Temporary Paralysis Research Articles

Non-Migraine Head Pain and Botulinum Toxin.

Botulinum toxin A (BT-A), a potential neurotoxin produced by the bacterium Clostridium botulinum, is known for its ability to prevent the release of acetylcholine at the neuromuscular synapse, leading to temporary muscle paralysis. BT-A is used for a wide range of therapeutic applications. Several studies have shown mechanisms beyond the inhibition of acetylcholine release for pain control. BT-A inhibits the release of neurotransmitters associated with pain and inflammation, such as glutamate, CGRP, and substance P. Additionally, it would be effective in nerve entrapment leading to neuronal hypersensitivity, which is known as a new pathogenesis of painful conditions. BT-A has been applied to the treatment of a wide variety of neurological disorders. Since 2010, BT-A application has been approved and widely used as a chronic migraine prophylaxis. Moreover, due to its effects on pain through sensory modulation, it may also be effective for other headaches. Several studies using BT-A, at different doses and administration sites for headaches, have shown beneficial effects on frequency and severity. In this review, we provide an overview of using BT-A to treat primary and secondary headache disorders.

Role of microscope in parotidectomy for identification and preservation of facial nerve: An institutional experience at Tertiary Care Hospital.

Objective: This study presents the authors' experience with performing parotidectomy while using the microscope and its outcomes, particularly concerning the identification and preservation of the facial nerve and its branches. Study Design: Prospective study. Setting: Tertiary Care Hospital; in Rawalpindi. Period: January 2020 to December 2023. Methods: Enrolled 70 patients with parotid lesions treated patient selection was based on the presence of parotid lesions. Data was entered and analysed by using SPSS V.26. Results: The gender distribution was 29 males (41.43%) and 41 females (58.57%), with a mean age of 38.2 years. The majority of cases involved pleomorphic adenoma, constituting 74.28% (n=52) of the total cases. Other tumor types included Warthin tumor (5.71%, n=4), monomorphic adenoma (2.86%, n=2), Mucoepidermoid carcinoma (14.29%, n=10), and adenoid cystic carcinoma (2.86%, n=2). In terms of the type of surgery performed, 82.86% (n=58) of cases underwent superficial parotidectomy, while 17.14% (n=12) underwent total conservative parotidectomy. Regarding facial nerve outcomes, temporary facial nerve paralysis was observed in 8.57% (n=6) of cases, while permanent facial nerve palsy occurred in 2.86% (n=2) of cases. Conclusion: We have seen that a microscope is a very valuable assistant in the identification and preservation of the facial nerve. Thus, we can recommend its use during the procedure in order to prevent morbidity of the patient.

Memory-Guided Saccades and Non-Motor Symptoms Improve after Botulinum Toxin Therapy in Cervical Dystonia

Background/Objectives: Cervical dystonia (CD) is a condition characterized by involuntary activity of cervical muscles, which is often accompanied by various non-motor symptoms. Recent studies indicate impaired saccadic eye movements in CD. Local administration of botulinum toxin type A (BoNT/A), which causes temporary paralysis of the injected muscle, is the first-line treatment of focal dystonia, including CD. To our knowledge, concurrent observation of the effect of BoNT/A on smooth eye movements, voluntary saccades, memory-guided saccades, and antisaccades in CD has not yet been explored. The aim of this study was to assess the effect of BoNT/A on eye movements and non-motor symptoms in patients with CD, which, when altered, could imply a central effect of BoNT/A. Methods: Thirty patients with CD performed smooth pursuit, prosaccadic expression, memory-guided saccades, and antisaccade tasks; eye movements were recorded by an eye tracker. Motor and non-motor symptoms, including depression, anxiety, pain, disability, and cognitive changes prior to and after BoNT/A administration, were also evaluated. Results: The number of correct onward counts (p < 0.001), overall correct memory-guided saccades count (p = 0.005), motor symptoms (p = 0.001), and non-motor symptoms, i.e., anxiety (p = 0.04), depression (p = 0.02), and cognition (p < 0.001) markedly improved after BoNT/A administration. Conclusions: Memory-guided saccades, depression, and anxiety improve after BoNT/A in CD.

