[The association of renalase single-nucleotide polymorphisms rs2576178 and rs10887800 with hypertension in patients with obstructive sleep apnea].

Objective: To evaluate the associations between the renalase single-nucleotide polymorphisms rs2576178 and rs10887800 and the risk of hypertension in OSA patients. Methods: A total of 3, 570 male OSA subjects diagnosed via standard polysomnography were included in this retrospective study. We recorded anthropometric, genomic, and polysomnographic parameters and blood pressure levels. All subjects were divided into four groups based on quartiles of the apnea-hypopnea index (AHI). The relationships between rs2576178 and rs10887800 and the risk of hypertension were evaluated using the binary logistic regression, and haplotype analysis. Results: In the bottom AHI quartile, rs10887800 was significantly associated with the risk of hypertension according to the dominant model [odds ratio(OR)=0.691, 95% confidence interval (CI)=0.483-0.990, P=0.044] even after adjustment for age, sex, and the body mass index. The G-A haplotype was associated with a co-effect of the two SNPs, namely, the risk of hypertension decreased (OR=0.879, 95%CI=0.784-0.986, P=0.028). Conclusions: We find no association between single rs2576178 or rs10887800 variants with the risk of hypertension in our OSA population. But, the synergistic effect of the two polymorphisms is associated with the risk of hypertension in OSA patients.

[Application of internal carotid artery stent in skull base surgery].

Objective: To report the experience of the application of internal carotid artery stent in skull base surgery, and to clarify the important role of internal carotid artery stent in skull base surgery. Methods: A retrospective study of 22 cases with skull base neoplasms implanted with internal carotid artery stents in the Department of ENT Head and Neck Surgery at the Sixth People's Hospital affiliated with Shanghai Jiao Tong University between July 2019 and January 2021 was conducted. Among them, 17 were male and 5 were female, aged between 33 and 75 years. There were 5 cases on the left, 16 cases on the right, and 1 case on both sides. Of these, there were 4 cases of jugular paraganglioma, 1 case of chondrosarcoma in the jugular foramen, 1 case of carotid body paraganglioma, and 16 cases of nasopharyngeal carcinoma after radiotherapy. Results: The degree of internal carotid artery erosion was assessed by computed tomography angiography (CTA), magnetic resonance imaging and digital subtraction angiography (DSA) images in 22 patients before surgery. It was found that the internal carotid artery was involved to varying degrees in all patients, so internal carotid artery stents were implanted before surgery. Tumor tissue was found to surround the internal carotid artery to varying degrees. Total or subtotal tumor resection was performed in all patients, and no intraoperative and postoperative complications occurred. The postoperative follow-up was 5 months to 2 years, and all patients had no complications such as spontaneous bleeding and pseudo aneurysm. There were no signs of stenosis or occlusion of the internal carotid artery stent segment in all cases. Conclusions: For patients with skull base tumors, preoperative imaging indicates the limited involvement of the internal carotid artery, and internal carotid artery stent implantation before surgery is a safe and effective treatment.

[Efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS):a multicenter randomized controlled trial].

Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.

[Obstructive sleep apnea and metabolic syndrome: an association study based on a large sample clinical database].

Objective: To investigate the prevalence and associated risk factors of metabolic syndrome (MS) in patients with obstructive sleep apnea (OSA). Methods: From July 2007 to June 2017, a total of 8 155 adult subjects, including 6 484 males and 1 671 females, aged 18-90 (43.13±12.28), body mass index 14.61~59.56 (25.59±3.98) kg/m2,who were admitted to the Department of Otorhinolaryngology head and Neck surgery of The Sixth People's Hospital affiliated to Shanghai Jiao Tong University, were retrospectively analyzed. All patients underwent polysomnography and biochemical tests. Subjects were divided into four groups (non-OSA, mild OSA, moderate OSA, and severe OSA) according to OSA severity. The prevalence of MS was expressed as percentage, and the correlation between OSA and MS and its characteristic pathophysiological indicators was evaluated by logistic regression model after adjusting for factors such as gender, age, BMI, neck circumference, hip circumference, smoking and alcohol consumption, and was expressed by odds ratio (OR). SPSS 25.0 software was used for statistical analysis. Results: The overall prevalence of MS was 43.6%, and that of non-/mild/moderate/severe OSA group was 18.6%, 30.4%, 43.8%, 57.1%.Logistic regression showed that patients with mild/moderate/severe OSA had an increased risk of MS compared with non-OSA patients, with adjusted OR values and confidence intervals of 1.27 (1.05-1.54), 1.84 (1.53-2.22), and 2.08 (1.76-2.46), respectively (P<0.01).In addition, indicators of OSA anoxic burden [oxygen drop index(Toxygen=7.1), minimum blood oxygen(Tminimum=56.3), blood oxygen saturation below 90% cumulative time ratio (TCT90=10.6) ]were closely associated with MS disease(P<0.01), but sleep fragmentation index (arousals index) was not significantly associated with MS disease. Conclusion: The risk of MS gradually increases with the severity of OSA, and the indicators reflecting OSA hypoxia burden are closely related to MS disease.

