Computed tomography demonstrates abnormalities of contralateral ear in subjects with unilateral sensorineural hearing loss

Purpose

Prior studies have associated gross inner ear abnormalities with pediatric sensorineural hearing loss (SNHL) using computed tomography (CT). No studies to date have specifically investigated morphologic inner ear abnormalities involving the contralateral unaffected ear in patients with unilateral SNHL. The purpose of this study is to evaluate contralateral inner ear structures of subjects with unilateral SNHL but no grossly abnormal findings on CT.

Materials and methods

IRB-approved retrospective analysis of pediatric temporal bone CT scans. 97 temporal bone CT scans, previously interpreted as “normal” based upon previously accepted guidelines by board certified neuroradiologists, were assessed using 12 measurements of the semicircular canals, cochlea and vestibule. The control-group consisted of 72 “normal” temporal bone CTs with underlying SNHL in the subject excluded. The study-group consisted of 25 normal-hearing contralateral temporal bones in subjects with unilateral SNHL. Multivariate analysis of covariance (MANCOVA) was then conducted to evaluate for differences between the study and control group.

Results

Cochlea basal turn lumen width was significantly greater in magnitude and central lucency of the lateral semicircular canal bony island was significantly lower in density for audiometrically normal ears of subjects with unilateral SNHL compared to controls.

Conclusion

Abnormalities of the inner ear were present in the contralateral audiometrically normal ears of subjects with unilateral SNHL. These data suggest that patients with unilateral SNHL may have a more pervasive disease process that results in abnormalities of both ears. The findings of a cochlea basal turn lumen width disparity >5% from “normal” and/or a lateral semicircular canal bony island central lucency disparity of >5% from “normal” may indicate inherent risk to the contralateral unaffected ear in pediatric patients with unilateral sensorineural hearing loss.     

Local perforator island flaps in post-traumatic reconstruction of middle third of the leg

Perforator flaps have been introduced for coverage of local and distant defects. Various designs of this flap are possible, but their role in the setting of trauma is debated. We report that it is possible to raise these flaps in cases of post-traumatic lower limb reconstruction with good results. Consideration must be given to the type of movement that is planned vis-a-vis the number of perforators identified.     

The pharmacokinetics of Toll-like receptor agonists and the impact on the immune system

Toll-like receptor (TLR) ligation activates both the innate and adaptive immune systems, and plays an important role in antiviral and anti-tumor immunity. Therefore, a significant amount of effort has been devoted to exploit the therapeutic potential of TLR agonists. Depending on the therapeutic purpose, either as adjuvants to vaccine, chemotherapy or standalone therapy, TLR agonists have been administered via different routes. Both preclinical and clinical studies have suggested that the route of administration has significant effects on pharmacokinetics, and that understanding these effects is critical to the success of TLR agonist drug development. This article will summarize the pharmacokinetics of TLR agonists with different administration routes, with an emphasis on clinical studies of TLR ligands in oncologic applications.     

逆行岛状筋膜蒂指背皮瓣修复同指指端缺损的临床分析

目的：对应用同指逆行岛状筋膜蒂指背皮瓣修复技术对患有指端缺损疾病的患者实施治疗的临床效果进行研究。方法选择在该院2012年8月—2014年8月就诊的患有指端缺损疾病的患者90例,随机分为对照组和治疗组,平均每组45例。采用腹部带蒂皮瓣技术对对照组患者实施治疗;采用同指逆行岛状筋膜蒂指背皮瓣修复技术对治疗组患者实施治疗。结果治疗组患者手部功能恢复正常时间(50.24±7.68)d和缺损修复治疗计划实施总时间(12.25±3.44)d明显短于对照组(74.92±10.64)、(17.59±4.51)d;指端缺损疾病治疗效果(总有效率93.4%)明显优于对照组（总有效率75.6%);在手术修复治疗的围术期出现不良反应的人数（1例）明显少于对照组（8例）。结论应用同指逆行岛状筋膜蒂指背皮瓣修复技术对患有指端缺损疾病的患者实施治疗的临床效果非常明显。     

Molecular characterization of Klebsiella pneumoniae isolated from renal transplanted patients: virulence markers,extended-spectrum β-lactamases,and genetic relatedness

The objective was to characterize virulence markers and β-lactam resistance in Klebsiella pneumoniae isolates from renal transplant patients and to evaluate their genetic relatedness. Two main genetic lineages were detected: 1 carried bla_CTX-M-15 not associated to IncFIIA plasmid replicon, which was found on the other lineage not expressing CTX-M–type enzyme. PAI III₅₃₆ and PAI II_CFT073 were detected for the first time in K. pneumoniae in 1 clone, while the siderophore kfu was carried by the other, with only PAI IV₅₃₆. The molecular data indicate colonization before admission and fuel the discussion on implementation of antibiotherapy before surgery.     

The promise of methylation on beads for cancer detection and treatment

Despite numerous technical hurdles, the realization of true personalized medicine is becoming a progressive reality for the future of patient care. With the development of new techniques and tools to measure the genetic signature of tumors, biomarkers are increasingly being used to detect occult tumors, determine the choice of treatment and predict outcomes. Methylation of CpG islands at the promoter region of genes is a particularly exciting biomarker as it is cancer-specific. Older methods to detect methylation were cumbersome, operator-dependent and required large amounts of DNA. However, a newer technique called methylation on beads has resulted in a more uniform, streamlined and efficient assay. Furthermore, methylation on beads permits the extraction and processing of miniscule amounts of methylated tumor DNA in the peripheral blood. Such a technique may aid in the clinical detection and treatment of cancers in the future.     

On the [4-14C]Progesterone Metabolism of Keloid and Hypertrophic Scar: A Preliminary Report

Tissue specimens from keloids (K) and hypertrophic scars (H), as well as from the healthy skin in their vicinity (KS resp. HS) were incubated in a medium containing [4-¹⁴C]progesterone. The metabolites were isolated and verified with thin layer chromatography. All investigated tissue types produced as metabolites of progesterone 5α-pregnane-3,20-dione, 5α-pregnane-3α, 20α-diol, as well as probably 3α/β-hydroxy-5-pregnan-20 one. The diffusion of progesterone from the medium into the tissue was most effective in K, in sharp contrast to H. The ability of the tissue to take up progesterone from the medium was nearly double in HS as compared with KS. HS seems to metabolize progesterone nearly with the same effectivity as K, and those both twice as much as KS. There were also marked differencies in the division of metabolites between the tissue and the medium.     

低分子肝素对指动脉逆行岛状皮瓣静脉危象的预防

目的探讨应用低分子肝素预防指动脉逆行岛状皮瓣静脉危象的发生,提高皮瓣存活质量。方法自2008年3月至2012年3月,应用指动脉逆行岛状皮瓣修复手指创面17人,共19指,皮瓣面积1．8cm×1-4cm～3．5cm×2．5cm,蒂长1．5cm～2．2cm。术后除常规处理外,皮下注射低分子肝素5000IU,每日一次,共5d。术后观察皮瓣血液循环情况。结果皮瓣早期血液循环良好。皮瓣持续渗血时间及渗血量较多,在皮瓣外形成质软的凝血块,用药过程中皮瓣边缘不易形成黑色血痂,过程中均未出现静脉危象,所有皮瓣均存活且存活质量高。术后随访3周～6个月,皮瓣颜色和周围皮肤基本一致,质地较软,手指活动功能满意。结论皮下注射低分子肝素能延长逆行岛状皮瓣术后皮瓣渗血时间,减轻皮瓣早期静脉回流的负荷,有效预防皮瓣发生静脉危象,提高了皮瓣的存活质量。