Risk factors for myocardial injury during living donor liver transplantation in pediatric patients with biliary atresia.

BACKGROUND: Cold ischemia-reperfusion of the liver is an inevitable occurrence in liver transplantation that may also cause damage to the heart. Perioperative myocardial injury during liver transplantation can increase the incidence of postoperative mortality, but there is little research on the incidence of myocardial injury in children who undergo living donor liver transplantation (LDLT). Therefore, this study mainly explores the independent risk factors for myocardial injury in children who undergo LDLT. AIM: To analyze the data of children who underwent LDLT to determine the risk factors for intraoperative myocardial injury. METHODS: We retrospectively analyzed the inpatient records of pediatric patients who underwent LDLT in Tianjin First Central Hospital from January 1, 2020, to January 31, 2022. Recipient-related data and donor-related data were collected. The patients were divided into a myocardial injury group and a nonmyocardial injury group according to the value of the serum cardiac troponin I at the end of surgery for analysis. Univariate analysis and multivariate logistic regression were used to evaluate the risk factors for myocardial injury during LDLT in pediatric patients. RESULTS: A total of 302 patients met the inclusion criteria. The myocardial injury group had 142 individuals (47%), and the nonmyocardial injury group included 160 patients (53%). Age, height, and weight were significantly lower in the myocardial injury group (P < 0.001). The pediatric end-stage liver disease (PELD) score, total bilirubin, and international standardized ratio were significantly higher in the myocardial injury group (P < 0.001). The mean arterial pressure, lactate, hemoglobin before reperfusion, duration of the anhepatic phase, cold ischemic time, incidence of postreperfusion syndrome (PRS), and fresh frozen plasma transfusion were significantly different between the two groups (P < 0.05). The postoperative intensive care unit stay and peak total bilirubin values in the first 5 d after LDLT were significantly higher in the myocardial injury group (P < 0.05). The pediatric patients with biliary atresia in the nonmyocardial injury group who underwent LDLT had a considerably higher one-year survival rate than those in the myocardial injury group (P = 0.015). Multivariate logistic regression revealed the following independent risk factors for myocardial injury: a high PELD score [odds ratio (OR) = 1.065, 95% confidence interval (CI): 1.013-1.121; P = 0.014], a long duration of the anhepatic phase (OR = 1.021, 95%CI: 1.003-1.040; P = 0.025), and the occurrence of intraoperative PRS (OR = 1.966, 95%CI: 1.111-3.480; P = 0.020). CONCLUSION: A high PELD score, a long anhepatic phase duration, and the occurrence of intraoperative PRS were independent risk factors for myocardial injury during LDLT in pediatric patients with biliary atresia.

Epigenomic and Transcriptomic Prioritization of Candidate Obesity-Risk Regulatory GWAS SNPs.

Concern about rising rates of obesity has prompted searches for obesity-related single nucleotide polymorphisms (SNPs) in genome-wide association studies (GWAS). Identifying plausible regulatory SNPs is very difficult partially because of linkage disequilibrium. We used an unusual epigenomic and transcriptomic analysis of obesity GWAS-derived SNPs in adipose versus heterologous tissues. From 50 GWAS and 121,064 expanded SNPs, we prioritized 47 potential causal regulatory SNPs (Tier-1 SNPs) for 14 gene loci. A detailed examination of seven loci revealed that four (CABLES1, PC, PEMT, and FAM13A) had Tier-1 SNPs positioned so that they could regulate use of alternative transcription start sites, resulting in different polypeptides being generated or different amounts of an intronic microRNA gene being expressed. HOXA11 and long noncoding RNA gene RP11-392O17.1 had Tier-1 SNPs in their 3' or promoter region, respectively, and strong preferences for expression in subcutaneous versus visceral adipose tissue. ZBED3-AS1 had two intragenic Tier-1 SNPs, each of which could contribute to mediating obesity risk through modulating long-distance chromatin interactions. Our approach not only revealed especially credible novel regulatory SNPs, but also helped evaluate previously highlighted obesity GWAS SNPs that were candidates for transcription regulation.

