Mechanism of beta-sitosterol on hypertrophic scar fibroblasts:an analysis based on network pharmacology / 中国组织工程研究

BACKGROUND:At present,effective preventive and therapeutic measures for hypertrophic scar are still limited.In contrast,most of botanical herbs have few side effects and abundant sources,offering new ideas and approaches for the prevention and treatment for hypertrophic scar. OBJECTIVE:To explore the potential molecular mechanism of plant-derived β-sitosterol on hypertrophic scar fibroblasts by network pharmacology and molecular docking techniques and to initially verify it by cytological experiments. METHODS:Through the network pharmacology,the relevant database and software were used to screen the drug targets of β-sitosterol and obtain the hypertrophic scar-related disease targets.The potential(intersection)targets of β-sitosterol on hypertrophic scar were obtained.Cytoscape software and STRING database were used to construct the"drug-target-disease"network and protein-protein interaction network,and screen out the core targets in the protein-protein interaction network.Gene ontology(GO)biological function and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway enrichment analyses of intersection targets were conducted through the DAVID database,and the signaling pathways and core target genes closely related to the intersection targets were further identified through literature analysis.AutoDock software was used to perform the molecular docking of β-sitosterol and core target proteins.In vitro cellular assays were used to verify the effects of β-sitosterol on proliferation,apoptosis,cell cycle distribution and mRNA expression of core target genes in human hypertrophic scar fibroblasts. RESULTS AND CONCLUSION:There were 56 intersection targets of β-sitosterol and hypertrophic scar and 10 core targets were identified in the protein-protein interaction network,including tyrosine kinase,mitogen-activated protein kinase 3(MAPK3),cysteine protease 3(CASP3),apolipoprotein E,estrogen receptor 1,sterol regulatory element-binding transcription factor 1,peroxisome proliferator-activated receptor alpha,C-reactive protein,intercellular adhesion molecule 1,and catalase.Combined with the literatures and the functional analysis of the KEGG and GO,the MAPK signaling pathway was further identified to be closely related to the intersection targets,and MAPK3(ERK1-MAPK),CASP3,P53 and tumor necrosis factor were identified as the core targets.The molecular docking results indicated that β-sitosterol was well bound to the core target proteins.Cellular assays showed that 100 μmol/L β-sitosterol inhibited hypertrophic scar fibroblast proliferation,decreased mitochondrial membrane potential and induced apoptosis(P<0.01),increased the proportion of G1-phase cells and decreased the proportion of S-phase cells(P<0.05),upregulated the mRNA expression of CASP3,P53 and tumor necrosis factor(P<0.05),and downregulated the mRNA expression of MAPK3(P<0.001).To conclude,β-sitosterol may induce cell apoptosis in hypertrophic scar fibroblasts by activating the tumor necrosis factor pathway and upregulating the expression of CASP3 and P53,while inhibiting the ERK-MAPK pathway to arrest cell cycle and thus reduce the proliferation of hypertrophic scar fibroblasts.

Bioinformatics analysis and validation of differentially expressed genes and small molecule drug prediction in proliferative scar / 中国组织工程研究

BACKGROUND:Hypertrophic scar is a skin fibrosis disease characterized by excessive proliferation of fibroblasts,epidermal thickening,and stratum corneum dysfunction.At present,the pathogenesis of Hypertrophic scar is still unclear. OBJECTIVE:To screen the core(Hub)genes and important signaling pathways in hypertrophic scar-related datasets based on bioinformatics,and then verify them by cell experiments to predict small molecule drugs that may have therapeutic effects on hypertrophic scar. METHODS:Datasets related to hypertrophic scar were searched from Gene Expression Omnibus(GEO)database,and differentially expressed genes were identified by R software analysis.Gene ontology and KEGG enrichment analyses were performed for differentially expressed genes.Protein-protein interaction network of differentially expressed genes was constructed using String online platform.Then,the key genes and core modules in the protein-protein interaction network were screened by Cytohubba and MCODE plugin-in Cytoscape software respectively,and the Hub genes were obtained by the intersection of the above key genes and the genes that formed the core module.Real-time fluorescent quantitative PCR was used to verify the difference in Hub gene mRNA expression between human hypertrophic scar and normal skin epidermal stem cells.The histological data from the Human Protein Atlas were used to verify the differences in the expression and distribution of Hub gene-encoded proteins in the two kinds of human tissues.Finally,the potential drugs for hypertrophic scar were predicted by the connectivity map database. RESULTS AND CONCLUSION:Among the identified differentially expressed genes,102 genes were up-regulated and 702 genes were down-regulated.Gene ontology and KEGG analysis showed that the enriched signaling pathways and biological processes were mainly involved in tight junction,arachidonic acid metabolism,extracellular matrix receptor interaction,epidermal development and keratinization.Eight Hub genes were found to be closely related to the mevalonate pathway that regulates cholesterol metabolism,including HMGCS1,DHCR7,MSMO1,FDPS,MVK,HMGCR,MVD and ACAT2.Compared with the normal skin group,the mRNA expression of HMGCS1,DHCR7,MSMO1,FDPS,HMGCR,MVD and ACAT2 in the hypertrophic scar group decreased significantly(P＜0.05),while MVK mRNA expression had no significant change(P＞0.05).Except for MVK,the expression levels of other Hub gene-encoded proteins in normal skin tissue were higher than those in hypertrophic scar tissue(P＜0.05).The top 10 candidate drugs included protein kinase A inhibitor(H-89),serine protease inhibitor(Dabigatran-Etexilate),FLT3 inhibitor(sunitinib),among which resveratrol and β-sitosterol are plant extracts.To conclude,Hub genes closely related to mevalonate metabolism may affect the structure and function of the epidermis by regulating lipid metabolism,which may an important pathogenesis of hypertrophic scar.The small-molecule compounds identified in this study can be used as candidate drugs for the treatment of hypertrophic scar.

