The involvement of Sting in exacerbating acute lung injury in sepsis via the PARP-1/NLRP3 signaling pathway.

BACKGROUND: Interferon gene stimulator (Sting) is an indispensable adaptor protein that plays a crucial role in acute lung injury (ALI) induced by sepsis, and the PARP-1/NLRP3 signaling pathway may be an integral component of the inflammatory response mediated by Sting. However, the regulatory role of Sting in the PARP-1/NLRP3 pathway in ALI remains insufficiently elucidated. METHODS: Using lipopolysaccharide (LPS) to induce ALI in C57BL/6 mice and HUVEC cells, an in vivo and in vitro model was established. In vivo, Sting agonists and inhibitors were administered, while in vitro, Sting was knocked down using siRNA. ELISA was employed to quantify the levels of IL-1ß, IL-6, and TNF-α. TUNEL staining was conducted to assess cellular apoptosis, while co-immunoprecipitation was utilized to investigate the interaction between Sting and NLRP3. Expression levels of Sting, NLRP3, PARP-1, among others, were assessed via Western blotting and RT-qPCR. Lung HE staining and lung wet/dry ratio were evaluated in the in vivo mouse model. To validate the role of the PARP-1/NLRP3 signaling pathway, PARP-1 inhibitors were employed both in vivo and in vitro. RESULTS: In vitro experiments revealed that the Sting agonist group exacerbated LPS-induced pulmonary pathological damage, pulmonary edema, inflammatory response (increased levels of IL-6, TNF-α, and IL-1ß), and cellular injury, whereas the Sting inhibitor group significantly ameliorated the aforementioned injuries, with further improvement observed in the combination therapy of Sting inhibitor and PARP-1 inhibitor. Western blotting and RT-qPCR results demonstrated significant suppression of ICAM-1, VCAM-1, NLRP3, and PARP-1 expression in the Sting inhibitor group, with this reduction further enhanced in the Sting inhibitor + PARP-1 inhibitor treatment group, exhibiting opposite outcomes to the agonist. Furthermore, in vitro experiments using HUVEC cell lines validated these findings. CONCLUSIONS: Our study provides new insights into the roles of Sting and the PARP-1/NLRP3 signaling pathway in inflammatory responses, offering novel targets for the development of therapeutic interventions against inflammatory reactions.

High-Tc 1D Phase-Transition Semiconductor Photoluminescent Material with Broadband Emission.

One dimensional (1D) organic-inorganic halide hybrid perovskites have the advantages of excellent organic cation modifiability and diversity of inorganic framework structures, which cannot be ignored in the development of multi-functional phase-transition materials in photoelectric and photovoltaic devices. Here, we have successfully modified and synthesized an organic-inorganic hybrid perovskite photoelectric multifunctional phase-transition material: [C7 H13 ONCH2 F]⋅PbBr3 (1). The synergistic effect of the order double disorder transition of organic cations and the change of the degree of distortion of the inorganic framework leads to its high temperature reversible phase-transition point of Tc =374 K/346 K and its ultra-low loss high-quality dielectric switch response. Through in-depth research and calculation, compound 1 also has excellent semiconductor characteristics with a band gap of 3.06 eV and the photoluminescence characteristics of self-trapped exciton (STE) broadband emission. Undoubtedly, this modification strategy provides a new choice for the research field of organic-inorganic hybrid perovskite reversible phase-transition photoelectric multifunctional materials with rich coupling properties.

Zero-Dimensional Sn-Based Enantiomeric Phase-Transition Materials with High-Tc and Dielectric Switching.

The combination of chirality and phase-transition materials has broad application prospects. Therefore, based on the quasi-spherical theory and the thought strategy of introducing chirality, we have successfully synthesized a pair of chiral enantiomeric ligands (R/S)-triethyl-(2-hydroxypropyl)ammonium iodide, which can be combined with a tin hexachloride anion to obtain a pair of new organic-inorganic hybrid enantiomeric high-temperature plastic phase-transition materials: (R/S)-[CH3 CH(OH)CH2 N(CH2 CH3 )3 ]2 SnCl6 (1-R/1-S), which have a high temperature phase transition of Tc =384 K, crystallize in the P21 chiral space group at room temperature, and have obvious CD signals. In addition, compounds 1-R and 1-S have a good low-loss dielectric switch and broadband gap. This work is conducive to the research into chiral high-temperature reversible plastic phase-transition materials, and promotes the development of multi-functional phase-transition materials.

