The influence of nasal bacterial microbiome diversity on the pathogenesis and prognosis of chronic rhinosinusitis patients with polyps.

PURPOSE: The role of the microbiome in the paranasal sinuses and its contribution to sinus mucosal health and disease remains poorly understood. Consequently, we examined the nasal microbiome of chronic rhinosinusitis patients with polyps (CRSwNP), chronic sinusitis without nasal polyps (CRSsNP) and a control population, associated with IL-5 of nasal polyp tissues and postoperative follow-up of CRSwNP patients, in search of nasal microbial community characteristics related to pathogenesis and prognosis of CRSwNP, providing a new perspective for further understanding of the disease. METHODS: The middle meatus secretions of 77 CRSwNP, 36 CRSsNP and 34 non-CRS subjects were collected. The bacterial microbiome composition was detected using high-throughput sequencing technology based on 16S rRNA, and the differences in the nasal microbial diversity among the three groups were compared. At the same time, nasal polyp tissues were collected to detect the expression of IL-5 and analyse its relationship with the structural characteristics of nasal microbial colonies. Postoperative follow-up of patients with CRSwNP was conducted for 1 year to record the recurrence of nasal polyps and analyse the correlation between the recurrence of nasal polyps and IL-5 as well as the characteristics of nasal microbial diversity. RESULTS: The results showed that the average Sobs index (579.31) of the non-CRS group was significantly higher than that of the CRSwNP group (387.31, P = 0.03). PCoA analysis showed that the microbial distribution in the three groups was mostly similar, with only a few unique to each group. At the phylum level, Actinobacteria and Chlamydia in the non-CRS group were significantly higher than those in the CRSwNP and CRSsNP groups. At the genus level, Corynebacterium and Dolosigranulum in the non-CRS group were significantly higher than those in the CRSwNP and CRSsNP groups. Twenty-five CRSwNP patients had nasal polyps that were IL-5 positive, accounting for 32.47%, and the relative abundance of Enterobacter was 6.37% ± 5.92%, which was significantly higher than 0.58% ± 0.11% in the IL-5 negative group. No significant difference was found after correction (p = 0.026, FDR p > 0.05). One year after surgery, 77 patients with CRSwNP who underwent surgery were successfully followed up, and 12 patients with CRSwNP relapsed, with a recurrence rate of 15.6%. Total nasal symptom scores (TNSS) were significantly higher in the recurrent group than in the nonrecurrent group (P = 0.000). No differences in microbial diversity were found between the CRSwNP populations in the recurrent group and the nonrecurrent group at both the phylum and genus levels. For the nonrecurrent CRSwNP group, the relative abundance of Actinobacteria (PDR P = 0.012) and Corynebacterium (PDR P = 0.003) was higher than that before surgery, and the relative abundance of Bacteroidetes (PDR P = 0.040) was lower than that before surgery. However, for the recurrence CRSwNP group, there was no significant difference in the nasal microbiome between postoperation and preoperation. CONCLUSION: In conclusion, microbial dysbiosis in the nasal cavity is associated with the pathogenesis of CRSwNP. In Southwest China, the inflammatory pattern of nasal polyps is not dominated by eosinophilic infiltration of Th2-type inflammation. The recurrence of nasal polyps after ESS may be potentially related to the decrease in protective bacteria and the increase in pathogenic bacteria, and the improvement of postoperative bacterial disorder is correlated with the nonrecurrence of CRSwNP.

Comparing the nasal bacterial microbiome diversity of allergic rhinitis, chronic rhinosinusitis and control subjects.