Research advances on the role and mechanism of microRNA in hypertrophic scar / 中华烧伤杂志

Hypertrophic scar (HS) affects the function and beauty of patients, and brings a heavy psychological burden to patients. However, the specific pathogenesis mechanism of HS in molecular biology level is not yet clear, and this disease is still one of the clinical diseases difficult to prevent and cure. MicroRNA (miR) is a family of single-stranded endogenous noncoding RNAs that can regulate gene expression. The abnormal transcription of miR in hypertrophic scar fibroblasts can affect the transduction and expression of downstream signal pathway or protein, and the exploration of miR and its downstream signal pathway and protein helps deeply understand the occurrence and development mechanism of scar hyperplasia. This article summarized and analyzed how miR and multiple signal pathways involve in the formation and development of HS in recent years, and further outlined the interaction between miR and target genes in HS.

Nursing care of patients with neuromyelitis optica spectrum diseases treated with immunoadsorption therapy / 中国实用护理杂志

Objective:To explore the application and nursing of protein A immunosorbent in patients with neuromyelitis optica spectrum diseases.Methods:Ten patients with neuromyelitis optica spectrum diseases were treated with protein A immunoadsorption therapy. Psychological nursing was emphasized. Comprehensive evaluation was conducted before adsorption to determine the prescription of adsorption therapy. During adsorption therapy, hypotension, membrane rupture and hemolysis of plasma separator, shivering and other adverse reactions were accurately prevented and treated. After treatment, attention should be paid to the prevention of nosocomial infection, regeneration and preservation of adsorption column.Results:After immunoadsorption therapy, the serum IgG level, antibody and EDSS score of 10 patients decreased to varying degrees. The serum IgG decreased from (6.04±2.77)g/L to (2.23±1.74)g/L. No serious complications occurred, no failure of immunosorbent operation, and the patients′ condition was better than before.Conclusions:Protein A immunosorbent therapy for neuromyelitis optica spectrum diseases is safe and effective. Standardized evaluation, operation and nursing are the key to achieve good results.

Primary experience and discussion on the treatment of esthesioneuroblastoma / 中华耳鼻咽喉头颈外科杂志

Objective: To summarize the preliminary experience in the treatment of esthesioneuroblastoma (ENB) and to explore the effect of age, chemotherapy, modified Kadish stage and pathological grade on the prognosis of ENB. Methods: The clinical data of 87 ENB patients from the First Affiliated Hospital of Sun Yat-sen University and Sun Yat-sen University Cancer Center between June 2002 and November 2017 were retrospectively analyzed. The modified Kadish stage was used to evaluate the extent of the lesions, and the Hyams grading system was used for pathological grading. The patients were followed up regularly to evaluate the recurrence and metastasis of the tumor. Cox proportional hazard model was used for univariate and multivariate analyses. Prognostic factors with P<0.05 in univariate analysis were included in multivariate analysis. After controlling the confounding factors, the model coefficients were used to calculate the hazard ratio (HR) and 95% confidence interval (CI). Results: The median follow-up time of ENB patients was 29 months, and the 5-year overall survival rate was 39.3%. In univariate analysis, age, chemotherapy, modified Kadish stage and pathology grade were independent predictors of overall survival, while gender, radiotherapy and surgery were not prognostic factors. Multivariate analysis showed that modified Kadish stage and pathology grade were independent predictors of overall survival rate after excluding confounding factors. Conclusions: Age, chemotherapy, modified Kadish stage and pathological grade are taking important role in the overall survival rate of patients with ENB. Modified Kadish stage and pathological grade are independent predictors of overall survival rate.

