Penetrating neck trauma caused by a rebar: A case report.

RATIONALE: Penetrating neck trauma has a mortality of 3% to 6% and is associated with serious complications, mainly due to the high density of vital structures in this area and the lack of corresponding protection from bone. PATIENT CONCERNS: A 55-year-old man who suffered neck trauma involving the parotid gland, caused by a rebar, after suffering a fall from the second floor of a building. DIAGNOSES: Penetrating neck trauma. INTERVENTIONS: The patient underwent a neck exploration under general anesthesia in the emergency operating room and tracheotomy was performed prophylactically. OUTCOMES: The foreign object was ultimately removed successfully with no complications. LESSONS: We concluded that computed tomography (CT) and three-dimensional reconstruction of the CT images can be a viable method to exclude macrovascular injury for patients who are in an emergency condition and are not eligible for computed tomography angiography (CTA). A chest tube could be used as an option for the removal of foreign bodies in the case of sharp or rough objects (such as spiral foreign bodies), when fully exposing the foreign body and its track.

Facile microencapsulation of olive oil in porous starch granules: Fabrication, characterization, and oxidative stability.

In this study, starch with porous structures derived from purple sweet potato was prepared and used as a food-grade polymer for the microencapsulation of olive oil. The optimal reaction conditions for preparing porous starch were determined to improve its adsorption capacity as effective microcapsule-wall materials. Olive oil was then impregnated in microspheres, and loading ratio was optimized by investigating the restrictive factors, including the mass ratio of olive oil to porous starch, as well as the embedding temperature and time. The presence of olive oil in the starch matrix was confirmed by SEM, FTIR, and TGA. Results demonstrated that the porous starch-based microencapsulation exhibit a stable olive oil loading ratio and a significant improvement in oxidative stability compared with free olive oil. The newly-proposed process used in this work was easy to scale up for developing a new and attractive method for oil protection in the food industry.

Effect of Kruppel-like factor 4 on Notch pathway in hepatic stellate cells.

The relationship between Kruppel-like factor 4 (KLF4) and the Notch pathway was determined to investigate the effect of KLF4 on the activation of hepatic stellate cells and underlying mechanisms. Fifty SPF BALB/c mice were randomly divided into two groups. A liver fibrosis model was established in 25 mice as the experimental group, and the remaining 25 mice served as controls. On the day 0, 7, 14, and 35, liver tissues were removed for immunofluorescent detection. The Notch pathway inhibitor DAPT was added to the primary original hepatic stellate cells, and KLF4 and Notch-associated factor expression was detected by qRT-PCR. Additionally, the hepatic stellate cell line LX-2 was used to establish control and experimental groups, and was cultured in vitro. LX-2 cells in the experimental groups were treated with DAPT and the Notch activator transforming growth factor-beta 1 separately, whereas those in the control group were given isotonic culture medium. After 48 h, KLF4 expression was examined by Western blotting. After transient transfection of LX-2 cells to increase KLF4, the expression of Notch factor was examined. Immunofluorescence analysis showed that, with the aggravation of liver fibrosis, the absorbance (A) values of KLF4 were decreased (day 0: 980.73±153.19; day 7: 1087.99±230.23; day 14: 390.95±93.56; day 35: 245.99±87.34). The expression of Notch pathway- related factors (Notch-1, Notch-2, and Jagged-1) in the hepatic stellate cell membrane was negatively correlated to KLF4 expression. With the increase of KLF4 expression, Notch-2 (0.73±0.13) and Jagged-1 (0.43±0.12) expression decreased, whereas Notch-1 level was not detectable. When the Notch pathway was inhibited, KLF4 levels generally increased (18.12±1.31). Our results indicate that KLF4 expression is negatively correlated to the Notch pathway in hepatic stellate cells, which may provide a reference for the treatment of hepatic fibrosis.

Trans-superior meatus endoscopic surgery of sphenoidal sinus and sellar area: a surgical technique for lesion of sellar area.

