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Background: Image-guided system (IGS) has been gradually applied in the field of rhinology, making functional endoscopic sinus surgery (FESS) a truly minimally invasive and precise surgery. This study was based on real-world data from China hospitals and aimed to evaluate the cost-effectiveness of the IGS navigation system in FESS.Methods: This was a two-center retrospective chart review of patients with chronic rhinosinusitis who underwent FESS, including open frontal sinus between July 1, 2018 and December 31, 2019 in China. The intervention group consisted of 100 patients who underwent FESS with the IGS navigation system (IGS group), and the control group consisted of 100 patients who underwent conventional FESS (Non-IGS group). Data were collected from surgical notes and hospital medical records. The primary endpoints for clinical effectiveness and safety were rehospitalization rate due to bleeding, reoperation rate due to bleeding, and reoperation rate due to recurrence.Results: There were no cases of rehospitalization due to bleeding, reoperation due to bleeding, and reoperation due to recurrence in the IGS group. In the non-IGS group, there were four cases of rehospitalization due to bleeding; all four patients underwent hemostasis surgery with an incidence of 4.00% (P=0.121). No cases of reoperation due to recurrence were in the non-IGS group. The total hospitalization cost was 17,391.51 CNY in the IGS group and 17,538.13 CNY in the non-IGS group per patient, with no statistical difference between the two groups (P=0.715). Compared with the non-IGS group, the IGS group had an overall cost saving of 146.62 CNY per patient. Although the procedure-related medical costs of IGS group were increased by 1,286.12 CNY compared with the non-IGS group, this was more than offset by other costs.Conclusion: The results of the study indicated that the IGS may reduce occurrence of rehospitalization and reoperation due to postoperative bleeding. Although the use of navigation technology increased the cost of surgery, its clinical effectiveness brought other medical cost savings, resulting in no significant difference in the overall cost of navigation surgery compared to conventional surgery. The IGS should be considered cost-effectiveness in the treatment of FESS.

The Southeast Tibet is characterized by extensive low-relief high-elevation surfaces that have been interpreted as “relict surfaces”, where thermochronological data generally show old ages and very little exhumation during the India-Asia collision. Those relict surfaces are proposed either to be formed at low elevation and then uplifted and dissected by large rivers since middle Miocene, or to inherit a pre-existing low-relief landscape by or prior to the collision, as revealed by stable-isotope paleoaltimetry. Among these relict surfaces, the BaimaXueshan low-relief (We compile and model published thermochronometric ages for BaimaXueshan massif, east of the Mekong River, to constrain its exhumation and relief history using the thermo-kinematic code Pecube. Modelling results show regional rock uplift at a rate of 0.25 km/Myr since ~10 Ma, following slow exhumation at a rate of 0.01 km/Myr since at least 22 Ma. Estimated Mekong River incision accounts for a maximum of 30% of the total exhumation since 10 Ma. We interpret moderate exhumation of the BaimaXueshan massif since 10 Ma as a response to a regional uplift due to the continuous northward indentation of NE India in a zone around the Eastern Himalayan Syntaxis (EHS) and delimited by Longmucuo-Shuanghu suture in the north. Thus BaimaXueshan massif with significant exhumation could not be classified as “relict surface”, as proposed by previous studies and its low relief results from in part glacial “buzzsaw-like” processes at high elevation, enhancing since ~2 Ma. In contrast, modelling results for the high-relief, high-elevation Kawagebo massif to the west of the Mekong River, facing the BaimaXueshan massif, imply a similar contribution of Mekong River incision (25%) to exhumation, but much stronger local rock uplift at a rate of 0.45 km/Myr since at least 10 Ma, accelerating to 1.86 km/Myr since 1.6 Ma. We show that the thermochronometric ages are best reproduced by local rock uplift related to late Miocene reactivation of a kinked westward-dipping thrust, striking roughly parallel to the Mekong River, with a steep shallow segment flattening out at depth. Thus, the strong differences in elevation and relief that characterize both massifs are linked to variable exhumation histories due to a strongly differing tectonic imprint.

