Oropharyngeal Stenosis Caused by Significant Scar Hyperplasia Following Tonsillectomy: A Case Report.

Oropharyngeal stenosis (OPS) is a relatively rare long-term complication of tonsillectomy in children, resulting from the narrowing of the upper aerodigestive tract between the soft palate, pharyngeal sidewalls, and base of the tongue. This is the first reported case of OPS due to significant scar hyperplasia; however, whether it is as prone to recurrence as skin scar hypertrophy remains unknown. In this article, we present the case of a 5-year-old girl who presented to our otolaryngology clinic with sleep snoring and suffocation. Her medical history included tonsillectomy and adenoidectomy, performed 3 years prior to presentation. The patient underwent a combination of surgery and administration of triamcinolone injections, resulting in significant symptomatic improvement. To date, no signs of recurrence have been reported.

The combined plasma membrane coating and cluster bombing strategy for improved tumor-targeting gene delivery of silicon nanoclusters.

With the promising biosafety and favorable cell imaging efficiency, silicon quantum dots (SiQDs) was broadly exploited as non-viral gene carriers in recent years. However, the low transfection efficiency and weak targeting ability hindered its further clinical applications. In this study, the combined plasma membrane coating and cluster bombing strategy was adopted to enhance the gene delivery potential of silicon quantum dots nanoclusters (SiNC). Initially, SiNC was generated via 3, 3'-Dithiodipropionic acid (DipA) crosslinking of SiQDs, then the obtained nanoclusters were coated by distinct plasma membrane. Interestingly, cell membrane coated SiNC (CM-SiNC) underwent particle size change, the typical character of "cluster bombing", when exposed to high GSH concentration, which was observed in the tumor microenvironment. Meanwhile, CM-SiNC can be efficiently uptaken by HEK 293T and HeLa cells, therefore transferring DNA into those cells. More importantly, among the particles coated by HeLa (HeLa-M), Red Blood (RBC-M) or RAW267.4 (RAW-M) cell membrane, HeLa cell membrane coating exhibited better cellular uptake and transfection efficiency in HeLa cells, which suggested the encouraging tumor targeting ability. In sum, these data suggested that cluster bombing of SiNC could be beneficial for physical stability and biodistribution, the additional plasma membrane coating further endowed SiNC the efficient gene delivery and tumor targeting ability. Therefore, CM-SiNC had the potential as a gene delivery vector and its application should be further addressed in vivo.

Development of a biomimetic DNA delivery system by encapsulating polyethyleneimine functionalized silicon quantum dots with cell membranes.

Quantum dots (QDs) are renowned for their remarkable optoelectronic properties, making them suitable for applications such as bioimaging and optoelectronics. However, their use in gene delivery has been restricted due to the low DNA loading capacity. This study aimed to develop a biomimetic DNA delivery system by encapsulating polyethyleneimine (PEI) functionalized silicon QDs (SiQDs) with cell membranes and evaluate its potential as a gene vector in vitro. To achieve this, hydrophilic dispersed silicon QDs (PQDs) were prepared through a one-pot hydrothermal reaction of PEI and 3-Aminopropyltrimethoxysilane (APTMS). Subsequently, red blood cell membrane (RBCM) encapsulated biomimetic QDs (CM-PQDs) was obtained through the extrusion method. The CM-PQDs exhibited higher DNA loading capacity and better stability than naked SiQDs. The CM-PQDs/DNA complex was effectively taken up by cells, as observed through the fluorescence characteristics of QDs themselves. Both CM-P10QDs (prepared with PEI10k) and CM-P25QDs (prepared with PEI25k) could deliver DNA into cells and express the reporter protein successfully. CM-P25QDs showed a higher transfection efficiency of 77.32% in 293 T cells and 47.11% in HeLa cells than SiQDs and CM-P10QDs. The results also indicated that cell membrane encapsulation could effectively reduce the cytotoxicity of SiQDs further. Therefore, the study concludes that CM-PQDs have the potential to serve as a safe and traceable biomimetic gene delivery system.

Preparation of PEI-modified nanoparticles by dopamine self-polymerization for efficient DNA delivery.

