Endoscopic vidian and vidian-branch neurectomy for refractory allergic rhinitis: A systematic review.

BACKGROUND: Endoscopic vidian neurectomy is expected to provide good therapeutic relief in patients with allergic rhinitis (AR) being refractory to medication therapy or conservative surgery. However, the evidence bases for its benefit remain debatable. In this study, we conducted a systematic review and meta-analysis to clarify the therapeutic role of various forms of vidian neurectomy in refractory AR. METHOD: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct a systematic review of primary studies that reported original patient data for endoscopic vidian neurectomy (EVN) and vidian-branch neurectomy, which includes selective vidian neurectomy (SVN) and posterior nasal neurectomy (PNN). The primary outcome was patient-reported outcome measures (PROMs), including the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) and Visual Analog Scale (VAS), to assess an improvement in nasal symptom severity and quality of patient's life. The incidence of surgical complications and other objective outcomes were considered secondary outcomes. RESULTS: This review included 24 clinical studies involving 1677 patients with refractory AR, of which 510 patients in six studies had combined chronic rhinosinusitis with nasal polyps (CRSwNP) and 95 patients in one study had combined asthma. Postoperative PROMs were significantly better than preoperatively in almost all patients who underwent vidianp (RQLQ: standardized mean difference [SMD] = 2.66, 95% confidence interval [CI] = 2.40-2.92, p < 0.001; VAS: SMD = 5.15, 95% CI = 4.29-6.02, p < 0.001) or vidian-branch neurectomy (RQLQ in PNN: SMD = 3.29, 95% CI = 2.45-4.13, p < 0.001; VAS in PNN: SMD = 4.38, 95% CI = 3.41-5.34, p < 0.001), and were generally better than in the conservative treatment group. Dividing with 18 months as the cutoff point, a subgroup analysis of the follow-up period was conducted, and the results showed that both long-term and short-term postoperative patients had considerably reduced symptoms compared to the preoperative period. The two surgical procedures, SVN and PNN, attributed to vidian-branch neurectomy have extremely few complications. However, EVN is more likely to cause dry eyes and palatal numbness, with no other serious complications. In patients with AR and CRSwNP, vidian or selective vidian neurectomy combined with functional endoscopic sinus surgery (FESS) is more effective than conventional FESS (RQLQ: SMD = 2.17, 95% CI = 1.66-2.69, p < 0.001; VAS: SMD = 6.42, 95% CI = 4.78-8.06, p < 0.001). For patients who have both AR and asthma, SVN with pharyngeal branch excision is a potential treatment option. CONCLUSION: EVN and vidian-branch neurectomy (including SVN and PNN) are effective treatments, but the former has a higher risk of complications. Additionally, vidian-branch neurectomy with FESS is beneficial for patients with mixed CRSwNP. SVN is a potential approach for patients with coexisting AR and asthma.

Structured Emulgels by Interfacial Assembly of Terpenes and Nanochitin.

Interfacial assemblies formed by colloidal complexation are effective in multiphase stabilization, as shown in structured liquids and Pickering emulgels. Herein, we demonstrate a type of biobased colloidal system that spontaneously stabilizes an organic phase in a continuous hydrogel phase. Specifically, a triterpene extracted from bark (betulin, BE) is added to an organic phase containing a coniferous resin (rosin acid, a diterpene). BE is shown to take part in strong noncovalent interactions with the nanochitin dispersed in the aqueous (hydrogel) phase, leading to a complex of high interfacial activity. The viscoelastic response of the system is rationalized by the presence of a superstable structured dual network. When used as a templating material, the emulgel develops into structured liquids and cryogels. The herein introduced all-biobased type of nanoparticle surfactant system forms a gel ("emulsion-filled" with "aggregated droplets") that features the functional benefits of both betulin and nanochitin.

Super-Macroporous Lightweight Materials Templated from Bicontinuous Intra-Phase Jammed Emulsion Gels Based on Nanochitin.

