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Objective: To construct a silk fibroin–bone microparticle composite based on a porous silk fibroin membrane and to study its feasibility as a material to reconstruct an orbital bone defect. Methods: A 3D porous silk fibroin membrane scaffold was constructed with a defined pore size and incorporated with bone microparticles from a New Zealand rabbit orbital bone defect. The silk fibroin–bone microparticle composite was then implanted into the orbital bone defect to promote osteogenesis along the surface of the porous silk fibroin membrane. The feasibility of constructing an ideal orbital defect repair material and the silk fibroin–bone micronucleus complex was evaluated by animal experiments, molecular biology, histomorphology, imaging, raw molecular mechanisms, and the biological behavior of the material in vivo. Results: The silk fibroin–bone microparticle composite promotes angiogenesis and osteogenesis to repair bone defects in vivo. Moreover, SF (silk fibroin)/BD (bone dust) complex promotes osteogenesis and angiogenesis by activating FGF2 (Fibroblast Growth Factor 2) and SF scaffolds can bind and restore FGF2. Conclusion: Silk fibroin is biocompatible and the silk fibroin–bone microparticle complex successfully repaired orbital bone defects. Additionally, fibroblast growth factor expression around or within the remaining incompletely degraded silk fibroin materials was observed in vivo.

Objective: We aimed to review the long-term hearing outcomes of intact bridge tympanomastoidectomy (IBM) to discuss hearing preservation and combine the theory of “modified miniature lung,” middle ear ventilation, and gas pressure balance theory to explore the possible reasons for long-term stable hearing. Study Design: We designed a collection of patients with chronic suppurative otitis media (CSOM) who underwent IBM and divided them into 2 groups to compare long-term and short-term hearing level. Setting: From April 2007 to July 2017, 102 patients received IBM for CSOM treatment in Eye & ENT Hospital of Fudan University. Methods: We divided the patients into 2 groups according to whether the follow-up period was longer than 6 months. We used the numerical value of the air-bone gap difference as an index to evaluate the degree of hearing recovery. Results: We found that 99/102 (97.1%) of the hearings were improved to more than 3 frequencies. There was no significant difference between long-term hearing level and short-term hearing level, which means IBM could get long-term hearing stability. Conclusion: Intact bridge tympanomastoidectomy could provide significant hearing recovery and long-term hearing stability.

Objective:Immunity is associated with acute low tone hearing loss. However, the exact pathophysiology of immunity-mediated acute low tone hearing loss remains unknown. In this study, we evaluated the presence, therapeutic effectiveness, and immunopathological mechanisms of anti-endothelial cell autoantibodies (AECEs) in patients with acute low-frequency hearing loss.Material and Methods:Forty-nine patients who were treated as inpatients having acute low-frequency hearing loss and additional symptoms, such as ear fullness, tinnitus, dizziness, or hyperacusis, were enrolled in this study. Serum samples from these patients were collected for laboratory serum autoimmunity detection, including AECAs, antinuclear antibodies, immunoglobulin, and circular immune complex. Therapeutic responses to combination therapy in short-term outcome and serum cytokine levels were compared between AECA-positive and AECA-negative patients.Results:Anti-endothelial cell autoantibodies–positive patients tended to show significantly less response to standard therapy compared with AECAs controls ( P < .05). Moreover, some serum cytokine levels elevated in both AECAs− and AECAs+ groups. Positive ratio of interleukin-8 and concentrations of macrophage inflammatory protein-1α were found higher in AECAs+ groups ( P < .05).Conclusion:The results supported that AECAs might wield influence on the short-term outcome of acute low-tone hearing loss (ALHL) treatment. Furthermore, AECA-mediated acute low-frequency hearing loss possibly involved dysregulation of inflammation process and release of cytokines.

Oxidative stress plays an important role in the pathogenesis of aminoglycoside-induced hearing loss and represents a promising target for treatment. We tested the potential effect of apigenin, a natural flavonoid with anticancer, anti-inflammatory, and antioxidant activities, on neomycin-induced ototoxicity in cochlear hair cells in vitro. Results showed that apigenin significantly ameliorated the loss of hair cells and the accumulation of reactive oxygen species upon neomycin injury. Further evidence suggested that the nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway was activated by apigenin treatment. Disruption of the Nrf2 axis abolished the effects of apigenin on the alleviation of oxidative stress and subsequent apoptosis of hair cells. This study provided evidence of the protective effect of apigenin on cochlear hair cells and its underlying mechanism.