Neuromuscular Pharmacodynamics of Rocuronium in Diabetic Rats / 中国医学科学院学报

Objective To investigate diabetes-mediated changes in the neuromuscular pharmacodynamics of rocuronium in rats. Methods Diabetes mellitus was induced by a single injection of streptozotocin in rats.A total of 24 male SD rats were assigned to four groups using random number table:the normal control group,diabetic 2-week group,diabetic 4-week group,and diabetic 8-week group(6 rats per group).The sciatic nerve was stimulated in a rain-of-four(TOF)pattern,and the twitch tension changes in the tibialis anterior muscle were demonstrated by mechanomyography after intravenous injection of rocuronium in vivo.The time course characteristics of rocuronium,including onset time,and the recovery time from rocuronium injection to TOF ratio 75%(RT75%)and 90%(RT90%),were recorded,and half maximal inhibitory concentration(IC)values of rocuronium were determined using a four-parameter dose response curve. Results Compared with the normal controls,the diabetic rats had significantly prolonged onset time of rocuronium,while the RT75% and RT90% were decreased at all rocuronium doses(PConclusion Diabetes is associated with the rat skeletal muscle hyposensitivity to rocuronium,which is featured by prolonged onset time of rocuronium,decreased RT 75% and RT 90%,and right shift of the cumulative dose-response curve of rocuronium.

Screening of MYH7 gene mutation sites in hypertrophic cardiomyopathy and its significance / 中华医学杂志(英文版)

BACKGROUND@#There have been few reports of mutations in the beta-myosin heavy chain (MYH7) gene in hypertrophic cardiomyopathy (HCM), which is associated with sudden cardiac death caused by HCM. This study aimed to screen the mutation sites in the sarcomeric gene MYH7 in Chinese patients with HCM. We also planned to analyze the pathogenicity of the mutation site as well as its significance in clinical and forensic medicine.@*METHODS@#From January 2006 to June 2017, autopsy cases were collected from the Department of Pathology, the Affiliated Hospital of Qingdao University. The experiment was to detect MYH7 gene status in formalin-fixed paraffin-embedded tissues from 18 independent autopsy cases who suffered HCM related sudden death (fatal HCM) and 20 cases without cardiomyopathy. Common mutation exon fragments of MYH7 gene were amplified by polymerase chain reaction. The end-of-deoxygenation method and gene cloning method were further performed to analyze the mutation sites. Homologous comparison among mutant sites was conducted using BLAST online database.@*RESULTS@#The 1336th nucleotide of MYH7 gene at exon 14 was converted from T to G in one HCM case, resulting in the conversion of threonine (Thr) at position 446 to proline (Pro). In another case, the 1402th nucleotide at exon 14 was converted from T to C, resulting in the conversion of phenylalanine (Phe) at position 468 to leucine (Leu). Homologous comparison results showed that the two amino acid residues of Thr446 and Phe468 are highly conserved among different species.@*CONCLUSIONS@#Our results showed fatal HCM harbored mutations of Thr446Pro and Phe468Leu in the MYH7 gene. It is significant for clinical and forensic medicine to further explore the functions and detailed mechanisms of these mutations.

Effects of different types of bone cement augmentation of pedicle screws on prognosis of osteoporotic thoraco-lumbar fractures in elderly patients / 局解手术学杂志