Zp4 is completely dispensable for fertility in female rats†.

Zona pellucida (ZP), which is composed of at most four extracellular glycoproteins (ZP1, ZP2, ZP3, and ZP4) in mammals, shelters the oocytes and is vital in female fertility. Several studies have identified the indispensable roles of ZP1-3 in maintaining normal female fertility. However, the understanding of ZP4 is still very poor because only one study on ZP4-associated infertility performed in rabbits has been reported up to date. Here we investigated the function of mammalian Zp4 by creating a knockout (KO) rat strain (Zp4-/- rat) using CRISPR-Cas9-mediated DNA-editing method. The influence of Zp4 KO on ZP morphology and some pivotal processes of reproduction, including oogenesis, ovulation, fertilization, and pup production, were studied using periodic acid-Schiff's staining, superovulation, in vitro fertilization, and natural mating. The ZP morphology in Zp4-/- rats was normal, and none of these pivotal processes was affected. This study renewed the knowledge of mammalian Zp4 by suggesting that Zp4 was completely dispensable for female fertility.

Histamine H4 receptor regulates IL-6 and INF-γ secretion in native monocytes from healthy subjects and patients with allergic rhinitis.

Histamine H1 receptor (H1R) and histamine H4 receptor (H4R) are essential in allergic inflammation. The roles of H4R have been characterized in T cell subsets, whereas the functional properties of H4R in monocytes remain unclear. In the current study, the responses of H4R in peripheral monocytes from patients with allergic rhinitis (AR) were investigated. The results confirmed that H4R has the functional effects of mediating cytokine production (i.e., down-regulating IFN-γ and up-regulating IL-6) in cells from a monocyte cell line following challenge with histamine. We demonstrated that when monocytes from AR patients were stimulated with allergen extracts of house dust mite (HDM), IFN-γ secretion was dependent on H4R activity, but IL-6 secretion was based on H1R activity. Furthermore, a combination of H1R and H4R antagonists was more effective at blocking the inflammatory response in monocytes than treatment with either type of antagonist alone.

Primary nasopharyngeal polyps: a case series on a rare clinical entity.

Primary non-neoplastic polyps originating from the nasopharynx have not been reported in the English language literature. We present the clinical and histopathological features of three primary nasopharyngeal polyps. Clinical data of three patients with primary nasopharyngeal polyps treated at the Department of Otolaryngology, The First Affiliated Hospital of Sun Yat-sen University between 2005 and 2015 were analyzed and presented. Three male patients from 45 to 63 years presented with nasopharyngeal masses. CT or MRI examination showed nasopharyngeal space-occupying lesions. Two patients were initially diagnosed with nasopharyngeal angiofibroma and one patient with nasopharyngeal carcinoma. After surgical excision, based on the histological examination, the tissue masses were all diagnosed as inflammatory polyps. Histologically, the polyps demonstrated significant oedema, collagen deposition, leukocytic infiltration, and epithelial remodelling. Primary nasopharyngeal polyps represent a distinct clinical entity and should be considered in the differential diagnosis of nasopharyngeal masses.

Differential Expression Patterns of EGF, EGFR, and ERBB4 in Nasal Polyp Epithelium.

Epidermal growth factor receptors play an important role in airway epithelial cell growth and differentiation. The current study investigates the expression profiles of EGF, EGFR and ERBB4 in patients with nasal polyps (NP), and their response to glucocorticosteroid (GC) treatment. Fifty patients with NP (40 without GC treatment and 10 with oral GC) and 20 control subjects with septal deviation were recruited into the study. Protein levels of EGF, EGFR, and ERBB4 were evaluated by immune-staining. In healthy nasal epithelium, EGF and EGFR localized within p63+ basal cells, while ERBB4 localized within ciliated cells. GC-naïve NP epithelium showed weak expression of EGF in 90% of samples versus 5% of controls. EGFR was significantly increased in the epithelium with basal cell hyperplasia from GC-naïve NPs (78%, 31/40) compared to controls (23%, 4/17). EGFR was also found in some degranulating goblet cells. ERBB4 expression was significantly higher in hyperplastic epithelium from GC-naïve NPs (65%, 26/40) than in controls (6%, 1/17). GC treatment restored the EGF expression and normalized the EGFR and ERBB4 expression in NPs. Differential expression patterns of EGF, EGFR, and ERBB4 are essential in epithelial restitution and remodeling in nasal epithelium.

