Somalactams A-D: Anti-inflammatory Macrolide Lactams with Unique Ring Systems from an Arctic Actinomycete Strain.

Four new PKS-NRPS-derived macrolide lactams with three unique ring fusion types were discovered from the Arctic sponge associated actinomycete Streptomyces somaliensis 1107 using a genome mining strategy. Their structures were elucidated by a combination of MS, NMR spectroscopic analysis, and single-crystal X-ray diffraction. Biosynthetically, a novel gene cluster sml consisting of three polyketide synthases and one hybrid polyketide synthase-nonribosomal peptide synthetase together with cytochrome P450s and flavin-containing monooxygenases and oxidoreductases was demonstrated to assemble the unique skeleton. Pharmacological studies revealed that compound 1 displayed a potent anti-inflammatory effect without cytotoxicity. It inhibited IL-6 and TNF-α release in the serum of LPS-stimulated RAW264.7 macrophage cells with IC50 values of 5.76 and 0.18 µM, respectively, and modulated the MAPK pathway. Moreover, compound 1 alleviated LPS-induced systemic inflammation in our transgenic fluorescent zebrafish model.

Retrospective analysis of clinical features and prognosis of nasopharyngeal carcinoma in children and adolescents.

Objectives: To investigate the clinical characteristics and prognosis of nasopharyngeal carcinoma (NPC) in children and adolescents in different age groups. Materials and methods: The clinical data of 51 patients with NPC aged ≤ 18 years who were treated in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2012 to May 2017 were retrospectively analyzed. The patients were divided into children group (≤12 years old) and adolescent group (12-18 years old) with 12 years old as the boundary. The clinical characteristics, diagnosis, treatment, and prognosis of the children and adolescent groups were compared. Results: The symptoms of the first diagnosis in the children group were mainly nasal congestion (P = 0.043) and ear symptoms (P = 0.008). The diagnosis rate of nasopharyngeal biopsy in the children group was lower (P = 0.001), while the rate of diagnosis of cervical mass biopsy was significantly higher than that in the adolescent group (P = 0.009). The proportion of keratinizing squamous cell carcinoma of the children group was higher than that of the adolescent group (P = 0.006). There was no significant difference in TNM stage and risk stratification between the two groups, but the number of cases in the III-IVa children group who received induction chemotherapy + concurrent chemoradiotherapy was less than that in the adolescent group (P = 0.013). The proportion of radiotherapy in the upper and lower cervical lymph node drainage areas was lower than that in the adolescent group (P = 0.001). The percentage of recurrence and metastasis in the children group was higher than that in the adolescent group (P = 0.026). Conclusion: The diagnosis in the children group depended on endoscopic biopsy and neck mass biopsy, and the proportion of keratinizing squamous cell carcinoma was higher. The number of cases of induction chemotherapy and concurrent chemoradiotherapy in the children group was less than that in the adolescent group, and the proportion of radiotherapy in the upper and lower cervical lymph node drainage areas was lower than that in the adolescent group. Clinically, it is necessary to improve the understanding of the clinical characteristics of children with NPC and take appropriate treatment strategies.

Retrospective analysis of clinical characteristics and risk factors of differentiated thyroid cancer in children.

Background: The incidence rate of children with thyroid cancer has an increasing trend. This study aimed to investigate the clinical characteristics and therapeutic approaches of differentiated thyroid cancer (DTC) in Chinese children. Materials and methods: From January 1998 to March 2022, 52 cases undergoing surgical resection in Xinhua Hospital affiliated to Shanghai Jiao Tong University were divided by age (≤ 7 years old: n = 14 and 8-13 years old, n = 38). Treatment methods and clinical features were analyzed to evaluate prognostic factors for oncological outcomes. Results: Among the 52 cases, the proportion of local invasion in the pre-school group was found to be higher than that in the school-age group (p = 0.01). T stage was significantly different between the two groups (p ≤ 0.05); the proportion of T1-2 was higher in the school-age group (32 cases, 84.2%), while the proportion of T4 was higher in the pre-school group (6 cases, 42.8%) relatively. The postoperative complication rate was dramatically higher in pre-school children (p ≤ 0.05). Additionally, the total thyroidectomy rate in the non-recurrent group was slightly higher than that in the recurrent group (p ≤ 0.05). Over half of the recurrent cases had low T stage and low ATA (American Thyroid Association) risk levels at initial diagnosis (78.3 and 51.4%). Conclusion: The local invasion, tumor stage, and recurrent laryngeal nerve (RLN) injury rates of the pre-school group were higher than that of the school-age group, where young age served as a potential hazard in DTC children. Hence, surgeons should emphasize high-risk features and optimize individualized surgical procedures for DTC children.