Objective To compare the effects of different types of bone cement augmentation of pedicle screws on the prognosis of osteo -porotic thoracolumbar fractures in elderly patients.Methods From August 2013 to November 2016,184 elderly patients with osteoporotic thoracolumbar fractures in our hospital were selected as the research object,all the patients were randomly divided into observation group and control group,94 cases in each group.Two groups were treated with pedicle screw fixation,the control group received conventional pedicle screw combined with PMMA bone cement augmentation,and the observation group were treated by cannulated pedicle screws combined with PMMA bone cement augmentation,the prognosis of the two groups were recorded.Results All patients were successfully completed the oper-ation without serious complications occurred.There was no significant difference in operation time,intraoperative blood loss,the amount of sin-gle vertebral bone cement,hospitalization time between the two groups(P>0.05).The postoperative 1 month incidence rate of cerebrospinal fluid leakage,bone cement leakage,wound infection,loosening of internal fixation was 4.3% in the observation group,which was lower than 21.3%in the control group,the difference was significant(P<0.05).The postoperative 1 month of vertebral height in the observation group and the control group were respectively(4.53 ±1.11)mm and(5.09 ±1.42)mm that were lower than the preoperative(6.41 ±1.39)mm and(6.38 ±1.31)mm(P<0.05),meanwhile the vertebral height at postoperative 1 month of the observation group was lower than that of the control group,the differences were significant(P<0.05).There were 0 case of Frankle grade A,0 case of grade B,10 cases of grade C, 18 cases of grade D,66 cases of grade E in the observation group at postoperative 1 month,and there were 6 cases,14 cases,20 cases,20 ca-ses and 34 cases of corresponding Frankle grade in the control group,the observation group was significantly better than the control group,the differences were significant(P<0.05).Conclusion The application of cannulated pedicle screw combined with PMMA bone cement in the osteoporotic thoracolumbar fractures does not increase the difficulty of operation,and it can reduce the complications and reduce vertebral height,which is conducive to the recovery of nerve function.

Surgical outcome of percutaneous endoscopic technique for highly migrated disc herniation via three different approaches / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the clinical effects of percutaneous endoscopic technique via three different approaches for highly migrated lumbar disc herniation.</p><p><b>METHODS</b>The clinical data of 68 patients underwent percutaneous endoscopic technique from June 2011 to June 2014 were retrospectively analyzed. There were 43 males and 25 females, aged from 11 to 77 years old with an average of (42.29±15.92) years. The patients were divided into three groups according to different operative approaches, of them, 45 cases were by transforaminal approach (group A), 15 cases by translaminar approach (group B), and 8 cases by transpedicular approach (group C). There was 1 case in level L₂,₃, 12 cases in L₃,₄, 36 cases in L₄,₅, 19 cases in L₅S₁. The herniated disc was migrated superiorly in 23 patients, inferiorly in 45 patients. MRI were available to confirm migrated disc pre-and post-operatively. Operation time, loss blood volume, intraoperative and postoperative complications, time of back to work (postoperative recovery time) were recorded. Preoperative and postoperative VAS were used to evaluate low back pain and sciatica and JOA and MacNab criteria were used to evaluate functional recovery.</p><p><b>RESULTS</b>All the operations were successful and all the patients were followed up from 12 to 40 months with an average of (18.0±15.9) months. Seven patients(3 cases in group A, 3 cases in group B, 1 case in group C) complicated with transient paraesthesia (hyperalgesia or hypesthesia), and the symptoms relieved after symptomatic treatment with neurotrophic medicine, at final follow-up, no symptoms were left. One case in group B complicated with dura mater tearing during operation and it was untreated, there was no resulted complications such as headache and sinus tract of skin. In group A, B, C, the mean VAS score of sciatica improved from preoperative 6.93±1.34, 6.33±1.23, 6.13±1.73 to 0.80±0.87, 0.73±0.70, 0.38±0.52 at final follow-up; and JOA score improved from preoperative 9.09±2.62, 9.80±2.31, 10.50±2.93 to 26.82±1.53, 25.93±1.58, 26.50±1.51 at final follow-up, respectively(<0.05). There was no significant difference among three groups(>0.05). There was no significant difference in loss blood volume, postoperative recovery time among three groups. But operation time of group B was shorter than other two groups. According to MacNab criterion to assess the clinical effects, 42 cases got excellent results, 21 good, 5 fair.</p><p><b>CONCLUSIONS</b>Percutaneous endoscopic technique is a safe and effective method for surgical treatment of highly migrated herniation. The decision of operative approach should be made by characters of anatomy. By tanspedicular approach the lesion could be found directly. However, it depends on good skill and equipment.</p>

Therapeutic effect of atorvastatin on asymptomatic heart failure after myocardial infarction and its influence on prognosis / 心血管康复医学杂志