PURPOSE: Until now, the microbiome of the nasal cavity and its contribution to nasal mucosal disease has remained poorly understood. The advent of cultivation-free molecular methods makes it possible to characterize the total microbiome of the nasal cavity. We sought to assess the microbial diversity and composition of the middle meatus in allergic rhinitis (AR) patients, chronic rhinosinusitis patients without polyps (CRSsNP) and a control population to determine the microbiota associated with the pathogenesis of AR and CRSsNP. METHODS: Microbial characterization was determined using 16S rRNA gene sequencing of 122 nasal swabs collected from patients with AR (n = 52) and CRSsNP (n = 37), and from healthy controls (n = 33). RESULTS: There was no difference in nasal microbiome richness and diversity among the three groups, and the dominant phyla were similar among three groups including Firmicutes, Proteobacteria, Actinobacteria and Bacteroidetes. However, Spirochaetae abundance was significantly higher in AR than in the control group after FDR correction (FDR p = 0.021). At the genus level, although there was no statistical significance after FDR correction, there was a trend that Pseudomonas and Peptostreptococcaceae abundance were higher in AR than in controls (p = 0.005, p = 0.005) and CRSsNP (p = 0.023, p = 0.034); Lactobacillus abundance was lower in AR than in controls (p = 0.021); Moraxella abundance was lower in CRSsNP than in controls (p = 0.006); Haemophilus abundance was higher in CRSsNP than in AR (p = 0.003) but lower in AR than in controls (p = 0.018). CONCLUSION: These results suggested that microbial dysbiosis may play a role in the pathogenesis of heterogeneous nasal mucosal inflammation.

Clinical analysis of tracheobronchial foreign body aspiration in children: a focus on external and intrinsic factors.

BACKGROUND: Tracheobronchial foreign body aspiration (TFBA) is a critical disease in children and is extremely dangerous, even life-threatening. The factors affecting the occurrence and prognosis of TFBA are complex. The purpose of this study is to examine the external and intrinsic factors affecting clinical features of TFBA in West China and propose potential effective intervention measures. METHODS: We retrospectively analyzed the clinical data of pediatric patients diagnosed with TFBA with foreign bodies (FBs) removed by rigid bronchoscopy under general anesthesia at the otolaryngology department from December 2017 to November 2018. The data included age, sex, clinical symptoms, type and location of FB, guardians, prehospital duration and residence of these pediatric patients. RESULTS: The ratio of males (72) to females (53) was 1.4:1. Children aged from 1 to 3 years accounted for 76% (95/125) of patients. Cough, continuous fever and dyspnea were the primary symptoms. The right primary bronchus was the most common location of FB detection by rigid bronchoscopy (67 cases, 53.6%). Organic FBs were most common in our study. Guardians of patients significantly differed in the rural (parents 16, grandparents 31) and urban (parents 52, grandparents 26) groups (χ2 = 12.583, p = 0.000). More children in the rural group than in the urban group had a treatment delay longer than 72 h. More children in the group with no history of FB aspiration (12, 25%) than in the group with prior FB aspiration had a treatment delay longer than 72 h. CONCLUSION: Pediatric TFBA is a common emergency in otolaryngology. Age, sex, tracheobronchial anatomy and other physiological elements were defined as intrinsic factors, while guardians, residence, FB species and prehospital time were defined as external factors of TFBA. External and intrinsic factors both influence the occurrence and progression of TFBA. It is extremely important to take effective measures to control external factors, which can decrease morbidity and mortality.

Adult laryngeal Embryonal Rhabdomyosarcoma: a case report and literature review.

BACKGROUND: Laryngeal rhabdomyosarcomas (RMSs) mainly occurred in children, while were extremely rare in adults. Consequently, less information was available to guide clinicians to manage adult RMSs in larynx. CASE PRESENTATION: A 42-year-old man presented with a 2-year history of gradually worsening hoarseness. Then, he underwent a surgery with suspension laryngoscope with initially being diagnosed as vocal cord cyst. Unexpectedly, the lesion was proved to be embryonal rhabdomyosarcoma (ERMS), pathologically. Next, he underwent chemoradiotherapy, while the tumor relapsed 18 months after the last treatment. Subsequently, a vertical hemilaryngectomy and a right selective neck dissection was performed, and the chemotherapy according to the anticancer drug sensitivity in vitro was arranged. Until the last check-up 18 months after chemotherapy, the patient did not display clinical or radiological signs of local recurrence and metastases. CONCLUSIONS: Misdiagnosis and missed diagnosis of laryngeal RMSs might appear when tumors presented as smooth protuberance. We reported the first case of laryngeal RMSs in an adult with the multidisciplinary strategy based on the chemosensitivity assay in vitro. Furthermore, a systematic review of the literature was also discussed, highlighting the initial diagnostic pitfalls and subsequent management problems that may occur with this uncommon tumor.