Large Spontaneous Polarization Ferroelectric Property, Switchable Second-Harmonic Generation Responses, and Magnetism in an Fe-Based Compound.

Since the switchable spontaneous polarization of ferroelectric materials endows it with many useful properties such as a large pyroelectric coefficient, switchable spontaneous polarization, and semiconductor, it has a wide range of application prospects, and the research of high-performance molecular ferroelectric materials has become a hot spot. We obtained a 0D organic-inorganic hybrid ferroelectric [(CH3)3NCH2CH2CH3]2FeCl4 (1) with well-defined ferroelectric domains and excellent domain inversion and exhibited a relatively large spontaneous polarization (Ps = 9 µC/m-2) and a Curie temperature (Tc) of 394 K. Furthermore, compound 1 belongs to the non-centrosymmetrical space group Cmc21 and has a strong second-harmonic generation signal. Interestingly, we also performed magnetic tests on 1, which confirmed that it is a magnetic material. This work provides clues for exploring the application of high-performance molecular ferroelectric materials in future multifunctional smart devices.

High-Tc Quadratic Nonlinear Optical and Dielectric Switchings in Fe-Based Plastic Crystalline Ferroelectric.

Plastic crystals, as a molecular material with multiple functions, have become a research hotspot in the exploration of new ferroelectric crystal compounds, especially due to their unique solid-solid phase transition properties. Based on this, we synthesized a new 0D organic-inorganic hybrid Fe-based plastic ferroelectric [(CH3)3NCH2CHCH2]FeCl4 (1), which has a high-temperature phase transition point of 393 K, obvious ferroelectric domains, and spontaneous polarization and has been tested by dielectric and piezoelectric power microscopy (PFM) and ultraviolet absorption (UV-vis). At room temperature, it crystallizes in the space group Cmc21 and has an obvious SHG switch. In addition, compound 1 also has an optical narrow band gap of 2.45 eV, indicating that compound 1 is a high-quality semiconductor material. This work advances the development of plastic ferroelectrics and provides an avenue for exploring the frequency-doubling response and optoelectronic properties of high-temperature plastic ferroelectrics.

New Technology: Compound Abnormal Muscle Response During Microvascular Decompression for Hemifacial Spasm.

OBJECTIVE: To discuss effect of intraoperative compound abnormal muscle response (AMR) in patients undergoing microvascular decompression (MVD) for hemifacial spasm (HFS). METHODS: Eighty-six HFS patients were underwent single or compound AMR monitoring during MVD. Single AMR recording was from the frontal muscle by stimulation of the marginal mandibular branch. Compound AMR recordings were obtained from the orbicularis oris and mentalis muscles by electrical stimulation of the temporal branch of the facial nerve, and from the frontal and orbicularis oculi muscles by stimulation of the marginal mandibular branch. Clinical outcome was compared with compound AMR results at the completion of MVD. RESULTS: Forty-two of 45 patients' AMR were recorded by compound AMR monitoring and 34 of 41 patients' AMR were recorded by single AMR monitoring during MVD. Hemifacial spasm resolved completely in 41 patients whose compound AMR was recorded and in 26 patients whose single AMR was recorded. Compound AMR gained a sensitivity of 96.3% and a specificity of 97.2%. Correspondingly, single AMR gained a sensitivity of 97.1% and a specificity of 86.3%. CONCLUSIONS: Our results suggest that compound AMR is more suitable than single AMR in MVD for HFS.

High-Temperature Phase Transition Containing Switchable Dielectric Behavior, Long Fluorescence Lifetime, and Distinct Photoluminescence Changes in a 2D Hybrid CuBr4 Perovskite.

A novel organic-inorganic hybrid perovskite crystal, [ClC6H4(CH2)2NH3]2CuBr4 (1), having experienced an invertible high-temperature phase transition near Tc (the Curie temperature Tc = 355 K), has been successfully synthesized. The phase-transition characteristics for compound 1 are thoroughly revealed by specific heat capacity (Cp), differential thermal analysis, and differential scanning calorimetry tests, possessing 16 K broad thermal hysteresis. Multiple-temperature powder X-ray diffraction analysis further proves the phase-transition behavior of compound 1. Moreover, compound 1 exhibits a significant steplike dielectric response near Tc, revealing that it can be deemed to be a promising dielectric switching material. The variable-temperature fluorescence experiments show distinct photoluminescence (PL) changes of compound 1. Further investigation and calculation disclose that the fluorescence lifetime of compound 1 can reach as long as 55.46 µs, indicating that it can be a potential PL material. All of these researches contribute a substitutable avenue in the design and construction of neoteric phase-transition compounds combining high Curie temperature and PL properties.

