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.

The effects of cognitive bias modification for attention and interpretation on the postoperative psychological resilience and quality of life of patients with pituitary adenoma: a randomized trial.

BACKGROUND: Negative emotions such as anxiety and depression may have a bearing on patients' psychological resilience and quality of life (QoL) following surgery. Cognitive bias modification (CBM) for attention and interpretation has been confirmed to alleviate anxiety and depression. However, the psychological effects of CBM attention and interpretation on Chinese patients with pituitary adenoma have hardly received research attention. METHODS: This prospective interventional study enrolled 100 patients undergoing surgical treatment for pituitary adenoma. Participants were divided into an experimental group and a control group, with 50 cases in each group. Baseline characteristics of included patients were collected. Patients in the control group were given routine training, and those in experimental group received routine training plus CBM attention and interpretation training. The Connor-Davidson Resilience Scale (CD-RISC) was used to assess patients' psychological resilience. The patients' levels of anxiety and depression were assessed using the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). QoL was assessed based on the European Organization for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30). RESULTS: No statistical difference was found between the 2 groups in CD-RISC, SAS, SDS, or QoL score at baseline (P>0.05). After CBM training, psychological resilience and QoL in the experimental group improved, and the levels of anxiety and depression decreased (P<0.05). Furthermore, the experimental group showed statistically superior psychological resilience and QoL than the control group. The levels of anxiety and depression in the experimental group were statistically lower than those in the control group (P<0.05). CONCLUSIONS: CBM for attention and interpretation effectively improves the psychological resilience of patients and reduces the symptoms of anxiety and depression, thus improving patients' postoperative QoL. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2100045899.

Prognostic Biomarker ZNF311 and Its Correlation With Tumor Progression and Immune Infiltrates in Glioma.

BACKGROUND: Gliomas, particularly high-grade gliomas, are the most common primary brain tumors. From the Chinese Glioma Genome Atlas (CGGA) database, the relationships between the altered molecular pathways and gliomas could be easily observed. A close connection in the occurrence of the pathogenesis exists between the microenvironment, the glioma, and the associated genes. METHODS: Validation of the role of ZNF311 oncogene was confirmed by data from the CGGA dataset on glioblastoma and low-grade glioma. Furthermore, we used CIBERSORT to analyze the correlation between ZNF311 and cancer immune infiltrates. RESULTS: According to our analysis, ZNF311 was expressed higher in patients with grade-depended glioma with poor prognosis. In addition, we obtained valuable prognostic results between isocitrate dehydrogenase 1 (IDH1) and ZNF311 through the analysis of integrated correlations. Similarly, we simultaneously revealed the prognostic results between 1p/19q and ZNF311. In addition, we found that ZNF311 is correlated with a large number of tumor-infiltrating immune cells. CONCLUSIONS: Based on the study findings, we conclude that ZNF311 is potentially a novel biomarker for assessing prognosis and immune infiltration in glioblastoma and diffuse glioma cases.

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.

The Differential Expression and Possible Function of Long Noncoding RNAs in Liver Cells Infected by Dengue Virus.

The function of long noncoding RNAs (lncRNAs) in liver injury resulted by dengue virus (DENV) infection have not yet been explored. The differential expression profiles of lncRNAs (as well as mRNAs) in the L-02 liver cells infected by DENV1, DENV2, or uninfected were compared and analyzed after a high throughput RNA seq. The significantly up-regulated and down-regulated lncRNAs (or mRNAs) resulted by DENV infection were identified with a cutoff value at log2 (ratio) ≥ 1.5 and log2 (ratio) ≤ -1.5 (ratio = the reads of the lncRNAs or mRNAs from the infection groups divided by the reads from the control group). Several differentially expressed lncRNAs were verified with reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR). Target gene analysis, pre-miRNA prediction, and the lncRNA-mRNA co-expression network construction were performed to predict the function of the differentially expressed lncRNAs. The differentially expressed lncRNAs were associated with biosynthesis, DNA/RNA related processes, inhibition of estrogen signaling pathway, sterol biosynthetic process, protein dimerization activity, vesicular fraction in DENV1 infection group; and with protein secretion, methyltransferase process, host cell cytoskeleton reorganization and the small GTPase Ras superfamily, inhibition of cell proliferation, induction of apoptosis in DENV2 infection. LncRNAs might be novel diagnostic markers and targets for further researches on dengue infection and liver injury resulted by dengue virus.