Non-equilibrium multiphase systems are formed by mixing two immiscible nanoparticle dispersions, leading to bicontinuous emulsions that template cryogels with interconnected, tortuous channels. Herein, a renewable, rod-like biocolloid (chitin nanocrystals, ChNC) is used to kinetically arrest bicontinuous morphologies. Specifically, it is found that ChNC stabilizes intra-phase jammed bicontinuous systems at an ultra-low particle concentration (as low as 0.6 wt.%), leading to tailorable morphologies. The synergistic effects of ChNC high aspect ratio, intrinsic stiffness, and interparticle interactions produce hydrogelation and, upon drying, lead to open channels bearing dual characteristic sizes, suitably integrated into robust bicontinuous ultra-lightweight solids. Overall, it demonstrates the successful formation of ChNC-jammed bicontinuous emulsions and a facile emulsion templating route to synthesize chitin cryogels that form unique super-macroporous networks.

The relationship between serum homocysteine levels and sudden sensorineural hearing loss: a meta-analysis.

OBJECTIVE: There was disagreement over the association between serum/plasma homocysteine (HCY) levels and sudden sensorineural hearing loss (SSNHL). Through the use of a meta-analysis, this study aims to determine whether there is a significant difference in serum homocysteine levels between the SSNHL group and the control group. DESIGN: The Cochrane Library, EMBASE, and PubMed databases were all thoroughly searched. The two independent reviewers thoroughly examined the initially searched articles. The data results were calculated by standard mean difference (SMD) or odds ratios (OR). Review Manager (version 5.3) was applied to statistical data. STUDY SAMPLE: There were 766 participants in the 6 trials with continuous outcomes that were part of the meta-analysis A. In addition, meta-analysis B, which included 961 people, contained a total of 3 studies with dichotomous results. RESULTS: Both meta-analyses revealed the same conclusion that serum/plasma HCY levels in the SSNHL patients are higher than those in the controls (SMD 0.41, 95 % confidence interval (CI) 0.11 to 0.72, P < 0.01; OR 3.27, 95 % CI 2.16 to 4.94, P < 0.01). CONCLUSION: This study demonstrated that the SSNHL patients' serum/plasma HCY levels were greater than those of the control group.

A Rare Case of Deceptive Maxillary Ameloblastoma.

Ameloblastoma (AM) is a rare epithelium-derived odontogenic tumor, mostly involving the mandible and less often the maxilla. Most AMs are benign and characterized by indolence and local invasiveness, with a high recurrence rate. Herein, we present a case of maxillary AM in a 42-year-old female suffering from left nasal congestion and facial swelling for almost one month after endoscopic surgery at a local hospital. The mass was completely resected by a transnasal functional endoscopic sinus surgery based on radiographic examination. Subsequently, postsurgical histopathological examinations were conducted, and she was diagnosed with a plexiform AM pattern. Immunohistochemical staining revealed that the tumor was positive for PCK, P63, CK5/6, and CK14 but negative for S100, ER, and Ki67. Based on these findings, the patient was diagnosed with maxillary AM.

Liquid metal and Mxene enable self-healing soft electronics based on double networks of bacterial cellulose hydrogels.

Liquid metal (LM) nanodroplets and MXene nanosheets are integrated with sulfonated bacterial nanocellulose (BNC) and acrylic acid (AA). Upon fast sonication, AA polymerization leads to a crosslinked composite hydrogel in which BNC exfoliates Mxene, forming organized conductive pathways. Soft conducting properties are achieved in the presence of colloidally stable core-shell LM nanodroplets. Due to the unique gelation mechanism and the effect of Mxene, the hydrogels spontaneously undergo surface wrinkling, which improves their electrical sensitivity (GF = 8.09). The hydrogels are further shown to display interfacial adhesion to a variety of surfaces, ultra-elasticity (tailorable elongation, from 1000 % to 3200 %), indentation resistance and self-healing capabilities. Such properties are demonstrated in wearable, force mapping, multi-sensing and patternable electroluminescence devices.

Can polysomnography be replaced by ApneaGraph200 for OSA diagnosis? A protocol for systematic review and meta-analysis.