Surgical and anesthetic considerations in a unique case of temporary iatrogenic facial nerve paralysis after superficial parotidectomy

Parotid neoplasms are a common indication for parotidectomy, a procedure that carries a risk of facial paralysis. Modern advances in surgical and anesthesia techniques, including facial nerve monitoring have resulted in low rates of permanent facial nerve paralysis. We present a case of temporary postoperative right facial nerve paralysis after intact facial nerve neuromonitoring at the completion of resection. The proposed mechanism of this phenomenon is related to the effects of local anesthetic infiltration from a fat graft used for oncologic reconstruction. This case emphasizes the importance of judicious and carefully timed local anesthetic use, clear facial nerve monitoring, and coordination between care teams.

A Systematic Review and Comparative Analysis of Botox Treatment in Aesthetic and Therapeutic Applications: Advantages, Disadvantages, and Patient Outcomes.

The objective of this review article is to comprehensively analyze Botox treatment, emphasizing its aesthetic and therapeutic applications, along with the associated advantages, disadvantages, and patient outcomes. By reviewing current literature, the article evaluates Botox's efficacy and safety in various clinical settings, including cosmetic procedures and medical treatments for conditions such as chronic migraines and excessive sweating, while also exploring patient satisfaction and potential risks. This review article provides a comprehensive analysis of Botox treatment, focusing on its aesthetic and therapeutic applications, as well as the associated advantages, disadvantages, and patient outcomes. Botulinum toxin, derived from Clostridium botulinum, is widely recognized for its ability to induce temporary muscle paralysis, leading to significant improvements in both cosmetic and medical conditions. The article reviews findings from recent clinical trials, case reports, and observational studies, highlighting the efficacy and safety of Botox in treating various conditions such as chronic migraines, excessive sweating, and muscle spasticity, alongside its cosmetic use in wrinkle reduction. While the benefits of Botox are substantial, including its minimally invasive nature and high patient satisfaction rates, potential risks and complications, including rare adverse events, are also discussed.

Modified buried vertical mattress suture technique for excisional suturing of benign parotid tumors: A retrospective study.

The purpose of this retrospective patient chart review was to analyze the clinical data of 52 patients with benign parotid tumors who underwent modified buried vertical mattress sutures and to assess the postoperative complication rate and patient scarring. A total of 52 patients with benign parotid tumors underwent total parotidectomy and modified buried vertical mattress suture. Variables included general characteristics (age, gender, tumor diameter, and pathologic type), surgical indicators (suture time, wound healing time, operative time, hospital stay, bleeding volume, and drainage volume), complication rates, and Sunnybrook facial neurological function score, visual scar scale (VSS) score and patient and observer scar assessment scale (POSAS) score. Most tumors were less than 3 cm in diameter, with pleomorphic adenomas being the most common. Suture time was 14.83 ± 1.61 min, operative time was 58.90 ± 15.76 min and hospital stay were 5.12 ± 0.96 days. Postoperatively, salivary fistulae developed in one patient, Frey's syndrome in two patients, temporary facial paralysis in six patients and temporary numbness in the incision area in six patients. At 6 months postoperatively, 86.5% of patients had a Sunnybrook score of more than 80, and VSS scores and POSAS scores were between one and two. The postoperative complication rate was 30.8%, and the scarring in the facial incision area was mild and close to normal skin at 3 years postoperatively.

Functional Electrical Stimulation and Brain-Machine Interfaces for Simultaneous Control of Wrist and Finger Flexion.

