Surgical treatment of nasopharyngeal cancer - a consensus recommendation from two Chinese associations.

BACKGROUND: Surgical treatment is playing an increasingly important role in the management of nasopharyngeal carcinoma (NPC). This consensus focuses on the indications for optimal surgery, and surgical methods in the whole process of treatment for NPC to provide a useful reference to assist these difficult clinical decisions. METHODOLOGY: A thorough review of available literature on NPC and surgery was conducted by the Association for the prevention and treatment of nasopharyngeal carcinoma in China, international exchange and promotion Association for medicine and healthcare, and the Committee on nasopharyngeal cancer of Guangdong provincial anticancer association. A set of questions and a preliminary draft guideline was circulated to a panel of 1096 experienced specialists on this disease for voting on controversial areas and comments. A refined second proposal, based on a summary of the initial voting and different opinions expressed, was recirculated to the experts in two authoritative medical science and technology academic groups in the prevention and treatment of NPC in China for review and reconsideration. RESULTS: The initial round of questions showed variations in clinical practice even among similar specialists, reflecting the lack of high-quality supporting data and resulting difficulties in formulating clinical decisions. Through exchange of comments and iterative revisions, recommendations with high-to-moderate agreement were formulated on general treatment strategies and details of surgery, including indications and surgical approaches. CONCLUSION: By standardizing the surgical indications and practice, we hope not only to improve the surgical outcomes, but also to highlight the key directions of future clinical research in the surgical management of NPC.

[Incidence and prognosis of olfactory and gustatory dysfunctions related to infection of SARS-CoV-2 Omicron strain: a national multi-center survey of 35 566 population].

Objective: This cross-sectional investigation aimed to determine the incidence, clinical characteristics, prognosis, and related risk factors of olfactory and gustatory dysfunctions related to infection with the SARS-CoV-2 Omicron strain in mainland China. Methods: Data of patients with SARS-CoV-2 from December 28, 2022, to February 21, 2023, were collected through online and offline questionnaires from 45 tertiary hospitals and one center for disease control and prevention in mainland China. The questionnaire included demographic information, previous health history, smoking and alcohol drinking, SARS-CoV-2 vaccination, olfactory and gustatory function before and after infection, other symptoms after infection, as well as the duration and improvement of olfactory and gustatory dysfunction. The self-reported olfactory and gustatory functions of patients were evaluated using the Olfactory VAS scale and Gustatory VAS scale. Results: A total of 35 566 valid questionnaires were obtained, revealing a high incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain (67.75%). Females(χ2=367.013, P<0.001) and young people(χ2=120.210, P<0.001) were more likely to develop these dysfunctions. Gender(OR=1.564, 95%CI: 1.487-1.645), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), oral health status (OR=0.881, 95%CI: 0.839-0.926), smoking history (OR=1.152, 95%CI=1.080-1.229), and drinking history (OR=0.854, 95%CI: 0.785-0.928) were correlated with the occurrence of olfactory and taste dysfunctions related to SARS-CoV-2(above P<0.001). 44.62% (4 391/9 840) of the patients who had not recovered their sense of smell and taste also suffered from nasal congestion, runny nose, and 32.62% (3 210/9 840) suffered from dry mouth and sore throat. The improvement of olfactory and taste functions was correlated with the persistence of accompanying symptoms(χ2=10.873, P=0.001). The average score of olfactory and taste VAS scale was 8.41 and 8.51 respectively before SARS-CoV-2 infection, but decreased to3.69 and 4.29 respectively after SARS-CoV-2 infection, and recovered to 5.83and 6.55 respectively at the time of the survey. The median duration of olfactory and gustatory dysfunctions was 15 days and 12 days, respectively, with 0.5% (121/24 096) of patients experiencing these dysfunctions for more than 28 days. The overall self-reported improvement rate of smell and taste dysfunctions was 59.16% (14 256/24 096). Gender(OR=0.893, 95%CI: 0.839-0.951), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), history of head and facial trauma(OR=1.180, 95%CI: 1.036-1.344, P=0.013), nose (OR=1.104, 95%CI: 1.042-1.171, P=0.001) and oral (OR=1.162, 95%CI: 1.096-1.233) health status, smoking history(OR=0.765, 95%CI: 0.709-0.825), and the persistence of accompanying symptoms (OR=0.359, 95%CI: 0.332-0.388) were correlated with the recovery of olfactory and taste dysfunctions related to SARS-CoV-2 (above P<0.001 except for the indicated values). Conclusion: The incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain is high in mainland China, with females and young people more likely to develop these dysfunctions. Active and effective intervention measures may be required for cases that persist for a long time. The recovery of olfactory and taste functions is influenced by several factors, including gender, SARS-CoV-2 vaccination status, history of head and facial trauma, nasal and oral health status, smoking history, and persistence of accompanying symptoms.