BACKGROUND: It is yet unknown if the ApneaGraph200 system can replace the Polysomnography system (PSG), which is now the gold standard for obstructive sleep apnea (OSA) diagnosis. We performed a meta-analysis to evaluate the difference in apnea hypopnea index and lowest oxygen saturation levels between the AG200 system and PSG system. METHODS: Utilizing PubMed, Elsevier, Wanfang, and China National Knowledge Internet (CNKI), a thorough literature search was carried out. Eligible studies contrasting the AG200 system and the PSG system were found by two separate researchers. Review Manager (version 5.3) was adopted for data synthesis. RESULTS: The meta-analysis A pooled the comparison of AHI between the AG and PSG groups, and included seven studies involving a total of 419 participants, which revealed that there was a significant difference in AHI between the above two diagnostic methods (standard mean difference (SMD) = - 0.19, 95% confidence interval (CI) = - 0.32 to - 0.05, P = 0.008). As a supplementary, meta-analysis B pooled the comparison of lowest oxygen saturation between the AG and PSG groups and included five studies involving a total of 224 participants. It revealed that there was no significant difference between the AG group and the PSG group (SMD = 0.09, 95% CI - 0.24 to 0.43, P = 0.58). CONCLUSION: The ApneaGraph200 system can be used for the initial screening of OSA patients, but it is not a complete alternative to polysomnography for the diagnosis and severity of the OSA condition.

Sinonasal Teratocarcinosarcoma Involving Orbital and Intracranial Extension: A Rare Case Report.

Sinonasal teratocarcinosarcoma (SNTCS) is one of the rarest and most highly invasive malignant neoplasms often found in the nasal cavity and paranasal sinuses. SNTCS is often misdiagnosed because of its morphological heterogeneity. Due to its rarity, clinical characteristics and optimal therapy have not been well-established. Here, we present a case of SNTCS with orbital and intracranial extensions. A 48-year-old male patient presented with left-side nasal obstruction for 3 years. He appeared with visual and neurological symptoms 2 months ago. On radiographic examination, a mass was observed in the left paranasal sinuses with orbital and intracranial extension involvement. The mass was surgically resected. In the future, knowledge of this entity may assist in the accurate diagnosis and proper management of SNTCS.

Serum leptin differs in children with obstructive sleep apnea: A meta-analysis and PRISMA compliant article.

BACKGROUND: Obstructive sleep apnea (OSA) as an independent cardiovascular risk factor has been proposed, but the mechanisms underlying cardiovascular disease is far from being completely elucidated. Leptin, an inflammatory cytokine produced by adipocytes, contributes to the modulation of metabolism, respiratory control, and inflammation, which are factors associated with cardiovascular disease. Serum levels of leptin in children with OSA have shown conflicting results in previous studies. METHODS: We performed a meta-analysis to clarify the correlation between leptin expression of the OSA patients following the PRISMA. PubMed, Embase, and Web of Science were systematically searched for relevant studies, and then independently screened by two researchers, and analyzed the data through STATA version 12.0. RESULTS: In a total of 5 articles including 469 participants, the data analysis showed that serum leptin levels were elevated in children with OSA (MD, 6.36; 95% CI, 0.24-12.49, P < .001), compared to the control group. Subgroup analysis were performed based on body mass index. The results of subgroup analysis demonstrated that the serum leptin concentration was correlated with body mass index in children with OSA (MD, 9.70; 95% CI, 0.22-11.18, P < .001). CONCLUSIONS: The serum leptin levels were elevated in children with OSA, compared to the control group. It could add to our developing understanding of the pathogenesis and potential treatments for children with OSA, and help us to recognize the relevance of OSA in determining cardiovascular issues among children.

Potential otogenic complications caused by cholesteatoma of the contralateral ear in patients with otogenic abscess secondary to middle ear cholesteatoma of one ear: A case report.

BACKGROUND: Otogenic brain abscess caused by middle ear cholesteatoma is a potentially serious and life-threatening complication in the ear, nose, and throat clinic. The mortality rate associated with otogenic brain abscesses is 8%-26.3%. Recently, in China, the incidence of brain abscess secondary to middle ear cholesteatoma has started to increase due to antibiotic resistance. CASE SUMMARY: A 55-year-old male presented hearing loss in the right ear and headache for 1 mo in 2018. Computed tomography (CT) showed an area of low density in the right middle ear and mastoid and auditory ossicle defects and a small amount of soft tissue density in the left middle ear. The parietal wall of the right tympanic cavity and the posterior wall of the mastoid sinus were thin and less continuous. Cranial magnetic resonance imaging revealed an area of low intensity encapsulated by an area of high intensity in the right temporal lobe. We diagnosed him with a brain abscess secondary to middle ear cholesteatoma. He received surgery to drain the abscess followed by a modified radical mastoidectomy. The patient visited our department 3 years later because of intermittent otorrhea in the left ear. CT revealed that the area of the soft tissue density in the left middle ear and mastoid was significantly increased. The posterior wall of the mastoid sinus was destroyed, leaving the left middle ear connecting with the brain. The patient underwent a modified radical mastoidectomy in the left ear. CONCLUSION: Regular follow-up and timely treatment of contralateral ear disease are vital for the prevention of otogenic complications in patients with otogenic abscesses secondary to middle ear cholesteatoma in the unilateral ear.

