Exposure of the Cavernous Sinus via the Endoscopic Transorbital and Endoscopic Endonasal Approaches: A Comparative Study.

OBJECTIVE: To compare the endoscopic transorbital approach (ETOA) and endoscopic endonasal approach (EEA) in terms of cavernous sinus (CS) exposure. METHODS: Four cadaveric heads (8 sides) were dissected. The CS was accessed using the EEA and ETOA. Stereotactic measurements of the length of the main structures exposed, angles of attack, depths of surgical corridor, and areas of exposure were obtained and compared between the approaches. An illustrative case is also presented. RESULTS: The endoscopic transorbital approach (ETOA) exposed the lateral and superior compartments of the CS without obstruction by the internal carotid artery (ICA). The EEA exposed all compartments after mobilizing the ICA. Both approaches enabled similar exposure of the cranial nerves. The depth of surgical corridor was significantly shorter with the ETOA (P < 0.01). The areas of lateral compartment exposure were similar. As the number of instruments placed into the surgical channel increased, the available angles of attack with the ETOA became smaller and were smaller than those of the EEA. In the clinical case presented, the tumor was successfully removed without complications. CONCLUSIONS: The ETOA has the advantages of a sterile surgical channel, short operation time, little patient trauma, short surgical corridor, large exposure area, and interdural pathway; moreover, it allows dissection through the interdural space without entering the neurovascular compartment of the CS. Although the space for manipulation of instruments is limited, the ETOA is suitable for treating selected tumors in the superior and lateral compartments of the CS.

Exportin 4 depletion leads to nuclear accumulation of a subset of circular RNAs.

Numerous RNAs are exported from the nucleus, abnormalities of which lead to cellular complications and diseases. How thousands of circular RNAs (circRNAs) are exported from the nucleus remains elusive. Here, we provide lines of evidence to demonstrate a link between the conserved Exportin 4 (XPO4) and nuclear export of a subset of circRNAs in metazoans. Exonic circRNAs (ecircRNAs) with higher expression levels, larger length, and lower GC content are more sensitive to XPO4 deficiency. Cellular insufficiency of XPO4 leads to nuclear circRNA accumulation, circRNA:DNA (ciR-loop) formation, linear RNA:DNA (liR-loop) buildup, and DNA damage. DDX39 known to modulate circRNA export can resolve ciR-loop, and splicing factors involved in the biogenesis of circRNAs can also affect the levels of ciR-loop. Testis and brain are two organs with high abundance of circRNAs, and insufficient XPO4 levels are detrimental, as Xpo4 heterozygous mice display male infertility and neural phenotypes. Increased levels of ciR-loop, R-loop, and DNA damage along with decreased cell numbers are observed in testis and hippocampus of Xpo4 heterozygotes. This study sheds light on the understandings of mechanism of circRNA export and reveals the significance of efficient nuclear export of circRNAs in cellular physiology.

Contrast between traditional and machine learning algorithms based on a urine culture predictive model: a multicenter retrospective study in patients with urinary calculi.

Background: Quick and accurate identification of urinary calculi patients with positive urinary cultures is critical to the choice of the treatment strategy. Predictive models based on machine learning algorithms provide a new way to solve this problem. This study aims to determine the predictive value of machine learning algorithms using a urine culture predictive model based on patients with urinary calculi. Methods: Data were collected from four clinical centers in the period of June 2016, to May 2019. 2,054 cases were included in the study. The dataset was randomly split into ratios of 5:5, 6:4, and 7:3 for model construction and validation. Predictive models of urine culture outcomes were constructed and validated by logistic regression, random forest, adaboost, and gradient boosting decision tree (GBDT) models. Each ratio's construction and verification were repeated five times independently for cross-validation. The Matthews correlation coefficient (MMC), F1-score, receiver operating characteristic (ROC) curve with the area under curve (AUC) was used to evaluate the performance of each prediction model. The additive net reclassification index (NRI) and absolute NRI were used to assess the predictive capabilities of the models. Results: Four prediction models of urinary culture results in patients with urinary calculi were constructed. The mean AUCs of the logistic regression, random forest, adaboost, and GBDT models were 0.761 (95% CI: 0.753-0.770), 0.790 (95% CI: 0.782-0.798), 0.779 (95% CI: 0.766-0.791), and 0.831 (95% CI: 0.823-0.840), respectively. Moreover, the average MMC and F1-score of GBDT model was 0.460 and 0.588, which was improved compared to logistic regression model of 0.335 and 0.501. The additive NRI and absolute NRI of the GBDT and logistic regression models were 0.124 (95% CI: 0.106-0.142) and 0.065 (95% CI: 0.060-0.069), respectively. Conclusions: Our results indicate that machine learning algorithms may be useful tools for urine culture outcome prediction in patients with urinary calculi because they exhibit superior performance compared with the logistic regression model.

Endoscopy during neurotomy of the nervus intermedius for nervus intermedius neuralgia: a case report.

Nervus intermedius neuralgia (NIN) is a rare craniofacial neuralgia with features of paroxysmal pain in the deep ear. Because of sensory nerves overlap in the ear, the diagnosis of NIN is often difficult and not definitive. Here, we present the case of a 70-year-old woman who had deep-ear pain for more than 4 years and was diagnosed with trigeminal neuralgia and treated with carbamazepine without relief in another hospital. Magnetic resonance tomographic angiography revealed no neurovascular conflict with the trigeminal nerve, whereas the anterior inferior cerebellar artery (AICA) was close to the VII/VIII complex. We performed left-sided suboccipital retrosigmoid craniotomy. Surgical exploration under endoscopy clearly showed that the nervus intermedius was compressed by the AICA from behind. The ear pain was completely relieved immediately after nervus intermedius sectioning. The intraoperative findings and postoperative results confirmed that the compression of the nervus intermedius by the AICA caused the otalgia. A patient's specific pain, combined with preoperative imaging examination, is useful in the diagnosis of NIN. Neuroendoscopy has the advantages of enabling a clear field of view and close observation, thus aiding in the identification and accurate cutting of the nervus intermedius during the operation.

Convenient method of synthesizing 3-ethoxycarbonyl indoles.

We have developed a convenient two-step procedure for the synthesis of 3-ethoxycarbonyl indoles from commercially available materials. The two-step procedure involves the synthesis of 2-aryl-3-hydroxypropenoic acid ester, followed by a catalytic reduction. This method is efficient, simple, and selective.