Histopathological features of sinonasal inverted papillomas in chinese patients.

OBJECTIVES/HYPOTHESIS: Nasal inverted papilloma (IP) is a benign tumor with high recurrence rates. Evidence of inflammation has been reported in IP in Caucasian studies. This study aimed to investigate the histopathological patterns and their associations with clinical characteristics in Chinese patients with IP. STUDY DESIGN: Basic science study. METHODS: IP tissues were obtained from 50 Chinese patients with unilateral IPs. Biopsies of inferior turbinate mucosa from 17 healthy subjects were used as controls. The histological patterns and severity of epithelial remodeling and inflammatory cell infiltration were evaluated and analyzed for associations with clinical characteristics. RESULTS: Thirty-one percent of IP specimens were classified as grade I (mild remodeling) and 49% as grade II (moderate and severe remodeling). Concomitant inflammatory nasal polyps were found in 14 patients (28%). Recurrent IP was strongly associated with grade II (odds ratio: 5.81, 95% confidence interval: 1.34-25.18). Except CD4(+) T cells, quantities of neutrophils, macrophages, eosinophils, CD8(+) T cells, and FoxP3(+) T-reg cells were significantly elevated in IP. Of these, neutrophils were the predominant cell type in IP. CONCLUSIONS: Inflammation may have potential roles in IPs and the higher grade of epithelial remodeling was associated with the recurrence of IPs. LEVEL OF EVIDENCE: NA.

Epidemiological characterization and risk factors of allergic rhinitis in the general population in Guangzhou City in china.

The prevalence of allergic rhinitis (AR) in China has increased with an apparent geographic variation. The current study aims to investigate the AR prevalence/classification, diagnosis/treatment conditions, trigger factors, and risk factors in the general population of Guangzhou, the third biggest city in China. A cross-sectional survey was performed in the citizens in Guangzhou from December 2009 to March 2010 by using a stratified multistage cluster sampling method. All subjects were asked to complete a comprehensive questionnaire via a face to face interview. A total of 9,899 questionnaires were valid. The prevalence rate of AR in the general population of Guangzhou was 6.24%, with a significant higher prevalence in urban area (8.32%) versus rural area (3.43%). Among the AR subjects, most (87%) were diagnosed with intermittent AR and 87% suffered from moderate-severe symptoms. High percentages of the AR patients did not have previously physician-based diagnosis (34%) or specific medical treatment (55%). Morning time, winter season, and cold air were the most common trigger factors of AR. Family history of AR, current living place, living place during babyhood, smoking, home renovation, and pet ownership were the significant risk factors associated with AR prevalence in the population. The study demonstrated comprehensive epidemiological and clinical information about the AR in Guangzhou population. Change of living environment and lifestyles had strong impacts on the prevalence of AR. Public health policies should help the patients benefit from a proper diagnosis/treatment and specifically target the local risk factors, in order to control the AR incidence.

In vivo and in vitro studies of Th17 response to specific immunotherapy in house dust mite-induced allergic rhinitis patients.