Achieving efficient and safe gene delivery is of great significance to promote the development of gene therapy. In this work, a polydopamine (PDA) layer was coated on the surface of Fe3 O4 nanoparticles (NPs) by dopamine (DA) self-polymerization, and then magnetic Fe3 O4 NPs were prepared by the Michael addition between amino groups in polyethyleneimine (PEI) and PDA. The prepared Fe3 O4 NPs (named Fe3 O4 @PDA@PEI) were characterized by Fourier transform infrared (FTIR), atomic force microscopy (AFM), and scanning electron microscopy (SEM). As an efficient and safe gene carrier, the potential of Fe3 O4 @PDA@PEI was evaluated by agarose gel electrophoresis, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, fluorescence microscopy, and flow cytometry. The results show that the Fe3 O4 @PDA@PEI NPs are stable hydrophilic NPs with a particle size of 50-150 nm. It can efficiently condense DNA at low N/P ratios and protect it from nuclease degradation. In addition, the Fe3 O4 @PDA@PEI NPs have higher safety than PEI. Further, the Fe3 O4 @PDA@PEI/DNA polyplexes could be effectively absorbed by cells and successfully transfected and exhibit higher cellular uptake and gene transfection efficiency than PEI/DNA polyplexes. The findings indicate that the Fe3 O4 @PDA@PEI NPs have the potential to be developed into a novel gene vector.

Benign paroxysmal positional vertigo with congenital nystagmus: A case report.

BACKGROUND: Benign paroxysmal positional vertigo (BPPV) is a form of temporary vertigo induced by moving the head to a specific position. It is a self-limited, peripheral, vestibular disease and can be divided into primary and secondary forms. Congenital nystagmus (CN), an involuntary, rhythmic, binocular-symmetry, conjugated eye movement, is found at birth or within 3 mo of birth. According to the pathogenesis, CN can be divided into sensory-defect nystagmus and motor-defect nystagmus. The coexistence of BPPV and CN is rarely seen in the clinic. CASE SUMMARY: A 62-year-old woman presented to our clinic complaining of a 15-d history of recurrent positional vertigo. The vertigo lasting less than 1 min occurred when she turned over, sometimes accompanied by nausea and vomiting. Both the patient and her father had CN. Her spontaneous nystagmus was horizontal to right; however, the gaze test revealed variable horizontal nystagmus with the same degree when the eyes moved. The patient's Dix-Hallpike test was normal, except for persistent nystagmus, and the roll test showed severe variable horizontal nystagmus, which lasted for about 20 s in the same direction as her head movement to the right and left, although the right-side nystagmus was stronger than the left-side. Since these symptoms were accompanied by nausea, she was diagnosed with BPPV with CN and treated by manual reduction. CONCLUSION: Though rare, if BPPV with CN is correctly identified and diagnosed, reduction treatment is comparably effective to other vertigo types.

Case report: Conquer a complex variant: Coronary-pulmonary artery fistulas, atrial septal defect and bicuspid pulmonary valve, under beating heart surgery.

Coronary artery to pulmonary artery fistula (CPAF) is a congenital or acquired abnormal channel between arteries, with a left-to-right cardiac shunting, which may lead to myocardial ischemia, arrhythmia, thrombotic complications, and heart failure. CPAF is usually detected by coronary angiography but few reports have used beating-heart surgery as a detection method. The patient in this case report is a 39-year-old male diagnosed with atrial septal defect (ASD), bicuspid pulmonary valve, and moderate tricuspid regurgitation (TR). He is asymptomatic. In preoperative evaluation, significant CPAF was suspected using echocardiography. The patient refused coronary angiography due to allergic history. Therefore, the cardiac team designed and performed on-pump beating-heart surgery (OPBHS) to detect and repair these disorders, and suggested OPBHS as a myocardial protection strategy for the patient at low surgical risk. A rare and complex cardiovascular case with CPAFs from two branches of the left anterior descending coronary (LAD) artery to the main pulmonary artery (MPA) with ASD, bicuspid pulmonary valve, and moderate TR has not yet been reported in the literature, and its embryological hypothesis has been further analyzed in this report.

Fabrication of zein-based hydrophilic nanoparticles for efficient gene delivery by layer-by-layer assembly.