CONCLUSION: A trans-superior meatus endoscopic approach to treat diseases in the sphenoid sinus and sellar area is a safe, minimally traumatic, and effective method. OBJECTIVE: To avoid complications, we explored the use of the superior meatus and superior turbinate in the endoscope approach to the sphenoid sinus and sellar area. PATIENTS AND METHODS: This was a retrospective analysis of the curative effect of the trans-superior meatus approach for diseases in the sphenoid sinus and sellar area in 138 cases. RESULTS: All of 138 patients had successful operations and no serious complication occurred. All cases were followed up for a period of 1-3 years. No recurrence was found in 94 patients with isolated sphenoid sinus disease (sinusitis, mucoceles, or mycosis). Of 24 patients with pituitary adenoma, 17 patients had entire resection and no recurrence was found. Four patients had subtotal resection and three patients had partial resection with postoperative radiotherapy, and preoperative symptoms were improved. Of 13 cases of cerebrospinal rhinorrhea in the sphenoid sinus, 12 cases were successfully repaired by a single operation and 1 case was successfully repaired by a repeat operation. Among seven cases with decompression of the optic canal, four had obvious effect, two cases showed improvement, and there was no improvement in one case.

[The diagnosis and treatment of special airway foreign body].

OBJECTIVE: The aim of this study was to discuss the diagnosis and treatment of special airway foreign body. METHOD: Clinical data of 69 patients with airway foreign body were analyzed,of which 45 patients underwent rigid bronchoscopy while another 24 patients underwent tracheotomy. RESULT: The operations succeeded in 43 of the 45 patients who underwent rigid bronchoscopy, while the other 2 patients died of respiratory failure because of the foreign body slipping off at the level of the glottis. All of the 24 other patients were cured, in which continuous saturation of blood oxygen below 90% occurred in 8 patients and turned normal after positive airway pressure in intensive care unit (ICU). The total cure rate reached 97.1%. CONCLUSION: Most of special foreign body in the airway can be taken out through tracheotomy under general anesthesia. If the foreign body is too big and irregularly, or the patients is too young or have the pulmonary atelectasis, it is much safer to remove foreign body by tracheotomy.

[Image examination of postoperative evaluation for the cochlear implanted electrode].

OBJECTIVE: To evaluate the image feature of the X-ray plain film, the spiral computed tomography (CT) scans and three dimension reconstruction of inner ear with implanted electrode. METHODS: Eighteen patients of cochlear implant (MEDEL Combi 40+) recipients were involved in this study. The implanted electrode of all patients were examined on the fifth to seventh postoperative day, by the use of X-ray plain film with either anteroposterior transorbital projection (nine cases) or lateral position with coronal 60 degrees away from the examine table (nine cases). Three of the cochlear implant recipients were examined by the way of spiral CT scans with axial 1 mm image slices. The data of the CT scans was transferred to workstation for three-dimensioned reconstruction (direct volume rendering) of the inner ear. RESULTS: The X-ray plain film from both of anteroposterior projection and lateral with coronal 60 degrees projection provide satisfactory image of implanted electrode including the shape and the position in the temporal bone. The insertion depth of the electrode can be evaluated indirectly. In contrast, the images from CT scans with 3D reconstruction of the inner ear demonstrate more accurately the shape, the position, and the insertion depth of the electrode. Moreover, each of the electrode pairs can be identified clearly. CONCLUSIONS: X-ray plain film can meet the routine needs of postoperative evaluation of the implanted electrode with several kinds of head position of projection. But CT scans with 3D reconstruction of inner ear provide more accurate image of the spacial relationship of the electrode in the cochlear canal with direct demonstration of electrode insertion depth in the cochlea.

[Integrated methods for assessing auditory nerve-auditory pathway integrity].

OBJECTIVE: To evaluate the feasibility and value of integrated methods to assess auditory pathway integrity. METHOD: Twenty-four cases of bilateral profoundly-deafened individuals who were considered as the candidates of cochlear implantation were included in this study. Auditory pathway integrity from these candidates of cochlear implantation were assessed with the integrated methods established by our team, which consist of 5 categories including 1. audiological test; 2. radiological imaging study; 3. ear-canal electric audiometry; 4. response to sound in daily life; and 5. speech development. RESULT: Twenty-three candidates who meet the criteria of auditory nerve-auditory pathway integrity received cochlear implantation with improved hearing and speech development postoperatively. The remainder one of the 24 candidates was diagnosed as bilateral absence of auditory nerve. The fault of cochlear implantation was avoided. CONCLUSION: The integrated methods for assessing auditory pathway integrity is feasible and valuable. Auditory nerve-auditory pathway integrity should be considered and included as one of the most important criteria for cochlear implantation candidate.