[Analysis of relationship between distribution of pathogenic microorganisms in olfactory cleft and olfactory disorders among patients with upper respiratory inflammation during the prevention and control of COVID-19].

Objective: To explore the relationship between pathogens in the olfactory cleft area and olfactory disorders in patients with upper respiratory inflammation (URI) during the prevention and control of 2019 novel coronavirus disease (COVID-19). Methods: A total of 234 URI patients including acute upper respiratory infection, chronic rhinosinusitis (CRS), allergic rhinitis (AR) were continuously selected from September 2020 to March 2021 in Beijing Anzhen Hospital and 98 healthy adults were enrolled as controls. The secretions from the olfactory cleft of all subjects were collected with nasal swabs under nasal endoscopy. Multiple real-time fluorescent quantitative polymerase chain reaction detection method was used to detect nucleic acids of 33 types of respiratory pathogenic microorganism. Sniffin' Sticks olfactory test was performed on all patients with URI. URI patients with olfactory dysfunction were followed up for 9 (8, 10) months (M (Q1, Q3)). SPSS 20.0 software was used for statistical analysis. Results: Among the 98 controls, 9 (9.18%) were positive for pathogenic microorganisms, including 1 (1.02%) rhinovirus, 1 (1.02%) parainfluenza virus type 3, 3 (3.06%) enterovirus, 1 (1.02%) staphylococcus aureus and 3 (3.06%) Moraxella catarrhalis. Among the 234 URI patients, 111 (47.44%) had olfactory disorders and 123 (52.56%) had normal sense of smell. In the olfactory disorder group (111 cases), 38 cases (34.23%) were positive for pathogenic microorganisms, and 4 cases (3.60%) were mixed infection, including 11 cases of rhinovirus (9.91%), 5 cases of coronavirus 229E (4.50%), 2 cases of coronavirus OC43/NL63 (1.80%), 3 cases of parainfluenza virus type 1 (2.70%), 2 cases of enterovirus (1.80%), 1 case of influenza B virus type BV (0.90%), 11 cases of Staphylococcus aureus (9.91%), 7 cases of Moraxella catarrhalis (6.31%), and 1 case of Klebsiella pneumoniae (0.90%). In the normal smell group (123 cases), 18 cases (14.63%) were positive for pathogenic microorganisms, and 1 case (0.81%) was mixed infection, including 3 cases of rhinovirus (2.44%), 4 cases of coronavirus 229E (3.25%), 1 case of Influenza virus type 3 (0.81%), 3 cases of enterovirus (2.44%), 3 cases of Staphylococcus aureus (2.44%), 4 cases of Moraxella catarrhalis (3.25%), and 1 case of Klebsiella pneumoniae (0.81%). Univariate analysis between the two groups found that there were significant differences in the detection rate of pathogenic microorganisms, rhinovirus and Staphylococcus aureus between the groups (all P<0.05). The detection rate of parainfluenza virus type 1, Staphylococcus aureus, and rhinovirus were different between the patients with olfactory disorder and normal olfactory function in the three subgroups of acute upper respiratory tract infection, CRS and AR, respectively (χ2 value was 3.88, 4.53 and 4.73, respectively, all P<0.05). During the follow-up period, among the 111 patients with olfactory disorder, 71 (63.96%) patients' olfactory function returned to normal, 32 (28.83%) patients' olfactory function improved but not completely returned to normal, 8 (7.21%) patients' olfactory function did not improve. Conclusions: During the prevention and control of COVID-19, rhinovirus or Staphylococcus aureus infection or colonization of URI patients is closely related to olfactory disorders. Parainfluenza virus type 1 infection can cause relatively persistent olfactory disorders in patients with acute upper respiratory tract infection. Staphylococcus aureus and rhinovirus colonization are related to the occurrence of olfactory dysfunction in CRS and AR patients respectively.