As a natural biological macromolecule, zein has broad application prospects in drug delivery due to its unique self-assembly properties. In this work, zein/sodium alginate (Zein/SA) nanocomposites were prepared by a pH-cycle method, Then Zein/SA/PEI (ZSP) nanocomposites were prepared by efficient layer-by-layer assembly method, ZSP nanocomposite of higher transfection performance was further labeled by folic acid (FA). After characterizing the physicochemical properties of ZSP by various methods, the potential of ZSP as a gene delivery vehicle was explored in vitro. The results showed that ZSP had good dispersibility and stability, the diameter distribution was in the range of 124-203 nm, and it had a typical core-shell structure, which could effectively condensate DNA and protect it from nuclease hydrolysis. ZSP exhibited proton buffering capacity similar to PEI, lower cellular toxicity, lower protein adsorption and erythrocyte hemolysis effect than PEI. ZSP/pDNA complexes could be taken up by cells and exhibited higher transfection efficiency than PEI/DNA complexes at the same weight ratio. The transfection efficiency of the complex in HeLa and 293T cells can be improved by FA labeling, especially in HeLa cells. These results provide new perspective for the design and development of efficient zein-based gene delivery systems.

Three-dimensional reconstruction facilitates thoracoscopic anatomical partial lobectomy by an inexperienced surgeon: a single-institution retrospective review.

BACKGROUND: This study aimed to evaluate the effect of three-dimensional (3D) interactive quantitative surgical planning on the outcome of video-assisted thoracoscopic surgery (VATS) anatomical partial lobectomy (APL), and to investigate the learning curve of 3D reconstruction-assisted VATS APL assisted. METHODS: We retrospectively analyzed 156 cases of solitary pulmonary ground-glass opacity (GGO) lesions in patients who underwent 3D interactive quantitative VATS APL. Digital imaging and communications in medicine data were recorded for each patient. We used Materialise 3-Matic software to make 3D reconstructed images. All surgeries were performed by the same thoracic surgeon at the Cardiothoracic Surgery Department of Yichang Central People's Hospital between February 28, 2018, and April 20, 2020. The learning curve was evaluated using operative time and the cumulative sum (CUSUM) value of operative time in all cases. RESULTS: VATS APL was performed in every patient successfully, and there were no conversions to thoracotomy or lobectomy. The median surgical margin distance was 2.2 (range, 2.0-2.8) cm. All patients had an R0 complete cancer resection on histology. The histological subtypes of the segmental lesions included 69 cases of minimally invasive adenocarcinoma (MIA), 61 cases of adenocarcinoma, one case of squamous cell carcinoma, 16 cases of adenocarcinoma in situ (AIS), and nine cases of atypical adenomatous hyperplasia (AAH). The median operation time was 119 (range, 57-245) min, and median intraoperative blood loss was 37 (range, 15-247) mL. The median duration of thoracic drainage tube insertion was 2.3 (range, 1-23) days after surgery. The median length of postoperative hospital stay was 3.7 (range, 3-25) days. There were no cases of perioperative death. During the median postoperative follow-up period of 11 (range, 2-26) months, no tumor recurrence or postoperative death was observed. 3D interactive quantitative surgical planning facilitates safe and efficient VATS APL with a learning curve of 30 cases. CONCLUSIONS: 3D interactive quantitative surgical planning for VATS APL is a feasible option for inexperienced surgeons, with acceptable safety and complications.

A simplified model for determining the cutting plane during thoracoscopic anatomical partial lobectomy of the right lower lobe.

BACKGROUND: Few studies have examined the use of two-dimensional computed tomography (2D CT) and three-dimensional (3D) reconstruction images to determine the intersegmental plane (ISP) for pulmonary segmentectomy, but a systematic approach and nomenclature are currently lacking. This current study used 3D reconstruction of CT imaging to analyze variations in the right lower lobe's pulmonary ISP and created a simplified model to determine the optimum cutting plane (CP) for clinical application for operative planning and use during thoracoscopic anatomical partial lobectomy (APL). METHODS: Between January 2018 and October 2019, 325 patients with pulmonary lesions were identified who underwent thin-slice CT scans of the chest. The ISPs were identified by analyzing the 2D CT scans and 3D reconstruction images and the anatomical characteristics segmental boundary. The CP for the thoracoscopic procedure was then determined within the safe surgical margins, and a simplified CP model was created. RESULTS: The boundary between adjacent lung segment A and segment B was be expressed as "ISP: Sa-Sb". The ISP was divided into venous ISP (VISP), arterial ISP (AISP), and bronchial ISP (BISP). The proposed model of the CP can be expressed as follows: CP (f) = (V/A/B) ISP (x) + (V/A/B) sub ISP (y) + (V/A/B) sub-sub ISP (z). CONCLUSIONS: This report is a first attempt to provide a nomenclature for identifying the ISP, and create a simplified model for determining the CP for thoracoscopic partial lobectomy.

