Incidence and prognosis of olfactory and gustatory dysfunctions related to SARS-CoV-2 Omicron strain infection in China: A national multicenter survey of 35,566 individuals.

Objective: This cross-sectional study aimed to determine the epidemiology of olfactory and gustatory dysfunctions related to COVID-19 in China. Methods: This study was conducted by 45 tertiary Grade-A hospitals in China. Online and offline questionnaire data were obtained from patients infected with COVID-19 between December 28, 2022, and February 21, 2023. The collected information included basic demographics, medical history, smoking and drinking history, vaccination history, changes in olfactory and gustatory functions before and after infection, and other postinfection symptoms, as well as the duration and improvement status of olfactory and gustatory disorders. Results: Complete questionnaires were obtained from 35,566 subjects. The overall incidence of olfactory and taste dysfunction was 67.75%. Being female or being a cigarette smoker increased the likelihood of developing olfactory and taste dysfunction. Having received four doses of the vaccine or having good oral health or being a alcohol drinker decreased the risk of such dysfunction. Before infection, the average olfactory and taste VAS scores were 8.41 and 8.51, respectively; after infection, they decreased to 3.69 and 4.29 and recovered to 5.83 and 6.55 by the time of the survey. The median duration of dysosmia and dysgeusia was 15 and 12 days, respectively, with 0.5% of patients having symptoms lasting for more than 28 days. The overall self-reported improvement rate was 59.16%. Recovery was higher in males, never smokers, those who received two or three vaccine doses, and those that had never experienced dental health issues, or chronic accompanying symptoms. Conclusions: The incidence of dysosmia and dysgeusia following infection with the SARS-CoV-2 virus is high in China. Incidence and prognosis are influenced by several factors, including sex, SARS-CoV-2 vaccination, history of head-facial trauma, nasal and oral health status, smoking and drinking history, and the persistence of accompanying symptoms.

[Clinical analysis of resection and dura skull base reconstruction of cranionasal communication tumor in 31 cases].

Objective:To explore the methods of resection, dura and skull base repair and reconstruction of cranionasal communication tumor. Methods:Data of 31 patients with cranionasal communication tumor who underwent dura and skull base reconstruction after tumor resection from 2018 to 2022 were collected. Follow-up lasted for 3 to 41 months. Results:A total of 31 patients were enrolled, including 20 males and 11 females. The ages ranged from 19 to 74 years, with a median age of 57 years old. There were 17 benign lesions（one case of hemangioma, one case of Rathke cyst, one case of squamous papilloma, one case of craniopharyngioma, two cases of meningocele, two cases of varus papilloma, two cases of meningioma of grade Ⅰ, three cases of schwannoma, four cases of pituitary tumor） and 14 malignant lesions（one case of osteosarcoma, one case of poorly differentiated carcinoma, two cases of varus papilloma malignancy, two cases of olfactory neuroblastoma, two cases of adenocarcinoma, two cases of adenoid cystic carcinoma, four cases of squamous cell carcinoma） . Sixteen cases underwent nasal endoscopy combined with craniofacial incision and 15 cases underwent nasal endoscopy surgery alone. Complete resection of the mass and dura and skull base reconstruction were performed in all 31 patients, and free graft repair was performed in 8 cases（fascia lata in 5 cases and nasal mucosa in 3 cases）. Twenty-three cases were repaired with pedicled flaps（septal mucosal flap alone in 11 cases, septal mucosal flap combined with free graft in 6 cases, and cap aponeurosis combined with free graft in 6 cases）. Eight out of 31 patients underwent skull base bone repair. Postoperative cerebral hemorrhage occurred in 1 case, cerebrospinal fluid leakage in 1 case, intracranial infection in 2 cases. All patients were successfully treated without severe sequelae. Cerebrospinal fluid leakage and intracranial infection occurred in one patient after radiotherapy, who recovered after conservative treatment. All 17 patients with benign lesions survived. Thirteen out of 14 patients with malignant lesions received radiotherapy after surgery, nine survived without recurrence, five cases recurred, of which 2 survived with tumor, one underwent reoperation and 2 died. Conclusion:Cranionasal communication tumors are high-risk diseases of anterior and middle skull base, and various surgical repair methods could be selected after complete resection of the tumor. Successful reconstruction and multidisciplinary cooperation are crucial for treatment outcome.