Characterization of Cytosine Methylation and the DNA Methyltransferases of Toxoplasma gondii.

DNA methylation is a key epigenetic modification which confers phenotypic plasticity and adaptation. Cyst-forming strains of Toxoplasma gondii undergo tachyzoite to bradyzoite conversion after initial acute infection of a host, and the reverse conversion may occur in immune-suppressed hosts. The formation of m5C is catalyzed by DNA methyltransferase (DNMT). We identified two functional DNA methyltransferases, TgDNMTa and TgDNMTb, in T. gondii that may mediate DNA methylation. The recombinant proteins showed intrinsic methyltransferase activity; both have higher transcription levels in bradyzoites than that in tachyzoites. We performed genome-wide analysis of DNA methylation in tachyzoites and bradyzoites. The results showed more methylation sites in bradyzoites than that in tachyzoites. The most significantly enriched GO-terms of genes with DNA methylation were associated with basal cellular processes such as energy metabolism and parasite resistance to host immunity. Tachyzoite proliferation in parasitophorous vacuoles (PV) can be inhibited by the DNA methyltransferase inhibitor 5-azacytidine, a chemical analogue of the nucleotide cytosine that can inactivate DNA methyltransferases. These findings provide the first confirmation of DNA methylation in T. gondii.

Evaluation of aminotransferase abnormality in dengue patients: A meta analysis.

Dengue virus is a type of flavivirus transmitted by Aedes mosquitoes. The symptoms of infection by this virus range from asymptomatic or mild symptomatic dengue fever (DF) to dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). Significant abnormality in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) has been shown in a large number of dengue infection cases and to be indicator for liver injury provided that there are no other combined infections or liver injury. This study aims to assess the abnormal levels of liver aminotransferase in dengue patients. The related literature was searched in multiple databases, including PubMed, Embase, Google Scholar and Cochrane Library. The literature was selected through strict inclusion and exclusion criteria, and the quantitative synthesis of the liver aminotransferase abnormality was performed with R software. The fixed or random effects model was employed based on the results of the statistical test for homogeneity. In total, 15 studies were included. The proportion of AST abnormality with 95% confidence interval (95% CI) was 0.80 (95% CI: 0.56-0.92) in DHF patients and 0.75 (95% CI: 0.63-0.84) in DF patients; the proportion of ALT abnormality was 0.54 (95% CI: 0.34-0.73) in DHF patients and 0.52 (95% CI: 0.41-0.63) in DF patients. Serum ALT and AST levels may be indicators for evaluating liver injury in dengue infection and for diagnosis and treatment effect.

[Secretion and Distribution of Rhoptry Protein 16 during Toxoplasma gondii Invasion into Host Cells].

Objective: To examine the secretion and localization of Toxoplasma gondii Rhoptry protein 16 （ROP16） during invasion of different strains of T. gondii into host cells. Methods: The Tgrop16 gene was amplified by PCR on the cDNA of T. gondii RH strain, subcloned into the plasmid pET-32a（+）, and expressed in Escherichia coli BL21（DE3） under the induction of isopropyl ß-D-1-thiogalactopyranoside. New Zealand rabbit was immuned with the expressed recombinant protein TgROP16 to produce polyclonal anti-TgROP16 antibody. The specificity and sensitivity of the polyclonal antibody were examined by Western blotting and indirect ELISA, respectively. The transcriptional and protein levels of Tgrop16 in T. gondii RH strain and Pru strain were determined by real-time PCR and Western blotting, respectively. The secretion and distribution of TgROP16 in human foreskin fibroblasts (HFFs) during the invasion by T. gondii RH strain and Pru strain were examined by indirect immunofluorescence assay (IFA). Results: Western blotting showed a specific band at M(r) of ～100 000, indicating that the specific rabbit-derived anti-TgROP16 polyclonal antibody was capable of recognizing TgROP16. Indirect ELISA revealed a titer of 1:25 600 for the antibody. The relative expression level of Tgrop16 in Pru strain［（7.786±0.206）］ was 7 times than that in RH strain［（1.000±0.110）］（P<0.05） as detected by real-time PCR, and TgROP16 protein level was higher in RH strain than in Pru strain. IFA showed that TgROP16 was localized on the apical complex of the unrecruited tachyzoite of T. gondii before invasion and was secreted out of the recruited tachyzoite after invasion. Conclusion: The anti-TgROP16 polyclonal antibody has high specificity and sensitivity. The TgROP16 protein level is higher in the RH strain than in the Pru strain. For both strains, TgROP16 is localized on the apical complex of the unrecruited tachyzoite before invasion and secreted out of the recruited tachyzoite during invasion.