New Spiro-Sesquiterpenoids from the Marine Sponge Myrmekioderma sp.

Three new spiro-sesquiterpenoids, myrmekiones A-C (1-3), were isolated from the marine sponge Myrmekioderma sp. collected from the South China Sea. The structures of 1-3 were experimentally illuminated though comprehensive NMR spectra, X-ray diffraction analysis and calculated ECD. These three compounds possessed a special spiro skeleton. Compound 1 was characterized by a chamigrane-type structure, it is the first time to obtain the single-crystal of this type of oil compounds. 2 and 3 were a pair of diastereoisomers that possessed an acorane skeleton. This study expands the chemical diversity of marine origin spiro-metabolites.

NAD+ attenuates bilirubin-induced augmentation of voltage-gated calcium currents in neurons of the ventral cochlear nucleus.

Nicotinamide adenine dinucleotide (NAD+) is a ubiquitous molecule with wide-ranging roles in several cell processes, such as regulation of calcium homeostasis and protection against cell injuries. However, the roles of NAD+ in neuroprotection is poorly understood. The main neurons in ventral cochlear nucleus (VCN) are highly susceptible to bilirubin-associated excitotoxicity. We investigated the effects of NAD+ on VCN neurons by whole cell patch-clamp recordings. We found that NAD+ effectively reverses and inhibits bilirubin-mediated enhancement of voltage-gated calcium (VGCC) currents in VCN neurons. Moreover, NAD+ itself did not affect VGCC currents. These results collectively suggest that NAD+ may be neuroprotective by attenuating Ca2+ influx to suppress bilirubin-induced intracellular Ca2+ overloads. Our research provides a basis for evaluation of NAD+ as a promising therapeutic target for bilirubin encephalopathy and excitotoxicity associated with other neurological disorders.

Marine-Derived Stichloroside C2 Inhibits Epithelial-Mesenchymal Transition and Induces Apoptosis through the Mitogen-Activated Protein Kinase Signalling Pathway in Triple-Negative Breast Cancer Cells.

Background: Triterpenoid saponins from sea cucumbers exhibit significant antitumour, antifungal, and antibacterial activities. However, the associated molecular mechanisms have yet to be elucidated. In this study, we screened and explored the antitumour activity and underlying mechanisms of triterpenoid saponins isolated from Thelenota ananas. Methods: We isolated and purified sea cucumber saponins, determined their chemical structures, and confirmed their function in vitro. We also screened and explored the antitumour activity and underlying mechanisms of triterpenoid saponins isolated from Thelenota ananas. Results: Four saponins were discovered from sea cucumber Thelenota ananas collected from the South China Sea. We found that stichloroside C2 (STC2) inhibited the proliferation and clonogenesis of the human triple-negative breast cancer (TNBC) cell line MDA-MB-231 and mouse TNBC cell line 4 T1 in a dose-dependent manner and induced apoptosis and cycle arrest in these two TNBC cell lines. STC2 induced DNA damage in two TNBC cell lines and significantly increased the protein expression level of the DNA double-strand break marker γ-H2AX. STC2 downregulated the protein expression levels of phosphorylated cyclin-dependent kinase 1 (CDK1), cyclin B1, CDK2, and cyclin A2 in MDA-MB-231 and 4 T1 cells. STC2 upregulated Bax and cleaved PARP protein expression in two types of breast cancer cells. In addition, STC2 promoted E-cadherin expression; inhibited vimentin expression; upregulated the phosphorylation levels of the mitogen-activated protein kinase (MAPK) signalling pathway-related proteins p38, JNK, and ERK1/2; and downregulated Akt phosphorylation. Conclusions: STC2 exerts anti-TNBC activity, inhibits epithelial-mesenchymal transition (EMT), and induces apoptosis by regulating the cell cycle, EMT-related proteins, and MAPK signalling pathway.

