Efficacy of carbon dioxide laser and caustic agent cauterisation for the focal granular myringitis: A randomised trial.

OBJECTIVES: Granular myringitis (GM) is a troublesome disease with a high incidence of recurrence and relapse. CO2 laser vaporisation and trichloroacetic acid (TAA) have been applied in treating several otological diseases, both with favourable therapeutic efficacy. However, long-term therapeutic efficacy of both CO2 laser vaporisation and TAA cauterisation against GM has not yet been evaluated. We aimed to investigate the therapeutic potential of CO2 laser vaporisation and TAA cauterisation in GM management. STUDY DESIGN: Prospective and randomised study. PARTICIPANTS: A total of 88 GM patients who failed therapy with boric acid, alcohol and glycerin ear drop otic solution between July 2009 and January 2018 were included. Participants were randomly assigned to receive CO2 laser vaporisation (n = 39) or TAA cauterisation (n = 49). MAIN OUTCOME MEASURES: Main outcomes were treatment success, complications after 4 months of treatment, and recurrence within 4-12 months after treatment. RESULTS: The success rate was significantly higher in the CO2 group than in the TAA group (94.9% vs. 77.6%, p = .023). After 4 months of treatment, the GM recurrence rate was comparable between the two groups (13.5% vs. 18.4%, p = .562). The CO2 laser group had one case of perforation and one case of severe vertigo, whereas one participant in the TAA cauterisation group experienced hearing loss. CONCLUSION: Both TAA cauterisation and CO2 laser vaporisation are safe and effective treatments for GM. The success rate of CO2 laser vaporisation for treating GM is higher than that of TAA cauterisation. Recurrence rates are comparable within 1 year.

Naringenin induces endoplasmic reticulum stress-mediated cell apoptosis and autophagy in human oral squamous cell carcinoma cells.

Human oral squamous cell carcinoma (OSCC) has been one of the most common oral cancers owing to high percentage of betel nuts chewers, smokers, and alcohol consumption. With current treatment strategies in OSCC, more than half patients relapse and develop distant metastases with poor prognosis. To overcome the incident, OSCC poses a challenge in current therapies and treatments. Naringenin, a natural flavonoid, has been noted for antitumor effects on various types of cancers; however, the effects of naringenin on OSCC remain bias. In this study, naringenin demonstrated the potential multifunction in human OSCC cells not only leading to cell apoptosis, but also alternating the general function of autophagy, serving as pro-survival mechanism by inducing the endoplasmic reticulum (ER) stress signaling through intracellular reactive oxygen species (ROS) production. In the process of programmed cell death, naringenin induced apoptotic signaling through caspase-cascade, mitochondrial dysfunction, and ER stress by aberrance of Ca2+ release. In contrast, under the presence of naringenin, the pro-survival has been altered into pro-death to activate the caspases-mediated apoptosis achieving cell death. The cross-function of apoptosis and autophagy has demonstrated the effect of naringenin-induced intracellular ROS activity in OSCC cells. Therefore, this study found that the effect of naringenin induces intracellular ROS to trigger programmed cell death and ER stress through the mechanisms of apoptosis and autophagy in human oral squamous carcinoma. PRACTICAL APPLICATIONS: This study revealed that naringenin debilitated the OSCC cell viability via the intracellular ROS production, ER stress, and autophagy, leading to cell apoptosis. Based on these studies and findings, naringenin provided an antitumor effect as a novel natural compound to improve the current therapies in OSCC.

Self-Powered, Self-Healed, and Shape-Adaptive Ultraviolet Photodetectors.

The emergence of self-healing devices in recent years has drawn a great amount of attention in both academics and industry. Self-healed devices can autonomically restore a rupture as unexpected destruction occurs, which can efficiently prolong the life span of the devices; hence, they have an enhanced durability and decreased replacement cost. As a result, integration of wearable devices with self-healed electronics has become an indispensable issue in smart wearable devices. In this study, we present the first self-powered, self-healed, and wearable ultraviolet (UV) photodetector based on the integration of agarose/poly(vinyl alcohol) (PVA) double network (DN) hydrogels, which have the advantages of good mechanical strength, self-healing ability, and tolerability of multiple types of damage. With the integration of a DN hydrogel substrate, the photodetector enables 90% of the initial efficiency to be restored after five healing cycles, and each rapid healing time is suppressed to only 10 s. The proposed device has several merits, including having an all spray coating, self-sustainability, biocompatibility, good sensitivity, mechanical flexibility, and an outstanding healing ability, which are all essential to build smart electronic systems. The unprecedented self-healed photodetector expands the future scope of electronic skin design, and it also offers a new platform for the development of next-generation wearable electronics.

Self-Healing Nanophotonics: Robust and Soft Random Lasers.