Intranasal budesonide for rhinitis during a high airborne pollution period: a randomized controlled trial.

BACKGROUND: Air pollution may induce or reinforce nasal inflammation regardless of allergy status. There is limited direct clinical evidence informing the treatment of airborne pollution-related rhinitis. OBJECTIVE: To assess the effectiveness of intranasal budesonide in adults with self-reported rhinitis symptoms triggered/worsened by airborne pollution. METHODS: Adults in northern China with self-reported rhinitis symptoms triggered or worsened by airborne pollution were randomized to budesonide 256 µg/day or placebo for 10 days in pollution season (October 2019 to February 2020). The primary endpoint was the mean change from baseline in 24-h reflective total nasal symptom score (rTNSS) averaged over 10 days. The secondary endpoints were subject-assessed Global Impression of Change (SGIC), mean change from baseline in individual nasal symptom severity, and mean change from baseline in individual non-nasal symptoms of cough and postnasal drip severity. One-sided P < 0.0125 was considered statistically significant. RESULTS: After an interruption by COVID-19, an interim analysis showed that the study could be ended for efficacy with n = 206 participants (103/group) since the primary efficacy endpoint demonstrated significant results. The final efficacy results showed that the 10-day-averaged rTNSS change in the budesonide group was greater than with placebo (- 2.20 vs - 1.72, P = 0.0107). Budesonide also significantly improved 10-day-averaged itching/sneezing change (- 0.75 vs - 0.51, P = 0.0009). Results for SGIC and all other individual symptoms did not show significant differences between the two groups. CONCLUSIONS: Intranasal budesonide 256 µg once daily improved the total nasal symptoms and itching/sneezing over 10 days in adults with rhinitis triggered/worsened by airborne pollution.

Derivation and validation of a lipid-covered prognostic model for mature T-cell lymphomas.

BACKGROUND: Mature T-cell lymphomas (MTCLs), a group of diseases with high aggressiveness and vulnerable prognosis, lack for the accurate prognostic stratification systems at present. Novel prognostic markers and models are urgently demanded. Aberrant lipid metabolism is closely related to the tumor progression but its prognostic significance in MTCLs remains unexplored. This study aims to investigate the relationship between dysregulated lipid metabolism and survival prognosis of MTCLs and establish a novel and well-performed prognostic scoring system for MTCL patients. METHODS: A total of 173 treatment-naive patients were enrolled in this study. Univariate and multivariate Cox regression analysis were performed to assess the prognostic significance of serum lipid profiles and screen out independent prognostic factors, which constituted a novel prognostic model for MTCLs. The performance of the novel model was assessed in the training and validation cohort, respectively, by examining its calibration, discrimination and clinical utility. RESULTS: Among the 173 included patients, 115 patients (01/2006-12/2016) constituted the training cohort and 58 patients (01/2017-06/2020) formed the validation cohort. Univariate analysis revealed declined total cholesterol (TC, P = 0.000), high-density lipoprotein cholesterol (HDL-C, P = 0.000) and increased triglycerides (TG, P = 0.000) correlated to inferior survival outcomes. Multivariate analysis revealed extranodal involved sites ≥ 2 (hazard ratio [HR]: 2.439; P = 0.036), ß2-MG ≥ 3 mg/L (HR: 4.165; P = 0.003) and TC < 3.58 mmol/L (HR: 3.338; P = 0.000) were independent predictors. Subsequently, a novel prognostic model, EnBC score, was constructed with these three factors. Harrell's C-index of the model in the training and validation cohort was 0.840 (95% CI 0.810-0.870) and 0.882 (95% CI 0.822-0.942), respectively, with well-fitted calibration curves. The model divided patients into four risk groups with distinct OS [median OS: not available (NA) vs. NA vs. 14.0 vs. 4.0 months, P < 0.0001] and PFS (median PFS: 84.0 vs. 19.0 vs. 8.0 vs. 1.5 months, P < 0.0001). Time-dependent receiver operating characteristic curve and decision curve analysis  further revealed that EnBC score provided higher diagnostic capacity and clinical benefit, compared with International Prognostic Index (IPI). CONCLUSION: Firstly, abnormal serum lipid metabolism was demonstrated significantly related to the survival of MTCL patients. Furthermore, a lipid-covered prognostic scoring system was established and performed well in stratifying patients with MTCLs.