Microvascular Decompression Alone without Rhizotomy Is an Effective Way of Treating Glossopharyngeal Neuralgia: Clinical Analysis of 46 Cases.

BACKGROUND: Microvascular decompression (MVD) has been the right choice for glossopharyngeal neuralgia (GPN) patients. However, whether glossopharyngeal/vagal nerve root rhizotomy should be combined with MVD is still controversial. OBJECTIVE: To evaluate whether glossopharyngeal/vagal nerve root rhizotomy during MVD is necessary for the treatment of GPN. METHODS: We performed a retrospective study of 46 GPN patients who underwent MVD surgery alone in our hospital, and their patient demographics, clinical presentations, and intraoperative findings are shown. The immediate and long-term follow-up outcomes were investigated to show the treatment's efficiency and safety; the outcome was also compared with our previous study. The relevant literature was reviewed to show complications for GPN patients undergoing glossopharyngeal/vagal nerve root rhizotomy with MVD. RESULTS: The most common offending vessel was the posterior inferior cerebellar artery (60.9%). 100% of the patients were pain-free (score of I on the Barrow Neurological Institute pain intensity [BNI-P] scale) immediately after MVD surgery, while 1 patient relapsed with occasional pain 12 months after the operation (score of III on the BNI-P scale). Poor wound healing and hearing loss were found in 1 case each. No complications related to the glossopharyngeal nerve/vagal nerve were reported. Some surgical techniques, such as thorough exploration of the CN IX-X rootlets, full freeing from arachnoid adhesions, and usage of a moist gelatin sponge, can improve the success rate of the operation. CONCLUSIONS: MVD alone without rhizotomy is an effective and safe method for patients with GPN.

Surgical Treatment of Hemifacial Spasm Caused by the Compression of Internal Auditory Canal of Facial Nerve.

OBJECTIVE: To make out the way to distinguish the offending vessels compressed the internal auditory canal part of the facial nerve. METHODS: The hemifacial spasm patients were treated of microvascular decompression surgery with neurophysiologic monitoring. The patients were found that the internal auditory canal of the facial nerves was fully compressed, and the records of surgery monitoring were analyzed. RESULTS: All the patients were recorded the delay incubation period in electromyography monitoring, and all patients were hemifacial spasm free finally. CONCLUSION: Some hemifacial spasms were caused by internal auditory canal compression, so during the operation, the authors should explore the whole course of the facial nerve and compress the internal auditory canal part with the aid of neurophysiologic monitoring.

Utility of Brainstem Trigeminal Evoked Potentials in Patients With Primary Trigeminal Neuralgia Treated by Microvascular Decompression.

OBJECTIVE: To investigate the characteristics of brainstem trigeminal evoked potentials (BTEP) waveform in patients with and without trigeminal neuralgia (TN), and to discuss the utility of BTEP in patients with primary TN treated by microvascular decompression (MVD). METHODS: A retrospective review of 43 patients who underwent BTEP between January 2016 and June 2016, including 33 patients with TN who underwent MVD and 10 patients without TN. Brainstem trigeminal evoked potentials characteristics of TN and non-TN were summarized, in particular to compare the BTEP changes between pre- and post-MVD, and to discover the relationship between BTEP changes and surgical outcome. RESULTS: Brainstem trigeminal evoked potentials can be recorded in patients without trigeminal neuralgia. Abnormal BTEP could be recorded when different branches were stimulated. After decompression, the original W2, W3 disappeared and then replaced by a large wave in most patients, or original wave poorly differentiated improved in some patients, showed as shorter latency and (or) amplitude increased. Brainstem trigeminal evoked potentials waveform of healthy side in patients with trigeminal neuralgia was similar to the waveform of patients without TN. In 3 patients, after decompression the W2, W3 peaks increased, and the latency, duration, IPLD did not change significantly. Until discharge, 87.9% (29/33) of the patients presented complete absence of pain without medication (BNI I) and 93.9% (31/33) had good pain control without medication (BNI I-II). CONCLUSION: Brainstem trigeminal evoked potentials can reflect the conduction function of the trigeminal nerve to evaluate the functional level of the trigeminal nerve conduction pathway. The improvement and restoration of BTEP waveforms are closely related to the postoperative curative effect.