Brain-machine interface (BMI) controlled functional electrical stimulation (FES) is a promising treatment to restore hand movements to people with cervical spinal cord injury. Recent intracortical BMIs have shown unprecedented successes in decoding user intentions, however the hand movements restored by FES have largely been limited to predetermined grasps. Restoring dexterous hand movements will require continuous control of many biomechanically linked degrees-of-freedom in the hand, such as wrist and finger flexion, that would form the basis of those movements. Here we investigate the ability to restore simultaneous wrist and finger flexion, which would enable grasping with a controlled hand posture and assist in manipulating objects once grasped. We demonstrate that intramuscular FES can enable monkeys with temporarily paralyzed hands to move their fingers and wrist across a functional range of motion, spanning an average 88.6 degrees at the metacarpophalangeal joint flexion and 71.3 degrees of wrist flexion, and intramuscular FES can control both joints simultaneously in a real-time task. Additionally, we demonstrate a monkey using an intracortical BMI to control the wrist and finger flexion in a virtual hand, both before and after the hand is temporarily paralyzed, even achieving success rates and acquisition times equivalent to able-bodied control with BMI control after temporary paralysis in two sessions. Together, this outlines a method using an artificial brain-to-body interface that could restore continuous wrist and finger movements after spinal cord injury.

Safety and cosmesis of gasless endoscopic thyroidectomy: a retrospective study.

Despite growing interest in gasless endoscopic unilateral thyroid lobectomy via the axillary approach, there are a lack of sufficient data on its safety and cosmetic outcomes. This retrospective study analysed the clinical outcomes and postoperative complications of 161 patients who underwent this surgery for thyroid cancer and nodules, with particular attention given to complications and patient satisfaction with cosmetic outcomes. All 161 patients (143 females, 18 males) successfully underwent the operation without conversion to open surgery. Temporary vocal cord paralysis occurred in five patients, with no other serious complications observed. The cosmetic outcomes were generally good, with no recurrences or tumour implantations observed during follow-up. For carefully selected patients, gasless endoscopic unilateral thyroid lobectomy via the axillary approach is not only safe but also provides excellent cosmetic results.

Lower face contouring through botulinum toxin therapy: an overview

Botulinum toxin (Botox) has been used cosmetically to reduce and prevent wrinkles since 1989, but its application has since expanded to include treatment of other patient concerns, including masseter muscle hypertrophy. Abnormal enlargement of the masseter, a muscle located in the jaw, can give patients a larger or squarish facial appearance; the injection of Botox, through causing temporary paralysis of the masseter and a resultant reduction in muscle activity, can lead to a slimmer and less square jawline. However, careful patient selection is required, and approaches to injection technique and dosage vary. Francesca Ramadan provides an overview.

The risk factors for postoperative temporary vocal cord paralysis after thyroid cancer surgery: an observational retrospective cohort study.

To analyze the potential factors influencing new-onset postoperative transient vocal cord paralysis (VCP) in thyroid cancer patients. Case information of 8340 thyroid cancer patients hospitalized at China-Japan Union Hospital of Jilin University, Jilin Province, China, in the Thyroid Surgery Department from January 2018 to December 2020 was collected retrospectively and analyzed. The possible influencing factors were analyzed using a χ2 test, rank-sum test, and multiple logistic regression analysis. A nomogram was used to construct the clinical prediction model that was validated in the validation set by receiver operating characteristic, calibration curves, and Decision curve analysis. The strengthening the reporting of cohort, cross-sectional, and case-control studies in surgery (STROCSS) guideline was followed to conduct a retrospective cohort study. A total of 8340 patients, including 1817 (21.8%) men and 6523 (78.2%) women, were enrolled in this study. The rate of temporary VCP was 3.6% (308/8340). Based on the results of postoperative laryngoscopy, the patients were divided into VCP group and non-VCP group. Comparative analysis between the groups revealed that potential factors associated with postoperative transient VCP were tumor location on the dorsal side of the gland ( P =0.042), ultrasound showing a maximum nodal diameter >1cm ( P =0.002), multifocal carcinoma ( P <0.001), invasion of surrounding tissue ( P =0.005), lymph node metastases in the central compartment ( P =0.034), lateral cervical lymph node metastasis ( P <0.001), and prolonged operation ( P <0.001). A multiple logistic regression analysis showed that the independent risk factors in postoperative transient VCP were T stage (OR=1.411, P =0.013, 95% CI: 1.075-1.853), multifocal carcinoma (OR=1.532, P =0.013, 95% CI: 1.095-2.144), and duration of surgery (OR=1.009, P <0.001, 95% CI: 1.006-1.012). Finally, a clinical prediction model was established via a nomogram and was validated in the validation set, although its diagnostic efficacy needs to be improved further. High T stage, multifocal carcinoma, and prolonged operation time may be independent risk factors for the occurrence of postoperative transient VCP in patients undergoing initial surgery for thyroid cancer.

