Balloon Dilation Eustachian Tuboplasty Combined with Tympanotomy Tube Insertion for Treatment of Refractory Otitis Media with Effusion: A Randomized, Prospective, Controlled Trial Comparing Local Anesthesia Combined Sedation Versus General Anesthesia.

BACKGROUND Balloon dilation eustachian tuboplasty (BET) is used to treat eustachian dysfunction but its therapeutic effect and cost-effectiveness when combined with tympanotomy tube insertion (TBI) on refractory otitis media with effusion under local anesthesia with sedation compared to traditional general anesthesia are not well understood. MATERIAL AND METHODS Forty patients with refractory secretory otitis media who received BET+TBI were enrolled in this study and randomized into the local anesthesia with sedation group (n=20) and general anesthesia group (n=20). Tympanometry (TMM), 7-item eustachian tube dysfunction questionnaire (ETDQ-7) results, intraoperative anesthesia accidents, and operation costs were compared between the groups. RESULTS Patients in the local anesthesia with sedation group exhibited intraoperative awareness and pain. Differences in TMM, ETDQ-7 results, and postoperative VAS scores between the groups were comparable (P>0.05). Notably, operative time and treatment costs in the local anesthesia group were lower compared with general anesthesia group. CONCLUSIONS The treatment effects and safety of local anesthesia and general anesthesia under BET combined with TBI for treatment of refractory otitis media with effusion are comparable. However, further studies should aim at reducing pain and discomfort.

Single-cell resolution profiling of the immune microenvironment in primary and metastatic nasopharyngeal carcinoma.

BACKGROUND: Nasopharyngeal carcinoma (NPC) is an assertive malignancy with partially understood underlying mechanisms, urging further study into its diverse and dynamic tumor microenvironment (TME) to bolster diagnosis, treatment, and prognostic accuracy. AIMS: To track the evolutionary route of metastasis, here we perform a yielding scRNA-seq data from 24 primary carcinoma, 7 peripheral blood mononuclear cell (PBMC) nasopharyngeal carcinoma, and 7 metastatic carcinoma patients' sample. MATERIALS AND METHODS: Following high quality control and filtration, a total of 292,298 cells from these tumors were classified into 10 clusters: T cells, B cells, Macrophages/Monocytes, Natural Killer (NK) cells, Plasma cells, plasmacytoid Dendritic Cells, Migratory Dendritic Cells, Mast cells, Cancer-Associated Fibroblasts, and Epithelial cells. RESULTS: By comparing and analyzing the different functional capacities of cellular entities within primary and metastatic nasopharyngeal carcinoma, coupled with a detailed investigation into the heterogeneity and differential fate trajectories of T cells, B cells, and myeloid cells, as well as assessing the interactions of cell-cell communicative heterogeneity between these carcinogenic states, we established single-cell atlases for primary and metastatic tumors and identified a large number of potential therapeutic targets. CONCLUSION: This comprehensive analysis significantly advances our understanding of nasopharyngeal carcinoma (NPC) metastasis by detailing the evolutionary dynamics and the impact of the tumor microenvironment at a single-cell resolution, thereby laying a crucial foundation for future metastatic tumor research and providing new insights into immune heterogeneity, molecular interactions, and potential therapeutic strategies for NPC.

Integrated analysis of multiple metabolome and transcriptome revealed the accumulation of flavonoids and associated molecular regulation mechanisms in Rubus chingii Hu at different developmental stages.