Effect of N-acetyl-cysteine treatment on sensorineural hearing loss: a meta-analysis.

N-acetyl-cysteine (NAC) is an efficacious treatment for sensorineural hearing loss in animal models, such as noise-induced hearing loss (NIHL), however previous research into the effect of NAC on patients with hearing loss produced contradictory results. In this study, we investigated the effect of NAC treatment on sensorineural hearing loss. PubMed, Web of Science and Embase databases were searched in their entirety using the key words: hearing loss, NAC, N-acetylcysteine, and sensorineural hearing loss. Studies which included assessment of hearing loss with pure-tone threshold (PTA) data were selected. Eligible studies regarding the effects of NAC treatment on patients with hearing loss were collected by two independent reviewers. A total of 1197 individuals were included from seven published studies. Two studies reported data for a sudden idiopathic sensorineural hearing loss (SISNHL) group. Three studies reported data for a NIHL group. Other studies reported data for drug-induced hearing loss. The meta-analysis demonstrated that the overall effect of NAC treatment on sensorineural hearing loss was invalid. However, NAC treatment was linked with improved patient outcomes of hearing tests in cases of sudden hearing loss, but did not prevent hearing loss induced by noise or ototoxicity. However, there is a need for better-designed studies with larger samples to further prove the correlation between the effect of NAC and hearing loss.

Nanochitin: Chemistry, Structure, Assembly, and Applications.

Chitin, a fascinating biopolymer found in living organisms, fulfills current demands of availability, sustainability, biocompatibility, biodegradability, functionality, and renewability. A feature of chitin is its ability to structure into hierarchical assemblies, spanning the nano- and macroscales, imparting toughness and resistance (chemical, biological, among others) to multicomponent materials as well as adding adaptability, tunability, and versatility. Retaining the inherent structural characteristics of chitin and its colloidal features in dispersed media has been central to its use, considering it as a building block for the construction of emerging materials. Top-down chitin designs have been reported and differentiate from the traditional molecular-level, bottom-up synthesis and assembly for material development. Such topics are the focus of this Review, which also covers the origins and biological characteristics of chitin and their influence on the morphological and physical-chemical properties. We discuss recent achievements in the isolation, deconstruction, and fractionation of chitin nanostructures of varying axial aspects (nanofibrils and nanorods) along with methods for their modification and assembly into functional materials. We highlight the role of nanochitin in its native architecture and as a component of materials subjected to multiscale interactions, leading to highly dynamic and functional structures. We introduce the most recent advances in the applications of nanochitin-derived materials and industrialization efforts, following green manufacturing principles. Finally, we offer a critical perspective about the adoption of nanochitin in the context of advanced, sustainable materials.

A rare case of Epstein-Barr virus-positive anaplastic plasmacytoma in the sinonasal tract.

Epstein-Barr virus-positive anaplastic plasmacytoma in the sinonasal tract is uncommon. Herein, we present the case of a 40-year-old male patient with a right sinonasal tract filled with a soft tissue mass, as shown on CT. Apart from frequent nosebleeds, he did not report any specific sinonasal symptoms, such as nasal obstruction, discharge, or loss of smell. The patient underwent functional endoscopic sinus surgery under general anesthesia. The diagnosis of Epstein-Barr virus-positive anaplastic plasmacytoma was confirmed by lesion biopsy, subsequent immunohistochemical staining, and in situ hybridization.

[Research status of Epstein Barr virus in children with adenotonsillar hypertrophy].