Hsa_circ_0124055 and hsa_circ_0101622 regulate proliferation and apoptosis in thyroid cancer and serve as prognostic and diagnostic indicators.

OBJECTIVE: Recent studies have corroborated that circular RNAs (circRNAs) as endogenous noncoding RNAs gain research interest in carcinogenesis, functioning as prognostic and diagnostic biomarkers and therapeutic targets. The present study is aimed to determine whether circRNAs could serve as prognostic and diagnostic biomarkers to predict thyroid carcinoma. MATERIALS AND METHODS: High-throughput sequencing analysis was conducted to detect circRNAs expression profile in thyroid cancer. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) measurement was utilized to validate circRNAs expression in blood and tissue specimens. Kaplan-Meier method and receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were used to assess whether circRNAs could function as prognostic and diagnostic biomarkers of thyroid cancer, respectively. RESULTS: Hsa_circ_0124055 and hsa_circ_0101622 as the most conspicuous biomarkers were significantly increased in tumor tissues and plasma of thyroid cancer patients. High hsa_circ_0124055 or hsa_circ_0101622 expression exhibited shorter overall survival. Our findings also provided strong evidence that plasma hsa_circ_0124055 (AUC = 0.836, 95% CI: 0.763-0.908, p<0.001) and hsa_circ_0101622 (AUC = 0.805, 95% CI: 0.727-0.883, p<0.001) could be used as diagnostic markers for thyroid cancer, and hsa_circ_0124055 combined with hsa_circ_0101622 could provide a more powerful diagnostic value (AUC = 0.911, 95% CI: 0.859-0.962, p<0.001) than the use of hsa_circ_0124055 or hsa_circ_0101622 alone. Furthermore, the knockdown of hsa_circ_0124055 or hsa_circ_0101622 exhibited a significant anti-proliferative and pro-apoptotic activity of thyroid cancer cells in vivo and in vitro. CONCLUSIONS: Both hsa_circ_0124055 and hsa_circ_0101622 could facilitate the prognosis and diagnosis of thyroid cancer, and function as the therapeutic targets for clinical practice.

[Analysis of factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps].

Objective: To analyze the factors affecting olfactory disfunctions in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: This was a retrospective analysis. Eighty-eight patients with CRSwNP who underwent endoscopic sinus surgery in Beijing Anzhen Hospital from 2014 to 2018 were enrolled, including 22 males and 66 females, with the age of (48.1±11.3) years old(Mean±SD). Sniffin' Sticks olfactory test, Lund-Mackay score and modified sinus CT olfactory cleft score, nasal resistance and acoustic reflex examination, blood routine and blood biochemistry test, serum specific IgE test were performed before surgery and nasal polyps of all patients were collected for eosinophil count during surgery. According to bilateral total TDI score, the patients were divided into normal olfactory function group and olfactory disfunction group. The clinical baseline data were compared between the two groups. According to the results of single factor analysis, factors which were significant different between the two groups and clinically useful indicators were further included in the multivariate Logistic regression model analysis, then a model predicting olfactory disfunction in patients with CRSwNP was initially established. P<0.05 was considered statistically significant. Results: Among 88 patients with CRSwNP, 32 (36.4%) patients were with normal olfaction and 56 (63.6%) patients were with olfactory disfunction, including 40 (45.5%) of hyposmia and 16 (18.2%) of anosmia. Tissue eosinophil count, blood eosinophil percentage and blood urea concentration had significant difference between the two groups (12.7[2.0, 52.3]/HP (M[P(25), P(75)]) vs 38.6[16.2, 87.0]/HP, 2.75[1.60, 4.80]% vs 4.35[2.50, 6.60]%, (5.56±1.15) mmol/L vs (4.98±1.33) mmol/L, all P<0.05). Modified sinus CT olfactory cleft score and Lund-Mackay score except for ostiomeatal complex score were statistically significant between the two groups (all P<0.05). Multivariate Logistic regression analysis showed that the bilateral and total olfactory cleft score and blood urea concentration were statistically significant, in addition, the bilateral and total olfactory cleft score was a risk factor (OR=2.108, 95%CI: 1.407-3.159, P<0.001) and blood urea within a certain concentration was a protective factor (OR=0.461, 95%CI: 0.240-0.884, P=0.020). Further studies found that the area under the ROC curve of the model with tissue eosinophil count, blood eosinophil percentage, bilateral and total olfactory cleft score, total inspiratory volume and blood urea concentration was 0.888 (P<0.01), which had good predictive value for olfactory disorders in CRSwNP. Conclusions: The modified sinus CT olfactory cleft score is closely related to the olfactory disorders in patients with CRSwNP. A certain degree of elevated blood urea concentration may have a protective effect on the olfactory function of patients with CRSwNP.