The activity of leaf extracts, fractions, and isolated compounds from Ptaeroxylon obliquum against nine phytopathogenic fungi and the nematode Meloidogyne incognita

Phytopathogenic fungi and nematodes cause great losses in economically important crops and food production especially in developing countries. To minimize the use of fungicides and nematicides, researchers have concentrated on the use of natural products for crop disease prevention or control. The aim of the study was to investigate the antifungal activity of Ptaeroxylon obliquum leaf extracts, fractions, and isolated compounds (obliquumol and a mixture of lupeol and β-amyrin) and nematocidal activity of fractions (hexane, chloroform and 30% water in methanol and the isolated compounds) on Meloidogyne incognita. Nine phytopathogenic fungi (Aspergillus niger, A. parasiticus, Colletotrichum gloeosporioides, Fusarium oxysporum, Penicillium digitatum, P. expansum, P. italicum, P. janthinellum, and Rhizoctonia solani) were used for testing and nematocidal activity was determined on motility of plant parasitic nematode Meloidogyne incognita race 2 juveniles. Serial microdilution test was utilized to determine the minimum inhibitory concentration (MIC) of each sample against the fungus. Motility tests was done on the second-stage juveniles (J2s) of M. incognita. The most susceptible phytopathogenic fungal species to the acetone crude leaf extracts were A. niger, C. gloeosporioides and P. digitatum with MIC of 80 μg/ml which is considered pharmacological significant. Rhizoctonia solani was the most susceptible fungus against obliquumol and, lupeol and β-amyrin mixture with MIC values of 8 μg/ml and 16 μg/ml respectively. Lupeol & β-amyrin mixture had good activity on juvenile motility at high concentrations used which was significantly high (p ≤ 0.05) after 24 h, further incubation resulted in temporary paralysis at lower concentrations. Fractions and obliquumol showed good activity after 48 h, stable paralysis was observed up to 72 h. The extracts and isolated compounds may be useful as fungicides if the in vitro results can be confirmed under field conditions at levels not toxic to beneficial soil organisms.

Efficacy and Safety Analysis of Botox Application and Iatrogenic Botulism: Panacea or Peril?

Clostridium botulinum toxin-A (BoNT-A) creates temporary paralysis in the muscles by acting on the muscle-nerve junction. It is injected into the mimic muscles when a decrease in the movements of the mimic muscles is desired. Despite many favorable applications, the use of BoNT-A is not without drawbacks. Although there is no expected serious side effect on health in BoNT-A treatments, various problems can be encountered in patients treated for aesthetic purposes. Botulism is a rare but potentially life-threatening syndrome, which is caused by the toxin produced by the bacterium Clostridium botulinum, which acts on the nervous system, vegetative forms of C. botulinum can only survive in anaerobic conditions, while spore forms are common in nature and can withstand harsh conditions. Botulism can stem from bacterial spores which release toxin in the body; in the form of enteric botulism, and wound botulism. The cases that develop 'iatrogenic botulism' after such procedures are usually those receiving high-dose toxin for therapeutic purposes. The treatment of botulism mainly consists of anti-toxin therapy and, if necessary, intensive care to prevent organ failures, including respiratory support. This article aims to cover all these issues related to botulism and other adverse outcomes related to BoNT-A injection in light of the most recent literature.