Aromatic Ring Substituted Aaptamine Analogues as Potential Cytotoxic Agents against Extranodal Natural Killer/T-Cell Lymphoma.

A chemical modification study was conducted on the marine natural product aaptamine (1), isolated from the marine sponge Aaptos aaptos. Thirty new derivatives substituted by various aromatic rings at the 3- and 7-positions of aaptamine were prepared by bromination, followed by the Suzuki coupling reaction. Sixteen compounds displayed cytotoxicities to four cancer cell lines (IC50 < 10 µM). In particular, compound 5i demonstrated a significant antiproliferative effect on the extranodal natural killer/T-cell lymphoma (ENKT) cell line SNK-6 with an IC50 value of 0.6 µM. Additionally, compound 5i showed cytotoxicities to multiple lymphoma cell lines, including Ramos, Raji, WSU-DLCL2, and SU-DHL-4 cells.

Sinonasal mucosal melanoma: a 10-year experience of 36 cases in China.

BACKGROUND: Sinonasal mucosal melanoma (SNMM) is a rare tumor with a poor prognosis. This study aimed to assess the clinical and imaging features, progression, treatment, and possible prognostic factors of SNMM. METHODS: Thirty-six patients with SNMM were retrospectively reviewed in the Department of Otolaryngology & Head and Neck Surgery of Xinhua Hospital from January 2008 to December 2017. RESULTS: The age of the first diagnosis was 67.4±10.8 years; the most common clinical symptoms included epistaxis, nasal obstruction, headache, and facial pain. Most tumors originated in the nasal cavity (63.9%) and at stage IV (77.8%). Melanin in melanoma showed typical signal intensity on magnetic resonance imaging (MRI), T1WI had high signal while T2WI had low signal. 41.6% of patients had the typical MRI findings. Treatment included surgery, surgery with radiotherapy, and radiotherapy only. The follow-up time ranged from 4 to 96 months, with a median time of 22 months, 1-, 3-, and 5-year OS is 80.6%, 36.1%, and 13.9%, respectively. The 3-year OS was better in cases in the T3 stage than the T4 stage (P=0.02). However, tumors that originated from the paranasal sinus had a poorer prognosis than the nasal cavity (P=0.04). The cases receiving postoperative radiotherapy showed poorer prognosis (P=0.02). Other factors were not found to be associated with prognosis, including gender, age, lymph node metastasis, distant metastasis, computed tomography (CT) enhancement, and typical MRI findings. CONCLUSIONS: The SNMM was a devastating tumor with poor outcomes; most cases were diagnosed at late stages, which may account for poor prognosis. Tumors with melanin feature MRI findings do not have a better prognosis. The treatment of postoperative radiotherapy is still controversial.

Systematic Elucidation of the Mechanism of Oroxylum indicum via Network Pharmacology.

Oroxylum indicum (O. indicum) is an important traditional Chinese medicine that exerts a wide spectrum of pharmacological activities. However, the pharmacological effect of O. indicum and its mechanism of action have not to be systematically elucidated yet. In this study, the druggability for active compounds of O. indicum was assessed via Traditional Chinese Medicine Systems Pharmacology Database (TCMSP), and the potential drug targets of O. indicum were identified using PharmMapper database. Additionally, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed via WebGestalt. Drug-target-pathway networks were constructed using Cytoscape to give a visual view. Our findings revealed that O. indicum has extremely superb druggability with 41 putative identified target genes. GO, KEGG, and network analyses showed that these targets were associated with inflammatory immunoreactions, cancer, and other biological processes. In summary, O. indicum is predicted to target multiple genes/proteins and pathways that shape a network which can exert systematic pharmacological effects.

