, the method revealed corrosion susceptibility as measured by the improved test: aristalloy > sybraloy > (dispersalloy, phasealloy, tytin). SIGNIFICANCE: Having run the initially proposed guidelines, a number of clarifying changes were made so that the corrosion susceptibilities of five dental amalgams could be clearly differentiated.     

股骨头圆韧带生物学特征及临床研究进展

股骨头圆韧带是连接人体髋臼内下缘和股骨头的韧带,其内走行圆韧带动脉,以往观点认为股骨头圆韧带是人体胚胎发育的残余,在成人髋关节中并不具有任何生物学作用。但深入研究发现,股骨头圆韧带是一种强韧的关节内韧带,具有较重要的生理学功能。本文就股骨头圆韧带的生物学特点及其在先天性髋关节发育不良中的重要功能进行综述。     

Fourteen babies born after round spermatid injection into human oocytes

During the human in vitro fertilization procedure in the assisted reproductive technology, intracytoplasmic sperm injection is routinely used to inject a spermatozoon or a less mature elongating spermatid into the oocyte. In some infertile men, round spermatids (haploid male germ cells that have completed meiosis) are the most mature cells visible during testicular biopsy. The microsurgical injection of a round spermatid into an oocyte as a substitute is commonly referred to as round spermatid injection (ROSI). Currently, human ROSI is considered a very inefficient procedure and of no clinical value. Herein, we report the birth and development of 14 children born to 12 women following ROSI of 734 oocytes previously activated by an electric current. The round spermatids came from men who had been diagnosed as not having spermatozoa or elongated spermatids by andrologists at other hospitals after a first Micro-TESE. A key to our success was our ability to identify round spermatids accurately before oocyte injection. As of today, all children born after ROSI in our clinic are without any unusual physical, mental, or epigenetic problems. Thus, for men whose germ cells are unable to develop beyond the round spermatid stage, ROSI can, as a last resort, enable them to have their own genetic offspring.Azoospermia, a condition in which there are no spermatozoa in the ejaculate, occurs in 1% of men in the general population (1). For men with obstructive azoospermia, microsurgical aspiration of epididymal spermatozoa has been performed, and the pregnancy rate following injection of oocytes with epididymal spermatozoa is comparable to that following injection of ejaculated spermatozoa (2). However, up to 94% (17 of 18) of azoospermic men are diagnosed as having nonobstructive azoospermia (3). For such men, microscopic testicular sperm extraction (micro-TESE) has been widely performed to obtain testicular spermatozoa, which are reportedly found in up to 60% of all such cases (4–7). When neither spermatozoa nor late-stage spermatids are found in the testes, such men are considered sterile and are advised to consider using a sperm donor. However, clinicians should consider another possibility: the injection of round spermatids into oocytes. In our clinic, we have found that about 30% of nonobstructive azoospermic men with neither spermatozoa nor late-stage spermatids did possess round spermatids (8), and that such germ cells can be used as a last resort.In an earlier investigation, Ogura and Yanagimachi (9) found that hamster round spermatids electro-fused with oocytes formed pronuclei, which could participate in syngamy. Subsequently, they reported the birth of normal mouse offspring following microsurgical injection of round spermatids (ROSI) (10, 11). Male mice homologous for a mutation in the cAMP responsive-element modulator gene (Crem) are unable to undergo spermiogenesis, and therefore the most advanced spermatogenic cells present in such males are round spermatids (12). According to Yanagimachi et al. (13), round spermatids collected from the testes of such Crem-null males were able to produce fertile offspring following their injection into mature oocytes. The idea of using spermatids as substitutes for spermatozoa in humans was first proposed by Edwards et al. (14). Since the first ROSI human babies were obtained by Tesarik et al. (15, 16), additional pregnancies have been reported (17–19). However, there have been very few similar reports in recent years, perhaps because many clinical investigators have become pessimistic as to the efficiency, safety, and practical value of ROSI (20–23). Indeed, both the Practice Committee of American Society for Reproductive Medicine and the Practice Committee of Society for Assisted Reproductive Technology (24) considered ROSI as an experimental rather than a recommended practice. In an attempt to take this further, we tried to obtain spermatozoa by culturing human primary spermatocytes in vitro. Although some spermatocytes developed into round spermatids, they did not develop further (25), and attempts to transform round spermatids into spermatozoa in vitro met with limited success (8). Therefore, when we did not found normal-looking spermatozoa or late spermatids in micro-TESE, we used the round spermatids from the patients for the ROSI. Here, we report the details of the ROSI procedure that lead to the birth of 14 babies born between September 2011 and March 2014.     