Freezing Effect and Bystander Effect: Overlaps and Differences

The present article provides a detailed comparison of two psychological phenomena, the freezing effect and the bystander effect, across their neurobiological, cognitive, emotional, and behavioral dimensions. This study focuses on identifying and analyzing the similarities and differences between these two responses to stressful and traumatic events. While the freezing effect is characterized by an involuntary neurobiological response to immediate threats, resulting in temporary immobilization or paralysis, the bystander effect describes a cognitive and social phenomenon where individuals refrain from offering help in emergencies when others are present. The study explores affective aspects, including emotional responses and trauma-related impacts associated with both phenomena. Through a comparative analysis, this research unveils important understandings regarding the distinctions among these responses, including their triggers, underlying mechanisms, and observable behaviors. It also highlights overlapping aspects, particularly in how both phenomena can lead to inaction in critical moments. This comparative study contributes to a deeper understanding of the complex interaction between the brain, individual cognition, and social dynamics in the face of danger and stress. The findings of this research have significant implications for understanding human behavior in emergencies, offering valuable perspectives that can be applied in the domains of psychology, training for emergency response, and trauma therapy.

Oligopeptides analysis in spiderhawk's venom (Pepsis decorata Perty, 1833, Hymenoptera: Pompilidae)

AbstractWasps have been neglected in toxinological studies, even with their diversity of species, when compared to other groups of venomous animals such as snakes, scorpions, and spiders. Solitary wasps, such as Pepsis decorata, are known for their mechanism of total or temporary paralysis of the host. In addition, their venoms are considered sources for studies of small peptides, bioactive peptides with neural and antimicrobial activities. In this work, some oligopeptides were analyzed by de novo sequencing identifying 39 oligopeptide sequences. Some sequences were similar to proctolin, a bradykinin‐potentiating peptide, and poneritoxin, one bradykinin‐related peptide. As proctolin‐like peptides were the major constituent in distinct experimental conditions, it was selected for further in silico studies in order to understand its possible importance as a constituent of wasp venom and whether these peptides could be of biotechnological importance. We investigate its binding mode comparing with proctolin and we further analyzed the importance of the tyrosine‐leucine‐glutamic acid (YLE) tripeptide‐motif conservation. This experimental, an in silico approach, increased the range of compounds identified in peptide analyses proving good characterization of little‐known peptidic compounds.

New mutation within a common haplotype is associated with calf muscle weakness in Holsteins

A recessive haplotype resulting in elevated calf mortality but with apparent incomplete penetrance was previously linked to the end of chromosome 16 (78.7-80.7 Mbp). Genotype analysis of 5.6 million Holsteins indicated that the haplotype was common and traced back to 1952, with a key ancestor born in 1984 (HOUSA1964484, Southwind) identified from chip genotypes as homozygous for the suspect haplotype. Sequence data from Southwind (an affected calf) and the sire of the affected calf were scanned for candidate mutations. A missense mutation with a deleterious projected impact at 79,613,592 bp was homozygous in the affected calf and heterozygous in the calf's sire and Southwind. Sequence data available from the Cooperative Dairy DNA Repository for 299 other Holsteins indicated a 97% concordance with the haplotype and an 89% call rate. The exon amino acid sequence appears to be broadly conserved in the CACNA1S gene, and mutations in humans and mice can cause phenotypes of temporary or permanent paralysis analogous to those in calves with the haplotype causing muscle weakness (HMW). Improved methods for using pedigree to track new mutations within existing haplotypes were developed and applied to the haplotypes for both muscle weakness and Holstein cholesterol deficiency (HCD). For HCD, concordance of the gene test with its haplotype status was greatly improved. For both defects, haplotype status was matched to heifer livability records for 558,000 calves. For HMW, only 46 heifers with livability records were homozygous and traced only to Southwind on both sides. Of those, 52% died before 18 mo at an average age of 1.7 ± 1.6 mo, but that death rate may be underestimated if only healthier calves were genotyped. The death rate was 2.4% for noncarriers. Different reporting methods or dominance effects may be needed to include HMW and other partially lethal effects in selection and mating. Direct tests are needed for new mutations within existing common haplotypes because tracking can be difficult even with accurate pedigrees when the original haplotype has a high frequency.

