Maxillary Nerve as Landmark for Exposure of the Internal Maxillary Artery in Extracranial-Intracranial Bypass Surgery.

OBJECTIVE: To establish a new method for fast exposure of the internal maxillary artery (IMA) during extracranial-intracranial bypass surgery. METHODS: To explore the positional relationship between the IMA and the maxillary nerve and pterygomaxillary fissure, 11 formalin-fixed cadaveric specimens were dissected. Three bone windows of the middle fossa were created for further analysis. Then the IMA length that could be pulled up above the middle fossa was measured after different degrees of removal of bony structure. The IMA branches under each bone window were also explored in detail. RESULTS: The top of the pterygomaxillary fissure was located 11.50 mm anterolateral to the foramen rotundum. The IMA could be identified just inferior to the infratemporal segment maxillary nerve in all specimens. After drilling of the first bone window, the IMA length that could be pulled above the middle fossa bone was 6.85 mm. After drilling of the second bone window and further mobilization, the IMA length that could be harvested was significantly longer (9.04 mm vs. 6.85 mm; P < 0.001). Removal of the third bone window did not significantly improve the IMA length that could be harvested. CONCLUSIONS: The maxillary nerve could be used as a reliable landmark for the exposure of the IMA in the pterygopalatine fossa. With our technique, the IMA could be easily exposed and sufficiently dissected without zygomatic osteotomy and extensive middle fossa floor removal.

Elevated Blood Glucose is Associated with Severe Exacerbation of Chronic Obstructive Pulmonary Disease.

Background: To evaluate the association of elevated blood glucose with the risk of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). Methods: Totally 526 consecutive patients with COPD recruited between Jan. 2018 and July 2019 were included in this study. Based on the American Diabetes Association's Standards of Care, these patients were divided into three groups according to HbA1c level: low HbA1c level (HbA1c <5.7%, n=204), moderate HbA1c level (HbA1c 5.7-6.4%, n=165), and high HbA1c level (HbA1c ≥6.5%, n=157). All subjects were followed up for 18 months. Multivariate Cox regression analysis was used to evaluate the predicting value of HbA1c for the time of the next COPD severe exacerbation. Results: Totally 141 (26.8%) patients in the study had at least 1 severe exacerbation. The proportion of patients suffering from at least 1 severe exacerbation was significantly higher (P<0.01) for patients with high (36.3%) and moderate HbA1c levels (25.5%) compared to those with low HbA1c levels (20.6%). Multivariate Cox regression analysis indicated that high (HR=2.74, 95% CI: 1.70-4.41; P<0.01) and moderate HbA1c levels (HR=2.19, 95% CI: 1.39-3.46; P<0.01) were significantly associated with a higher risk of the next severe exacerbation compared with low HbA1c level, after controlling for potential confounders including age, gender, body mass index (BMI), smoking status, disease duration of COPD, frequency of hospitalization due to acute exacerbation of COPD (AECOPD) in the past 12 months, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, COPD assessment test (CAT) score, corticosteroids use, hypertension, and cardiovascular diseases. Subgroup analyses also indicated a significant association between HbA1c levels and risk of the next severe exacerbation in different GOLD stages and diabetes status. Conclusion: Elevated blood glucose, no matter with or without diabetes, is significantly associated with a higher risk of the next severe exacerbation for patients with COPD.

Serum miR-19a expression correlates with worse prognosis of patients with non-small cell lung cancer.

OBJECTIVES: The aim of this study was to investigate the expression levels of miR-19a in non-small cell lung cancer (NSCLC) tissue and serum, and to clarify the relationships of serum miR-19a expression with clinical factors and prognosis of NSCLC patients. METHODS: Expression levels of miR-19a in 25 paired NSCLC, paracancerous tissues and serum, and sera from 103 controls and 201 NSCLC patients were respectively detected using real-time quantitative PCR. RESULTS: Compared with the paracancerous tissue, miR-19a was overexpressed in NSCLC tissue (P = 0.006), and there was a strong correlation between expression levels of miR-19 in 25 paired sera and tissues (P = 0.001). Serum miR-19a expression in NSCLC patients was significantly upregulated compared with those in healthy individuals (P = 0.001). High serum miR-19a expression was significantly correlated with TNM stage and lymph node metastasis (P = 0.004 and 0.017, respectively). Survival analysis revealed that overall survival rate of patients with high serum miR-19a expression was significantly worse than those of patients with low serum miR-19a expression (hazard ratio = 1.438, 95% confidence interval 1.007-2.052, P = 0.046). CONCLUSION: High serum miR-19a expression may be an independent poor prognostic factor for survival in NSCLC patients.