Airway obstruction caused by adenotonsillar hypertrophy is one of the most common otolaryngological diseases in children. In recent years, Epstein Barr virus has been found to be closely related to adenotonsillar hypertrophy. This review summarizes the mechanism and epidemiology of adenotonsillar hypertrophy and obstructive sleep apnea syndrome caused by Epstein Barr virus.

N-Acetylcysteine Combined With Dexamethasone Treatment Improves Sudden Sensorineural Hearing Loss and Attenuates Hair Cell Death Caused by ROS Stress.

Sudden sensorineural hearing loss (SSNHL) is a common emergency in the world. Increasing evidence of imbalance of oxidant-antioxidant were found in SSNHL patients. Steroids combined with antioxidants may be a potential strategy for the treatment of SSNHL. In cochlear explant experiment, we found that N-acetylcysteine (NAC) combined with dexamethasone can effectively protect hair cells from oxidative stress when they were both at ineffective concentrations alone. A clinic trial was designed to explore whether oral NAC combined with intratympanic dexamethasone (ITD) as a salvage treatment has a better therapeutic effect. 41 patients with SSNHL were randomized to two groups. 23 patients in control group received ITD therapy alone, while 18 patient s in NAC group were treated with oral NAC and ITD. The patients were followed-up on day 1st (initiation of treatment) and day 14th. Overall, there was no statistical difference in final pure-tone threshold average (PTA) improvement between those two groups. However, a significant hearing gain at 8,000 Hz was observed in NAC group. Moreover, the hearing recovery rates of NAC group is much higher than that in control group. These results demonstrated that oral NAC in combination with ITD therapy is a more effective therapy for SSNHL than ITD alone.

The differences in plasma/serum ghrelin levels between obstructive sleep apnea-hypopnea patients and controls: A protocol for systematic review and meta-analysis.

BACKGROUND: The association between obstructive sleep apnea-hypopnea syndrome (OSAHS) and plasma/serum ghrelin levels remains controversial. We performed a meta-analysis to evaluate the difference in plasma/serum ghrelin levels between OSAHS patients and controls. METHODS: Database of PubMed, SCI, and Elsevier were searched entirely. Two independents identified eligible studies of ghrelin levels in OSAHS patients. ReviewManager (version 5.3) was adopted for data synthesis. RESULTS: The meta-analysis A pooled the comparison of ghrelin concentrations in OSAHS patients and controls, which included 7 studies and involving 446 participants. The result of the meta-analysis A indicated that plasma/serum ghrelin levels were no significant differences between the OSAHS group and the control group (standard mean difference (SMD) = 0.08, 95% confidence interval (CI) = -0.12 to 0.28, P = .43). As a supplementary, meta-analysis B pooled the comparison of plasma/serum ghrelin levels in OSAHS patients before and after continuous positive airway pressure (CPAP) therapy, which included 155 participants from 4 studies, it revealed that plasma/serum ghrelin levels were no significant differences between before and after CPAP therapy (SMD = 0.12, 95%CI = -0.07 to 0.31, P = .22). CONCLUSION: The meta-analysis A demonstrated that plasma/serum ghrelin levels were no significant differences between the OSAHS group and the control group. The meta-analysis B showed plasma/serum ghrelin levels have no significant changes after CPAP therapy in OSAHS patients.

The Relationship Between Otitis Media With Effusion and Gastroesophageal Reflux Disease: A Meta-analysis.

OBJECTIVE: Recent studies have investigated the mechanism by which refluxed gastric materials reach the middle ear, to establish otitis media with effusion (OME) causal relation between them in both children and adults. Therefore, the relationship between OME and gastro-esophageal reflux disease (GERD) should be further studied extensively. METHODS: To identify eligible original articles, we searched a range of computerized databases, including Medline via PubMed, EMBASE, CNKI, and Web of Science with a systematic searching strategy. Subgroup analysis was performed to analyze heterogeneity and Egger and Begg funnel plot to assess the publication bias of the included articles. RESULTS: The meta-analysis had an overall sample size of 1961. We identified a significant relationship between OME and GERD, with a pooled odds ratio (OR) of 4.52 (95% confidence interval [CI]: 2.42-8.44; p < 0.001). The pooled data were calculated with the random-effects model as a high significant heterogeneity was found among the studies and there was no significant publication bias observed. CONCLUSIONS: The meta-analysis suggested that there was a significant association between otitis media with effusion and gastroesophageal reflux disease.