&lt;i&gt;Ayurvedic&lt;/i&gt; Management of Bell’s Palsy - A Case Report

Background: Bell’s palsy is a sudden and unexplained condition characterized by temporary weakness or paralysis of one side of the face or the areas supplied by the facial nerve, resulting from the paralysis of the peripheral facial nerve. It can be caused by various factors varying from trauma, infection, ischemia, or inflammation that affects the seventh cranial nerve. In Ayurveda, Bell’s palsy can be compared to Ardita Vata, a condition described within the realm of Vatavyadhi Chapter mentioned in various Samhitas and its treatment has also been explained in detail in Samhitas. Aim and Objectives: The effectiveness of different Kriyakalpa techniques, as well as oral medication, was studied and observed in detail in this medical study by investigating a patient with Acute Bell’s palsy. The main goal was to assess the outcomes of these interventions which is a much better option than Allopathic steroids. Settings: A fresh case of Bell’s palsy that had occurred only 24 hours ago was treated at the outpatient Department of Shalakya Tantra OPD at Dr. D. Y. Patil College of Ayurved and Research Centre, Pimpri, Pune. The patient’s condition was evaluated before and after receiving the prescribed treatment. Treatment Plan: The individual received Mukhabhyanga (facial massage) with Mahamasha oil, Nadi Sweda (sweating therapy) with Dashamoola herbal decoction fumigation, Marsha Nasya (intranasal treatment) with Panchendriya vardhana oil, and Netratarpana with Ksheerabala oil for seven days in addition to Shamana medication for one month. Result: Significant progress was noted according to the House-Brackmann scale. Following 15 days of therapy, the scale decreased from IV to III, and subsequently to II and I after the 30th day of monitoring. Conclusion: This study demonstrates encouraging and speedy outcomes of Ayurvedic therapy by taking into account factors of Vatavyadhi, particularly Ardita Vata, without exhibiting any complexities.

Radial Head Replacement: Management of Elbow and Forearm Instability after Comminuted Radial Head Fractures Associated with Elbow Dislocation