Characteristics and prognosis of idiopathic sudden sensorineural hearing loss in aged people: a retrospective study.

Background: Few studies focused on the prognosis of sudden sensorineural hearing loss (ISSHL) of aged people. Objectives: The aim of this study is to analyze the characteristics, treatment, and prognostic factors of ISSHL in aged people. Material and methods: A total of 278 patients diagnosed of ISSHL in aged people from 2014 to 2019 were retrospectively analyzed. Univariates were analyzed by univariate and multivariate logistic analysis. Results: Among the 13 univariates, the patients' age was younger in the overall recovery group ORG (p = .018), while onset days was shorter in ORG (p = .000). The percentage of DM and HTN comorbidities were higher in ORG (p = .026 and .038). Meanwhile differences were significant in audiogram configurations (p = .037), the degree of hearing loss (p = .033), and types of lipid treatment (p = .020). Then these seven independent risk factors were included in the multivariate analysis, final results indicated that hypertension (p = .028), lipid control groups (p = .009), age (p = .000), and onset days (p = .001) were related to the treatment outcome of ISSHL. Conclusions: The prognosis of ISSHL in aged patients was closely related to age, the onset days of treatment, and good control of complications such as hypertension and hyperlipidemia, so vascular factors were considered as the main causes of morbidity.

Intestinal dysbacteriosis potentiates ovalbumin-induced allergic airway inflammation by inhibiting microRNA-130a to upregulate tumor necrosis factor α.

Allergic airway diseases (AAD), including chronic disorders such as allergic rhinitis, are resulted from complicated immunological interactions. Intestinal dysbacteriosis (ID) has been implicated in immune response to respiratory infections. We aimed to investigate the effect of ID on a mouse model of AAD, and the potential molecular factors involved. Ovalbumin (OVA) was employed to sensitize and challenge mice to elicit allergic inflammation in the upper as well as the lower airways. OVA-induced AAD model mice and control mice were raised with or without antibiotics treatment to establish the combinational AAD + ID mouse model. Characteristic symptoms of AAD were evaluated in regard to allergic symptoms, serum OVA specific IgE level, as well as inflammation cells, cytokines and microRNA expression profile in nasal lavage fluid (NALF) and bronchoalveolar lavage fluid (BALF). In AAD mice, ID caused increased nasal rubbing, sneezing, serum OVA specific IgE level and pro-inflammatory cytokine tumor necrosis factor α (TNF-α) in NALF and BALF. ID also inhibited microRNA-130a of AAD mice. Further molecular experiments indicated that microRNA-130a could specifically target and repress TNF-α. ID increases the susceptibility to AAD and allergic inflammatory response, possibly by inhibiting microRNA-130a to upregulate TNF-α.

Treatment of Orbital Complications Following Acute Rhinosinusitis in Children.