Objective: To study the clinical anatomy of the epitympanum, the attic, and its medial wall, to try to discover a new clinical operation-related anatomical landmark, and to investigate the adjacent anatomical relationship with this landmark. Materials and Methods: Eight donor temporal bone specimens were dissected endoscopically. For 29 healthy persons (17 males and 12 females), CT images of the temporal bone (57 ears) were taken, 3-dimensional (3-D) reconstruction and multidimensional plane reconstruction were performed, and identification and assessment of 3-D spatial relationships between any 2 of these complex structures were done. Results: 3-D images of the temporal bone structures including the facial nerve, the cochlea, the semicircular canal, and the brain plate were reconstructed and shown in detail. We discovered a new clinical surgery-related anatomical landmark (the “cog” tangent and the trailing edge of the cog). Based on the tangent and the trailing edge of the cog, we quantified the anatomical relationship between it and its neighboring important structures. Conclusion: Based on endoscopic anatomy and the temporal bone spiral CT 3-D structure reconstruction of the epitympanum, the attic, and the adjacent structures, we found an extension of the clinical significance the cog. Quantification of the adjacent anatomical relationship of this landmark is very important for otology microsurgical operation.

Background/Purpose: To retrospectively analyze the epidemiological features, clinical diagnosis, and treatment of 610 patients with maxillofacial fractures, while providing a reference for the prevention and optimized treatment of maxillofacial fractures. Methods: Data of patients with maxillofacial fractures who were treated and followed up at the Second People’s Hospital of Kashi Prefecture from June 2012 to April 2018 were summarized. The epidemiological features, clinical manifestations, fracture sites, treatment methods, and results were analyzed. Results: The highest incidence was in the age range of 20 to 49 years. The main cause of fracture was traffic injury. Mandibular fractures accounted for 37.77%, zygoma and zygomatic arch fractures for 37.00%, and maxillary fractures for 21.19%. Atypical zygomatic arch fractures were more common in the maxilla, followed by Le Fort I and II fractures. Closed fractures accounted for 85.97%. Many (73.39%) patients were treated with computed tomography 3-dimensional (3D)-mediated precision modified incision internal fixation with satisfactory results. Conclusions: There is a high incidence of maxillofacial fractures among young men, especially in summer, with the most common injuries being traffic-related injuries. The most common site is the mandible, followed by the zygomatic arch, zygomatic complex, and maxilla. Computed tomography 3D-mediated precision modified incision internal fixation can achieve satisfactory results.

To explore the structural characteristics of the cochlea in three-dimensional (3D) detail using 3D micro-computed tomography (mCT) image reconstruction of the osseous labyrinth, with the aim of improving the structural design of electrodes, the selection of stimulation sites, and the effectiveness of cochlear implantation. Three temporal bones were selected from among adult donors' temporal bone specimens. A micro-CT apparatus (GE eXplore) was used to scan three specimens with a voxel resolution of 45 μm. We obtained about 460 slices/specimen, which produced abundant data. The osseous labyrinth images of three specimens were reconstructed from mCT. The cochlea and its spiral characteristics were measured precisely using Able Software 3D-DOCTOR. The 3D images of the osseous labyrinth, including the cochlea, vestibule, and semicircular canals, were reconstructed. The 3D models of the cochlea showed the spatial relationships and surface structural characteristics. Quantitative data concerning the cochlea and its spiral structural characteristics were analyzed with regard to cochlear implantation. The 3D reconstruction of mCT images clearly displayed the detailed spiral structural characteristics of the osseous labyrinth. Quantitative data regarding the cochlea and its spiral structural characteristics could help to improve electrode structural design, signal processing, and the effectiveness of cochlear implantation. Clin. Anat. 30:39-43, 2017. © 2016 Wiley Periodicals, Inc.

Objective: To characterize the morphology of chondrocytes and the expression and secretion of active collagen II by these cells cultured within a regenerated silk fibroin film. Silk fibroin film cytocompatibility and the effect of silk fibroin on chondrocytes in vitro were also evaluated. Methods: Chondrocytes were transfected with a lentivirus containing a green fluorescent protein marker and cultured within a regenerated silk fibroin film. Effects on chondrocyte adhesion, growth, and expression of functional collagen II were assessed in vitro by analysis with immunofluorescent histochemistry and laser scanning confocal microscopy. Results: The results of this study showed that the regenerated silk fibroin film had no cytotoxic effect on chondrocytes. The regenerated silk fibroin film facilitated the adhesion of chondrocytes with typical morphology. Chondrocytes cultured within silk fibroin films exhibited the expression of collagen II in vitro. Conclusion: Regenerated silk fibroin film was found to be an excellent biomaterial with good cytocompatibility for chondrocytes, because these cells remained functional and maintained normal cell morphology when cultured in silk-based biomaterials. These results suggest that silk-based chondrocyte biomaterial complexes may provide a feasible and functional biomaterial for repairing clinical cartilage defects.