Delayed relief of hemifacial spasm after microvascular decompression: can it be avoided?

BACKGROUND: Although microvascular decompression (MVD) surgery has been widely accepted as an effective treatment for hemifacial spasm (HFS), delayed relief cases have been frequently reported. Therefore, the value of an immediate redo MVD should be discussed. METHODS: This study included 1,435 HFS patients who underwent MVD with intraoperative abnormal muscle response (AMR) monitoring from 2011 through 2013 at XinHua Hospital. These cases were analyzed retrospectively with emphasis on the postoperative outcomes and introaperative findings. RESULTS: After MVD, 1,384 HFS patients obtained relief immediately. The 51 unrelieved patients underwent AMR monitoring again the next day; this was positive in 48 and negative in 3 patients. These three patients with negative AMR obtained relief spontaneously within a week. Among the 48 positive patients, 31 and 11 were underwent redo MVD within a week and 5-22 months, respectively, and all achieved relief after the second operation. Of the six remainig patients, two obtained relief within 2 months and 4 remained unchanged in the up-to-3-year's follow-up period. In redo MVDs, insufficient decompression of the facial nerve accounted for the failure. Finally, in this database, the immediate postoperative cure rate was 96.4 %; with earlier redo MVD, the final cure rate could be increased to 99.9 %. CONCLUSIONS: Despite being a reasonable remedy for HFS in the hands of an experienced neurosurgeon, sometimes small vessels can be missed while managing the main offending arteries during MVDs, which might account for the delayed relief. Therefore, reexamination of the AMR is necessary for unimproved patients; if a positive result is recorded, an immediate redo MVD is suggested.

Management of vessels passing through the facial nerve in the treatment of hemifacial spasm.

BACKGROUND: In hemifacial spasm, it is extremely rare to find a vessel passing through the facial nerve. In this study, we present our experience of the surgical treatment of four such patients. METHODS: From January 2010 to Match 2015, we treated 2,576 hemifacial spasm patients with microvascular decompression in our department. Of these, four had an intraneural vessel. Intraoperative findings and treatment were recorded, and postoperative outcomes were analyzed. RESULTS: In three patients, the intraneural vessel was the anterior inferior cerebellar artery, which we wrapped with small pieces of wet gelatin and Teflon sponge. A small vein found in the fourth patient was treated with facial nerve combing. Complete decompression was achieved and abnormal muscle response disappeared. Three patients got an excellent result and one patient got a good result. One patient had postoperative facial paralysis, which improved over 10 months of follow-up. CONCLUSION: If an artery passes through the facial nerve, it can be decompressed by wrapping the vessel with wet gelatin and Teflon sponge. If a vein passes through the facial nerve, combing can be used. Intraoperative abnormal muscle response monitoring is very helpful in achieving complete decompression.

Microvascular Decompression for Trigeminal Neuralgia: Zone Exploration and Decompression Techniques.

OBJECTIVE: The aim of this study is to introduce zone exploration of the trigeminal nerve and decompression techniques for different types of vasculars. METHODS: The trigeminal nerve was sectioned into 5 zones. Zone 1, 2, 3, 4 was located at the rostral, caudal, ventral, and dorsal part of the nerve root entry zone (REZ) respectively, and zone 5 was located at the distal of the nerve root. This study contained 86 patients with trigeminal neuralgia underwent microvascular decompression. Every zone was exposed through preoperative imaging. During the operation, offending vessels were explored from zone 1 to zone 5, and different decompression techniques were used for different types of vessels. RESULTS: Through zone exploration, the sensitivity of preoperative imaging was 96.5% and specificity was 100%. Location of the neurovascular conflict was in the zone 1 in 53.5% of the patients, zone 2 in 32.6%, zone 3 in 45.3%, zone 4 in 29.1%, and zone 5 in 34.9%. In total, 2 zones were both involved in 59.3%, and 3 zones were involved in 18.6%. All offending arteries were moved away and interposed with Teflon sponge. Offending veins of 11 patients were too small to interpose, and coagulated and cut was adopted. The other offending veins were interposed with wet gelatin and Teflon sponge, respectively. CONCLUSIONS: Zone exploration is helpful in finding offending vessels and adequate decompression can be achieved by choosing different methods according to different types of offending vessels.