International audience; The incision history of the Three Rivers (Salween, Mekong, and Yangtze) region in the Southeast Tibetan Plateau has been linked to both tectonic and climatic controls. In this study, we report new apatite (U‐Th)/He and fission‐track thermochronology data from the >6,000‐m‐high Kawagebo massif, which forms the edge of the high plateau on the western flank of the steepened knickzone reach of the middle Mekong River valley. Thermal‐history modeling of a thermochronological age‐elevation profile shows rapid cooling since ~1.5 Ma and suggests a mean Quaternary exhumation rate of >1 km/Myr at the valley bottom. The amount of Quaternary exhumation is too high to be caused by fluvial incision alone and requires additional tectonic uplift. Comparing our data from the western flank of the Mekong River valley with published data from the eastern flank shows differential exhumation across the valley in the late Miocene, with the western flank undergoing more exhumation, but relatively uniform exhumation in the Quaternary. We relate rapid exhumation since the late Miocene on the western flank of the Mekong valley and the high topography of the Kawagebo massif to localized tectonic uplift associated with a restraining (left stepping) overstep between the still‐active right‐lateral Parlung and Zhongdian strike‐slip faults. The pattern of river steepness index across the knickzone also indicates that it results from locally focused uplift. Our results demonstrate the importance of detailed thermochronologic studies in this very active region to constrain the complex multiphase tectonic history before invoking any potential climatic forcing of river incision.

The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n = 72) received MeroGel as the MEPA, Group 2 (n = 64) cartilage, and Group 3 (n = 69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.Mean pre- and post-operative ABG was 30.9 dB and 17.6 dB in Group 1, 31.4 dB and 21.9 dB in Group 2, and 32.2 dB and 19.1 dB in Group 3. The ABG closure was 13.3 ± 7.5 in Group 1, 9.5 ± 5.9 in Group 2, and 13.1 ± 9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p .05). The ABG closure was statistically significantly smaller in Group 2 than in other two groups (p .05).Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.

The fluorine content of coal has been well documented, while such data of coal spoil are limited. In the present paper, fluorine in coal spoils and its releasing behavior were studied via leaching and combustion tests, as well as field investigation. Fluoride pollution in groundwater and soil occurred in the air depositing areas of coal spoils. The average content of fluorine in coal spoils was 525 mg/kg with the highest value of 1885 mg/kg. The only XRD detectable inorganic fluorine phase was fluorphlogopite. The absence of major fluorine bearing minerals in coal spoils suggested that bulk fluorine, rather than trace phases, resided in the mineral matrix. The major extracted species were water soluble fluorine and exchangeable fluorine in the coal spoils. Batch leaching tests illustrated that the leachable fluoride in coal spoils was widely distributed, ranging from 2.0 to 108.4 mg/kg. Column leaching tests showed a clear pH-dependent leaching behavior of fluorine: lower pH situation led to fluorine release from the mineral matrix; the loosely bound or easily exchangeable fluorine was also flushed out of the column. The higher ion strength or alkaline bicarbonate/carbonate rich leaching solution tended to free more fluorine into the acidic aqueous solution. The leachable fluorine in coal spoils was estimated as ca. 6%, based on the results of leaching tests. Also, our research found that over 90% of fluorine in coal spoils could be released into the atmosphere as a result of spontaneous combustion, accounting for over 40% of the total atmospheric fluorine emissions in northern China. Our investigation suggests that it is urgent to conduct comprehensive studies to assist the management and control of fluorine pollution at coal spoil banks.

Objectives/Hypothesis To evaluate the acoustic effect after canal wall-down tympanoplasty with sectioning of the tensor tympani muscle (TTM) tendon in patients with chronic otitis media. Study Design Prospective, controlled clinical trial. Methods From January 2010 to April 2014, 212 patients underwent canal wall-down tympanoplasty with ossicular chain reconstruction in one-stage surgery. For this study, the patients were assigned to two groups. In group 1 (107 patients), the TTM tensor would be removed during the surgery, whereas it would be retained in group 2 (105 patients). Pre- and postoperative air conduction and bone conduction thresholds at 0.5, 1, 2, and 4 kHz were reported, and the air-bone gaps (ABGs) were measured. Results Mean postoperative ABG was 16.0 dB in group 1 and 17.0 dB in group 2 and the ABG closure was 11.9 ± 8.5 in group 1 and 11.8 ± 9.7 in group 2. Both were not statistically different (P = .2381 and P = .9625). Overall, 84.1% of patients in group 1 and 75.2% of patients in group 2 attained a postoperative ABG of 20 dB or less. Success rate in group 1 is slightly higher than group 2, but not significant (P = .1255). Conclusions The section of the tensor tympani muscle tendon in canal wall-down tympanoplasty with ossiculoplasty had no statistically significant influence on sound transmission and can be a safe maneuver in middle ear surgery. Level of Evidence 4 Laryngoscope, 125:2358–2361, 2015