The inflammatory microenvironment of nasal polyps in patients with chronic rhinosinusitis and the relationship of this microenvironment with the nasal microbiome.

BACKGROUND: We investigated the characteristics of the microbial community of the nasal sinuses in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) and identified the correlations of the nasal microbiome with the inflammatory microenvironment of the nasal cavity. METHODOLOGY: We collected matched nasal secretion and polyp tissue samples from 77 CRSwNP patients. Then, we extracted microbial DNA from cotton swabs, used high-throughput sequencing technology based on 16S ribosomal RNA (rRNA) to detect the bacterial community composition, and detected cytokines such as interleukin (IL)-5, IL-8, IL-17a, IL-17e, IL-18, IL-27 and interferon (INF)-gamma in the polyp tissue samples using Luminex. Eosinophils and neutrophils in the peripheral blood and polyp tissue were counted, and the relationships between inflammatory factors or inflammatory cell counts and nasal microbial diversity were analyzed. RESULTS: Among the inflammatory factors evaluated, IL-5 had a positive rate of 32.47%, IFN-γ had a positive rate of 84.42%, IL-17A and IL-17E had positive rates of 75.32%, IL-18 had a positive rate of 94.81%, IL-27 had a positive rate of 68.83%, and IL-8 had a positive rate of 100%. IL-17a and IL-27 were negatively correlated with both Enterobacter and Anaerococcus, IL-8 was negatively correlated with both Enterobacter and Staphylococcus, IL-18 was positively correlated with Candidatus Arthromitus and negatively correlated with Haemophilus, and IL-27 was positively correlated with Faecalibaculum. Lactobacillus and Enterococcus were positively correlated with the degree of neutrophil infiltration in nasal polyp tissue. CONCLUSIONS: In Southwest China, inflammation of the nasal polyps exhibits a variety of patterns. Enterobacteria and anaerobic bacteria may be correlated with the inflammatory pattern of nasal polyps. The neutrophil-mediated inflammatory response plays an important role in patients with CRSwNP in Southwest China.

[Research status and prospect of tissue engineering technology in treatment of atrophic rhinitis].

Objective: To review the research progress of the feasibility of a new treatment method for atrophic rhinitis (ATR) based on tissue engineering technology (seed cells, scaffold materials, and growth factors), and provide new ideas for the treatment of ATR. Methods: The literature related to ATR was extensively reviewed. Focusing on the three aspects of seed cells, scaffold materials, and growth factors, the recent research progress of ATR treatment was reviewed, and the future directions of tissue engineering technology to treat ATR were proposed. Results: The pathogenesis and etiology of ATR are still unclear, and the effectiveness of the current treatments are still unsatisfactory. The construction of a cell-scaffold complex with sustained and controlled release of exogenous cytokines is expected to reverse the pathological changes of ATR, promoting the regeneration of normal nasal mucosa and reconstructing the atrophic turbinate. In recent years, the research progress of exosomes, three-dimensional printing, and organoids will promote the development of tissue engineering technology for ATR. Conclusion: Tissue engineering technology can provide a new treatment method for ATR.

The influence of nasal microbiome diversity and inflammatory patterns on the prognosis of nasal polyps.

