[Clinical analysis of resection and dura skull base reconstruction of cranionasal communication tumor in 31 cases].

Objective:To explore the methods of resection, dura and skull base repair and reconstruction of cranionasal communication tumor. Methods:Data of 31 patients with cranionasal communication tumor who underwent dura and skull base reconstruction after tumor resection from 2018 to 2022 were collected. Follow-up lasted for 3 to 41 months. Results:A total of 31 patients were enrolled, including 20 males and 11 females. The ages ranged from 19 to 74 years, with a median age of 57 years old. There were 17 benign lesions（one case of hemangioma, one case of Rathke cyst, one case of squamous papilloma, one case of craniopharyngioma, two cases of meningocele, two cases of varus papilloma, two cases of meningioma of grade Ⅰ, three cases of schwannoma, four cases of pituitary tumor） and 14 malignant lesions（one case of osteosarcoma, one case of poorly differentiated carcinoma, two cases of varus papilloma malignancy, two cases of olfactory neuroblastoma, two cases of adenocarcinoma, two cases of adenoid cystic carcinoma, four cases of squamous cell carcinoma） . Sixteen cases underwent nasal endoscopy combined with craniofacial incision and 15 cases underwent nasal endoscopy surgery alone. Complete resection of the mass and dura and skull base reconstruction were performed in all 31 patients, and free graft repair was performed in 8 cases（fascia lata in 5 cases and nasal mucosa in 3 cases）. Twenty-three cases were repaired with pedicled flaps（septal mucosal flap alone in 11 cases, septal mucosal flap combined with free graft in 6 cases, and cap aponeurosis combined with free graft in 6 cases）. Eight out of 31 patients underwent skull base bone repair. Postoperative cerebral hemorrhage occurred in 1 case, cerebrospinal fluid leakage in 1 case, intracranial infection in 2 cases. All patients were successfully treated without severe sequelae. Cerebrospinal fluid leakage and intracranial infection occurred in one patient after radiotherapy, who recovered after conservative treatment. All 17 patients with benign lesions survived. Thirteen out of 14 patients with malignant lesions received radiotherapy after surgery, nine survived without recurrence, five cases recurred, of which 2 survived with tumor, one underwent reoperation and 2 died. Conclusion:Cranionasal communication tumors are high-risk diseases of anterior and middle skull base, and various surgical repair methods could be selected after complete resection of the tumor. Successful reconstruction and multidisciplinary cooperation are crucial for treatment outcome.

DJ-1 Protects auditory cells from cisplatin-induced ototoxicity via regulating apoptosis and autophagy.

AIMS: DJ-1, a multifunctional protein encoded by the Park7 gene, is tightly related to mitochondrial dysfunction, oxidative stress, protein aggregation, and autophagy regulation. The current study was designed to investigate whether DJ-1 is expressed in auditory cells and, if so, to explore the possible correlation between DJ-1 and cisplatin-induced ototoxicity in this type of cells. METHODS: The location and dynamic expression of DJ-1 in mouse cochlea hair cells (HCs) and House Ear Institute-Organ of Corti 1 (HEI-OC1 cells) were detected by immunofluorescence, real-time PCR, and western blot. The apoptosis of auditory cells was assessed by TUNEL staining and flow cytometry. The levels of ROS were evaluated by MitoSox red staining. The expression of protein cleaved caspase-9, cleaved caspase-3, and LC3B was examined by immunofluorescence and western blot. The expressions of certain key factors relevant to apoptosis (Bcl-2 and Bax) and autophagy (Beclin1, p-JNK, and p-c-Jun) were determined by western blot. The dynamic alterations of those factors in response to DJ-1 knockdown in HEI-OC1 cells (DJ-1-KD) were measured by western blot and MitoSox red staining. RESULTS: The expression of DJ-1 was clearly shown in both HCs and HEI-OC1 cells and cisplatin led to the reduction of DJ-1 expression in a concentration and time-dependent manner. Meanwhile, cisplatin-induced apoptotic process was implemented by promoting reactive oxygen species (ROS) production and activating the mitochondrial pathway. Furthermore, DJ-1 explicitly participated in cisplatin-trigged cell damage by regulating autophagy. CONCLUSIONS: Findings from this work clearly reveal, for the first time, that DJ-1 is expressed in the cochlea. Of particular importance, DJ-1 exerts its protective action against cisplatin-elicited injury on auditory cells via regulating apoptosis and autophagy, which provides a new strategy for the prevention of cisplatin-induced ototoxicity.

Characteristics and prognosis of idiopathic sudden sensorineural hearing loss in aged people: a retrospective study.