Objective: To study therapeutic effect of atorvastatin on patients with asymptomatic heart failure (AHF) after myocardial infarction, and its influence on prognosis.Methods: Clinical data of 100 AHF patients after myocardial infarction, who were treated in our hospital from Jul 2014 to Jul 2015, were analyzed.According to random number table, patients were randomly and equally divided into routine treatment group and atorvastatin group (received atorvastatin based on routine treatment).Cardiac function indexes, plasma levels of BNP and N-terminal pro B-type natriuretic peptide (NT-proBNP), 6min walking distance (6MWD) and cardiac function score were measured and compared between two groups before and after treatment.Course of treatment was one year.Results: Compared with before treatment, after treatment, there were significant rise in left ventricular ejection fraction (LVEF) and 6MWD, and significant reductions in left ventricular end-diastolic dimension (LVEDd), left ventricular end-systolic dimension (LVESd), plasma levels of BNP and NT-proBNP, and cardiac function score in both groups(P=0.001 all).Compared with routine treatment group after treatment, there were significant rise in LVEF [(52.48±8.65)% vs.(57.86±9.70)%] and 6MWD [(262.60±12.40)m vs.(282.65±15.50)m], and significant reductions in LVESd [(36.23±2.13)mm vs.(30.08±2.05)mm], LVEDd [(58.61±6.40)mm vs.(51.25±6.18)mm], plasma levels of BNP [(267.48±42.10)pg/ml vs.(149.40±32.30)pg/ml] and NT-proBNP [(524.65±138.60)pg/ml vs.(406.20±112.45)pg/ml], and cardiac function score [(2.30±0.22) scores vs.(1.15±0.10) scores] in atorvastatin group(P<0.01 all).Conclusion: Atorvastatin can alleviate left ventricular remodeling, reduce plasma levels of BNP and NT-proBNP, and improve cardiac function in AHF patients after myocardial infarction, which is worth extending.

Comparison of the effect of small incision non -phacoemulsification and phacoemulsification surgery in the ;treatment of cataract / 中国基层医药

Objective To compare the effect of small incision non -phacoemulsification and phacoemulsifi-cation surgery in the treatment of cataract.Methods 90 patients with cataract were selected and randomly divided into ultrasound group and non -ultrasound group,45 cases in each group,who received small incision non -phac-oemulsification and cataract phacoemulsification surgery,respectively.The effect,dry eye symptom score,tear film breakup time and Schirmer test in the two groups were compared.Results The overall response rate in the ultrasound group (93.33%)was obviously higher than that in the non -ultrasound group(62.22%),the difference was statistically significant(χ2 =12.60,P <0.05).The dry eye symptom score[(3.34 ±0.31)points,(3.13 ±0.14)points]in the ultrasound group were significantly lower than those in the non -ultrasound group[(3.89 ±0.26)points,(3.46 ± 0.19)points]at postoperative 1 month and 3 months(t =9.12,9.38,all P <0.05).After the treatment,the tear film breakup time and Schirmer test [(7.34 ±0.45 )s,(5 .56 ±0.54)min]in the ultrasound group were significantly better than the non -ultrasound group[(5.55 ±0.42)s,(2.45 ±0.44)min](t =19.51,29.96,all P <0.05). Conclusion Phacoemulsification surgery exerts obvious effect in the treatment of cataract and induces non -obvious postoperative dry eye symptoms,it is significantly better than small incision non -phacoemulsification and has clinical significance.

Parkinson's Disease with Fatigue: Clinical Characteristics and Potential Mechanisms Relevant to α-Synuclein Oligomer

BACKGROUND AND PURPOSE: The aim of this study was to identify the clinical characteristics and potential mechanisms relevant to pathological proteins in Parkinson's disease (PD) patients who experience fatigue. METHODS: PD patients (n=102) were evaluated using a fatigue severity scale and scales for motor and nonmotor symptoms. The levels of three pathological proteins-α-synuclein oligomer, β-amyloid (Aβ)(1-42), and tau-were measured in 102 cerebrospinal fluid (CSF) samples from these PD patients. Linear regression analyses were performed between fatigue score and the CSF levels of the above-listed pathological proteins in PD patients. RESULTS: The frequency of fatigue in the PD patients was 62.75%. The fatigue group had worse motor symptoms and anxiety, depression, and autonomic dysfunction. The CSF level of α-synuclein oligomer was higher and that of Aβ1-42 was lower in the fatigue group than in the non-fatigue group. In multiple linear regression analyses, fatigue severity was significantly and positively correlated with the α-synuclein oligomer level in the CSF of PD patients, after adjusting for confounders. CONCLUSIONS: PD patients experience a high frequency of fatigue. PD patients with fatigue have worse motor and part nonmotor symptoms. Fatigue in PD patients is associated with an increased α-synuclein oligomer level in the CSF.