[Characteristics of Dix-Hallpike test induced nystagmus].

Objective:To retrospectively analyze the characteristics of 100 cases with Dix-Hallpike test induced nystagmus, especially the vertical downward component.Method:One hundred cases with positive Dix-Hallpike test between December 2017 and January 2018 were included in this study. Dix-Hallpike test and roll test were performed in all patients, and the max slow phase velocity (SPV), latency and duration of positional nystagmus were analyzed with SPSS 22.0 software.Result:According to the difference in the direction and duration of the nystagmus in the head-hanging position on Dix-Hallpike test, 100 patients were classified into 9 types. When only the vertical components were considered, 56 cases presented with bilateral or unilateral vertical upward component, among which 52 cases had unilateral torsional with vertical upward component, 4 cases had bilateral torsional with vertical upward component; 7 cases presented with vertically upward in one side and the vertically downward in the other side; 47 cases presented with bilateral or unilateral vertical downward component. In addition, 8 cases showed the reverse phase nystagmus. Of the 100 patients with positive Dix-hallpike, 20 cases were positive in roll test and 5 cases showing horizontal nystagmus and 15 cases showing torsional and vertical nystagmus.Conclusion:Vertical component in the positional nystagmus was common, and care should be taken to interpret the nystagmus into the underlying disorder.

[Progress in research of vestibular migraine].

Estibular migraineis a common disease with symptoms of vertigo and migraine，which is the most common type of recurrent vertigo. The overall prevalence rate of the population is up to 1%. However, owing to its diversity of symptoms, large individual differences, the scarcity of professional clinical knowledge and the lack of effective diagnostic means, the rate of misdiagnosis is very high. Therefore, this article summarized the parts of clinical manifestations, pathogenesis, diagnostic criteria, treatment and prevention of vestibular migraine.

[Classification of acute vestibular syndrome].

Objective:To explore the epidemiological characteristics and to help accomplish accurate diagnosis and treatment strategies by analyzing the composition and clinical features of various diseases with acute constant vertigo.Method:We retrospectively analyzed medical records (including name, sex, age, diabetes, hypertension, history of vertigo, family history, etc.),otoneurological examination, vestibular function tests and radiological examination of patients with acute vestibular syndrome.We classified various diseases according to diagnostic criteria, and then analyze the clinical data.Result:A total of 77 patients with acute vestibular syndrome were enrolled in this study. It included 34 patients with vestibular neuritis, 18 patients with sudden sensorineural deafness with vertigo, 1 with vestibular schwannoma, 6 with acute vestibular syndrome with migraine, 3 with Hunter syndrome with vertigo, 1 with vertigo after trauma,1 with acute bilateral vestibulopathy, 9 with acute vertigo syndrome with other etiology, 3 with acute labyrinthitis, and 1 with posterior circulation infarction. There were no significant differences in the age and course of disease between different etiologies (P>0.05). There were statistical differences between vestibular neuritis and sudden sensorineural deafness with vertigo among head impulse test and hearing loss (P<0.05). There was significant difference in hearing between sudden sensorineural deafness with vertigo and acute vertigo syndrome (P<0.05).Conclusion:Most of the acute vestibular syndrome patients attending the otorhinolaryngology head and neck surgery clinic were peripheral acute vestibular syndrome, vestibular neuritis, and sudden sensorineural deafness with vertigo.Patients with acute vestibular syndrome with migraine are not rare, and central vertigo can also be seen.

[A multicenter randomized controlled study on the treatment of acute and chronic pharyngitis with Binglianqingye Spray].

Objective:To further evaluate the clinical efficacy and safety of Binglianqingye Spray on acute and chronic pharyngitis by clinical observation. Method:A randomized, double-blind and multicenter clinical trial which served Jinsangzi Tablet and Jinhoujian Spray as the control groups was conducted to observe the effect of Binglianqingye Spray on 360 patients with acute and chronic pharyngitis. Result:Binglianqingye Spray could significantly improve the symptoms with the exact clinical efficacy of the acute pharyngitis or chronic pharyngitis, such as sore throat, pharyngeal mucosa and uvula, dry throat burning, headache, cough, pharynx posterior wall lymphoid follicles hyperemia swelling and mandibular angle lymph node swelling and so on, but it occasionally occurred urine abnormalities and urine sugar adverse reactions. At the same time, the taste satisfaction was 82.1%. Conclusion:The combined effects of Binglianqingye Spray on the treatment of acute pharyngitis or chronic pharyngitis are well, the adverse reaction is rare and the patient's compliance is high.

[The correlation analysis of the cochlear hydrops degree found by MRI angiography with Meiniere's disease classification].