Background: Few studies focused on the prognosis of sudden sensorineural hearing loss (ISSHL) of aged people. Objectives: The aim of this study is to analyze the characteristics, treatment, and prognostic factors of ISSHL in aged people. Material and methods: A total of 278 patients diagnosed of ISSHL in aged people from 2014 to 2019 were retrospectively analyzed. Univariates were analyzed by univariate and multivariate logistic analysis. Results: Among the 13 univariates, the patients' age was younger in the overall recovery group ORG (p = .018), while onset days was shorter in ORG (p = .000). The percentage of DM and HTN comorbidities were higher in ORG (p = .026 and .038). Meanwhile differences were significant in audiogram configurations (p = .037), the degree of hearing loss (p = .033), and types of lipid treatment (p = .020). Then these seven independent risk factors were included in the multivariate analysis, final results indicated that hypertension (p = .028), lipid control groups (p = .009), age (p = .000), and onset days (p = .001) were related to the treatment outcome of ISSHL. Conclusions: The prognosis of ISSHL in aged patients was closely related to age, the onset days of treatment, and good control of complications such as hypertension and hyperlipidemia, so vascular factors were considered as the main causes of morbidity.

Anti-inflammatory effect of curcumin on mast cell-mediated allergic responses in ovalbumin-induced allergic rhinitis mouse.

Curcumin has commonly been used for the treatment of various allergic diseases. However, its precise anti-allergic rhinitis effect and mechanism remain unknown. In the present study, the effect of curcumin on allergic responses in ovalbumin (OVA)-induced allergic rhinitis mouse was investigated. We explored the effect of curcumin on the release of allergic inflammatory mediators, such as histamine, OVA-specific IgE, and inflammatory cytokines. Also, we found that curcumin improved rhinitis symptoms, inhibited the histopathological changes of nasal mucosa, and decreased the serum levels of histamine, OVA-specific IgE and TNF-α in OVA-induced allergic rhinitis mice. In addition, curcumin suppressed the production of inflammatory cytokines, such as TNF-α, IL-1ß, IL-6 and IL-8. Moreover, curcumin significantly inhibited PMA-induced p-ERK, p-p38, p-JNK, p-Iκ-Bα and NF-κB. These findings suggest that curcumin has an anti-allergic effect through modulating mast cell-mediated allergic responses in allergic rhinitis, at least partly by inhibiting MAPK/NF-κB pathway.

Cytokine Responses to Specific Immunotherapy in House Dust Mite-Induced Allergic Rhinitis Patients.

Allergen-specific immunotherapy is the only immunomodulatory treatment that may alter the natural course of allergic disease. However, cytokine responses accompanying sublingual immunotherapy (SLIT) responder phenotypes have not been fully understood. Herein, we examined the level of crucial plasma cytokines during SLIT and evaluated whether their changes correlated to symptom scores. We observed that the levels of interleukin (IL)-17 and complement components C3a and C5a as well as IL-4 at year 3 of SLIT were significantly decreased than those at baseline. In contrast, there was no significant difference in the levels of IL-5, IL-13, and interferon (IFN)-γ. Notably, a significant positive correlation was found between the levels of IL-17 and the symptom scores at year 3. These results suggest that IL-17 could be considered a potential biomarker for the therapeutic effect of SLIT in allergic rhinitis caused by house dust mite.

[Clinical effect of orbit fracture reconstruction under nasal endoscope].

OBJECTIVE: To investigate the clinical effect of orbit blowout fracture reconstruction under nasal endoscope. METHODS: Forty-one cases of orbit fracture were reconstructed for lost or damaged orbit under nasal endoscope through maxillary sinus, ethmoidal sinus or the both. RESULTS: Among the 35 cases of orbit blowout fracture, enophthalmos in 33 cases were completely improved, 29 cases were symmetrical to normal eye after operation without diplopia except that 6 cases had slight enophthalmos accompanied with slight diplopia. Among these 6 cases, 4 cases returned to normal without diplopia 6 months after operation. In the 6 cases of orbit non-blowout fracture, 4 cases were symmetrical to normal eye after operation without enophthalmos, diplopia and facial malformation. One case had slight enophthalmos and diplopia, 1 case had slight enophthalmos with slight facial malformation. CONCLUSIONS: The surgery under nasal endoscope is safe and credible. The method can be easily mastered and its complication is less.

[Analysis of the clinical and pathological characteristics of sinonasal neoplasms].