Emprical factors associated with Brainstem auditory evoked potential monitoring during microvascular decompression for hemifacial spasm and its correlation to hearing loss.

BACKGROUND: Cranial nerve VIII is at risk during microvascular decompression (MVD) for hemifacial spasm (HFS). The primary aim of this study is to evaluate the empirical factors associated with brainstem auditory evoked potential monitoring and its correlation to post operative hearing loss (HL) after MVD for HFS. METHODS: Pre-operative and post-operative audiogram data and BAEP from ninety-four patients who underwent MVD for HFS were analyzed. Pure tone audiometry (PTA) and Speech Discrimination Score (SDS) were performed on all patients before and after surgery. Intraoperative neurophysiological data were reviewed independently. HL was assessed using the AAO-HNS classification system for non-serviceable hearing loss (Class C/D), defined as PTA >50 dB and/or SDS <50% within the speech range of frequencies. RESULTS: Patients with HL had higher rates of loss in the amplitude of wave V and prolongation in the interpeak latency of peak I-V latency during MVD. Gender, age, side, and MVD duration did not increase the risk of HL. There was no correlation between successive number of BAEP changes (reflective of the number of surgical attempts) and HL. There was no association between the speed of recovery of BAEPs and HL. CONCLUSIONS: Patients with new post-operative HL have a faster rate of change in the amplitude of wave V and the interpeak I-V latency during intraoperative BAEP monitoring for HFS. Our alarm criteria to inform the surgeon about impending nerve injury might have to be modified and prospectively tested to prevent rapid change in BAEPs.

Combined intraoperative monitoring of abnormal muscle response and Z-L response for hemifacial spasm with tandem compression type.

BACKGROUND: Multiple neurovascular compression is present in about 38 % cases of hemifacial spasm (HFS). In these cases, the vertebral artery (VA) compresses another vessel, which in turn compresses the nerve. This type was named as "the tandem type". In the tandem type, the real offending vessel is often concealed by the VA. It is sometimes neglected by the surgeons. In this study, we report our experience in using abnormal muscle response (AMR) and ZL-Response (ZLR) simultaneously as intraoperative monitoring for MVD surgery of HFS with "the tandem type" vascular compression involving VA. METHODS: Fourteen "tandem type" patients treated with microvascular decompression surgery (MVD) surgery were included. ZLR and AMR were recorded simultaneously to identify the offending vessels in operation. RESULTS: After MVD surgery, 13 patients achieved excellent resolution of spasm. In one case, the patient failed to attain resolution in the first operation, underwent early reoperation and had good resolution. There were no operative deaths or serious operative complications. In all 14 cases, we found that VA compressed the anterior inferior cerebellar artery (AICA) or posterior inferior cerebellar artery (PICA), which in turn compressed the root exit zone (REZ). A typical ZLR was identified from the AICA or PICA but not from the VA. AMR was absent in one case and persisted in one case. After the VA was transposed, the typical AMR was unchanged, unstable or disappeared, and ZLR from the AICA/PICA also existed. AMR and ZLR did not disappear until AICA/PICA was sufficiently decompressed. CONCLUSIONS: The combination of AMR and ZLR provides more useful information than does the AMR alone, and ZLR may be the only useful intraoperative monitoring for MVD surgery in times when AMR is absent or persists. ZLR played a crucial role in finding the real offending vessel, which was often concealed by the VA in tandem type.

Down-Regulated JDP2 Attenuated Trophoblast Invasion and Migration in Preeclampsia by Inhibiting Epithelial-Mesenchymal Transition through the Wnt/ß-Catenin Pathway.