Objective: To explore and quantify the surgically relevant anatomic relationships and three-dimensional (3D) morphology of the supralabyrinthine space, and enable a deeper, clearer understanding of its regional anatomy. Materials and Methods: 3D-DOCTOR software was used to create a 3D reconstruction of the axial CT images and multiplanar reformatting of 55 slices of temporal bone in 29 patients (17 males and 12 females), whose average age was 38.69 ± 17.81 years. The 3D relationships between the mutual complex structures were displayed graphically and measured. Results: The important structures within the temporal bone were displayed in detail. 3D relationships between the structures in the temporal bone, such as the ossicles, facial nerves, labyrinth, and skull base, were quantified. Conclusion: Quantification of surgically relevant anatomic relationships and the morphology of the supralabyrinthine space in three dimensions are very helpful in surgical dissection.

To explore the feasibility of constructing a functional biomaterial complex with regenerated silk fibroin membrane and immortalized chondrocytes in vivo. Rat auricular chondrocytes (RACs) were transfected with the lentivirus vector pGC-FU-hTERT-3FLAG or pGC-FU-GFP-3FLAG, encoding the human telomerase reverse transcriptase (hTERT) or GFP gene. The effects of regenerated silk fibroin film on the adhesion, growth of immortalized chondrocytes and expression of collagen II in vitro were analyzed with immunofluorescent histochemistry. Immortalized RACs were transformed. Induction by nutrient medium promoted higher expression levels of collagen II in transformed chondrocytes. The regenerated silk fibroin film was not cytotoxic to immortalized chondrocytes and had no adverse influence on their adhesion. Collagen II expression was good in the immortalized chondrocytes in vivo. The construction of a silk-based biomaterial complex with immortalized chondrocytes may provide a feasible kind of functional biomaterial for the repair of cartilage defects in clinical applications. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 102A: 1071–1078, 2014.

To explore the structural characteristics of the cochlea in three-dimensional (3D) detail using 3D micro-computed tomography (mCT) image reconstruction of the osseous labyrinth, with the aim of improving the structural design of electrodes, the selection of stimulation sites, and the effectiveness of cochlear implantation. Three temporal bones were selected from among adult donors' temporal bone specimens. A micro-CT apparatus (GE eXplore) was used to scan three specimens with a voxel resolution of 45 μm. We obtained about 460 slices/specimen, which produced abundant data. The osseous labyrinth images of three specimens were reconstructed from mCT. The cochlea and its spiral characteristics were measured precisely using Able Software 3D-DOCTOR. The 3D images of the osseous labyrinth, including the cochlea, vestibule, and semicircular canals, were reconstructed. The 3D models of the cochlea showed the spatial relationships and surface structural characteristics. Quantitative data concerning the cochlea and its spiral structural characteristics were analyzed with regard to cochlear implantation. The 3D reconstruction of mCT images clearly displayed the detailed spiral structural characteristics of the osseous labyrinth. Quantitative data regarding the cochlea and its spiral structural characteristics could help to improve electrode structural design, signal processing, and the effectiveness of cochlear implantation. Clin. Anat. 30:39-43, 2017. © 2016 Wiley Periodicals, Inc.

Objectives To explore the feasibility of silk fibroin as a biomaterial coating used in tracheal defect reconstruction. Methods Silk fibroin was subcutaneously embedded in three rabbits and as an artificial implant material coating to reconstruct 12 rabbits' tracheal defects. The postoperative radiologic and histologic characterization was summarized. Results The thickness of the fibroblasts layer covering the porus and nonporus silk fibroin film was 240.4 ± 9.9 and 302.3 ± 10.5 μm, respectively, and there was no statistical difference (P > 0.05) within each group. There was no foreign-body granuloma or macrophagocyte infiltration around the silk film. The tracheal reconstruction study showed a normal mucous membrane with normal cilial growth on the artificial implant and no visible granulation tissue in the reconstructed tracheal cavity. Conclusions Silk fibroin is a potential new biomaterial coating for tracheal defect reconstruction. The mechanism of silk fibroin appears to promote tracheal mucous membrane, which may be related to its molecular structure and biology.