OBJECTIVE: To investigate the clinical and pathological characteristics of sinonasal neoplasms. METHOD: A cohort of 333 patients with sinonasal neoplasm, which were confirmed by surgical pathology, were enrolled in this study. The clinicopathological characteristics, in terms of age, sex, location, and disease constituent ratio were retrospectively reviewed. RESULT: (1) In this series of patients, there were 200 males and 133 females, aged from 2 to 84 years, with a median of 54 years. The benign to malignant ratio was 1.1:1. As for their origination, 144 tumors arose from the nasal cavity, while, 191 tumors derived from sinus, including 90 from maxillary sinus, 31 from frontal sinus, 46 from ethmoid sinus, and 24 from sphenoidal sinus. (2) Disease constituent ratio decreased in order of epithelial tissue, soft tissue, lymphohematopoietic tissue, bone and cartilaginous tissue, ectopic intracranial tumors. The five most frequent malignant tumors were squamous carcinoma, lymphoma, adenoid cystic carcinoma, malignant melanoma and esthesioneuroblastoma, while, benign tumors ranked in the top five were papilloma, fibroma, osteoma, angioma and ectopic intracranial tumors,respectively. (3) Of 200 cases arising from epithelium, 118 were benign, 82 were malignant, and the benign to malignant ratio was 1.4:1. Of 68 cases from soft tissue, 37 were benign and 31 were malignant tumors (ratio, 1.2:1). Among the 22 cases from bone and cartilaginous tissue, 17 were benign and 5 were malignant (ratio, 3.4:1). With respect to the 29 cases from lymphohematopoietic tissue, the majority of tumors were malignant (28 cases), with only one benign case. In addition, ectopic intracranial tumors were also observed. Besides the above all, 12 cases of other types were found in this work. CONCLUSION: Neoplasms from different parts of nasal cavity and paranasal sinus have specific clinical characteristics. The pathological types of these tumors may be highly diverged. The diagnosis and differential diagnosis depend mainly on pathological examination. Comprehensive treatment, which employs surgery in combination with other modalities, is the main strategy for these tumors.

[Resection of tumors involving the cranio-naso-orbital area via fronto-orbito-ethmoidal approach].

OBJECTIVE: To introduce a better surgical approach for the resection of tumors involving the anterior and middle skull base and the fronto-orbito-ethmoidal area. METHODS: A "T" form incision was made in the fronto-orbito-ethmoidal region and along the nasal pyramid down. Parts of ethmoid sinus, lamina papyracea, fronto-orbito bone and behind wall of frontal sinus were resected in order to expose the tumors in the anterior skull base and the fronto-orbito-ethmoidal region. Then, the tumor was resected partly under the operation microscope, protecting the neighbouring important structures, for instance: optic nerve, internal carotid artery, sella, meninx, etc. The nasal pyramid was repaired and fixed to the frontal bone with titanium board and titanium nail in order to resume the appearance of a good face. RESULTS: Thirteen patients received tumour resection through this approach. The patients were followed-up for 24 months, 11 patients showed no tumour recurrence, no severe complication, such as cerebrospinal rhinorrhea, meningoencephlocele, etc, in this series. The facial appearance was good. CONCLUSIONS: The approach via the fronto-orbito-ethmoidal region is a good surgical procedure to resect the tumors involving the anterior and middle skull base and the fronto-orbito-ethmoidal area.

[Observation of the effect of BCG-SPN in FESS perioperative period].

OBJECTIVE: To observe the therapeutic effect of BCG-SPN and corticosteroid in endoscopic perioperative period of chronic rhinitis (CH) and nasal polyps (NP) combined with allergic rhinitis (AR) or asthma, and to inquire their immune mechanism and find new therapeutic approach. METHOD: Ninety-six patients diagnosed of CH and NP combined with AR or asthma were randomly divided into 3 groups. Group 1 was given 1ml of BCG-SPN intramuscular injection once every two days;group 2 was used corticosteroid nasal spray once a day; group III was given those two kinds of preparations as above, all for 5 weeks. The morphologic transformation of nasal mucosa was observed under endoscope within 6 months. RESULT: The rates of efficiency were as follow: group 1 70.97%, 2 73.33%, 3 90.63%. Statistically, the difference between group 1 and 2 was insignificant; while, the difference between group 3 and each of above was significant. CONCLUSION: BCG-SPN and corticosteroid nasal spray were both effective in nasal mucosa transformation in FESS postoperation for patients with allergic CH and NP; moreover, combined usages were better. The mechanism may be that the balance of Th1 and Th2 cell subgroup was modulated by different ways, so as to prevent allergic effect. Combined therapy provides new approach to deal with these kinds of patients.