Objective:To investigate the correlation between the levels of cochlear hydrops with the clinic classification of Meniere's disease(MD).Method:3D-FlAIR MRI was performed 24 hours after intratympanic injection of 8-fold diluted Gadopentetate Dimeglumine in 31 patients with unilateral MD. We evaluated the levels of cochlear hydrops and further analyzed the correlation between the levels of cochlear hydrops and thresholds of pure tone audiometry and clinic classification of MD. Result:MRI image clearly distinguished perilymph from endolymph in the labyrinth. The images showed different levels of enhancement of perilymphatic fluid spaces. In the 31 patients, obvious signs of endolymphatic hydrops were found, including 4 cases of level 0, 6 cases of level 1, 11 cases of level 2 and 10 cases of level 3. Their average hearing threshold was(54.37±3.88)dB HL. The levels of cochlear hydrops were significantly correlated with pure tone audiometry thresholds （r=0.636，P<0.01） and MD classification(r=0.516,P<0.01). None of the patients after intratympanic injection complained about discomfort or happened with any complications such as eardrum perforation, infection, and so on. Conclusion:The degree of endolymphatic hydrops based on MRI in MD patient has significant correlation with the pure tone audiometry and classification of disease. The examination can act as an objective index for MD diagnosis.

Expression of Epstein-Barr virus antibodies EA-IgG, Rta-IgG, and VCA-IgA in nasopharyngeal carcinoma and their use in a combined diagnostic assay.

Epstein-Barr virus (EBV) infection is closely associated with nasopharyngeal carcinoma, which can be monitored by the levels of Rta protein antibody IgG (Rta-IgG), early antigen antibody (EA-IgG), and viral capsid antibody (VCA-IgA). In the present study, we investigated the serum levels of Rta-IgG, EA-IgG, and VCA-IgA in nasopharyngeal cancer patients, and the diagnostic value of a combined assay that includes these antibodies in addition to the EBV-DNA. A total of 56 nasopharyngeal cancer patients were recruited as the study population, along with 48 benign rhinitis patients and 42 healthy individuals. Serum EA-IgG, Rta-IgG, and VCA-IgA levels were measured by enzyme-linked immunosorbent assay, and EBV-DNA was quantified with PCR. The diagnostic value of these indices was further evaluated by ROC curve analysis. The expression levels of EA-IgG, Rta-IgG, VCA-IgA, and EBV-DNA were elevated in the nasopharyngeal cancer patients, who had higher levels of these antibodies than those in the rhinitis patients, followed by the healthy individuals. These indices were also increased with advanced TNM stage. The overall diagnostic efficacy was ranked as follows: VCA-IgA, Rta-IgA, EA-IgA, and EBV-DNA. The combined diagnosis using these four indices increased the sensitivity to 98.21% and the negative predictive value to 98.61%, without any significant compromise on the test specificity. In conclusion, EA-IgG, Rta-IgG, VCA-IgA, and EBV-DNA expression levels were elevated in nasopharyngeal patients. The combined diagnostic value of these serum indices has important implications in nasopharyngeal carcinoma.

Effects of genetic correction on the differentiation of hair cell-like cells from iPSCs with MYO15A mutation.

Deafness or hearing loss is a major issue in human health. Inner ear hair cells are the main sensory receptors responsible for hearing. Defects in hair cells are one of the major causes of deafness. A combination of induced pluripotent stem cell (iPSC) technology with genome-editing technology may provide an attractive cell-based strategy to regenerate hair cells and treat hereditary deafness in humans. Here, we report the generation of iPSCs from members of a Chinese family carrying MYO15A c.4642G>A and c.8374G>A mutations and the induction of hair cell-like cells from those iPSCs. The compound heterozygous MYO15A mutations resulted in abnormal morphology and dysfunction of the derived hair cell-like cells. We used a CRISPR/Cas9 approach to genetically correct the MYO15A mutation in the iPSCs and rescued the morphology and function of the derived hair cell-like cells. Our data demonstrate the feasibility of generating inner ear hair cells from human iPSCs and the functional rescue of gene mutation-based deafness by using genetic correction.

[Screening of sleep apnea syndrome-a review of current situation].

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a chronic disorder characterized by repetitive apneas, oxygen desaturation and disruption during sleep. The main clinical manifestations of OSAHS are snores, intermittent hypoxia, morning headache, excessive daytime sleepiness, tired and memory descent. OSAHS affects 3%-20% of the general population. Although commonly accepted as the gold standard for diagnosis of OSAHS, PSG is thought to be time-consuming, labor-intensive, costly and uncomfortable. Evidence from epidemiology indicated that 93% of women and 82% of men with moderate to severe OSAHS have not been clinically diagnosed. An epidemiological survey in Shanghai, China, showed that more than 85% of OSAHS was undiagnosed. Studies showed that undiagnosed OSAHS is independently associated with the increased likelihood of hypertension, cardiovascular diseases, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. Thus, researchers have attempted to develop a simple and effective tool to screen patients with OSAHS, which has been reviewed and summarized in our article.