To understand the inflammatory microenvironment and microbiome factors for prognosis of chronic rhinosinusitis with polyps (CRSwNP), we explored the difference in characteristics of the microbiome of the nasal sinuses and inflammatory cytokines between recurrent and non-recurrent groups. We collected nasal secretions and polyp tissue from 77 CRSwNP patients. Then, we extracted microbial DNA from cotton swabs, performed high-throughput sequencing based on 16S rRNA to detect bacterial community composition, and analyzed cytokines such as IL-5, IL-8, IL-17a, IL-17e, IL-18, IL-27 and INF-gamma from polyp tissue using Luminex. The eosinophil and neutrophil cells in the peripheral blood and polyp tissue were counted. Postoperative follow-up of patients with CRSwNP for 1 year was conducted to record the recurrence of nasal polyps and analyze the correlation between the recurrence of nasal polyps and the characteristics of inflammatory cytokines, inflammatory cell count and nasal microbial diversity. After 1 year of follow-up, there were 12 recurrent patients, including 5 males and 7 females. Postoperative recurrence of nasal polyps was not significantly correlated with age, sex, asthma, allergic rhinitis or other allergic diseases in CRSwNP patients. In terms of the total nasal symptom score, the recurrent group was significantly higher than the non-recurrent group. In nasal polyp tissues, eosinophils (40.83/HP) and neutrophils (30.83/HP) in patients with CRSwNP in the recurrent group were significantly higher than those in the non-recurrent group (13.72/HP), and neutrophils (18.5/HP) were also significantly higher in the recurrent group than the non-recurrent group. The expression levels of IFN-, IL-17A, IL-17E and IL-18 were significantly higher in the recurrent group than in the non-recurrent group, and the positive rates were not different. In Southwest China, Enterobacteria and anaerobic bacteria may be correlated with the inflammatory pattern expression of nasal polyps. The neutrophil-mediated inflammatory response plays an important role in patients with CRSwNP in Southwest China and is correlated with nasal polyp recurrence. Recurrence of nasal polyps after endoscopic sinus surgery may be potentially associated with a reduced abundance of protective microorganisms and an increased number of pathogenic microorganisms.

Postoperative outcomes of free myocutaneous flap and pedicled myocutaneous flap for reconstruction in locally invasive thyroid carcinoma.

ABSTRACT: Locally invasive thyroid carcinoma (TC) often involves trachea. In such patients, the trachea needs to be reconstructed after surgery. We discuss the postoperative outcome and complications after trachea reconstruction by free myocutaneous flap (FMF) and pedicled myocutaneous flap (PMF).From January 2009 to September 2019, the clinical data of 38 patients with TC were retrospectively analyzed. Demographics, pathologic results, neoplasm staging, surgical protocol, decannulation, subjective speech function, and complications were documented.A total of 38 patients were analyzed (22 FMFs and 16 PMFs). Of the 38 patients, there is a similar rate of decannulation (81.8% in FMF and 75% in PMF), subjective speech function and complications.The FMF reconstruction and the PMF reconstruction have a similar result in terms of postoperative outcome and complications.

[The correlation between nasal bacterial microbiome diversity and surgical prognosis for chronic sinusitis with nasal polyp].

Objective:To compare the nasal microbiota diversity between chronic rhinosinusitis with nasal polyp（CRSwNP） patients and controls, postoperative recurrent with non-recurrent CRSwNP, in order to provide new sight in CRSwNP treatment and prognosis. Method:Forty-eight patients with CRSwNP were recruited as the experimental group, and 33 patients who underwent FESS and had no sinus inflammatory disease, including nasal septum deviation,inverted papilloma, pituitary adenomas, chronic dacryocystitis,or optical canal fractures, were recruited as control group. High-throughput sequencing of 16S rRNA was used to detect the bacterial communities in the nasal secretion which was collected from middle meatus during the operation. The difference of the microbiota diversity between CRSwNP and controls was compared. Patients with CRSwNP were followed up for 1 year after surgery to observe whether they had relapsed or not, and nasal secretions were collected again for bacterial microbiota detection. The difference between postoperative and preoperative microbiota of the non-recurrent CRSwNP were compared, and the difference between postoperative and preoperative microbiota of the recurrent CRSwNP were compared. Result:One year after surgery, 12 cases of CRSwNP recurred（recurrent rate 25%）. The clinical history of the recurrent group was longer than that of the non-recurrent group（P=0.018）, and the preoperative CT score（P=0.001）, nasal polyp size score（P=0.004） and the severity of postnasal drip symptom（P=0.032） in the recurrent group were significantly higher than non-recurrent group. Comparing the preoperative nasal microbiota of CRSwNP with control, there was no significant difference about the richness, α diversity and ß diversity, but the relative abundance of Actinobacteria（FDR P=0.004） and Corynebacterium（FDR P=0.005） of CRSwNP were significantly lower than that of control. After operation, the relative abundance of Actinobacteria（FDR P＝0.012） and Corynebacterium（FDR P＝0.003） increased, while the Bacteroidetes（FDR P＝0.040） decreased in the non-recurrent CRSwNP; However, there was no change in the nasal bacterial microbiota in the recurrent group. Conclusion:CRSwNP was associated with nasal bacterial dysbiosis, and the postoperative improvement of dysbiosis was correlated with the prognosis of CRSwNP.