Aquaporins in spermatozoa and testicular germ cells： identification and potential role

Mammalian spermatozoa have relatively high water permeability and swell readily, as in the hypo-osmotic swelling test used in the andrology clinic. Physiologically, spermatozoa experience changes in the osmolality of the surrounding fluids in both the male and the female tracts on their journey from the testis to the ovum. Sperm volume regulation in response to such osmotic challenges is important to maintain a stable cell size for the normal shape and function of the sperm tail. Alongside ion channels for the fluxes of osmolytes, water channels would be crucial for sperm volume regulation. In contrast to the deep knowledge and numerous studies on somatic cell aquaporins （AQPs）, the understanding of sperm AQPs is limited. Among the 13 AQPs, convincing evidence for their presence in spermatozoa has been confined to AQP7, AQP8 and AQP 11. Overall, current findings indicate a major role of AQP8 in water influx and efltux for sperm volume regulation, which is required for natural fertilization. The preliminary data suggestive of a role for AQP7 in sperm glycerol metabolism needs further substantiation. The association of AQP 11 with the residual cytoplasm of elongated spermatids and the distal tail of spermatozoa supports the hypothesis of more than just a role in conferring water permeability and also in the turnover and recycling of surplus cellular components made redundant during spermiogenesis and spermiation. This would be crucial for the maintenance of a germinal epithelium functioning efficiently in the production of spermatozoa.     

Use of Triple-Convergence Polypropylene Thread™ for the Aesthetic Correction of Partial Facial Paralysis

Rehabilitation and reanimation of the paralyzed face remains a challenge. A variety of autografts and allografts have been used for static facial suspension. We report two cases of long-standing partial facial paralysis treated with 3C triple-convergence polypropylene thread. A 39-year-old woman with right-sided partial facial paralysis underwent an endoscopy-assisted facial suspension using the 3C threads and a 60-year-old woman with right-sided partial facial paralysis underwent a round face-lifting combined with endoscopic brow lift and placement of 3C triple-convergence polypropylene threads. Its use for partial facial paralysis has not been previously described. The 1-year follow-up shows effective preservation of the surgical result and patient satisfaction.     

Intrahepatic sarcomatoid cholangiocarcinoma of round cell variant: a case report and immunohistochemical studies

Sarcomatoid transformation was observed in 4.5% of autopsied cases of intrahepatic cholangiocarcinoma. Here, we report a case of intrahepatic sarcomatoid cholangiocarcinoma with round cell feature, extremely rare variant. An 87-year-old man was incidentally found to have a tumor in the left lobe of the liver by abdominal computed tomography scans. The patient was clinically diagnosed to have intrahepatic cholangiocarcinoma and received palliative care without specific treatment. He died of hepatic insufficiency 3 months after the diagnosis. The autopsied liver specimens showed a reddish gray tumor of 4.0×2.8 cm in size. Histologically, the tumor was centrally hemorrhagic and necrotic and was composed of tubular adenocarcinoma and a round cell component, which has an eccentrically located nucleus and eosinophilic cytoplasm without mucin production. Immunohistochemically, the adenocarcinoma cells expressed cytokeratin 19 and β-catenin in their cytoplasm, with E-cadherin and CD44s at the plasma membrane. In the round cells, cytokeratin 19 and vimentin was detected in their cytoplasm and CD44s at the plasma membrane. E-cadherin immunoreactivity was weakly present in their cytoplasm and β-catenin was negative. Loss or reduction of the E-cadherin and β-catenin expressions and overexpression of CD44s in the round cells are suggested to be contributed to the high propensity for lymphatic permeation and poor prognosis.     

Clinical Aspects of Round Window Membrane Permeability Under Normal and Pathological Conditions

Current research and an overall review of 25 years of round window membrane studies are presented. The approach, rationale and concepts that have evolved from these studies are described. Ultrastructural studies of the round window membrane of humans, monkeys, felines and rodents have disclosed three basic layers: an outer epithelium, a middle core of connective tissue and an inner epithelium. Interspecies variations are mainly in terms of thickness, being thinnest in rodents and thickest in humans. Morphologic evidence suggests that the layers of the round window participate in resorption and secretion of substances to and from the inner ear, and that the membrane could play a role in the defense system of the ear. Different substances, including antibiotics and tracers, when placed in the middle ear side traverse the membrane. Tracers placed in perilymph become incorporated into the membrane by the inner epithelial cells. Permeability is selective and factors affecting permeability include size, concentration, electrical charge, thickness of the membrane and facilitating agents. Passage of substances through the membrane is by different pathways, the nature of which is seemingly decided at the outer epithelium of the membrane. Round window membrane studies have provided increased knowledge of the anatomy and function of this structure, as well as new insights into pathology and pathogenesis. The concepts that have evolved from these studies are potentially useful for understanding middle and inner ear interactions, and for eventual drug delivery (based on permeability) to the inner ear.