UNLABELLED: T helper (Th)17 cells have been implicated in the development of allergic rhinitis (AR), but their response to specific immunotherapy (SIT) remains unclear. We investigated the impact of SIT on Th17 response and Th1/Th2 changes in AR patients. Blood samples from AR patients (n = 20) who were monosensitized to house dust mite (HDM) were collected before the initiation of SIT (SIT-untreated) and after the end of 2-year SIT (SIT-treated) treatment. Twenty healthy volunteers were recruited as controls. In vitro HDM stimulation in peripheral blood mononuclear cells (PBMCs) was also performed. Expression levels of Th17 associated genes were determined in both PBMCs and plasma by PCR and ELISA, while Th17/Th1/Th2/IL10 producing cell proportions were evaluated in PBMCs by flow cytometry. The SIT effect was evaluated by assessing clinical symptoms. mRNA levels of Th17 specific genes (IL17 and RORC) were increased in SIT-untreated AR versus controls, and decreased following SIT treatment. SIT can change the production of Th17 associated genes (reduction of IL17, IL6, and IL23, but increase of IL27) in plasma from AR patients. Th2/Th1 ratio and proportions of Th17 cells were suppressed while IL10 producing CD4+ T cells were elevated after SIT. In vitro HDM challenge presents concordant patterns with in vivo findings: 1) increase of Th2 and Th17 response in AR patients; 2) suppression of IL10 producing CD4+ T cells in SIT-untreated AR but elevation in SIT-treated AR patients. Most importantly, a positive correlation between IL17 mRNA/protein levels and clinical symptom scores was observed. SIT significantly inhibits Th17 mediated inflammation in AR and IL17 may be a useful biomarker for both AR severity and SIT therapeutic effect. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000445774.

Down-regulation of EMP1 is associated with epithelial hyperplasia and metaplasia in nasal polyps.

AIMS: The aim of this study was to assess protein and mRNA expression of epithelial membrane protein 1 (EMP1) in the nasal mucosa of patients with nasal polyps (NP), and to determine what changes occur in response to glucocorticosteroid (GC) treatment. METHODS AND RESULTS: NP tissue was obtained from 55 patients, 18 of whom were treated with nasal GCs (i.e. these 18 patients had NP biopsies taken before and after treatment). Biopsies of inferior turbinate mucosa from 30 healthy subjects were used as controls. Quantitative PCR and immunohistochemistry were performed to determine the expression levels of EMP1. EMP1 mRNA expression was significantly lower (2.77-fold) in tissues from NP patients before GC treatment when compared to controls, but was increased in these patients after GC treatment. EMP1 staining in nasal epithelium co-localized with both basal (p63(+)) and differentiated (CK18(+)) epithelial cells. Their immunoreactivity was significantly greater in controls than NP patients. EMP1 mRNA levels were lower in the epithelium with severe hyperplasia (1.79-fold) or with metaplasia (1.85-fold) as compared to those with mild to moderate hyperplasia or non-metaplastic epithelium, respectively. Positive correlations between EMP1 and other epithelial cell-related gene (e.g. JUN, PTGS2, AREG etc.) mRNAs were observed. CONCLUSIONS: EMP1 could be a biomarker for aberrant epithelial remodelling and metaplasia in chronic inflammatory upper airway mucosa (e.g. NP).

Long-term efficacy of specific immunotherapy on house dust mite-induced allergic rhinitis in China.

OBJECTIVE: Although the effect of specific immunotherapy (SIT) on allergic rhinitis (AR) has been well documented in developed countries, its long-term efficacy in patients in developing countries (such as China) is poorly understood. This study investigated the long-term therapeutic and preventive effects of SIT on house dust mite (HDM)-induced AR in patients from China. DESIGN: Historical cohort study. SETTING: University hospital. SUBJECTS AND METHODS: One hundred forty-six AR patients with/without asthma allergic to HDM were investigated for 5 years after initiation of a 3-year course of subcutaneous SIT (SIT group, n = 106) or no SIT (control group, n = 40). The clinical responses of all patients were evaluated at baseline, the stop point of SIT (third year), and 2 years after SIT termination (fifth year), by clinical index including symptom and rescue medication scores (SMS), visual analog scale (VAS), total immunoglobulin E (tIgE), and specific IgE (sIgE). Asthma was assessed by clinical evaluation. RESULTS: The decrease of SMS and VAS from baseline was significantly improved in the SIT group compared with controls at both the third and fifth year. For patients without asthma at baseline, the odds ratio for no asthma was 3.57 (95% confidence interval, 1.05-12.91; P < .05) in favor of SIT. The serum sIgE/tIgE ratio was significantly increased after SIT treatment in the SIT group, but it was not related to SIT efficacy. CONCLUSION: SIT has a long-term effect of improving clinical symptoms and reducing the risk of development of asthma in Chinese AR patients.