Endolymphatic sac tumors (ELSTs) are locally invasive, osteolytic, and hypervascular tumors. If the labyrinth has not been invaded, the hearing should be preserved in operation.To summarize three cases of ELST and discuss whether to keep hearing in the surgical treatment of ELST.Complete otorhinolaryngological examinations with audiologic, vestibular, and neurologic evaluations were performed. CT and MRI scans were carried out before operation and in the course of follow-up. The patients underwent radical removal of the tumor through a transmastoid approach and accepted postoperative radiotherapy. In two of them, the structure of the labyrinth and facial nerve were preserved in operation.Histopathologic examinations agreed with features of an ELST. Patients suffered transitory vertigo shortly after operation, and so far, they are alive and well without further cranial nerve involvement. Case 3 patient has good hearing and facial nerve function now. No residual or recurrent tumor was detected on the postoperative MRI images.

One of the most unfortunate side effects of aminoglycoside (AG) antibiotics such as neomycin is that they target sensory hair cells (HCs) and can cause permanent hearing impairment. We have observed HC loss and microglia-like cell (MLC) activation in the inner ear (cochlea) following neomycin administration. We focused on CX3CL1, a membrane-bound glycoprotein expressed on neurons and endothelial cells, as a way to understand how the MLCs are activated and the role these cells play in HC loss. CX3CL1 is the exclusive ligand for CX3CR1, which is a chemokine receptor expressed on the surface of macrophages and MLCs. In vitro experiments showed that the expression levels of CX3CL1 and CX3CR1 increased in the cochlea upon neomycin treatment, and CX3CL1 was expressed on HCs, while CX3CR1 was expressed on MLCs. When cultured with 1 μg/mL exogenous CX3CL1, MLCs were activated by CX3CL1, and the cytokine level was increased in the cochleae leading to apoptosis in the HCs. In CX3CR1 knockout mice, a significantly greater number of cochlear HCs survived than in wild-type mice when the cochlear explants were cultured with neomycin in vitro. Furthermore, inhibiting the activation of MLCs with minocycline reduced the neomycin-induced HC loss and improved the hearing function in neomycin-treated mice in vivo. Our results demonstrate that CX3CL1-induced MLC activation plays an important role in the induction of HC death and provide evidence for CX3CL1 and CX3CR1 as promising new therapeutic targets for the prevention of hearing loss.

To explore the feasibility of constructing a functional biomaterial complex with regenerated silk fibroin membrane and immortalized chondrocytes in vivo. Rat auricular chondrocytes (RACs) were transfected with the lentivirus vector pGC-FU-hTERT-3FLAG or pGC-FU-GFP-3FLAG, encoding the human telomerase reverse transcriptase (hTERT) or GFP gene. The effects of regenerated silk fibroin film on the adhesion, growth of immortalized chondrocytes and expression of collagen II in vitro were analyzed with immunofluorescent histochemistry. Immortalized RACs were transformed. Induction by nutrient medium promoted higher expression levels of collagen II in transformed chondrocytes. The regenerated silk fibroin film was not cytotoxic to immortalized chondrocytes and had no adverse influence on their adhesion. Collagen II expression was good in the immortalized chondrocytes in vivo. The construction of a silk-based biomaterial complex with immortalized chondrocytes may provide a feasible kind of functional biomaterial for the repair of cartilage defects in clinical applications.

In the present work, we report a new facile method to fabricate porous three-dimensional regenerated silk fibroin (RSF) scaffolds through n-butanol- and freezing-induced conformation transition and phase separation. The effects of RSF concentration, freezing temperature and n-butanol addition on the microstructure, the secondary structures of silk fibroin and apparent mechanical properties of the RSF scaffolds were investigated by SEM, (13)C CP-MAS NMR spectra and mechanical testing, respectively. By adjusting the RSF concentration and n-butanol addition, the pore size of the scaffold could be controlled in the range from of 10 μm to 350 μm with 84%-98% of porosity. The tensile strength of the wet scaffold reached the maximum of 755.2±33.6 kPa when the concentration of RSF solution was increased to 15% w/w. Moreover, post-treatment with ethanol further induced conformation transition of RSF from random coil or helix to β-sheet. The porous scaffolds prepared by this facile and energy-saving method with good biocompatibility will have great potential for application in tissue engineering.