[Targeted-knockdown of Yes-associated protein inhibits the Warburg effect and the invasion of laryngeal cancer cells].

Objective: To investigate the migration and invasion behaviors of Hep-2 after the targeted knockdown of yes-associated protein (YAP). Methods: Hep-2 cells were knock-downed for YAP by shRNA as YAP-shRNA group, Hep-2 treated with non-specific shRNA as YAP-NC group, and Hep-2 with no treatment as control. Glucose uptake and lactate production in the cells were examined to assess Warburg effect. The migration and invasion behaviors of cells in three groups were observed. The expressions of vimentin and E-cadherin were detected by RT-PCR and Western Blot. The statistical software GraphPad Prism 7.0 was used to analyze significance of data. Two tailed Student' s t-tests was used to determine significance when only two groups were compared. P values of less than 0.05 was considered statistically significant. Results: Downregulation of YAP led to a obvious decrease in glucose uptake [(18.51±1.72)%] and lactate production [103.40±8.32] in Hep-2 cells compared with control [(41.20±1.11)% and 743.69±19.49, t=19.20 and 52.33, respectively, both P<0.01] and YAP-NC group [(39.60±0.78)% and 705.22±17.20, t=19.34 and 54.56, respectively, both P<0.01]. Compared with the control group (78.32±4.04) and YAP-NC group (77.28±3.11), the scratch healing ability of Hep-2 cells was significantly decreased in YAP-shRNA group (44.71±4.68). The P value was less than 0.01 (t=9.42 and 10.04). The number of cells with YAP-shRNA (33.30±4.19) passing through compartments was remarkable fewer than the control group (133.71±6.72) and YAP-NC group (126.32±4.21). The P value was less than 0.01 (t=21.96 and 27.13). The expression of E-cadherin protein in cells of YAP-shRNA group (6.16±0.11) was up-regulated compared with control (0.97±0.10, t=35.70, P<0.01) and YAP-NC group (1.13±0.09, t=36.28, P<0.01), while the expression of vimentin protein in cells of YAP-shRNA group (1.08±0.09) was down-regulated compared with control (5.67±0.12, t=29.91, P<0.01) and YAP-NC group (5.51±0.12, t=29.04, P<0.01). Conclusions: The down-regulation of YAP in Hep-2 inhibits the migration and invasion of cells via suppressing Warburg and EMT program.

[Evaluation of nasal cavity ventilation expansion techniques on obstructive sleep apnea hypopnea syndrome with nasal obstruction].