[Relationship between allergic symptoms and RORC2 and IL-17 in patients with allergic rhinitis].

OBJECTIVE: To evaluate the relationship between allergic symptoms and retinoic acid-related orphan receptor variant 2 (RORC2) and interleukin (IL) 17 in patients with allergic rhinitis (AR). METHODS: Blood sample, nasal secretion and nasal mucosa were taken from 23 patients with AR and 16 health individuals. The expression of RORC2 and IL-17 were detected by immunohistochemistry and quantitative real-time fluorescence reverse polymerase chain reaction. The allergic symptoms in patients were graded. RESULTS: The rate of positive cells of RORC2 and IL-17 in AR group were 0.17 ± 0.05 and 0.72 ± 0.13, higher than the 0.05 ± 0.02 and 0.27 ± 0.11 of health controls, the difference was statistically significant (t were 9.51 and 11.92 respectively, all P < 0.05). The expression level of RORC2 mRNA in nasal mucosa and peripheral blood of AR group were 0.063 ± 0.011 and 0.452 ± 0.031, higher than the 0.029 ± 0.009 and 0.239 ± 0.027 of health controls, the difference was statistically significant (t were 6.51 and 3.35 respectively, all P < 0.05). The concentrations of IL-17 in the nasal mucosa, nasal secretions and serum levels of AR group were (70.28 ± 10.69), (45.32 ± 8.55) and (6.76 ± 1.18) pg/ml, compared with (18.43 ± 8.34), (6.83 ± 1.31) and (0.74 ± 0.05) pg/ml of controls, the difference was statistically significant (t were 7.92, 17.66 and 15.43 respectively, all P < 0.05). The allergy symptom scores of AR group were 9.43 ± 1.27. There were correlations between the allergic symptom and the expression of RORC2 mRNA and IL-17 in nasal mucosa and peripheral blood (r value were 0.820, 0.746, 0.629, 0.841 respectively, all P < 0.05). CONCLUSION: RORC2 and IL-17 involved in the inflammatory response of AR and can be used as an indicator to judge the severity.

Role of p63/p73 in epithelial remodeling and their response to steroid treatment in nasal polyposis.

BACKGROUND: Nasal polyposis (NP) is recognized as aberrant epithelial remodeling, but the molecular mechanism underlying this process is poorly understood. Two important p53 homologues (p63 and p73) play a key role in orchestrating the epithelial development. OBJECTIVE: We intended to study whether p63 and p73 are involved in the epithelial remodeling seen in patients with NP and their response to oral glucocorticosteroid (GC) treatment. METHODS: Nasal polyp tissues were obtained from 65 patients, and inferior turbinates were obtained from 19 control subjects without NP. Among patients with NP, 20 were treated with oral prednisone, so that 2 sets of polyp biopsy specimens were taken before (GC naive) and after (GC treated) treatment. Immunohistochemistry and quantitative PCR were performed to determine the expression levels of p63 and p73. RESULTS: The increase in p63-positive cell numbers was significant in GC-naive NP epithelium (46%) compared with that seen in control epithelium (5%), and it was positively related to the epithelial hyperplasia in patients with NP. The increase in N-terminal transactivation domain p73-positive cell numbers was found in 27% of GC-naive patients with NP and 16% of control subjects, with no statistical difference. The mRNA expression of both p63 and p73 was significantly upregulated in GC-naive patients with NP versus control subjects, and a positive correlation between the p63 and p73 mRNAs was found in all nasal tissues. Furthermore, the improvement of epithelial structure and reduction of p63 mRNA/protein levels were found in patients with NP after GC treatment. CONCLUSIONS: Our results suggest that the ectopic expression of p63 in multiple cell layers is an important pathologic phenomenon in the epithelial remodeling seen in chronically inflamed airway epithelium (eg, in patients with NP), and its aberrant expression can be suppressed with GC treatment.