Complex reconstruction technique applied in advanced head and neck cancer.

Complex reconstruction skills in advanced head and neck cancer (HNC) could resolve the key problem of large defects after tumor resection. We combined the anterolateral thigh free flap, fascia lata flap, and greater saphenous vein graft in the reconstruction process of salvage surgery. Seven patients suffering from advanced HNC who experienced the failure of multiple therapeutic methods were enrolled in our study between June 2017 and January 2018. They all agreed to voluntarily undergo the tumor excision and complex reconstruction procedure we developed. The total flap size ranged from 20 × 13 cm to 30 × 15 cm. The length of the greater saphenous vein graft ranged from 4 to 11 cm. The hospitalization period ranged from 7 to 33 days. All of the flaps were viable, but in 1 patient, oral flap edge infection and necrosis necessitated partial debridement on day 7 postoperatively. All donor sites were closed primarily. We report our experience with this surgical method for complex reconstruction in advanced HNC patients.

Automatic Recognition of Laryngoscopic Images Using a Deep-Learning Technique.

OBJECTIVES/HYPOTHESIS: To develop a deep-learning-based computer-aided diagnosis system for distinguishing laryngeal neoplasms (benign, precancerous lesions, and cancer) and improve the clinician-based accuracy of diagnostic assessments of laryngoscopy findings. STUDY DESIGN: Retrospective study. METHODS: A total of 24,667 laryngoscopy images (normal, vocal nodule, polyps, leukoplakia and malignancy) were collected to develop and test a convolutional neural network (CNN)-based classifier. A comparison between the proposed CNN-based classifier and the clinical visual assessments (CVAs) by 12 otolaryngologists was conducted. RESULTS: In the independent testing dataset, an overall accuracy of 96.24% was achieved; for leukoplakia, benign, malignancy, normal, and vocal nodule, the sensitivity and specificity were 92.8% vs. 98.9%, 97% vs. 99.7%, 89% vs. 99.3%, 99.0% vs. 99.4%, and 97.2% vs. 99.1%, respectively. Furthermore, when compared with CVAs on the randomly selected test dataset, the CNN-based classifier outperformed physicians for most laryngeal conditions, with striking improvements in the ability to distinguish nodules (98% vs. 45%, P < .001), polyps (91% vs. 86%, P < .001), leukoplakia (91% vs. 65%, P < .001), and malignancy (90% vs. 54%, P < .001). CONCLUSIONS: The CNN-based classifier can provide a valuable reference for the diagnosis of laryngeal neoplasms during laryngoscopy, especially for distinguishing benign, precancerous, and cancer lesions. LEVEL OF EVIDENCE: NA Laryngoscope, 130:E686-E693, 2020.

Free posterior tibial artery perforator flap for 2-stage tracheal reconstruction in patients after resection of well-differentiated thyroid carcinoma invading the trachea.

BACKGROUND: The present study was conducted to explore the efficacy of using a free posterior tibial artery perforator flap (FPTAPF) for trachea reconstruction after resection of well-differentiated thyroid carcinoma (WDTC) invading the trachea. METHODS: We retrospectively collected and analyzed clinical and surgical data from 14 patients who underwent tracheal reconstruction using a FPTAPF after resection of WDTC invading the trachea between August 2014 and July 2017. RESULTS: Satisfactory tracheal structure and functional recovery were obtained in 11 of the 14 patients. One patient had breathing difficulties after tracheostomy closure tests because of bilateral recurrent laryngeal nerve damage caused by disease invasion. Tracheostomy incision was not closed in 2 patients because they received postoperative adjuvant radioactive iodine 131 treatment. CONCLUSION: Satisfactory tracheal reconstruction results were achieved in patients with resection of WDTC invading the trachea, indicating that a FPTAPF is a safe and reliable choice for management.