BACKGROUND: The orbital complications account for about 80% of all complications secondary to acute rhinosinusitis. If the treatment is not correct and in time, orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications. AIMS: To evaluate the therapeutic efficacy of conservative therapy for the patients with orbital cellulitis and endoscopic sinus surgery (ESS) performed on patients with subperiosteal abscess (SPA) secondary to acute rhinosinusitis in children. STUDY DESIGN: Retrospective cross-sectional study. METHODS: The retrospective study included 31 pediatric patients with orbital complications secondary to acute rhinosinusitis. In all cases, intensive treatment was initiated with a combination of oral or intravenous antibiotics, glucocorticoid and gelomyrtol forte after admission. ESS was performed if an improvement in the condition of patients did not occur after 48 hours. However, the patients with orbital SPA, motility disorders of eyeball or decreased vision received ESS immediately within 24 hours. RESULTS: Sixteen patients were cured by conservative therapy and 15 patients by ESS. All of the signs and symptoms disappeared after conservative therapy or ESS. There were no recurrences within the follow-up period of 1 to 8 years. CONCLUSION: Conservative therapy is an effective method for patients with inflammatory edema and most cases of orbital cellulitis in children. SPA can be cured by ESS.

Dietary Fiber Intake Regulates Intestinal Microflora and Inhibits Ovalbumin-Induced Allergic Airway Inflammation in a Mouse Model.

BACKGROUND: Recently, academic studies suggest that global growth of airway allergic disease has a close association with dietary changes including reduced consumption of fiber. Therefore, appropriate dietary fiber supplementation might be potential to prevent airway allergic disease (AAD). OBJECTIVE: We investigated whether dietary fiber intake suppressed the induction of AAD and tried to elucidate the possible underlying mechanisms. METHODS: The control mice and AAD model mice fed with 4% standard-fiber chow, while low-fiber group of mice fed with a 1.75% low-fiber chow. The two fiber-intervened groups including mice, apart from a standard-fiber diet, were also intragastric (i.g.) administrated daily with poorly fermentable cellulose or readily fermentable pectin (0.4% of daily body weight), respectively. All animals except normal mice were sensitized and challenged with ovalbumin (OVA) to induce airway allergic inflammation. Hallmarks of AAD were examined by histological analysis and ELISA. The variation in intestinal bacterial composition was assessed by qualitative analysis of 16S ribosomal DNA (rDNA) content in fecal samples using real-time PCR. RESULTS: Low-fiber diet aggravated inflammatory response in ovalbumin-induced allergic mice, whereas dietary fiber intake significantly suppressed the allergic responses, attenuated allergic symptoms of nasal rubbing and sneezing, decreased the pathology of eosinophil infiltration and goblet cell metaplasia in the nasal mucosa and lung, inhibited serum OVA-specific IgE levels, and lowered the levels of Th2 cytokines in NALF and BALF, but, increased Th1 (IFN-γ) cytokines. Additionally, dietary fiber intake also increased the proportion of Bacteroidetes and Actinobacteria, and decreased Firmicutes and Proteobacteria. Levels of probiotic bacteria, such as Lactobacillus and Bifidobacterium, were upgraded significantly. CONCLUSION: Long-term deficiency of dietary fiber intake increases the susceptibility to AAD, whereas proper fiber supplementation promotes effectively the balance of Th1/Th2 immunity and then attenuates allergic inflammatory responses significantly, as well as optimizes the structure of intestinal microbiota, which suggests potential for novel preventive and therapeutic intervention.

Is a high-fiber diet able to influence ovalbumin-induced allergic airway inflammation in a mouse model?