[Efficacy of sublingual immunotherapy with dermatophagoides farinae drops in patients with allergic rhinitis].

OBJECTIVE: To evaluate the efficacy of sublingual immunotherapy (SLIT) with dermatophagoides farinae drops in patients with allergic rhinitis (AR). METHODS: Two hundred and six patients with AR aged from 4 to 60 years were included in this study. Among them, 123 patients completed more than one year treatment, the number of patients completed one year, one year and a half, two years were 61, 41, 21 cases. Rhinitis symptom scores and medication scores of the three groups before and after treatment were compared. And rhinitis symptom scores and medication scores of patients with one year drug withdrawal after one and two years treatment were aslo compared. RESULTS: After SLIT one year, one year and a half, two years treatment, the symptoms in these patients were significantly improved compared with before. The symptom scores (x±s) were reduced from 6.00±2.27, 7.39±1.99 and 6.29±2.14 to 2.95±1.82, 3.28±2.58, 2.48±1.99. The differences were statistically significant (t value was 8.19, 10.29, and 5.97, all P<0.01). The proportion of patients without drug treatment of the three group were 68.9%, 73.2% and 80.9%, there was statistical significance before and after treatment in every group (value was 50.391, 43.619, 27.776, all P<0.01). Symptom improvement of sneezing, runny nose, nasal congestion, nasal itching were similar after one year, one year and a half, two years SLIT treatment, the differences were not statistically significant (F values were 1.200, 1.276 and 2.333, all P>0.05). The proportion of patients without drug treatment in the group which stopped medication one year after two year SLIT (76.2%) was higher than group stopped medication one year after one year SLIT (61.3%). There was no statistical significance (χ2=1.263, P>0.05). CONCLUSION: The dust mite drops can relieve symptoms after one year treatment, but the proposed two years treatment is important for the consolidation of improved symptoms, especially for the effect of reducing the use of symptomatic medication.

[Effects of garlicin on the expression of transcription factor T-bet and GATA-3 in blood lymph cells in rats with allergic rhinitis].

OBJECTIVE: To investigate the effects of garlicin on the expression of transcription factors T-bet and GATA-3 in blood lymph cells of experimental rats with allergic rhinitis. METHODS: Thirty healthy SD rats were randomly divided into 3 groups, with 10 rats for each. Ten rats (pharmacological group) were sensitized and intranasally challenged by ovalbumin (OVA), aluminium hydroxide hydrate gel and Bordetella pertussis (B. pertussis) inactive microorganism suspension adjuvants, as the allergic rhinitis models, and then injection of garlicin (0.4 ml) intraperitoneally per day for 10 days. Ten rats in the control group were immunized as the pharmacological group, and then injection of physiological saline as equal volume as garlicin. Ten rats in the negative control group were investigated using physiological saline only. Plasma and lymph cells were separated from 2 ml blood which was extracted from rat heart. Enzyme linked immunosorbent assay (ELISA) was utilized to detect the levels of plasma IL-4 and IFN-γ, and RT-PCR was utilized to detect the expression of T-bet and GATA-3. RESULTS: The levels of IL-4 (x(-) ± s) were (6.292 ± 1.734), (14.252 ± 1.971), (4.916 ± 0.600) pg/ml, respectively, and the levels of IFN-γ were (24.338 ± 2.375), (12.364 ± 1.749), (16.136 ± 2.012) pg/ml, respectively, among the pharmacological, control and negative control groups. The plasma level of IL-4 in the pharmacological group rats was lower than that of control group rats (t = 4.23, P < 0.05), while there was no significant difference between the pharmacological and negative control group rats (t = 1.01, P > 0.05). The plasma level of IFN-γ was increased significantly in the pharmacological group rats when compared with the value of control group rats (t = 4.61, P < 0.05) and with the negative control group (t = 5.79, P < 0.05), respectively. There was no significant difference (t = 1.17, P > 0.05) in plasma level of IFN-γ in the control group rats when compared with the negative control group. Relative quantization of expression of GATA-3 (median) was 0.826, 1.029 and 0.474, and those of T-bet (median) were 1.245, 0.280 and 0.544, respectively, among the pharmacological, control and negative control groups. There were significant difference among 3 groups (chi² = 6.599, P = 0.019; chi² = 9.884, P = 0.007, respectively). Relative quantization of expression of GATA-3 in the control group rats was significantly higher than that in the negative control group and pharmacological group rats (chi² value were 10.113 and 2.384, respectively, all P < 0.05), and that of GATA-3 in the pharmacological group rats was increased as compared to the negative control group rats (chi² = 3.784, P < 0.05). The level of expression of T-bet in pharmacological group rats was elevated markedly with a significant difference as compared to both control (chi² = 16.021, P < 0.05) and negative control groups (chi² = 14.103, P < 0.05). CONCLUSIONS: Garlicin may upregulate the expression of T-bet dramatically and downregulate the expression of transcription factor GATA-3 in the experimental models of allergic rhinitis.