The difference in nasal bacterial microbiome diversity between chronic rhinosinusitis patients with polyps and a control population.

BACKGROUND: Little is known regarding the role of the microbiome of the paranasal sinuses and its contribution to sinus mucosal health and disease. Consequently, we examined the microbiome of chronic rhinosinusitis patients with polyps (CRSwNP) and a control population to provide new insights into the microbiota associated with the pathogenesis of CRSwNP. METHODS: Fifty-nine CRSwNP patients and 27 controls were enrolled in the study. The bacterial communities of the middle meatus were detected using 16S ribosomal RNA (rRNA)-targeted Illumina MiSeq sequencing after microbial DNA was extracted from swabs. RESULTS: Although there was no difference in diversity between the 2 groups, richness was lower in the CRSwNP group than in the control group (p = 0.03). At the phylum level, Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes were predominant in both groups; however, the relative abundance was different, with the proportions of Actinobacteria (predominantly Corynebacterium) and Dolosigranulum being significantly higher in the control group than in the CRSwNP group. CONCLUSION: These results support the theory of microbial dysbiosis as the pathogenesis of CRSwNP. The reduction in the proportions of potentially protective bacteria may decrease the overall stability of the sinonasal bacterial community.

A CARE-compliant article: Lymphangiomatous polyps of the palatine tonsils in a miner: A case report.

RATIONALE: Lymphangiomatous polyps of the palatine tonsils are benign tumors that are rare in both adults and children. Most patients suffering from this disease present with nonspecific symptoms similar to those of chronic tonsillitis. PATIENT CONCERN: We report a case of a 21-year-old male miner who presented with a chronic history of a foreign body sensation in the oropharynx and an intermittently sore throat. DIAGNOSIS: The patient was preoperatively diagnosed with the palatine tonsils neoplasm. INTERVENTIONS: The neoplasm with palatine tonsils was completely resected under general anesthesia. The tissue was sent for histological examination, and the diagnosis was lymphangiomatous polyps of the palatine tonsils. OUTCOME: The surgical outcome was good, and no surgical site infection was recorded. After 12 months of follow-up, the miner was asymptomatic with no recurrence. LESSONS: Tonsillectomy is a curative method to address lymphangiomatous polyps (LAPs) of the tonsils which resulted in no recurrence during the clinical follow-up period. The etiology of this rare disorder and potential pathogenesis should be studied in the future, which would help prevent its occurrence.

Overexpression of B7-H3 as an opportunity for targeted therapy in head and neck cancers.

Head and neck cancers (HNCs) are the sixth most common type of cancer in the world. Despite the development of refined surgical techniques and precise targeted radiation, patients with HNCs have a dismal prognosis. Here, we examine the expression profile of B7-H3 in HNCs and verify whether B7-H3 can serve as a novel therapeutic target for HNCs via anti-B7-H3×CD3 bispecific antibodies (biAbs). We analyzed the expression level of B7-H3 in 274 HNC samples and evaluated the association between B7-H3 expression and clinicopathological parameters. Anti-B7-H3×CD3 biAbs were constructed, and the efficacy of these biAbs in targeting HNCs was assessed in vitro and in vivo. As a result, high expression of B7-H3 was detected in 66.1% of clinical HNC samples and was correlated with poor survival. Specific antitumor effects of anti-B7-H3×CD3 biAbs were confirmed in vitro using HNC cell lines. In xenograft HNC mouse model, anti-B7-H3×CD3 biAbs delayed tumor growth and prolonged survival. In conclusion, B7-H3 is frequently overexpressed in HNCs and could be a promising therapeutic target for biAb therapy.

Curcumol attenuates epithelial-mesenchymal transition of nasopharyngeal carcinoma cells via TGF-ß1.