INTRODUCTION: Preeclampsia (PE) is an immensely prevalent condition that poses a significant risk to both maternal and fetal health. It is recognized as a primary cause of perinatal morbidity and mortality. Despite extensive research efforts, the precise impact of JDP2 on trophoblast invasion and migration in the context of preeclampsia remains unclear. MATERIALS AND METHODS: The present study aimed to investigate the differential expression of JDP2 between normal control and preeclampsia placentas through the use of quantitative polymerase chain reaction (qPCR), western blotting, and immunostaining techniques. Furthermore, the effects of JDP2 overexpression and silencing on the migration, invasion, and wound healing capabilities of HTR-8/SVneo cells were evaluated. In addition, this study also examined the impact of JDP2 on epithelial-mesenchymal transition (EMT)-associated biomarkers and the Wnt/ß-catenin pathway. RESULTS: In the present investigation, it was ascertained that Jun dimerization protein 2 (JDP2) exhibited a substantial decrease in expression levels in placentae afflicted with preeclampsia in comparison to those of normal placentae. Impairment in migration and invasion was noted upon JDP2 down-regulation, whereas augmentation of migration and invasion was observed upon JDP2 overexpression in HTR-8/SVneo cells. Subsequently, western blot and immunofluorescence assays were conducted, revealing marked alterations in EMT-associated biomarkers, such as E-cadherin, N-cadherin, and ß-catenin, thereby indicating that JDP2 can facilitate cell invasion by modulating the EMT process in HTR-8/SVneo cells. Finally, activation of Wnt/ß-catenin signaling was observed as a result of JDP2. After that, IWR-1, a Wnt inhibitor, was used in the recovery study. IWR-1 could inhibit the role of JDP2 in promoting migration and invasion in HTR-8/SVneo cells. CONCLUSION: Our findings elucidated the impact of JDP2 on trophoblast invasion and migration in preeclampsia by suppressing the EMT through the Wnt/ß-catenin signaling pathway, thereby offering a potential prognostic and therapeutic biomarker for this condition.

Bidirectional photomagnetism, exciplex fluorescence and dielectric anomalies in a spin crossover Hofmann-type coordination polymer.

Stepped spin crossover (SCO) complexes with three or more spin states have promising applications in high-order data storage, multi-switches and multi-sensors. Further synergy with other functionalities, such as luminescence and dielectric properties, will provide a good chance to develop novel multifunctional SCO materials. Here, a bent pillar ligand and luminescent pyrene guest are integrated into a three-dimensional (3D) Hofmann-type metal-organic framework (MOF) [Fe(dpoda){Au(CN)2}2]·pyrene (dpoda = 2,5-di-(pyridyl)-1,3,4-oxadiazole). The magnetic data show an incomplete and two-step SCO behavior with the sequence of 1 ↔ 1/2 ↔ 1/4. The rare bi-directional light-induced excited spin-state trapping (LIESST) effect and light-induced stepped thermal relaxation after LIESST are observed. The pyrene guests interact with dpoda ligands via offset face-to-face π⋯π interactions to form intermolecular exciplex emissions. The competition between thermal quenching and stepped SCO properties results in a complicated and stepped exciplex fluorescence. Moreover, the stepped dielectric property with higher dielectric permittivity at lower temperature may be related to the more frustrated octahedral distortion parameters in the intermediate spin states. Hence, a 3D Hofmann-type MOF with bent pillar ligands and fluorescent guests illustrates an effective way for the development of multifunctional switching materials.

Hypoxic Bone Mesenchymal Stem Cell-Derived Exosomes Direct Schwann Cells Proliferation, Migration, and Paracrine to Accelerate Facial Nerve Regeneration via circRNA_Nkd2/miR-214-3p/MED19 Axis.

Background: Facial nerves have the potential for regeneration following injury, but this process is often challenging and slow. Schwann cells (SCs) are pivotal in this process. Bone mesenchymal stem cells (BMSC)-derived exosomes promote tissue repair through paracrine action, with hypoxic preconditioning enhancing their effects. The main purpose of this study was to determine whether hypoxia-preconditioned BMSC-derived exosomes (Hypo-Exos) exhibit a greater therapeutic effect on facial nerve repair/regeneration and reveal the mechanism. Methods: CCK-8, EdU, Transwell, and ELISA assays were used to evaluate the functions of Hypo-Exos in SCs. Histological analysis and Vibrissae Movements (VMs) recovery were used to evaluate the therapeutic effects of Hypo-Exos in rat model. circRNA array was used to identify the significantly differentially expressed exosomal circRNAs between normoxia-preconditioned BMSC-derived exosomes (Nor-Exos) and Hypo-Exos. miRDB, TargetScan, double luciferase assay, qRT-PCR and WB were used to predict and identify potential exosomal cirRNA_Nkd2-complementary miRNAs and its target gene. The function of exosomal circRNA_Nkd2 in facial nerve repair/regeneration was evaluated by cell and animal experiments. Results: This study confirmed that Hypo-Exos more effectively promote SCs proliferation, migration, and paracrine function, accelerating facial nerve repair following facial nerve injury (FNI) compared with Nor-Exos. Furthermore, circRNA analysis identified significant enrichment of circRNA_Nkd2 in Hypo-Exos compared with Nor-Exos. Exosomal circRNA_Nkd2 positively regulates mediator complex subunit 19 (MED19) expression by sponging rno-miR-214-3p. Conclusion: Our results demonstrated a mechanism by which Hypo-Exos enhanced SCs proliferation, migration, and paracrine function and facial nerve repair and regeneration following FNI through the circRNA_Nkd2/miR-214-3p/Med19 axis. Hypoxic preconditioning is an effective and promising method for optimizing the therapeutic action of BMSC-derived exosomes in FNI.