Effect of estrogen on proliferation and migration of human skin fibroblast / 中华医学美学美容杂志

Objective To explore the biological effects of estrogen (17β-E2) on the proliferation and migration of human skin fibroblast (HSFB).Methods HSFBs were isolated and cultured by enzyme digestion.The fourth generation of HSFBs were adopted; (1) the proliferating effect of diverse concentrations of 17β-E2 and 17β-E2+ ICI-182780 on HSFBs was determined with MTT method at 24,48,72,96 h; (2) the influence of 17β-E2 and ICI-182780 to HSFBs cycle distribution were determined with flow cytometry; (3) the migration effect of diverse concentrations of 17β-E2 and 17β-E2+ICI-182780 on HSFBs was determined at 24,48,and 72 hours after the creation of the scratch-wound in vitro.Results (1) The proliferating speed of HSFBs in 10-10mol/L 17β-E2 group (group A)was the highest of all at 48,72,96 h,which was higher than that in ICI-182780+10-10mol/L 17β-E2 group (group B) and control group (group C) (P＜0.01) ;(2) the HSFBs during the S phase in group A was more than that in groups B and C (P＜0.01),while the HSFBs during the G0/G1 phase was less than that in groups B and C (P＜0.01); (3) the migrating effect of HSFBs in 10-8mol/L 17β-E2 group (group D) was the highest of all at 48 h,which was higher than that in ICI-182780+10-10mol/L control group (group E)and control group (group F) (P＜0.01).Conclusions The concentration of 10-10mol/L estrogen has the strongest effect of promoting proliferation and that of 10-8mol/L has the strongest chemotaxis; ICI-182780 can abate the above effect effectively.

Clinical observation of topical steroid for the treatment of chronic rhinosinusitis in Chinese adults / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>This study was focused on the clinical effects of topical steroid for chronic rhinosinusitis (CRS) in Chinese adults.</p><p><b>METHODS</b>The CRS patients were randomly selected in the department of otorhinolaryngology, first affiliated hospital of Sun Yat-sen university between november 2010 and December 2011. Thirty-four CRS patients with polyps (CRSwNP) or CRS without polyps (CRSsNP), no prior surgeries were included. These patients were prescribed to use budesonide nasal spay for three months. Evaluation included visual analog score (VAS), sino-nasal outcome test-20(SNOT-20), CT scan (Lund-Mackay score). SPSS 16.0 software was used to analyze the data.</p><p><b>RESULTS</b>Four patients were lost to follow up, while the other 30 patients finished the 3-months' follow up. Except for smelling disturbance which was not statistically changed (t = 0.902, P > 0.05), VAS for nasal blockage (baseline: 4.84 ± 3.15, after treatment: 2.26 ± 2.27), rhinorrhea (baseline: 6.03 ± 2.93, after treatment: 1.96 ± 2.23), headache (baseline: 1.68 ± 2.66, after treatment: 0.42 ± 0.95), facial pressure (baseline: 2.04 ± 2.97, after treatment: 0.58 ± 1.42) and general symptom (baseline: 6.00 ± 2.75, after treatment: 2.71 ± 1.90) were statistically decreased (t value was 4.386, 6.740, 2.445, 2.980, 6.989, respectively, all P < 0.05). VAS of nasal blockage, rhinorrhea and general symptom were statistically decreased after one-month's treatment (all P < 0.05), but no statistical improvements were observed between first, second and the third month (all P > 0.05). SNOT-20 was significantly decreased after treatment (t = 3.687, P < 0.01). 22.2% patients were cured on CT scan.</p><p><b>CONCLUSIONS</b>Topical steroid improves objective symptoms and quality of life in CRS patients. Some of the patients can be cured in CT scores. The symptoms improvements begin from the first month, but do not change during the latter two months.</p>

Salvage management and subsequent treatment after internal carotid artery injury during transnasal endoscopic surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the cause, urgent management, further treatment, outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.</p><p><b>METHODS</b>Five ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region, involving 1 case of traumatic optic neuropathy, 1 case of sphenoidal cyst, 1 case of fungal sphenoid sinusitis, 1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor. These five cases were from three different hospitals in 1990 - 2009, and the clinical data were collected and retrospectively reviewed.</p><p><b>RESULTS</b>Injury of ICA was related with improper anatomic localization and operative procedures. The locations of injury were in cavernous segment in 3 cases, lacerum segment in 1 case, and clinic segment in 1 case, respectively. The types of injury included 3 cases of bleeding of laceration, 1 case of carotid cavernous fistula and 1 case of pseudoaneurysm. Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding. Four cases were successfully treated without craniocerebral or ocular complications, only 1 case died of massive blood loss. Among 4 survival cases, 1 patient abandoned further therapy, the other 3 patients were cured of primary disease by reoperation or subsequent treatment.</p><p><b>CONCLUSION</b>Preoperatively, reading carefully the imaging data, intraoperatively, identifying anatomical positions accurately, performing proper operation, and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages, all these procedures can effectively reduce the surgical risk of ICA injury.</p>