Association between Liver Fluke Infection and Hepatobiliary Pathological Changes: A Systematic Review and Meta-Analysis.

OBJECTIVE: To provide information about the role of liver fluke infection as a risk factor for hepatobiliary pathological changes and promote awareness among the people living in endemic areas, a systematic review and meta-analysis based on published studies was conducted to examine the association between liver fluke infection and hepatobiliary pathological changes. METHODS: Relevant original literature was searched in multiple literature databases, including PubMed, Cochrane, Clinical Evidence, Trip Database, Clinical Trials, Current Controlled Trials, Web of Science, the China National Knowledge Infrastructure (CNKI) database, and the Wanfang academic journal full-text database. Studies were selected based on strict screening with inclusion and exclusion criteria. Tests of heterogeneity, sensitivity and publication bias were performed with the Review Manager software, version 5.3, and meta-regression analyses were performed with the Stata software, version 11.0 (Stata Corporation, College Station, TX, USA). Pooled risk ratios (RRs) and odds ratios (ORs) with their 95% confidence intervals (95% CIs) were calculated and used to evaluate the risk of hepatobiliary pathological changes resulting from liver fluke infection. Linear trend analyses were conducted to determine the dose-response relationship using IBM SPSS Statistics 20.0. RESULT: A total of 36 studies were included in the meta-analysis. Significant associations were found between liver fluke infection and cholangitis or cholecystitis (RR: 7.80, P<0.001; OR: 15.98, P<0.001), cholelithiasis (RR: 2.42, P = 0.03; OR: 4.96, P = 0.03), hepatocellular carcinoma (OR: 4.69, P<0.001) and cholangiocarcinoma (RR: 10.43, P<0.001; OR: 4.37, P<0.001). In addition, heavier infection was significantly associated with higher incidence of hepatobiliary pathological changes (P<0.05). However, cirrhosis was not significantly associated with liver fluke infection (RR: 3.50, P = 0.06; OR: 5.79, P = 0.08). The statistical heterogeneity was significant, no significant difference was observed in the sensitivity analysis, and no publication bias was found. CONCLUSION: The meta-analysis found that liver fluke infection was significantly associated with cholangitis, cholecystitis, cholelithiasis, hepatocellular carcinoma and cholangiocarcinoma and that more severe infection was associated with higher incidence. However, the association between liver fluke infection and cirrhosis was not significant.

[Numerical simulation and heat transfer in sand therapy in Uyghur medicine].

OBJECTIVE: To investigate the mechanism of heat transfer process in sand therapy in Uyghur medicine. METHODS: A mathematical model was developed to describe the heat transfer process between human body and the sand during sand therapy. Temperature field was numerically simulated and analyzed based on this model. RESULTS: Temperature field in both human tissues and sand was calculated. The surface temperature of the sand and skin surface changed significantly at the beginning of the sand therapy, while sand temperature (5 cm deep) almost kept constant. The skin temperature dramatically increased at the beginning of the sand therapy and then slightly dropped. When sand was deeper than 10 cm, the thickness of sand would not influence the temperature field in human tissues during sand therapy. High initial temperature of sand might cause harmful skin burn. Threshold skin burn occurred if initial temperature of sand was higher than 64.6 degree C and if the therapy lasted more than 30 minutes. CONCLUSION: Temperature fieled in human tissues varies significantly with the initial temperature of sand, thickness of sand, and duration of therapy.

[Analysis of heat transfer in skin tissues subjected to hot water].

OBJECTIVE: To analyze heat transfer process in skin tissues subjected to hot water and thus to predict the extent of scald. METHOD: Basing on Pennes' Bio-heat Equation, a model for characterizing the damage process in tissues was presented and used for its analysis. RESULT: Temperature distribution in the tissues during the process and the time of beginning of scald were numerically obtained. It was found that the effects of different initial temperature distribution, convection coefficients between the hot water and the tissue surfaces, and the temperature of the hot water are significant. CONCLUSION: The transient heat transfer behavior in multi-layer tissues subjected to hot water can be predicted by the present model. It is useful in the clinical diagnosis and therapy for the scald caused by hot water.