The role of nitric oxide (NO) levels in patients with obstructive sleep apnea-hypopnea syndrome: a meta-analysis.

PURPOSE: The pathogenesis of cardiovascular disease (CVD) in patients with obstructive sleep apnea (OSA) is unclear. Several studies have suggested that CVD may be caused by oxidative stress from chronic intermittent hypoxia and associated vascular endothelial dysfunction. Oxidative stress in patients with OSA can induce endothelial cell apoptosis, aggravate vascular endothelial damage, and promote the expression of redox-sensitive genes and adhesion molecules. No meta-analysis has explored whether or not OSA is related to nitric oxide (NO). METHOD: To assess the association between serum/plasma NO levels and OSA, we performed a meta-analysis of the literature on the subject to grade the strength of evidence. RESULTS: OSA was significantly related to decreased serum or plasma NO levels (WMD = - 11.66, 95% CI - 17.21 to - 6.11; P < 0.01). Among the studies analyzed, there was high degree of heterogeneity (I2 = 79%, P < 0.01). Sensitivity analysis showed that after omitting any single study or converting a random effects model (REM) to a fixed effects model (FEM), the main results still held. CONCLUSIONS: This meta-analysis suggests a strong correlation between OSA and serum or plasma NO levels which may explain the link between intermittent hypoxia of OSA and risk of CVD. The strength of this finding may spur further basic and clinical research into vascular endothelial dysfunction in patients with OSA.

Transparent films by ionic liquid welding of cellulose nanofibers and polylactide: Enhanced biodegradability in marine environments.

We introduce a green and facile method to compatibilize hydrophobic polylactide (PLA) with hydrophilic cellulose nanofibers (CNF) by using ionic liquid ([DBNH][OAc]) welding with a cosolvent system (gamma-valerolactone). Such welding affords strong (230 MPa tensile strength), flexible (13% elongation at break), transparent (>90%) and defect-free CNF/PLA films. The films are biodegradable in marine environments (70% degradation in 7 weeks), facilitating the otherwise slow PLA decomposition. Physical, chemical and structural features of the films before and after welding are compared and factored in the trends observed for degradation in seawater. The results point to the possibility of PLA-based films forming a co-continuous system with nanocellulose to achieve an improved performance. The role of film morphology, hydrophobicity, and crystallinity is discussed to add to the prospects for packaging materials that simultaneously display accelerated degradability in marine environments.

Decreased expression of TNFRSF12A in thyroid gland cancer predicts poor prognosis: A study based on TCGA data.

Thyroid cancer (TC) is the most well-known endocrine neoplasia as well as a common malignant tumor in the head and neck. Our study was designed to assess the prognostic meaningful of TNFRSF12A expression in TC dependent on data acquired from TCGA and so as to increase further knowledge into the biological pathways involved in TC pathogenesis related TNFRSF12A.Information on gene expression and comparing clinical data were identified and downloaded from TCGA. Gene set enrichment analysis (GSEA) created an arranged list of all genes indicated by their connection with TNFRSF12A expression.Our study cohort included 370 (73.1%) female and 136 (26.9%) male patients. The scatter plot and paired plot showed the difference of TNFRSF12A expression between normal and tumor samples (P < .01). The univariate analysis suggested that TNFRSF12A-low associated essentially with age (HR: 1.15; 95%CI: 1.08-1.22; P < .01), stage (HR: 2.79; 95%CI: 1.43-5.46; I vs IV; P = .003) and tumor stage (HR: 2.39; 95%CI: 1.08-5.30; P = .031). The GSEA results show that type II diabetes mellitus, pantothenate and CoA biosynthesis, adipocytokine signaling pathway, PPAR signaling pathway, mTOR signaling pathway, insulin signaling pathway, are enriched in TNFRSF12A low expression phenotype.TNFRSF12A expression may be a potential useful prognostic molecular biomarker of bad survival in thyroid cancer, in addition, PPAR signaling pathway, insulin signaling pathway, mTOR signaling pathway may be the key pathway controlled by TNFRSF12A in thyroid cancer. Further experimental ought to be performed to demonstrate the biologic effect of TNFRSF12A.