Salvaging the transected hypoglossal nerve using descendens hypoglossi in patients undergoing hypoglossal-facial nerve anastomosis for facial palsy: a randomized clinical trial.

OBJECTIVE: Hypoglossal-facial nerve anastomosis (HFA) is the most commonly used surgical treatment for severe facial palsy that does not respond to conservative treatments. A major complication of HFA is the loss of tongue function. The authors aimed to evaluate whether anastomosing the transected hypoglossal nerve using the ramus descendens hypoglossi could prevent tongue deviation and dysfunction in patients undergoing HFA. METHODS: In this randomized trial, adult patients with severe peripheral facial palsy (House-Brackmann grade V or VI) who did not respond to at least 6 months of conservative treatment were randomized at a 1:1 ratio to undergo either HFA alone (control group) or HFA plus anastomosis between the hypoglossal nerve and descendens hypoglossi (intervention group). The primary endpoint was tongue deviation angle at 12 months. Key secondary endpoints included tongue disability (chewing difficulty, swallowing defect, and articulation defect), tongue disability index (TDI; range 1-4, with a higher score indicating more severe disability), and facial nerve function. RESULTS: Twenty patients were enrolled (10 in each group). At 12 months, the tongue deviation angle was significantly lower in the intervention group than in the control group (7.8° ± 5.1° vs 23.6° ± 9.6°, p < 0.001). Although not statistically significant, the intervention group had lower rates of chewing difficulty (1/10 vs 3/10, p = 0.58), swallowing defect (1/10 vs 5/10, p = 0.14), and articulation defect (2/10 vs 6/10, p = 0.17). TDI was significantly lower in the intervention group (1.5 ± 0.6 vs 2.5 ± 0.3, p < 0.001). The percentage of the patients achieving House-Brackmann grade II or III was 80% in each group. CONCLUSIONS: Anastomosis of the descendens hypoglossi to the transected hypoglossal nerve attenuated tongue deviation in patients undergoing HFA for facial palsy, without compromising facial nerve function. Clinical trial registration no: ChiCTR2000034372 (Chinese Clinical Trials Registry).

Surgical treatment of hemifacial spasm with zone-4 offending vessel.

BACKGROUND: Increasing evidence shows that vascular compression on any of the four zones of facial nerve may cause hemifacial spasms. Vascular compression on zone 4 (the cisternal portion) of the nerve is quite common, but only a very small percentage of such compression will elicit hemifacial spasm, because zone 4 is less susceptible than zone 3 (the root exit zone). Therefore, it seems difficult for the neurosurgeons to distinguish the real culprit vessels in zone 4. Here, our experience in treating vascular compression located in zone 4 of the facial nerve is reported. METHODS: Twelve patients of HFS due to compression of zone 4 were treated with microvascular decompression (MVD) surgery with the aid of combined monitoring of abnormal muscle response (AMR) and Z-L response (ZLR). RESULTS: All of the 12 patients had a zone 4 compression. In addition, there were vascular compressions on zone 3 (the root exit zone) and/or zone 2 (the attached segment) in six cases. AMR was absent in two cases, unstable in one case, and persisted after vascular decompression in another one case. ZLR was stable before decompression of zone 4 and disappeared after decompression in all cases. After MVD surgery, 11 patients were cured and one patient achieved good resolution of spasm. One patient had postoperative transient tinnitus. CONCLUSIONS: The neurosurgeon should not ignore vascular compression at zone 4, especially when compressions at zones 2 and 3 co-exist. With the aid of AMR and ZLR, we are able to judge whether offending vessels exist at zone 4.