Endoscopic nasopharyngectomy for locally recurrent nasopharyngeal carcinoma.

OBJECTIVES: Nasopharyngectomy is the primary treatment for locally recurrent nasopharyngeal carcinoma (rNPC). However, oncological nasopharyngectomy is difficult to achieve, even using extranasal surgical approaches, with potential risks of severe functional disabilities and serious complications. This report introduces an innovative, minimally invasive, oncological, endoscopic nasopharyngectomy. METHODS: Between October 2004 and January 2008, 37 rNPC patients received endoscopic nasopharyngectomy, with 17, 4, 14, and 2 cases of rT1N0M0, rT2aN0M0, rT2bN0M0, and rT3N0M0, respectively. Tumors in all patients were confined to the nasopharyngeal cavity, postnaris, nasal septum, superficial parapharyngeal space, or the base of the sphenoid sinus. Nasopharyngeal malignancies and adequate surgical margin (>0.5-1.0 cm) were required for continuous en bloc resection. RESULTS: Among the 37 endoscopic nasopharyngectomies, 35 achieved en bloc tumor resection with negative surgical margins. In the remaining two cases, the tumors were dissected into small blocks, and one had positive surgical margins. No patient received postoperative radiotherapy and no severe complication was observed. During the 6-45 months of follow-up (median, 24 months), five patients experienced in situ residual or recurrence with 1 submaxillary lymphatic metastasis. One patient developed distant metastases and died, one died of intracranial infection, and one died of another cancer. The 2-year overall survival rate, local relapse-free survival rate, and progression-free survival rate were 84.2%, 86.3%, and 82.6%, respectively. CONCLUSIONS: Appropriate endoscopic nasopharyngectomy is a minimally invasive, safe, and promising surgical modality for the en bloc excision of rNPCs with encouraging short-term outcome. Long-term patient follow-up is ongoing.

[Effect of garlicin on the serum levels of interleukin 4 and interferon gamma in allergic rhinitis model in rats].