Regularity of nasal mucous transitional course of different sinuses after functional endoscopic sinus surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVES</b>To explore the time regularity of nasal mucous transitional course of different sinuses after functional endoscopic sinus surgery.</p><p><b>METHODS</b>Seventy-seven chronic rhinosinusitis patients following functional endoscopic sinus surgery were prospectively collected. The endoscopic appearances of different sinuses were respectively evaluated with Lund-Kennedy scoring system in 2 weeks, 1, 2, 3, 6, 9 months, and 12 months postoperatively. Then the endoscopic scores and epithelization proportions of different sinuses in different stages were analyzed and compared.</p><p><b>RESULTS</b>Of 77 patients, 154 maxillary sinuses, 154 ethmoidal sinuses, 138 frontal sinuses, and 129 sphenoidal sinuses were scored endoscopically and analyzed statistically. In the 2 weeks after operation, the mucosa scores of sphenoidal sinus (3.5 ± 1.5), ethmoidal sinus (3.6 ± 1.4), maxillary sinus (3.7 ± 1.5), and frontal sinus (3.8 ± 1.5) showed no significant differences by no parameter tests (χ(2) = 1.674, P = 0.643). In the 2, 3, 6, and 9 months postoperatively, the assessment of four kinds of sinuses showed separate transitional tendency and the descending deflection points of scores and ascending peaks of epithelization proportions gradually emerged. In the 12 months postoperatively, by the above statistical methods, the mucosal scores (Z = -3.417, P = 0.001) and epithelization proportions (χ(2) = 4.313, P = 0.038) of sphenoidal sinus were superior to that of ethmoidal sinus, the mucosal scores (Z = -2.218, P = 0.027) and epithelization proportions (χ(2) = 4.292, P = 0.038) of ethmoidal sinus were superior to that of maxillary sinus, and the mucosal scores (Z = -2.244,P = 0.025) and epithelization proportions (χ(2) = 4.100, P = 0.043) of maxillary sinus were superior to that of frontal sinus.</p><p><b>CONCLUSIONS</b>The transitional course of different sinus mucosa after functional endoscopic sinus surgery shows significant time difference. The time sequencing to complete epithelization of sinuses is successively sphenoidal sinus, ethmoidal sinus, maxillary sinus, and frontal sinus.</p>

Resection of petrous apex cholesteatoma via endoscopic trans-sphenoidal approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To introduce our experience of resection of petrous apex cholesteatoma through endoscopic, transnasal, trans-sphenoidal approach in 3 cases, and present a surgical technique of intracystic resection of lesion which yielded a relatively stable long-term outcome.</p><p><b>METHODS</b>Resection of parasellar and petrous apex cholesteatoma via endoscopic transsphenoidal approach was performed in three patients between 2001 and 2006. Surgical technique was as follows: the ethmoid and sphenoid sinuses were opened under endoscope, the petrous apex was accessed by drilling skull base bone at the lateral wall of sphenoid sinus and anterior to the internal carotid artery, the cyst wall of cholesteatoma was incised and expanded, then intracystic removal of cholesteatoma was achieved by the suction, curette and rinsing.</p><p><b>RESULTS</b>The petrous apex cholesteatoma in all 3 patients were removed clearly by endoscopic, transnasal, trans-sphenoidal surgery in one time. Before surgery, two patients with headache and orbital apex syndrome had a remarkable improvement just on the day after operation and completely recovered in 1-4 weeks. No postoperative complications happened in all three patients. All patients had no recurrence in symptoms and no imaging evidences of recurrence at a follow-up of 3 - 7 years.</p><p><b>CONCLUSION</b>The petrous apex cholesteatoma around the parasellar region could be treated by intracystic removal via endoscopic, transnasal, transsphenoidal approach, without the need to strip and remove the cyst wall, and the long-term efficacy was reliable.</p>