Objective: To investigate the effect of nasal cavity ventilation expansion techniques in treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) with nasal obstruction. Methods: Thirty-two OSAHS patients with nasal obstruction hospitalized from January 2017 to January 2018 in Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital Affiliated to Anhui Medical University were selected, with 28 males and 4 females, aged 40.3±8.5 years old (x±s), and treated with individualized nasal cavity ventilation expansion techniques. Nasal acoustic reflex and resistance examination, polysomnography (PSG) monitoring were performed before and three months after operation. Nasal obstruction symptom evaluation (NOSE) and Quebec sleep questionnaire (QSQ) were completed as well. The nasal acoustic reflex, nasal resistance, NOSE, QSQ score, apnea hypopnea index (AHI) and lowest arterial oxygen saturation (LSaO(2)) before and after operation were compared and analyzed. SPSS 22.0 software was used for statistical analysis. Results: After the operation, the total nasal resistance and total score of NOSE scale of patients decreased significantly as well as the total score of QSQ scale increased significantly ((0.140±0.043) kPa·s/L vs (0.277±0.067) kPa·s/L, 9.84±4.11 vs 53.00±11.57, 5.67±0.43 vs 3.86±0.46, t value was 10.687, 18.035, -16.904, respectively, all P<0.05), and the scores of five dimensions increased in varying degrees. Among the indexes of PSG, there was no significant difference in AHI and LSaO(2) values before and after operation, but AHI decreased and LSaO(2) increased. Conclusion: Nasal cavity ventilation expansion techniques can effectively alleviate the symptoms of nasal obstruction in OSAHS patients and improve their sleep and quality of life.

[Effect of endoscopic sinus surgery on olfactory function in patients with chronic rhinosinusitis with nasal polyps].

Objective:To evaluate the effect of surgery on olfactory function in patients with chronic rhinosinusitis with nasal polyps（CRSwNP） by subjective and objective olfactory tests. Method:This was a retrospective study. Forty patients with CRSwNP who underwent endoscopic sinus surgery（ESS） from 2015 to 2017 in Beijing Anzhen Hospital were enrolled. Postoperative time was 6-46 months. The patients were followed up in October 2018 and examined using Sniffin' sticks olfactory test and olfactory event-related potentials （oERP）. The polyps collected during surgery were performed to eosinophil count and percentage calculation. They were divided into eosinophilic CRSwNP（ECRS） and non-eosinophilic CRSwNP（NECRS）. The subjective and objective olfactory functions between the two groups were compared before and after surgery respectively and the paired T test was performed between the postoperative and the preoperative Sniffin' sticks olfactory test. Covariance analysis was used to adjust the effect of different postoperative time on postoperative olfactory recovery. Result:There were 21（52.5%） ECRS and 19（47.5%） NECRS patients of the 40 patients with nasal polyps. There was statistical difference in the posterior ethmoid score and the posterior olfactory cleft score of CT. According to the criterion of total TDI increased more than 5.5, olfactory function in 21（52.5%） patients had improved. In addition, there was a significant improvement in olfactory function in ECRS group either in unilateral T/TDI or bilateral T/D/TDI, but only unilateral T/TDI increased in NECRS group. There was no significant difference in Sniffin' sticks olfactory test between the two groups, but there was a statistically significant difference in the latency of oERP after surgery. Conclusion:ESS could improve olfactory function in patients with CRSwNP by more than 50%. Bilateral olfactory improvement in ECRS was better than that in NECRS, but olfactory function in postoperative ECRS was still lower than that in NECRS. oERP can more objectively and accurately reflect the severity of olfactory disorders associated with eosinophilic inflammation.

[Clinical features and treatment outcome of inflammatory myofibroblastic tumor of the paranasal sinus].

Objective: To investigate the clinicopathological features and the clinical characteristics of inflammatory myofibroblastic tumor(IMT) of paranasal sinus. Method: Five cases of IMT of paranasal sinus treated from 2011 to 2018 were analyzed retrospectively. Of the 5 patients, CT and MRI were performed before operation. All tumors originated from paranasal sinus, and orbital, pterygopalatine fossa and palate was involved with variable degrees. All patients had been given operation and recovered well. Two cases received additional glucocorticoid therapy(prednisone) postoperatively. Result: After a follow-up of 3-80 months, one case recurred 2 years postoperatively and received surgery again. No recurrence was found after operation in the other four patients. The finial diagnosis depended on pathological findings. Postoperative pathological examination showed that the tumor cells were mainly composed of spindle fibroblasts and chronic inflammatory cells. Immunohistochemical staining showed positive expression of SMA protein. Conclusion: IMT of paranasal sinus is a rare clinical entity without specific clinical manifestations and the extent of the lesion can be assessed by imaging examinations. Pathological examination is required for final diagnosis. Radical resection should be taken for limited lesions. Besides surgery, corticosteroid administration and irradiation therapy is recommended in some circumstances. The overall prognosis is good.