Aaptolines A and B, Two New Quinoline Alkaloids from the Marine Sponge Aaptos aaptos.

Two new quinoline alkaloids, aaptolines A and B, were isolated from the marine sponge Aaptos aaptos. Their structures were determined by HR-ESI-MS data, NMR analysis, and X-ray crystallography. Structurally, aaptoline A is characterized as having a quinoline skeleton fused with a 1,4-dioxane motif at the C(7)-C(8) position, whereas aaptoline B possessed an intriguing 1H-pyrrolo[2,3-g]quinoline moiety. The cytotoxic assay of these compounds showed no cytotoxicity towards HepG2, A549, and PC9 cancer cell lines and had IC50 values greater than 20 µm.

Increased Type I and Decreased Type II Hair Cells after Deletion of Sox2 in the Developing Mouse Utricle.

The vestibular system of the inner ear contains Type I and Type II hair cells (HCs) generated from sensory progenitor cells; however, little is known about how the HC subtypes are formed. Sox2 (encoding SRY-box 2) is expressed in Type II, but not in Type I, HCs. The present study aimed to investigate the role of SOX2 in cell fate determination in Type I vs. Type II HCs. First, we confirmed that Type I HCs developed from Sox2-expressing cells through lineage tracing of Sox2-positive cells using a CAG-tdTomato reporter mouse crossed with a Sox2-CreER mouse. Then, Sox2 loss of function was induced in HCs, using Sox2flox transgenic mice crossed with a Gfi1-Cre driver mouse. Knockout of Sox2 in HCs increased the number of Type I HCs and decreased the number of Type II HCs, while the total number of HCs and Sox2-positive supporting cells did not change. In addition, the effect of Sox2-knockout persisted into adulthood, resulting in an increased number of Type I HCs. These results demonstrate that SOX2 plays a critical role in the determination of Type II vs. Type I HC fate. The results suggested that Sox2 is a potential target for generating Type I HCs, which may be important for regenerative strategies for balance disorders.

Increasing the expression level of ChR2 enhances the optogenetic excitability of cochlear neurons.

Optogenetics comprise a promising alternative to electrical stimulation for characterization of neural circuits and for the next generation of neural prostheses. Optogenetic stimulation relies on expression of photosensitive microbial proteins in animal cells to initiate a flow of ions into the cells in response to visible light. Here, we generated a novel transgenic mouse model in which we studied the optogenetic activation of spiral ganglion neurons, the primary afferent neurons of the auditory system, and showed a strong optogenetic response, with a similar amplitude as the acoustically evoked response. A twofold increase in the level of channelrhodopsin expression significantly increased the photosensitivity at both the single cell and organismal levels but also partially compromised the native electrophysiological properties of the neurons. The importance of channelrhodopsin expression level to optogenetic stimulation, revealed by these quantitative measurements, will be significant for the characterization of neural circuitry and for the use of optogenetics in neural prostheses.NEW & NOTEWORTHY This study reveals a dose-response relationship between channelrhodopsin expression and optogenetic excitation. Both single cell and organismal responses depend on the expression level of the heterologous protein. Expression level of the opsin is thus an important variable in determining the outcome of an optogenetic experiment. These results are key to the implementation of neural prostheses based on optogenetics, such as next generation cochlear implants, which would use light to elicit a neural response to sound.

Comparison of differentiated thyroid carcinoma recurrence and its clinical features in children of different ages.

The prevalence of differentiated thyroid carcinoma (DTC) in children is increasing. However, the clinical features and recurrence of DTC in children in different age groups, especially those less than 14 years old, are not well studied. We retrospectively investigated 73 children diagnosed with DTC in our hospital between January 1998 and July 2014. Data were reviewed for different age groups based on the age at initial diagnosis: 5-9, 10-14, or 15-19 years. The mean age of the recurrence group (10.6±4.1 years) was lower than that of the non-recurrence group (12.6±6.2 years; P=0.004). The main symptom at initial diagnosis was local invasion in the recurrence group, but was thyroid nodules in the non-recurrence group (P<0.001). The recurrence and non-recurrence groups did not differ in TNM stage or risk level. However, according to our age classification, the American Thyroid Association pediatric risk level was significantly different in three age groups (P=0.024). The DTC recurrence rate in each age group decreased as the age of the children increased (P=0.011). Thus, a high risk of recurrence and a high proportion of local invasion cases were observed in the youngest age group, suggesting that younger age is an important risk factor for DTC recurrence in children.