Macrolide therapy on nasal mucosal persistent refractory inflammation after endoscopic sinus surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To examine the clinical effect of low-dose (250 mg/d), long-term (12 - 28 weeks) macrolide Klacid on the persistent refractory inflammation of paranasal sinus mucosa following endoscopic sinus surgery (ESS).</p><p><b>METHODS</b>Thirteen patients from a consecutive series of 141 patients undergoing ESS for chronic rhinosinusitis (CRS) during 2004 - 2006 for the first time were recruited for persistent refractory inflammation over 2 years postoperatively. All patients were given Klacid 250 mg/d orally for 12 - 28 weeks and simultaneously maintained the usual treatment including intranasal corticosteroid, mucolytics, and nasal douche. At the end of treatment and the sequential 3 and 6 months, 13 patients were evaluated by symptoms of visual analogue scale and nasal endoscopy by Lund-Kennedy scoring system, respectively.</p><p><b>RESULTS</b>Among the 13 patients, 1 patient stopped therapy for no obvious benefit 5 months after treatment, 12 patients finished the planned treatment till achieving the stopping therapy standard. Ultimately both symptom (8.00 [7.50, 8.50] and 1.00 [0.25, 1.00], Z = -3.201, P < 0.01) and endoscopic evaluation (7.00 [6.50, 8.00] and 1.00 [0.00, 1.00], Z = -3.194, P < 0.01) showed total remarkable improvement after therapy in 13 patients. The comprehensive assessment showed very good outcomes in 6 cases, good in 6 cases, and no good outcomes in 1 case, respectively. During the sequential 3 months and 6 months, no recurrent sinusitis and side effect happened in any patients.</p><p><b>CONCLUSIONS</b>It is effective to treat chronic refractory sinusitis with a low-dose (250 mg/d), long-term (12 - 28 weeks) Klacid on nasal mucosal persistent refractory inflammation after ESS. Klacid is well tolerated and safe to CRS patients during the use of 12 - 28 weeks.</p>

Transnasal endoscopic frontal sinus surgery using expanded agger nasi approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility of endoscopic modified agger nasi approach for the surgical treatment of frontal sinus diseases.</p><p><b>METHODS</b>The data of patients undergoing modified agger nasi approach for frontal diseases were prospectively collected since January 2009, including demographic data, findings at surgery, presence of postoperative symptoms, endoscopic appearance of the frontal recess and sinus, and complications.</p><p><b>RESULTS</b>Nineteen patients were enrolled from January 2009 to August 2010. Seventeen patients had chronic rhinosinusitis, in which 13 patients (76.5%) completely healed, 3 patients (17.6%) improved and 1 patient (5.9%) failed. Two patients had frontal sinus and anterior ethmoid sinus inverted papilloma, with no recurrence. The patients were followed up from 6 to 24 months, medium 16 months. No severe complication occurred. No frontal recess adhesion was found. Four sides of frontal recess showed stenosis caused by tissue hypertrophy.</p><p><b>CONCLUSION</b>The modified agger nasi approach provides excellent access to frontal recess and frontal sinus, with good effect for preventing re-stenosis after surgery.</p>

Efficacy of endoscopic sinus surgery-based on multidisciplinary treatment for chronic rhinosinusitis with asthma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of endoscopic sinus surgery (ESS)-based on multidisciplinary treatment for patients with chronic rhinosinusitis (CRS) and asthma.</p><p><b>METHODS</b>The study included 25 CRS patients with asthma who received ESS from September 2006 to March 2009, besides surgery, who also used corticosteroid nasal spray, oral macrolide antibiotics and nasal irrigation perioperatively. Evaluation was performed before ESS, 1 year and 3 years post-ESS. Evaluation index included visual analogue scale (VAS) and endoscopy Lund-Kennedy assessment for CRS, and asthma control test (ACT) and pulmonary function tests for asthma.</p><p><b>RESULTS</b>Twenty-three (92%) patients were followed up for 12 months. Twelve (48%) of them were followed up for 36 months. CRS efficacy: VAS of general symptom significantly improved after ESS compared to pre-ESS (8.12 ± 0.60, x(-) ± s), after 1 year (3.20 ± 2.19) and 3 year (3.79 ± 2.32) follow up (both P = 0.000). There was no statistic difference between 1 year and 3 year follow up (P = 0.851). Endoscopy Lund-Kennedy score significantly improved in post-ESS after 1 year (4.35 ± 3.21) and 3 year (5.50 ± 2.64) follow up compared to pre-ESS (9.80 ± 2.10, both P = 0.000), and there was no difference between 1 year and 3 year follow up (P = 0.606). Asthma efficacy: ACT pre-ESS, 1 year and 3 year were 21.96 ± 2.16, 23.61 ± 1.94 and 22.33 ± 3.47, without statistic difference (F = 2.871, P = 0.065). Pulmonary function showed no significant change after surgery (Pre-ESS 74.68 ± 11.09, 1 year 73.27 ± 12.27, 3 year 73.50 ± 7.87, F = 0.076, P > 0.05).</p><p><b>CONCLUSIONS</b>ESS improves CRS with asthma significantly and persistently. Asthma control level, anti-asthma drug dose and pulmonary function remain stable after ESS.</p>