OBJECTIVE: To investigate the effect of garlicin on the levels of interferon gamma (INF-gamma) and interleukin 4 (IL-4) in blood of allergic rhinitis rat model. METHODS: Thirty healthy female SD rats were randomly divided into 3 groups: control group, negative control group and experimental group, 10 rats for each group. Ten rats (experimental group) were sensitized and intranasally challenged by ovalbumin, aluminium hydroxide hydrate gel and Bordetella pertussis inactive microorganism suspension adjuvants, as allergic rhinitis models, and then injection of garlicin(0.4 ml) intraperitoneally per day for 10 days. Control group rats were immunized as experimental group, and then injection of physiological saline as equal volume as garlicin. Negative control group rats were investigated using physiological saline. Blood of intrajugular vein of rat was extracted for separated plasma Enzyme liked immunosorbent assay (ELISA) was utilized to detect the serum levels of IL-4 and IFN-gamma. RESULTS: The serum levels (x +/- s) of IL4 were (22.81 +/- 8.79) pg/L, (41.43 +/- 4.93) pg/L, (9.93 +/- 2.07) pg/L, and those of IFN-gamma were (22.32 +/- 11.20) pg/L, (11.35 +/- 2.45) pg/L and (21.69 +/- 5.93) pg/L, respectively, among experimental group, control group and negative control group. The serum level of IL-4 in experimental group rats was lower than value of control group rats (t = 3.22, P < 0.05), while higher than negative control group (t = 4.17, P < 0.05). The serum level of IFN-gamma was increased significantly in experimental group rats with significant difference when compared with value of control group rats (t = 3.84, P < 0.05), while no difference was shown between experimental group and negative control group (t = 1.47, P > 0.05). CONCLUSIONS: Garlicin could increase serum level of INF-gamma and decrease serum level of IL4 significantly in allergic rhinitis rat model. It played an important role on regulating serum levels of cytokines of Thl and Th2.

[Genetic epidemiologic study on nasal polyps].

OBJECTIVE: To investigate the genetic mode of nasal polyp and the effect of genetic factor on occurrence of the disease. METHODS: A genetic epidemiological case-control study including 280 pedigrees (120 nasal polyp cases and 160 controls) was conducted. The segregation ratio and the heritability of nasal polyp were respectively estimated by the Li-Mantel-Gart method and the Falconer method. RESULTS: The segregation ratio was 0.124 (95% CI 0.081-0.167), significantly lower than 0.25, which showed that nasal polyp did not possess the characteristics of monogenetic model. The prevalence rate of first-degree and second-degree relatives in cases were 8.571% and 3.086% respectively, which were significantly different (X2 = 24.851, P < 0.01) and were higher than that noticed 1.376% and 1.141% in controls (X2 = 33.547 and 14.274, all P < 0.01). The heritability of the first-degree and second-degree relatives of nasal polyp was 64.488% and 61.947%. Among the first-degree relatives of nasal polyp probands, the heritability of the adult group and the children group were respectively 60.735% and 74.598% (the difference was significant, X2 = 4.504, P < 0.05). The heritability of the first-occurred group was 62.839% and the recurred group was 74.304% (the difference was significant, X2 = 4.105, P < 0.05). CONCLUSIONS: This study indicated that the genetic model of nasal polyp belonged to polygenetic and the genetic factors played an important role in the occurrence of nasal polyp, especially for young or recurred patients.

[Pathologic changes of palatopharyngeal muscle in patients with obstructive sleep apnea hypopnea syndrome].

OBJECTIVE: To study the pathologic changes of the palatopharyngeal muscles in patients with obstructive sleep apnea hypopnea syndrome (OSAHS), the role of the above muscles in OSAHS pathogenesis was discussed. METHODS: Thirty OSAHS patients receiving uvulopalatopharyngoplasty selected, and ten normal subjects without snoring as the control group. The successive longitudinal sections of palatopharyngeal muscle were stained for observing Troponin-I's content. All specimens were examined with transmission electronmicroscopy (TEM) and light microscopy. RESULTS: Twenty nine of 30 specimens obtained from OSAHS patients evaluated with TEM showed pathologic changes of different degrees. While 2 among 10 specimens in control group showed mild myofibril edema or hypertrophy, no pathologic changes shown in other specimens. Immunohistochemistrial results of all specimens sections stained for observing Troponin-I antibody have shown that negative grey degree value is 146.30 +/- 10.72 in study group and 107.50 +/- 4.81 in control group respectively. There is significant difference between these two groups (P < 0.05). The negative grey degree value of study groupl and study group2 are 143.12 and 148.80 respectively , no statistical difference (P > 0.05). CONCLUSIONS: Palatopharyngeal myelofibrosis may affect pharyngeal dilator muscles function, this could be one mechanism of upper airway collapsibility.