Self-healing technology promises a generation of innovation in cross-cutting subjects ranging from electronic skins, to wearable electronics, to point-of-care biomedical sensing modules. Recently, scientists have successfully pulled off significant advances in self-healing components including sensors, energy devices, transistors, and even integrated circuits. Lasers, one of the most important light sources, integrated with autonomous self-healability should be endowed with more functionalities and opportunities; however, the study of self-healing lasers is absent in all published reports. Here, the soft and self-healable random laser (SSRL) is presented. The SSRL can not only endure extreme external strain but also withstand several cutting/healing test cycles. Particularly, the damaged SSRL enables its functionality to be restored within just few minutes without the need of additional energy, chemical/electrical agents, or other healing stimuli, truly exhibiting a supple yet robust laser prototype. It is believed that SSRL can serve as a vital building block for next-generation laser technology as well as follow-on self-healing optoelectronics.

Waterproof Fabric-Based Multifunctional Triboelectric Nanogenerator for Universally Harvesting Energy from Raindrops, Wind, and Human Motions and as Self-Powered Sensors.

Developing nimble, shape-adaptable, conformable, and widely implementable energy harvesters with the capability to scavenge multiple renewable and ambient energy sources is highly demanded for distributed, remote, and wearable energy uses to meet the needs of internet of things. Here, the first single waterproof and fabric-based multifunctional triboelectric nanogenerator (WPF-MTENG) is presented, which can produce electricity from both natural tiny impacts (rain and wind) and body movements, and can not only serve as a flexible, adaptive, wearable, and universal energy collector but also act as a self-powered, active, fabric-based sensor. The working principle comes from a conjunction of contact triboelectrification and electrostatic induction during contact/separation of internal soft fabrics. The structural/material designs of the WPF-MTENG are systematically studied to optimize its performance, and its outputs under different conditions of rain, wind, and various body movements are comprehensively investigated. Its applicability is practically demonstrated in various objects and working situations to gather ambient energy. Lastly, a WPF-MTENG-based keypad as self-powered human-system interfaces is demonstrated on a garment for remotely controlling a music-player system. This multifunctional WPF-MTENG, which is as flexible as clothes, not only presents a promising step toward democratic collections of alternative energy but also provides a new vision for wearable technologies.

Fully endoscopic laser stapedotomy: is it comparable with microscopic surgery?

BACKGROUND: Microscopic stapedotomy is very successful and has long history, but it still has some constraints. Thus, otoendoscopy is increasingly popular nowadays. AIMS/OBJECTIVES: The retrospective review study was to investigate the role of endoscopic laser stapedotomy in treating patients with otosclerosis. MATERIALS AND METHODS: Seventeen patients who received endoscopic laser stapedotomy from April 2014 to July 2017 were enrolled and compared to 13 patients who had microscopic stapedotomy from February 2009 to March 2012. The anatomical structures, operative time, and postoperative hearing outcomes were assessed in two groups. Relation between external acoustic canal and operative time was also analyzed. RESULTS: Using an endoscope, the operative field was clear, with easily identified anatomy, without need to sacrifice bony structures. The operative time was significantly longer in the endoscopic group in 2014 and decreased in the following years. There was no significant difference of hearing improvements between the two groups. There was a weak correlation between the width of the external auditory canal and the operative time. CONCLUSIONS AND SIGNIFICANCE: Fully endoscopic stapes surgery is a feasible and safe surgical technique and results in satisfactory hearing outcomes. However, surgeons take longer to master the technique and to achieve shorter endoscopic operative times.

Actively Perceiving and Responsive Soft Robots Enabled by Self-Powered, Highly Extensible, and Highly Sensitive Triboelectric Proximity- and Pressure-Sensing Skins.

Robots that can move, feel, and respond like organisms will bring revolutionary impact to today's technologies. Soft robots with organism-like adaptive bodies have shown great potential in vast robot-human and robot-environment applications. Developing skin-like sensory devices allows them to naturally sense and interact with environment. Also, it would be better if the capabilities to feel can be active, like real skin. However, challenges in the complicated structures, incompatible moduli, poor stretchability and sensitivity, large driving voltage, and power dissipation hinder applicability of conventional technologies. Here, various actively perceivable and responsive soft robots are enabled by self-powered active triboelectric robotic skins (tribo-skins) that simultaneously possess excellent stretchability and excellent sensitivity in the low-pressure regime. The tribo-skins can actively sense proximity, contact, and pressure to external stimuli via self-generating electricity. The driving energy comes from a natural triboelectrification effect involving the cooperation of contact electrification and electrostatic induction. The perfect integration of the tribo-skins and soft actuators enables soft robots to perform various actively sensing and interactive tasks including actively perceiving their muscle motions, working states, textile's dampness, and even subtle human physiological signals. Moreover, the self-generating signals can drive optoelectronic devices for visual communication and be processed for diverse sophisticated uses.