[Anatomy and function of the Eustachian tube influence the development of chronic suppurative otitis media].

Objective:To explore the influence of anatomy and function of the Eustachian tube（ET） on the development of chronic suppurative otitis media. Method:We retrospectively enrolled 92 cases（184 ears） of adult patients with chronic suppurative otitis media（CSOM）, in whom 118 CSOM ears, 25 atelectasis ears and 41 normal ears were included. All patients underwent endoscopy, tympanometry, pure tone average, temporal bone computerized tomography scans and ET function test. Patients with pars flaccida retraction, cholesteatoma, ET obstruction or maxillofacial deformity were excluded. The length, angle and function of ET were analyzed. Result:The ET angle was （23.1±2.4） ° in CSOM ears, was （22.9±2.9） ° in atelectasis ears and was （25.1±3.0） ° in normal ears. The ETs were more horizontal in ears with CSOM and atelectasis（P<0.01）. The ET length was （39.2±4.3） mm in CSOM ears, was （41.7±5.8） mm in atelectasis ears and was （43.0±5.9） mm in normal ears. The ETs in CSOM ears were shorter compared to the ETs normal ears（P<0.01）. No significant difference was detected between the length of ETs of atelectasis ears and normal ears（P>0.05）. The ET dysfunction rate was 62% in CSOM ears, was 68% in atelectasis ears, which were both significantly higher than the dysfunction rate in normal ears（22%）（P<0.05）. Conclusion:The anatomical and functional changes of ETs contribute to the development of CSOM. For patients with more horizontal and shorter ETs as well as ETs dysfunction, more progressive treatment should be considered.

[Correlation of tissue eosinophil count and modified CT olfactory cleft score and olfactory function in patients with nasal polyps].

Objective:To investigate the effect of tissue eosinophil count on olfactory function in patients with chronic sinusitis with nasal polyps（CRSwNP）. Method:We prospectively selected 59 patients with CRSwNP. All the patients were not treated with oral or topical glucocorticoids for at least 1 month at the time of enrollment. All the nasal polyps were taken under local anesthesia in the outpatient department for eosinophil count and percentage calculation. The patients were divided into eosinophilic CRSwNP（ECRS group） and non-eosinophilic CRSwNP（non-ECRS group）. Baseline data was compared between the two groups. Spearman correlation analysis was performed on tissue eosinophil count and Lund-Mackay score, modified olfactory cleft scores, Sniffin' Sticks olfactory test, olfactory evoked potential peak latency and amplitude respectively. Result:Thirty-five of 59 patients with CRSwNP completed olfactory evoked potential test, from whom we collected stable waveforms. The ECRS group had a higher olfactory cleft area CT score, ethmoid sinus CT score and blood eosinophil count and percentage; there was a significant difference between the ECRS group and the non-ECRS group in single and bilateral odor test threshold（T value）（P=0.017）. There was no significant correlation between tissue eosinophil count and subjective olfactory VAS score（P>0.05）. Tissue eosinophil count was related to the bilateral T value in Sniffin' Sticks olfactory test（r=-0.322, P=0.013）, anterior and posterior olfactory cleft area scores（r=0.431 and 0.415, respectively, P=0.001） and olfactory evoked potential N1 latency（r=0.504, P=0.001） and P2 latency（r=0.374, P=0.020）, but not related to Lund-Mackay scores. In addition, there was a significant correlation between the unilateral T score in Sniffin' Sticks test and the unilateral olfactory evoked potential N1 latency（r=-0.505, P=0.002）. Conclusion:The increase of tissue eosinophilia was closely related to olfactory disfunctions in CRSwNP. It could be reflected by modified CT olfactory cleft score, Sniffin' Sticks olfactory test T value and oERP peak latency. In addition, T value was negatively consistent with latency of oERP N1 peak.

Highly Variable Expression of ESR1 Splice Variants in Human Liver: Implication in the Liver Gene Expression Regulation and Inter-Person Variability in Drug Metabolism and Liver Related Diseases.