Effect of Extracellular Matrix Coating on Cancer Cell Membrane-Encapsulated Polyethyleneimine/DNA Complexes for Efficient and Targeted DNA Delivery In Vitro.

Polyethyleneimine (PEI) has a good spongy proton effect and is an excellent nonviral gene vector, but its high charge density leads to the instability and toxicity of PEI/DNA complexes. Cell membrane (CM) capsules provide a universal and natural solution for this problem. Here, CM-coated PEI/DNA capsules (CPDcs) were prepared through extrusion, and the extracellular matrix was coated on CPDcs (ECM-CPDcs) for improved targeting. The results showed that compared with PEI/DNA complexes, CPDcs had core-shell structures (PEI/DNA complexes were coated by a 6-10 nm layer), lower cytotoxicity, and obvious homologous targeting. The internalization and transfection efficiency of 293T-CM-coated PEI70k/DNA capsules (293T-CP70Dcs) were 91.8 and 74.5%, respectively, which were higher than those of PEI70k/DNA complexes. Then, the internalization and transfection efficiency of 293T-CP70Dcs were further improved by ECM coating, which were 94.7 and 78.9%, respectively. Then, the internalization and transfection efficiency of 293T-CP70Dcs were further improved by ECM coating, which were 94.7 and 78.9%, respectively. Moreover, the homologous targeting of various CPDcs was improved by ECM coating, and other CPDcs also showed similar effects as 293T-CP70Dcs after ECM coating. These findings suggest that tumor-targeted CPDcs may have considerable advantages in gene delivery.

[Risk factors of mortality in severe chest trauma patients].

OBJECTIVE: To investigate the risk factors of mortality in patients with severe chest trauma (SCT). METHODS: The clinical data of 777 SCT [abbreviated injury scale (AIS) ≥3] patients who were treated in the Chongqing Emergency Medical Center from January 2006 to April 2009 were retrospectively reviewed. Stepwise logistic regression analysis was used to explore 15 possible mortality-related risk factors. RESULTS: Seven factors were found to be correlated with the mortality of SCT: age, hemorrhagic shock, multiple organ dysfunction syndrome (MODS), pulmonary infection, abdominal organ injury, Glasgow coma scale (GCS) score, and thorax AIS score. Among them five factors were the independent factors that might increase the mortality of SCT: hemorrhagic shock (B=1.710, OR=1.291, P=0.001), MODS (B=3.453, OR=1.028, P<0.001), pulmonary infection (B=2.396, OR=10.941, P<0.001), abdominal organ injury (B=1.542, OR=1.210, P=0.005), and thorax AIS score ≥4 (B=0.487, OR=1.622, P<0.001). Two factors showed protective effects: age ≤60 years (B=-0.035, OR=0.962, P=0.01) and GCS score ≥12 (B=-0.635, OR=0.320, P<0.001). CONCLUSIONS: Age, disease severity, and complications (hemorrhagic shock, MODS, and pulmonary infection) are independent risk factors of the mortality of SCT. Effective treatment programs targeting these risk factors may improve the outcomes of SCT patients.

[Association between the polymorphisms of cluster of differentiation 14 gene promoters and the susceptibility of multiple organ dysfunction syndrome after severe chest trauma].

OBJECTIVE: To investigate the polymorphisms of cluster of differentiation 14(CD14)gene promoters and explore whether such polymorphisms are associated with the susceptibility to multiple organ dysfunction syndrome(MODS) in Chongqing population. METHODS: The single nucleotide polymorphisms of the promoter region of CD14 gene at position -1145 and -159 were detected using polymerase chain reaction-restriction fragment length polymorphism method in 106 patients with severe chest trauma, among whom 47 were with MODS. RESULTS: Trauma patients carrying G allele tended to have a higher risk of MODS than those carrying A allele at position-1145, the MODS scores in trauma patients carrying G allele were significantly higher than those carrying A allele (P=0.217 for dominant effect and P=0.037 for recessive effect), and the MODS scores in trauma patients carrying T allele were significantly higher than those carrying C allele at position -159 (P=0.048 for dominant effect and P=0.198 for recessive effect). The genotypes of CD14 gene at positions -1145 and -159 were significantly correlated with the MODS scores (P=0.043,P=0.046). Compare with single-point mutation, simultaneous two-point mutation had significantly higher risk of MODS (Pü0.01), while the difference of MODS scores showed no statistical significance (P=0.239). CONCLUSION: The polymorphisms of CD14 gene promoters are associated with MODS after severe chest trauma in Chongqing population.