BACKGROUND: More recently, a large amount of experimental and clinical discovered that dietary- fiber intake would decrease the susceptibility to allergic airway disease (AAD) and respiratory inflammation. OBJECTIVE: To investigate whether a fiber-intake supplement is able to influence the induction of AAD and to elucidate the interactive relationship. METHODS: AAD model mice and control mice were raised on a fundamental diet with standard 4% fiber content, whereas other mice were fed a 10% fiber-content diet in the high fiber-content group, along with a 25% fiber-content diet instead in very-high fiber-content group. All experimental mice were sensitized and challenged with ovalbumin to induce allergic inflammation in both the upper and lower airways. Hallmarks of AAD were examined in terms of eosinophil infiltration and goblet cell metaplasia in subepithelial mucosa, T-helper type 1 (Th1) to Th2 skewing of the immune response. Furthermore, to elucidate the interrelations, we generated 16S ribosomal DNA from fecal samples and further validated the variation of colony composition in each group. RESULTS: The excessive high-fiber supplement induced a promoting effect rather than a suppressive effect, including a rise in nasal rubbing and sneezing, an increase in eosinophil inflammation and goblet cell metaplasia in subepithelial mucosa, and promoted Th2 skewing of the immune response as well as the production of serum levels of ovalbumin-specific immunoglobulin E. Moreover, overconsumption of dietary fiber greatly altered the construction of bacterial flora in the intestinal tract, including an increased proportion of Firmicutes, Actinobacteria, and Proteobacteria, and a decreased proportion of Bacteroidetes. CONCLUSION: Our work indicated that, instead of a protecting impact, excessive fiber intake preformed a negative influence on the induction of AAD. Therefore, we suspected that an excessive supplement of dietary fiber might not be an advisable method for the prevention and treatment of AADs.

Down-regulation of miR-26b induces cisplatin resistance in nasopharyngeal carcinoma by repressing JAG1.

Therapy against nasopharyngeal carcinoma (NPC) is hurdled by chemoresistance. Recent studies found that microRNA (miRNA) are important regulators of cancer resistance. In this study, we aimed to explore the role and mechanism of miR-26b in regulating NPC cisplatin (CDDP) resistance. Real-time PCR was used to evaluate miR-26b levels in CDDP-resistant and CDDP-sensitive NPC cells, as well as human NPC tissues. MiR-26b was ectopically overexpressed in CDDP-resistant cells, followed by monitoring changes in cell viability and apoptosis. Interaction between JAG1 and miR-26b was characterized by dual-luciferase reporter assay. Furthermore, we investigated whether ectopic JAG1 expression reversed CDDP sensitivity induced by miR-26b overexpression. The effect of FOXD3 down-regulation on miR-26b was also evaluated. Our results indicate that miR-26b was lower in the CDDP-resistant NPC cells, human NPC tissue, particularly in secondary metastases. Ectopic expression of miR-26b sensitized NPC cells to CDDP. JAG1 is a target of miR-26b, and its expression is inversely correlated with miR-26b. Overexpression of JAG1 reversed the CDDP sensitivity induced by miR-26b overexpression. FOXD3 expression was also down-regulated in CDDP-resistant NPC. FOXD3 promoted miR-26b expression and down-regulation of FOXD3 suppressed miR-26b expression. Down-regulation of miR-26b is closely correlated with the CDDP resistance in NPC.

Immunomodulatory effects of Escherichia coli ATCC 25922 on allergic airway inflammation in a mouse model.

BACKGROUND: Hygiene hypothesis demonstrates that the lack of microbial exposure would promote the development of allergic airway disease (AAD). Therefore, the gut microbiota, including Escherichia coli (E. coli), would probably offer a potential strategy for AAD. OBJECTIVE: To investigate whether E. coli infection is able to suppress the induction of AAD and to elucidate the underlying mechanisms. METHODS: Nonpathogenic E. coli ATCC 25922 was infected by gavage before AAD phase in three patterns: 10(8) or 10(6) CFU in neonates or 10(8) CFU in adults. Then mice were sensitized and challenged with ovalbumin (OVA) to induce allergic inflammation in both the upper and lower airways. Hallmarks of AAD, in terms of eosinophil infiltration and goblet cell metaplasia in subepithelial mucosa, Th2 skewing of the immune response, and levels of T regulate cells (Tregs), were examined by histological analysis, ELISA, and flow cytometry, respectively. RESULTS: E. coli, especially neonatally infected with an optimal dose, attenuated allergic responses, including a decrease in nasal rubbing and sneezing, a reduction in eosinophil inflammation and goblet cell metaplasia in subepithelial mucosa, decreased serum levels of OVA-specific IgE, and reduced Th2 (IL-4) cytokines. In contrast, this effect came with an increase of Th1 (IFN-r and IL-2) cytokines, and an enhancement of IL-10-secreting Tregs in paratracheal lymph nodes (PTLN). CONCLUSION: E. coli suppresses allergic responses in mice, probably via a shift from Th1 to Th2 and/or induction of Tregs. Moreover, this infection is age- and dose-dependent, which may open up novel possibilities for new therapeutic interventions.