Estrogen receptor alpha (ESR1) plays an important role in many tissues including the liver. Numerous alternative splice variants of ESR1 exist that encode ESR1 proteins with varying functions. We aim to study ESR1 genomic organization and its mRNA expression profile in human liver by incorporating information from literature and genomic databases (Ensembl, NCBI and GTEx), and employing a quantitative method to measure all known ESR1 mRNA splice variants in 36 human livers. We re-constructed ESR1 genomic organization map that contains 29 exons. ESR1 mRNA splice variants with varying 5' untranslated region (5'UTR) and/or missing each of eight coding exons are readily detectable in liver and other tissues. Moreover, we found extensive inter-individual variability in splice variant pattern of ESR1 transcripts. Specifically, ESR1 transcripts lacking first coding exon are the main transcripts in liver, which encode ESR1 proteins missing N-terminal 173 amino acids (for example, ERα46), reported previously to have either constitutive activity or dominant negative effects depending on cellular context. Moreover, some livers predominantly express ESR1 transcripts missing exon 10 or 16, encoding C-terminal truncated ESR1 proteins with varying ESR1 activities. Inter-person variability in ESR1 expression profile may contribute to inter-person variability in drug metabolism and susceptibility to liver related diseases.

[Application of modified brain protection double-lumen drainage tube in external drainage of chronic subdural hematoma].

Objective: To compare the clinical effects of modified double-lumen drainage tube and traditional silicone tube in external drainage of chronic subdural hematoma. Methods: Selected 49 patients suffering from chronic subdural hematoma hospitalized in the Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College between July 2016 and June 2018 who underwent external drainage, and divided them randomly into experimental groups (using modified brain protection double lumen drainage tube in 23 cases) and control group (using traditional silicone drainage tube in 26 cases). Comparison of postoperative hematoma residual volume, the tube indwelling time, the numbers of drainage tube contact with brain tissue and arachnoid membrane, the numbers of infections, the numbers of postoperative epilepsy cases, and changes in Modified Rankin Scale scores between the two groups. Results: At the time of extubation, the residual amount of hematoma in the experimental group was (13±7) ml, and that in the control group was (17±8) ml. There was no significantly statistical difference in the residual amount of hematoma between the experimental group and the control group (P>0.05). The tube indwelling time of the experimental group was (2.0±0.9) days, and that of the control group was (2.7±0.8) days. The difference between the experimental group and the control group in the drainage tube indwelling time was statistically significant (P<0.05). No cases of drainage tube contact with brain tissue and/or arachnoid membrane appeared in the experimental group, and 7 cases of drainage tube contact with brain tissue or arachnoid membrane appeared in the control group. No infection occurred in both groups. No cases of epilepsy occurred in preoperative, and there were 0 cases of epilepsy in the experimental group and 1 case in the control group in postoperative. There were significantly statistical differences in each of the two groups in the modified Rankin scale before and after surgery (P<0.001), there was no significant difference in postoperative Modified Rankin Scale scores between the two groups. Conclusion: The modified brain protection double-lumen drainage tube has good drainage effect in the external drainage of chronic subdural hematoma, and the short tube retention time, causing fewer complications. It is a safe and effective tool for treating chronic subdural hematoma, and it is worthy of clinical promotion.

[Risk factors analysis for recurrence of the idiopathic benign paroxysmal positional vertigo].

Objective:To study the risk factors of recurrence in patients with benign paroxysmal positional vertigo(BPPV) after successful repositioning treatment. Method: Two hundred and two cases of confirmed BPPV patients, were followed-up for 10 months after particle repositioning, and the incidence of recurrence was analyzed. The risk factors for recurrence were analyzed by logistic regression. Result: 51 out of 202 confirmed BPPV patients complained of recurrence. There was significant difference of the duration of vertigo before treatment, the times of repositioning and SDS between the two group(P<0.05). While the sex, the age, the incubation period of BPPV, the duration time of BPPV, underlying diseases and the type of canal were not associated with the residual dizziness(P>0.05). Logistic regression analysis showed that the times of repositioning and the SDS were the risk factor for residual dizziness. Conclusion:The effective repositioning and the psychological care are very important to reduce the recurrence of BPPV.

[Clinical application of pedicel frontal flap in reconstruction of the nasal defects].