OBJECTIVES The aims of this article are: 1) to re-evaluate the accuracy of multiple planar reconstruction computed tomography (MPR-CT) imaging on stapes-prosthesis parameters, and 2) to clarify possible relationships between prosthesis intravestibular depth and postoperative hearing outcomes. PATIENTS Seventy patients (46 women and 24 men; 32 right and 38 left sides) with the mean age of 40 years (range, 19-62 yr) with clinical otosclerosis. INTERVENTION(S) All patients underwent stapedotomy and were implanted with the same type of titanium piston prosthesis by the same surgeon. MAIN OUTCOME MEASURE(S) Postoperative MPR-CTs were obtained at patients' follow-up visits. The length and intravestibular depth of the stapes prosthesis (including absolute and relative depth) were calculated from the MPR-CT imaging. Relationships between the intravestibular depth of the prosthesis and hearing outcomes (pre- and postoperative audiograms) were analyzed using Spearman correlation analyses. RESULTS The length of the prosthesis was overestimated by 1.8% (0.1 mm) by the MPR-CT imaging. Axial and coronal measurements were significantly correlated (p

In this study, we aimed to explore the effect of inducible nitric oxide synthase (iNOS) on vascular endothelial growth factor (VEGF) expression in salivary gland adenoid cystic carcinoma (SACC). Using RNAi, we transfected chemically synthesised iNOS siRNA into ACC-M cells (a highly metastatic adenoid cystic carcinoma cell line) and detected the change in the gene and protein expression levels of iNOS and VEGF by qRT-PCR and Western blotting. A transwell invasiveness assay was used to examine the changes in invasive ability of ACC-M cells. Cell growth was determined using a CCK-8 assay. Apoptosis and cell-cycle phases were detected by flow cytometry. We found that silencing iNOS down-regulated the expression of VEGF and then inhibited cell growth and invasiveness of SACC cells, while it increased apoptosis. Therefore, we concluded that iNOS can regulate VEGF expression and iNOS may be a therapeutic target.

A bare quartz fiber with single refractive index is implanted into a polydimethylsiloxane (PDMS) microfluidic channel. The lasing gain medium consists of fluorescence resonance energy transfer (FRET) donor-acceptor dye pair Rhodamine B (RhB)-LDS821 mixture solution, which has a lower refractive index than that of the optical fiber and flows in the PDMS microfluidic channel. The circular cross section of the optical fiber forms a ring resonator and hosts high-quality (Q) whispering gallery modes (WGMs). Pumping along the optical fiber axis, the FRET characteristic parameters, i.e., the FRET efficiency \begin{document}$\eta $\end{document} and the Förster distance R0 of donor-acceptor dye pair, are firstly studied by using a continuous wave laser as a pump light source with a wavelength of 532 nm. The excited states are thencreated in the donor (RhB) by using a pulse laser with a wavelength of 532 nm and whose energy is transferred into the adjacent acceptor (LDS821) through the non-radiative FRET mechanism. Finaly, the emission of LDS821 iscoupled into the WGM of the ring resonator to lase. Due to the high energy transfer efficiency and high Q-factor, the acceptor shows a lasing threshold as low as 1.26 \begin{document}${\text{μ}}{\rm J}$\end{document}/mm2.

The current situation of cancer registration in China was systematically reviewed. So far, cancer registration in China has been making a great progress in the following aspects: the number of cancer registries and covered population have increased dramatically; a registration network has been established and completed gradually; regulations and rules improved remarkably; more attention is being paid by every level of government; a lot of registration software has been created and financial support ensured. However, we are still facing some problems and challenges, such as no stable groups of registrars, shortage of training opportunities, poor data quality, insufficient utilization and lack of multidisciplinary mechanisms, so that the cancer registration system still needs to be enhanced and improved. Along with the development of economy, science and information technology, methods and patterns of cancer registration is changing. It is to be expected that cancer registration will be automatic, nationwide and integrated with community healthcare in the near future.

A new enterprise management mode oriented by Management by Projects (MBP) has been gradually applied into modern enterprises. In the meantime, it is intriguing to notice some similarities in certain aspects between the ecosystem and project management processes which are implemented to better allocating resources within the context of the Enterprise Organizational System oriented by MBP(MBP-EOS). Based upon recognizing the fundamental principles of MBP, this paper analyzes the ecological phenomena and features of the MBP-EOS and further discusses the similarities between the ecosystem and the MBP-EOS in the ecological point of view. Furthermore, the final discussion provides insights and directions into future research.