The traditional Chinese herb Rubus chingii Hu (R. chingii) is widely used in clinical practice due to its beneficial effects. Flavonoids are the important class of pharmacological substances in R. chingii, however, the molecular mechanism underlying the differences in active flavonoid contents in R. chingii at different developmental stages remain poorly understood. In this experiment, we selected four developmental stages (GG, GY, YR, RR) of R. chingii as the research material. We studied the untargeted and targeted metabolic profiles of flavonoids in different periods of R. chingii, combining full-length and comparative transcriptome analyses. Functional analyses were conducted on genes implicated in flavonoid differences. GG and RR displayed relatively higher and lower contents of flavonols, flavones, flavanols, flavanones, and isoflavonoid, respectively. RNA-seq analyses showed structural genes such as RcPAL, RcC4H, Rc4CL, RcCHS, RcCHI, RcF3H, RcF3'H, and RcFLS in flavonoid biosynthesis pathway were upregulated in GG, which were essential for the accumulation flavanones, flavones, and flavonols (effective components). qRT-PCR analyses investigated that six structural genes RcCHI, RcF3H, 2 RcCHS, and 2 Rc4CL, two TFs RcMYB308 and RcMYB123 had a consistent expression pattern with which in transcriptome. Also, an interaction network showed that the RcMYB308 could positively regulate Ka3R, Qu, Qu3G, AS, Hy, Ti through RcF3H. Furthermore, Subcellular localization analysis revealed that RcMYB308 was localization to the nucleus. In tobacco, RcMYB308 was overexpressed, resulting in higher flavonoids, RcF3H, RcF3'H, RcCHI, and RcFLS. RcMYB308 upregulated RcF3H in dual-luciferase assays. These results provide new insights for further understanding the molecular mechanism regulating flavonol biosynthesis in R. chingii fruit, and also provide a potential MYB regulator for molecular breeding of R. chingii.

A Retrospective Analysis on the Effects and Complications of Endoscope-Assisted Transoral Approach and Lateral Cervical Approach in the Resection of Parapharyngeal Space Tumors.

Objective: To observe and compare the effects and complications of endoscope-assisted transoral approach and lateral cervical approach in the resection of parapharyngeal space (PSS) tumors. Methods: From January 2013 to September 2021, 69 patients with parapharyngeal space tumors in the Affiliated Hospital of Jiangnan University were divided into the control group (n = 37) and the observation group (n = 32) according to the mode of operation. The tumors in the parapharyngeal space were resected by the lateral cervical approach in the control group, and the tumors in the parapharyngeal space were removed by endoscopy-assisted transoral approach in the observation group. The general clinical data and operation conditions of the two groups, including operative blood loss, operation time, drainage volume and drainage time, hospital stay, perioperative pain degree, and tumor resection rate were collected and analyzed statistically. The patients were followed up for 6 months, and the complications of the two groups were recorded. Results: Compared with the control group, the operation time in the observation group was significantly shorter, and the amount of intraoperative bleeding in the observation group was significantly less than that in the control group, and the difference was statistically significant (P < 0.05). The postoperative drainage was less and the hospital stay in the observation group was shorter than that in the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in tumor resection rate between the two groups. The visual analog scale (VAS) score on the 1st and 3rd day after operation in the observation group was lower than that in the control group. After treatment, some patients in the two groups had complications such as nerve injury, dysphagia, difficulty in mouth opening, massive hemorrhage, and parotid fistula. The total incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant (P < 0.05). Conclusions: The effect of the endoscope-assisted transoral approach is similar to that of the lateral cervical approach in the resection of tumors in parapharyngeal space, but the endoscope-assisted transoral approach has shorter operation time, less intraoperative bleeding, and less postoperative drainage. The indwelling time and hospital stay of the drainage device were shorter than those of the patients with transcervical approach, and the perioperative stress response of patients with endoscope-assisted transoral approach is mild, which is beneficial to the physical and mental recovery of the patients.

Treatment and outcomes of endoscopic surgery and traditional open resection in sinonasal mucosal melanoma.

OBJECTIVE: The optimal surgical approach for sinonasal mucosal melanoma (SNM) remains under debate. We aimed to compare the therapeutic efficacy of traditional open resection and endoscopic surgery for patients with SNM treated at a single center. METHODS: Thirty-three patients diagnosed with SNM who underwent surgery between January 1995 and June 2014 at a single institution were retrospectively analyzed; 18 patients were treated using an open resection approach and 15 using an endoscopic resection approach for the primary tumor. The associations between open resection and endoscopic resection with treatment-related survival outcomes were assessed using the Kaplan-Meier method and log-rank test. RESULTS: The most common presenting symptoms were epistaxis and abstraction; the nasal cavity was the most common anatomic location. The open resection and endoscopic resection groups did not have significantly different demographic or tumor characteristics. Overall survival (p = .66) and disease-free survival (p = .73) were modest and did not differ significantly between the open resection and endoscopic resection groups. CONCLUSIONS: This retrospective study indicates that the endoscopic endonasal approach is an effective treatment for SNM in selected cases and, when performed by a skilled surgeon, can enable successful radical resection with a similar efficacy as traditional open resection.