This manuscript aims to identify an indication algorithm for the surgical treatment of radial head fractures associated with elbow dislocation. The study compares the mid-term functional outcomes of patients with multifragment radial head fracture treated by resection with the outcomes of patients treated with radial head replacement. The cohort of 34 patients who sustained a radial head fracture at the mean age of 42.5 years (age range 20-81 years) was broken down into two groups by type of surgery. The EXT group consists of 20 patients with the radial head fracture treated by radial head resection. The END group includes 14 patients treated with the radial head replacement. In all patients, the radial head fracture was associated with elbow dislocation (type IV fracture according to the Mason-Johnston classification). The modified Kocher's surgical approach was used in all patients of both the groups. In the EXT group, resection of the fragmented radial head was performed. In the END group, the ExploR® Modular Radial Head System (Zimmer, Biomet, USA) was used, consisting of a CoCr (cobalt chromium) alloy head and a titanium stem. The pain and the range of motion of the elbow and forearm were evaluated after the completion of the outpatient rehabilitation (the mean follow-up period was 2.4 years). Simultaneously, the elbow joint stability was assessed. Radiographs were taken to detect heterotopic ossifications, proximalization of the radius, and any signs of prosthesis loosening. The frequency of reoperations was followed-up. The MEPS (Mayo Elbow Performance Score) was calculated. In the EXT group, the mean elbow flexion was 117.5° and the mean pronation/supination was 166.9°. In 50% of patients, the MEPS obtained was greater than 90 points, which means an excellent functional outcome. In 1 patient (5%), recurrent elbow dislocation occurred which was the reason for revision surgery (elbow transfixation with the Kirschner wires and medial collateral ligament suture). Revision surgery was also performed in 2 patients (10%) in whom not all the radial head fragments were removed. Moreover, also observed was elbow joint instability (2 patients) and temporary radial nerve paralysis (1 patient). In 1 case discrete proximalization of the radius developed. The patients in the END group showed the mean elbow flexion of 112° and the mean pronation/supination of 135°. The MEPS obtained from 69% of patients was greater than 90 points, which means an excellent outcome. The pain under load was reported by 3 patients (21%). In 5 patients (35%), the X-rays showed radiolucent zone around the stem of the prosthesis. Neither revision surgery, nor prosthesis removal has been performed yet in any patient. No instability, neurological complications or infections have been reported. In both EXT and END group heterotopic ossifications have developed in 4 patients. Radial head replacement compared to the radial head resection in the management of multifragment fractures associated with elbow dislocations increase the elbow and forearm stability. The group of patients with an implanted radial head prosthesis shows a higher percentage of patients achieving excellent functional outcome than the group of patients with radial head resection. radial head, elbow, fracture, dislocation, resection, prosthesis.

Application of retroauricular sulcus incision in the operation of benign tumors in the deep lobe of parotid gland

Objective: To investigate the application of retroauricular groove incision in the resection of benign tumors in the deep lobe of parotid. Methods: From January 2017 to January 2022, 19 patients (11 males and 8 females, age ranged from 17 to 69 years, with a median age of 48) with benign tumor in the deep lobe of parotid gland underwent parotidectomy through retroauricular sulcus incision in Linyi People's Hospital. Among them, 17 cases with tumor diameter≤4.0 cm underwent simple retroauricular groove incision, and 2 cases were dumbbell type with tumor diameter>4.0 cm on the medial side of mandible protruding into the parapharyngeal space, in which the deep lobe and tumor of parotid gland were resected through retroauricular sulcus incision combined with intraoral incision. Results: Tumors were completely removed through retroauricular sulcus incision in 17 cases, and dumbbell type tumors were removed through retroauricular sulcus incision combined with intraoral incision in 2 cases. Postoperative pathological examinations showed pleomorphic adenoma in 13 cases, basal cell adenoma in 4 cases and Warthin's tumor in 2 cases. Temporary mandibular marginal branch paralysis occurred in 2 patients and returned to normal 3 weeks after operation. All incisions healed in Phase I. By following-up of 1-5 years with a median follow-up time of 3.1 years, none of the patients had Frey syndrome, salivary fistula, other complications and tumor recurrence. The patients and their families were satisfied with the postoperative facial appearances. Conclusion: The retroauricular groove approach can not only preserve the function of parotid superficial lobe and facial nerve, but also has less trauma, less tissue defect and hidden scar. As the advantages of less complication, low recurrence rate and good cosmetic effect, the incision is worthy of clinical application.