2018 Expert Consensus on the Management of Adverse Effects of Antiplatelet Therapy for Acute Coronary Syndrome in Taiwan.

Antiplatelet therapy is a key component in the treatment of acute coronary syndrome (ACS). The management of ACS has evolved considerably over recent years with the development of new and more potent antiplatelet agents. Clinical trials on ACS have demonstrated that potent antiplatelet agents can more effectively reduce cardiovascular events. However, there is a tipping point between safety and efficacy, beyond which the risk of bleeding and other adverse effects can outweigh the benefits of antiplatelet therapy. Striking a balance between safety and efficacy remains a major challenge. A consensus meeting of an expert panel composed of Taiwanese experts was held to provide recommendations for the management of adverse effects in patients with ACS receiving antiplatelet therapy. The common adverse effects of antiplatelet therapy include upper gastrointestinal bleeding, ecchymosis, hematuria, epistaxis and ticagrelor-related dyspnea. In this study, a literature review of these adverse events was performed and recommendations for the management were made.

Comparison of endoscopic and microscopic tympanoplasty.

Tympanoplasty was conventionally performed using a microscope for decades. However, since the endoscope began to be used in middle ear surgery in the 1970s, endoscopic tympanoplasty has gained increasing attention. The main objective of this study was to compare endoscopic and microscopic tympanoplasty with and without ossiculoplasty, demonstrating the potential advantages, disadvantages, and outcomes of each. This retrospective study included 126 patients with chronic otitis media who received tympanoplasty from 2013 to 2015 in our hospital. The clinical follow-up continued for at least 3 months postoperatively. Otoscopy and audiometry were conducted before and after the procedure. The different variables affecting surgical outcomes were thoroughly documented in each case. A total of 126 patients (131 ears) were included in this retrospective study. Moreover, 74 and 57 ears underwent endoscopic and microscopic tympanoplasty, respectively. The overall endoscopic tympanoplasty graft uptake rate was 97.7% (128/131). The operation time was significantly shorter in the endoscopic group statistically. A paired t test was used to compare pre- and postoperative audiometry results and showed significant differences between the endoscopic and microscopic groups. However, no statistically significant difference was observed in audiometry improvement between the two groups. No major complications were observed in any of the patients. Our study demonstrated that endoscopic tympanoplasty can be feasibly applied in middle ear surgery. The success rate, audiometry improvement, and complication rate are comparable between endoscopic tympanoplasty and conventional microscopic tympanoplasty. Moreover, the endoscopic group had smaller operation wounds and lower medical expenditures.

A Lemierre syndrome variant caused by Klebsiella pneumoniae.

Lemierre syndrome is an extremely rare disease characterized by oropharyngeal infection, septicemia, internal jugular vein thrombosis, and skip lesions. The most common causative pathogen is Fusobacterium necrophorum. We reported a 45-year-old woman who presented with left neck painful swelling and septicemia. Magnetic resonance imaging of the head and neck demonstrated venous thrombosis extending from the left internal jugular vein to the sigmoid sinus. During admission we discovered that the patient had uncontrolled diabetes mellitus. We also found a metastatic lesion through chest radiography. Klebsiella pneumoniae was cultivated from both blood samples and pus from deep neck spaces. Surgical drainage, early and adequate antibiotic treatment, anticoagulation, and strict control of blood glucose led to the patient's complete recovery. Because Lemierre syndrome is a forgotten disease in the era of antibiotics, awareness of the signs and symptoms of this disease is important because of its associated high mortality rate. This case illustrated that the presence of K pneumoniae can lead to Lemierre syndrome.

Isolation and characterization of the B798 light-harvesting baseplate from the chlorosomes of Chloroflexus aurantiacus.

The B798 light-harvesting baseplate of the chlorosome antenna complex of the thermophilic, filamentous anoxygenic phototrophic bacterium Chloroflexus aurantiacus has been isolated and characterized. Isolation was performed by using a hexanol-detergent treatment of freeze-thawed chlorosomes. The isolated baseplate consists of Bchl a, beta-carotene, and the 5.7 kDa CsmA protein with a ratio of 1.0 CsmA protein/1.6 Bchl a/4.2 beta-carotenes. The baseplate has characteristic absorbance at 798 nm as well as carotenoid absorbance maxima at 519, 489, and 462 nm. The energy transfer efficiency from the carotenoids to the Bchl a is 30% as measured by steady-state and ultrafast time-resolved fluorescence and absorption spectroscopies. Energy equilibration within the Bchl a absorbing regions exhibits ultrafast kinetics. Circular dichroism spectroscopy shows no evidence for excitonically coupled Bchl a pools within the 798 nm region.