The relationship between allergic status and adenotonsillar regrowth: a retrospective research on children after adenotonsillectomy.

Adenotonsillar regrowth in children after adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) is often seen in clinical treatment, however, the relationship between allergic disease and adenotonsillar regrowth remains unclear. In this retrospective study, children were assigned to either the recurrence or control group, and subdivided by age at operation. Among children over 36 months, those in the recurrence group had more allergic disease and higher IgE, IL-4, and IL-5 levels than the same-aged children in control group. The Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores for nasal symptoms and activity were higher in children older than 36 months in recurrence group. The results of immunohistochemistry and immunofluorescence showed that FoxP3+ cells (Tregs) were less, while GATA3+ cells (Th2 cells) were more in recurrence group for all ages. Allergic status and low levels of FoxP3 were proved as independent risk factors for adenotonsillar regrowth by multivariate logistic regression. These results indicate that allergic disease is a risk factor for adenotonsillar regrowth in children following T&A for OSA, and this risk increases with age. The decreased level of Tregs and subsequent changes in immune function play an important role in the pathogenesis of adenotonsillar regrowth.

Diphtheria Toxin-Induced Cell Death Triggers Wnt-Dependent Hair Cell Regeneration in Neonatal Mice.

UNLABELLED: Cochlear hair cells (HCs), the sensory cells that respond to sound, do not regenerate after damage in adult mammals, and their loss is a major cause of deafness. Here we show that HC regeneration in newborn mouse ears occurred spontaneously when the original cells were ablated by treatment with diphtheria toxin (DT) in ears that had been engineered to overexpress the DT receptor, but was not detectable when HCs were ablated in vivo by the aminoglycoside antibiotic neomycin. A variety of Wnts (Wnt1, Wnt2, Wnt2b, Wnt4, Wnt5a, Wnt7b, Wnt9a, Wnt9b, and Wnt11) and Wnt pathway component Krm2 were upregulated after DT damage. Nuclear ß-catenin was upregulated in HCs and supporting cells of the DT-damaged cochlea. Pharmacological inhibition of Wnt decreased spontaneous regeneration, confirming a role of Wnt signaling in HC regeneration. Inhibition of Notch signaling further potentiated supporting cell proliferation and HC differentiation that occurred spontaneously. The absence of new HCs in the neomycin ears was correlated to less robust Wnt pathway activation, but the ears subjected to neomycin treatment nonetheless showed increased cell division and HC differentiation after subsequent forced upregulation of ß-catenin. These studies suggest, first, that Wnt signaling plays a key role in regeneration, and, second, that the outcome of a regenerative response to damage in the newborn cochlea is determined by reaching a threshold level of Wnt signaling rather than its complete absence or presence. SIGNIFICANCE STATEMENT: Sensory HCs of the inner ear do not regenerate in the adult, and their loss is a major cause of deafness. We found that HCs regenerated spontaneously in the newborn mouse after diphtheria toxin (DT)-induced, but not neomycin-induced, HC death. Regeneration depended on activation of Wnt signaling, and regeneration in DT-treated ears correlated to a higher level of Wnt activation than occurred in nonregenerating neomycin-treated ears. This is significant because insufficient regeneration caused by a failure to reach a threshold level of signaling, if true in the adult, has the potential to be exploited for development of clinical approaches for the treatment of deafness caused by HC loss.

Basal cell adenoma of the parotid gland: clinical and pathological findings in 29 cases.