Intracoronary ECG ST-segment shift remission time during reactive coronary hyperemia (tau-icECG): a new approach to assess hemodynamic coronary stenosis severity

Abstract Background Coronary pressure-derived fractional flow reserve (FFR) measurements are recommended for hemodynamic coronary stenosis assessment. Given temporary paralysis of the coronary microcirculation during hyperemia, pressure is, in theory, directly related to coronary flow. Pressure drop during hyperemia across a coronary stenosis, thus, provides an estimate of its restrictive effect on flow. FFR during reactive hyperemia induced by a proximal, 1-minute coronary artery balloon occlusion has been shown non-inferior to FFR as obtained by adenosine-induced hyperemia. Intracoronary ECG (icECG) is more sensitive in detecting myocardial ischemia than the surface ECG, and can be easily obtained. Purpose The present study evaluated a novel diagnostic approach based on icECG ST-segment shift remission time for hemodynamic stenosis severity assessment. Methods This was a retrospective observational trial in patients with chronic coronary syndrome, who underwent hemodynamic measurements during a brief coronary occlusion with simultaneous icECG recording during coronary angiography. The icECG recording was used for a beat-to-beat analysis of the ST-segment elevation performed by a previously developed fully autonomous algorithm. The time after release of the 1-minute ostial coronary balloon occlusion when the ST elevation reached 50% of the pre-occlusion (baseline) isoelectric line, i.e., icECG remission half time (τ-icECG; τ=tau), was obtained by the algorithm (Figure1). τ-icECG was evaluated using the simultaneously obtained FFR at a threshold of 0.80 as reference parameter. Results 139 icECGs from 119 patients were analysed, 23 had to be excluded in advance, due to incomplete icECG recording or algorithm failure. A ROC-analysis of τ at a threshold of &amp;gt;8s found it significantly accurate for detecting a hemodynamically relevant coronary stenosis at FFR≤0.80 (area under the ROC-curve 0.618, 95% CI 0.507-0.735, sensitivity 60%, specificity 67%, p=0.037) (Figure2). Conclusion Τ-icECG, a measure of icECG ST-elevation remission time to isoelectricity as obtained during reactive hyperemia FFR accurately detects hemodynamically relevant coronary artery stenoses at a threshold of ≥ 8 seconds.

Preliminary analysis of neuroprotective effects of capillary fascia preservation recurrent laryngeal nerve anatomical method in right level Ⅵ dissection

Objective: To investigate the application and effect of capillary fascia preservation between the recurrent laryngeal nerve (RLN) and common carotid artery (fascia preservation method) in nerve protection when dissecting right level Ⅵ lymph nodes for patients with papillary thyroid carcinoma. Methods: A retrospective cohort study enrolling 195 patients with papillary thyroid carcinoma undergoing right level Ⅵ lymph node dissection in Beijing Tongren Hospital from March 2021 to August 2022 was carried out. The RLN was dissected by fascia preservation method in study group and by routine method in control group. The intraoperative electrical signal amplitude of the RLN, the number of dissected lymph nodes, and the postoperative complications were recorded and analyzed. Results: A total of 195 patients (study group: 94 cases, control group: 101 cases) were collected. There were 71 males and 124 females, with the median age of 32 (39, 51) years. In the study group, the total number of right level Ⅵ lymph nodes was significantly larger than the number of right Ⅵa level lymph nodes [8 (6, 11) vs 6 (4, 8), P<0.001]. There were no significant differences between the two groups in the number of level Ⅵa or level Ⅵb lymph nodes [Ⅵa: 6 (4, 8) vs 5 (3, 7), P=0.373; Ⅵb: 3 (1, 4) vs 2 (1, 4), P=0.337] and metastasis rate [Ⅵa: 51.1% (48/94) vs 52.5% (53/101), P=0.844; Ⅵb: 12.8% (12/94) vs 15.8% (16/101), P=0.541]. The ratio of electromyography (EMG) amplitude R2 in lower level Ⅵ and entry into larynx (grouped as>90%, 50%~90%,<50%) in the study group was significantly higher than that in the control group (P<0.001). No significant differences were detected between the two groups in temporary RLN paralysis [1.1% (1/94) vs 2.0% (2/101), P=1.000]. Conclusions: Fascia preservation method can decrease the stimulus and traction to RLN and preserve the capillary network serving RLN. It can thoroughly dissect lymph nodes and decrease the injury of RLN.