Superantigen-induced glucocorticoid insensitivity in the recurrence of chronic rhinosinusitis with nasal polyps.

OBJECTIVE: To investigate a potential mechanism by which superantigens could induce glucocorticoid insensitivity in chronic rhinosinusitis (CRS) patients. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary medical center. SUBJECTS AND METHODS: Sinonasal polyps were obtained from CRS patients with nasal polyps (CRSwNP; 20 without recurrence, 18 with recurrent NP followed for 1.5-2.0 years) and nasal mucosa from 16 CRS patients without nasal polyps (CRSsNP). Specimens were tested by enzyme-linked immunosorbent assay for staphylococcal exotoxins (SEs) including SEA, SEB, SEC, SED, and toxic shock syndrome toxin type-1 (TSST-1) and assessed by immunohistochemistry for glucocorticoid receptor (GR) α and ß, and the GRß/GRα ratio was analyzed. RESULTS: In CRSwNP, 13 of 18 (72.22%) subjects with subsequently recurrent NP, 11 of 20 (55.00%) subjects without NP recurrence, and 1 of 16 (6.25%) CRSsNP subjects with positive reactions for SEs were obtained. There were no positive results in controls. The expressions of GRß in 3 CRS groups and controls were significantly different (all P < .05), and a similar increasing tendency of the GRß/GRα ratio was found among groups besides the comparison of CRSwNP versus recurrent NP groups (P = .053). Furthermore, there was a clear trend of increased GRß expression in the enzyme-linked immunosorbent assay (ELISA)-positive samples compared with ELISA-negative samples. Concerning GRα, the expression was enhanced significantly just in toxin-positive recurrent NP versus controls (P = .048), but the relative induction of GRß was much higher, thereby leading to a higher GRß/GRα ratio. CONCLUSIONS: Bacterial superantigens may contribute to glucocorticoid insensitivity through induction of GRß, which appears to be a marker of steroid insensitivity in CRSwNP.

[Clinical effect of orbit fracture reconstruction under nasal endoscope].

OBJECTIVE: To investigate the clinical effect of orbit blowout fracture reconstruction under nasal endoscope. METHODS: Forty-one cases of orbit fracture were reconstructed for lost or damaged orbit under nasal endoscope through maxillary sinus, ethmoidal sinus or the both. RESULTS: Among the 35 cases of orbit blowout fracture, enophthalmos in 33 cases were completely improved, 29 cases were symmetrical to normal eye after operation without diplopia except that 6 cases had slight enophthalmos accompanied with slight diplopia. Among these 6 cases, 4 cases returned to normal without diplopia 6 months after operation. In the 6 cases of orbit non-blowout fracture, 4 cases were symmetrical to normal eye after operation without enophthalmos, diplopia and facial malformation. One case had slight enophthalmos and diplopia, 1 case had slight enophthalmos with slight facial malformation. CONCLUSIONS: The surgery under nasal endoscope is safe and credible. The method can be easily mastered and its complication is less.

[Analysis of the clinical and pathological characteristics of sinonasal neoplasms].