Objective:The aim of this study is to explorethe application of improving the design of the myocutaneous flap and the transfer mode in nasal facial defect. Method:Six cases with nasal defects were treated by using lateral or median vascular frontal flap which is nourished by supratrochlear and supraorbital arteries. Three patients with basal cell carcinoma of external nose and three patients with cranial base tumor were hospitalized and underwent surgeries. Result:There were 6 cases in this cohort, with the largest defect being 6.5 cm×3.0 cm and the smallest one being 3.0 cm×2.5 cm in size. Except one patient was missing, the rest of the patients flaps survived, and wounds were healed by first intention. Among 6 patients, 3 patients were treated with lateral forehead flap, 2 patients were treated with median forehead flap, and 1 patient was treated with oblique forehead flap. The follow-up being conducted for 6 months to 12 months, the flaps were normal color and sensation, satisfactory appearance and functional recovery of forehead region. Conclusion:Forearm myocutaneous vessels running more constant, superficial, rich blood supply, easy to dissect and can provide a larger area flap, suitable for different causes of nasal facial defect repair. Large area of flap can be provided. These may be favorable choice for repair of the nasal defects. The tunnel through which the flap was transferred to the defect should be wide enough to avoid flap necrosis because of pedicel flap constriction.

[Experience of successful rescue from 5 cases of internal carotid artery injury during transnasal endoscopic skull base surgery].

Objective: To investigate the cause and urgent management of internal carotid artery injury during transnasal endoscopic skull base surgery. Methods: Five cases of internal carotid artery injury encountered during transnasal endoscopic skull base surgery in Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of University of Science of Technology of China, Anhui Provincial Hospital from December 2010 to July 2017 were analysed retrospectively. There were 2 cases of adenoid cystic carcinoma, 1 case of salivary gland-type adenocarcinoma, 1 case of petrous apex cholesterol granulomas and 1 case of squamous carcinoma. The cause of internal carotid artery injury and subsequent treatment were analysed, in order to prevent internal carotid artery injury during transnasal endoscopic surgery. Results: Intraoperatively, all these 5 cases were packed with vaseline strip successfully. Two cases underwent subsequent intravascular covered stent graft implantation; 1 case underwent replacement of packing with muscle fascia graft; 1 case was packed with vaseline strip in nasal and nasopharyngeal cavity; 1 case accepted ligation of common carotid artery after failure of nasal packing. Four cases were successfully treated without craniocerebral or ocular complications. Otherwise, 1 case demonstrated with extremity paralysis after ligation. Follow up ranged from 6 to 84 months, no patient died. Conclusion: The injury of internal carotid artery is related with improper operative procedures and anatomic localization, which should be treated properly with emergent hemostasis, and an experienced multidisciplinary team to repair vascular damage is very important.

[Comparison and analysis of spontaneous cerebrospinal fluid rhinorrhea with and without empty sella patients].

Objective:To investigate the clinical characteristics and the diagnosis and treatment of spontaneous cerebrospinal fluid rhinorrhea with and without empty sella.Method: Retrospective analysis clinical data of 51 patients with spontaneous cerebrospinal fluid rhinorrhea，comparison of non-empty sella syndrome of spontaneous cerebrospinal fluid rhinorrhea with empty sella syndrome of spontaneous cerebrospinal fluid rhinorrhea patients with general characteristics，localization and treatment effect.Result:The incidence of spontaneous cerebrospinal fluid rhinorrhea patients was higher in females than in males，BMI index was higher than the normal value.Of these 51 patients，5 of them were discharged after conservative treatment.Endoscopic sinus surgery was performed in 46 cases，of which 4 cases recurred and all had empty sella syndrome，the success rate of surgical repair was 91.3%.The age of empty sella group，the proportion of high blood pressure and the number of patients with surgical recurrence were significantly higher than those in the non-empty sella group（P<0.05）.The defect locations of two groups were most common in the ethmoid roof，there were no statistically significant differences in each defect location （P＞0.05）. Conclusion:The spontaneous cerebrospinal fluid leak was common in obese middle-aged women，most common defect location in ethmoid roof，nasal endoscopic repair success rate was high，with empty sella surgery were more likely to recur.