The current study aimed to identify the effect and primary mechanism of Curcumol on the migration of nasopharyngeal carcinoma (NPC) cells in vitro and in vivo. Curcumol was dissolved in absolute ethyl alcohol and the experiment was performed in NPC 5­8F cells in vitro and in vivo. The effect of different concentrations of Curcumol on cell migration was determined using wound healing and Transwell assays. A cell counting kit­8 (CCK­8) assay was also performed in order to determine cell viability. Flow cytometry was used to detect the effect of Curcumol on apoptosis. The expression of epithelial­mesenchymal transition (EMT)­associated proteins and genes was evaluated by western blotting, reverse transcription­quantitative polymerase chain reaction (RT­qPCR) and ELISA. In addition, the antitumor activity of Curcumol was investigated in female BALB/C nude mice with orthotopic tumor implants. The results indicated that cell apoptosis was increased and the viability of NPC 5­8F cells was decreased following treatment with Curcumol at doses of 0.1, 0.2 and 0.4 µM/ml. The results of in vivo experiments indicated that tumor growth and weight were decreased following Curcumol administration. Furthermore, the results of western blotting and RT­qPCR demonstrated that Curcumol altered the level of E­cadherin and N­cadherin in a dose­dependent manner in vivo. Curcumol also regulated the secretion of protein markers in the serum that were associated with EMT and TGF­ß1 in the 5­8F xenograft mouse model. Thus, the results indicated that Curcumol induced TGF­ß1­mediated EMT arrest by regulating E­cadherin and N­cadherin, which may prevent further development of NPC.

Double-island anterolateral thigh free flap used in reconstruction for salvage surgery for locally recurrent head and neck carcinoma.

Salvage surgery is usually the only treatment for recurrent head and neck tumors but often poses a challenge to surgeons due to post-resected defects at 2 or more sites. Here we present the outcomes and rationale for reconstruction by a double-island anterolateral thigh (ALT) free flap following the salvage surgery.Patients treated with double-island ALT free flaps in salvage surgery between September 2012 and January 2017 at West China Hospital, Sichuan University were retrospectively viewed.A total of 18 patients (15 males) underwent reconstruction with double-island ALT free flaps (range from 40 to 77 years old). All patients had recurrent tumors after surgery and/or chemoradiotherapy and were selected for salvage surgery by a multidisciplinary team. The flaps were initially harvested as 7 cm × 7 cm to 16 cm × 10 cm single blocks and then divided into double-island flaps with each individual paddle ranging from5 cm × 3 cm to 10 cm × 8 cm. The average flap thickness was 3.5 cm (range from 2 to 6 cm), and the average pedicle length was 8 cm (range from 6 to 10 cm). A total of 18 arteries and 32 veins were anastomosed. Three patients developed fistula, 1 developed flap failure due to thrombosis and was re-operated with a pedicle flap. One patient died of pulmonary infection 6 months after the operation.Flap reconstruction for complex head and neck defects after salvage surgery remains challenging, but double-island ALT free flap reconstruction conducted by a multidisciplinary team and experienced surgeons would have a role in this setting.

A CARE-compliant article: Extranasal glial heterotopia in a female infant: A case report.

RATIONALE: Nasal glial heterotopia is a rare type of neoplasm consisting of meningothelial and/or neuroglial elements. PATIENT CONCERNS: A 17-month-old female infant was evaluated for treatment for a congenital mass present since birth on the right side of the nasal dorsum. DIAGNOSES: The patient was preoperatively diagnosed with a congenital extranasal neoplasm. INTERVENTIONS: Surgery was performed under general anesthesia, and the mass was completely resected. The tissue was sent for histological examination, and the diagnosis was of extranasal glial heterotopia. OUTCOMES: The surgical outcome was good, and no surgical site infection was recorded. After 6 months of follow-up, the girl was asymptomatic with no recurrence. LESSONS: Surgical excision, a curative method used to address extranasal glial heterotopia, resulted in no recurrence during the clinical follow-up period. The potential for an intracranial connection must always be kept in mind when considering how to surgically treat a congenital midline mass to prevent the risk of cerebrospinal fluid leakage.