After the surgical procedure of ossicular chain reconstruction, the effectiveness and/or stability of partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) were systematically compared and evaluated using meta-analysis. A total of 40 eligible investigations with 4,311 subjects were included in our study. There was a significant difference in the effectiveness of the reconstruction of the ossicular chain between PORP and TORP; the data showed a combined risk ratio (RR) of 1.28 (95 % CI 1.17–1.41, p < 0.00001), but no notable difference was obtained in staged procedures subgroup and cholesteatoma subgroup, with a combined RR of 1.13 (95 % CI 0.60–2.11, p = 0.70) in staged procedures subgroup and RR of 2.60 (95 % CI 0.20–36.21, p = 0.59 in cholesteatoma subgroup). There was a statistically significant difference in the stability of the prostheses in long-term follow-up, with a combined RR of 0.37 (95 % CI 0.16–0.85, p = 0.02), but no significant difference was observed in the total sample, with a combined RR of 0.64 (95 % CI 0.40–1.03, p = 0.06). Our overall results suggest that the effectiveness of PORP was higher than TORP, except within staged procedures subgroup and cholesteatoma subgroup. In addition, the stability of PORP was significantly superior to TORP in long-term follow-ups, but no significant effect was detected in the general study.

To study the vertical and pyramidal segment of facial nerve canal based on three-dimensional reconstruction of temporal bone CT, and provide a quantitative data for the middle ear and mastoid surgery.Reconstruction of adult axial CT images shows the vertical and pyramidal segment of facial nerve canal. Using the Able Software 3D-DOCTOR 3.5 to show and measure the angle of the vertical and pyramidal segment of the facial nerve canal and to analyze the features and regularity based on the measured data.According to the angle of the vertical and pyramidal segment of facial nerve canal based on the three-dimensional reconstruction model. A certain regularity has been found in the direction and the angle of different segments of the vertical and pyramidal segment of facial nerve canal.The temporal bone CT three-dimensional reconstruction can accurately show the characteristic and angle of the vertical and pyramidal segment of facial nerve canal. The characteristics and quantitative angle of the vertical and pyramidal segment of facial nerve canal from the anatomical viewpoint for clinical utility could keep the vertical and pyramidal segment of facial nerve from injury in temporal bone surgery.

To explore a set of quantitative methods to determine the position of the facial nerve based on three-dimensional CT reconstruction of temporal bone structures on personal computer, which can provide a series of important parameters for ear and the lateral skull base surgery.The internal structures of temporal bone were reconstructed based on a set of axial CT images of adult patients, the complicated relationship and their morphologic characteristics were clearly presented by using Able Software 3D-DOCTOR. The precise measurement of some parameters between facial nerve and its adjacent structures could easily be processed with the software. Based on all obtained data, the relationship of facial nerve and its adjacent structures were effectively summarized and analyzed.Three-dimensional images, including the facial nerve, tympanic anulus, auditory ossicles, chochleariform process, pyramidal eminence, internal auditory, the cochlea, semicircular canal, jugular fossa and carotid artery in the temporal bone, were reconstructed. Some parameters obtained from measuring the distance or angle between the facial nerve and its adjacent structures in the three-dimensional models had some extent regularity, which were benefit to design surgical approach and determine the position of facial nerve during relevant operation.CT 3D reconstruction can accurately display the detailed internal structures anatomy of the temporal bone and their quantitative spatial relationships.

Objective To investigate an effective method of quantitative analysis of the facial nerve and its adjacent structures on the basis of three-dimensional (3D) CT image reconstruction of the temporal bone. Methods The inner structures of the temporal bone from CT images of 34 healthy adults were reconstructed. Precise measurement of the facial nerve and its adjacent structures were accomplished by using Able Software 3D-DOCTOR. Results 3D images of temporal bone structures, including facial nerve, tympanic annulus, cochleariform process, cochlea, semicircular canals, jugular fossa, and carotid artery, were reconstructed. Quantitative data of the facial nerve and its adjacent structures were analyzed, especially the detailed spatial relationships between the facial nerve and the surface of the mastoid process or tympanomastoid fissure. Conclusion 3D reconstruction of CT images clearly displayed the detailed structures of the temporal bone. Quantitative data of the facial nerve and its adjacent structures are very useful for temporal bone surgery.