OBJECTIVE: To investigate the clinical and pathological characteristics of sinonasal neoplasms. METHOD: A cohort of 333 patients with sinonasal neoplasm, which were confirmed by surgical pathology, were enrolled in this study. The clinicopathological characteristics, in terms of age, sex, location, and disease constituent ratio were retrospectively reviewed. RESULT: (1) In this series of patients, there were 200 males and 133 females, aged from 2 to 84 years, with a median of 54 years. The benign to malignant ratio was 1.1:1. As for their origination, 144 tumors arose from the nasal cavity, while, 191 tumors derived from sinus, including 90 from maxillary sinus, 31 from frontal sinus, 46 from ethmoid sinus, and 24 from sphenoidal sinus. (2) Disease constituent ratio decreased in order of epithelial tissue, soft tissue, lymphohematopoietic tissue, bone and cartilaginous tissue, ectopic intracranial tumors. The five most frequent malignant tumors were squamous carcinoma, lymphoma, adenoid cystic carcinoma, malignant melanoma and esthesioneuroblastoma, while, benign tumors ranked in the top five were papilloma, fibroma, osteoma, angioma and ectopic intracranial tumors,respectively. (3) Of 200 cases arising from epithelium, 118 were benign, 82 were malignant, and the benign to malignant ratio was 1.4:1. Of 68 cases from soft tissue, 37 were benign and 31 were malignant tumors (ratio, 1.2:1). Among the 22 cases from bone and cartilaginous tissue, 17 were benign and 5 were malignant (ratio, 3.4:1). With respect to the 29 cases from lymphohematopoietic tissue, the majority of tumors were malignant (28 cases), with only one benign case. In addition, ectopic intracranial tumors were also observed. Besides the above all, 12 cases of other types were found in this work. CONCLUSION: Neoplasms from different parts of nasal cavity and paranasal sinus have specific clinical characteristics. The pathological types of these tumors may be highly diverged. The diagnosis and differential diagnosis depend mainly on pathological examination. Comprehensive treatment, which employs surgery in combination with other modalities, is the main strategy for these tumors.

[Establishment and pathophysiological observation of an experimental animal model of traumatic optic neuropathy].

OBJECTIVE: To establish an animal model of traumatic optic neuropathy (TON) that resemble to clinical state and study the mechanical principle and change of pathophysiology of its nerve injury for clinical diagnosis and treatment. METHODS: New Zealand white rabbits were used as the research objects. The method introduced by Wang Yi was repeated and improved. Mild and severe animal models of TON were established by reformed Wang Yi operation separately. After the spring gun struck, all animals were observed on pupils and direct light reflex and received the examinations of pattern reversal visual evoked potentials (PR-VEP). The pathophysiology of normal and injury optic nerve was observed. RESULTS: After recovery from anesthesia, the mydriasis and disappearance or dullness of direct light reflex happened in all injured eyes. No brain contusion, infection, orbital fracture and death were found. One optic nerve was broken with complete tunica vaginalis. The latency and amplitude of injured eyes deteriorated gradually. In group B, the waves became flat rapidly. After injury, the optic nerve underwent 3 stages: edema, hyperplasia and atrophy. The pathomorphological changes of injured eyes in group B were more serious than that in group A in any time. CONCLUSIONS: The reformed operation can establish constant nerve injury with high success rate. In mildly injured eyes, the injury deteriorated gradually. However, part visual function remained. In severely injured eyes, the pathomorphological changes were irreversible sooner after struck, and the visual function lost completely. There is a good correlation between PR-VEP and pathomorphology. PR-VEP can guide the clinical diagnosis and treatment.

[Therapeutic efficacy of combined treatment with surgical decompression and drug for traumatic optic neuropathy].

OBJECTIVE: To evaluate the therapeutic efficacy of combined treatment with surgical decompression and drug for traumatic optic neuropathy (TON) and analyze the influential factors. METHODS: A retrospective study on 69 patients (70 eyes) with TON treated with optic canal decompression through transnasal endoscopic approach and drug was conducted. The visual acuity was divided into 5 grades: no light perception (NLP), light perception (LP), hand move, count finger, > 0.02, marked as I-V respectively. Of 40 eyes with grade I, 18 eyes received emergency operation for severe optic canal fracture confirmed by CT; 22 eyes received corticosteroid therapy firstly and then operation. Of 30 eyes above grade I, 16 eyes with optic canal fracture confirmed by CT received emergency operation; 14 eyes received corticosteroid therapy firstly and 3 days later received operation. Postoperative follow-up lasted 3-12 months to observe the recovery of visual acuity. RESULTS: The therapeutic efficacy of patients with the visual acuity of LP and above LP was better than that of NLP (90.0% to 27.5%), the difference had statistical significance (chi(2) = 26.98, P < 0.001). In operated group, the therapeutic efficacy in patients whose visual acuity was improved from NLP after glucocorticoid therapy (80.0%) was better than that of the patients with no improvement (5.9%), the difference had statistical significance (chi(2) = 12.09, P < 0.001). CONCLUSION: The imaging findings of optic canal fracture can not be used as determinants for operation. The patients with NLP whose visual acuity had no improvement after corticosteroid therapy are poor candidates for surgical decompression. The visual acuity before treatment is the main factor affecting the therapeutic efficacy.

[Clinical research on delayed traumatic epistaxis and pseudoaneurysm].

OBJECTIVE: To explore the diagnosis and treatment of delayed traumatic epistaxis and put forward a concept of arteriola pseudoaneurysmal epistaxis originated from maxillofacial medium-sized artery. METHODS: The clinical data of 53 patients who had the typical symptoms of delayed traumatic epistaxis and received digital subtraction angiography examination and treated in recent 10 years were retrospectively analyzed. RESULTS: Among the 53 patients, 8 patients suffered from interval carotid artery pseudoaneurysm. For these 8 patients, 1 died of massive epistaxis before embolization, 7 received transcatheter arterial embolization( 6 cured and 1 died). Twenty patients suffered from traumatic carotid cavernous fistula, all were cured with endovascular occlusion by detachable balloon. Twenty-five patients suffered from maxillofacial artery hemorrhage. For these 25 patients, 21 were treated by transcatheter arterial embolization with gelatin sponge and coils, 4 by anterior ethmoidal artery ligation. The followed-up ranged from 6-72 months (median 5 years). All patients were successfully treated without serious complications and recurrent hemorrhage, except one patient who had recurred hemorrhage three weeks after transcatheter arterial embolization. This patient was again successfully treated by artery ligation. CONCLUSIONS: Interval carotid artery pseudoaneurysm, carotid cavernous fistula and maxillofacial medium-sized artery and arteriola pseudoaneurysm are the main causes of delayed traumatogenic epistaxis. Early diagnosis by digital subtraction angiography examination and transcatheter arterial embolization or artery ligation are the useful methods to treat delayed traumatic epistaxis and pseudoaneurysm.

[Treatment of cerebrospinal fluid rhinorrhea via transnasal endoscopic approach and its combination with frontal approach].

OBJECTIVE: To summarize the clinical experience in diagnosing and managing cerebrospinal fluid (CSF) rhinorrhea via transnasal endoscopic approach and its combination with frontal approach. METHODS: A retrospective study of 58 patients with CSF rhinorrhea was conducted. Fifty eight cases were all under CT. Fifty six cases underwent surgical treatment Among them, 45 patients were treated with transnasal endoscopic approach, 11 whose cerebrospinal fistulas located in back wall of frontal sinus and orbital-frontal part with fronto-rhinal approach. Two were without any surgical treatment. Among 56 cases who underwent surgical treatment, 31 cases were under normal CT, of which 25 were accurate. Another 25 cases were under thin-section spiral CT scan and three-dimensional reconstruction, of which 23 were accurate. Eight cases locating the fistulas inaccurately by CT found the fistulas by operation. RESULTS: Postoperative follow-up lasted from 6 months to 5 years, a median follow-up period of 3 years. Among 45 cases with transnasal endoscopic approach, 43 were cured after the first attempt, one was cured after the second attempt; one died because of the intracranial infection. Among 11 cases with fronto-rhinal reossification, 10 were cured after the first attempt, one with orbital-frontal absence after the fifth attempt. Two left hospital and lost following-up without any surgical treatment. CONCLUSIONS: Thin-section spiral CT scan and three-dimensional reconstruction make the leak locating more accurate. Combination of frontal approach may deal with transnasal endoscopic surgery's demerit to the unreachable site and enhance the achievement ratio of the first attempt.