OBJECTIVE: To determine the clinical and pathological features of basal cell adenoma (BCA) of the parotid gland. METHODS: This is a retrospective study of 29 parotid BCAs in 28 patients who underwent surgery at the Department of Otolaryngology Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, between October 2000 and June 2013. The tumors were categorized according to their location in the parotid gland as superior superficial lobe, inferior superficial lobe and deep lobe. RESULTS: The mean age was 57.0 years (range, 32-83 years). The clinical manifestations of parotid BCAs were consistent with those of other benign parotid tumors. There were no significant differences in age, average disease duration and tumor size among the three tumor groups. There were 11 deep tumors (11/29, 37.9%), and five of them exhibited cystic degeneration (5/11, 45.5%). A total of 15 patients underwent FNAB examination, and the results were positive in seven patients (7/15, 46.7%). Mild facial nerve function impairment occurred in five patients (House-Brackmann grade II), of whom, three had recovered by the 6-month follow-up. No cases of local recurrence or malignant transformation were observed during follow-up. CONCLUSION: The clinical features of BCA are consistent with those of other benign tumors. The deep lobe of the parotid gland is more likely to develop BCAs, and thus, this diagnosis should be considered in patients with deep-lobe tumors, especially when accompanied with cystic degeneration. FNAB can increase the rate of preoperative diagnoses.

Comparison between hearing screening-detected cases and sporadic cases of delayed-onset hearing loss in preschool-age children.

OBJECTIVE: This study aimed to compare the diagnosis and ages of intervention for cases of delayed-onset hearing loss identified sporadically or via a preschool hearing screening program. DESIGN: Retrospective study with the comparative analysis of two groups of children. STUDY SAMPLE: Cases identified from screening were selected from 34 321 preschool children who underwent screening for delayed-onset hearing loss between October 2009 and May 2011. Sporadic cases of delayed-onset hearing loss were selected from pediatric clinical records. Cases from the first group were excluded from the latter to avoid duplication. Two groups were given the same questionnaire to record risk indicators, diagnosis, and age at intervention. RESULTS: The average age of 26 children at the time of diagnosis in the screening group (52.81 ± 13.23 months) was significantly earlier than in the 33 cases identified in the sporadic group (62.03 ± 12.86 months; p < 0.05). The age at intervention of children with bilateral moderate to severe hearing loss in the screening group (50.40 ± 10.76 months) was also earlier than in the sporadic group (62.73 ± 13.77 months; p < 0.05). CONCLUSIONS: Improved rates of early diagnosis could therefore be achieved with hearing screening for preschool children with no significant symptoms of delayed-onset hearing loss.

A new hearing screening system for preschool children.

OBJECTIVES: This study aimed to investigate the practical application of Smart Hearing, a new hearing screening system for preschool children. METHODS: The screening system was applied to 6288 preschool children. The system auto-tested hearing thresholds at three frequencies: 1kHz, 2kHz, and 4kHz; a 30dB hearing level (HL) was the critical intensity for passing. Children with positive results were referred for audiological evaluation (pure tone audiometry, tympanometry and distortion product otoacoustic emissions assessment, etc.). To evaluate the test accuracy, 312 children (5%) were randomly selected to receive audiology assessment. RESULTS: In this study, 582 children (9.3%) tested positive in the screening, and the referral rate of the four age groups from 3 to 6 years old was 18.8%, 11.9%, 6.5% and 4.0%, respectively. A total of 463 children underwent audiological assessment, of which 12 cases (1.91‰; 95% CI: 0.83‰, 2.99‰) were diagnosed with permanent hearing loss, and 75 cases (1.19%; 95% CI: 0.92%, 1.46%) were diagnosed with temporary conductive hearing loss. No mixed hearing loss was found in this study. The specificity of the system was 92.6% and the sensitivity was only 37.5%. CONCLUSIONS: This screening system is suitable for the universal hearing screening of preschool children above 4 years old, and further improvements of the system are needed to increase its sensitivity.

Microdebrider removal under suspension laryngoscopy: an alternative surgical technique for subglottic hemangioma.

OBJECTIVE: To describe microdebrider removal of subglottic hemangiomas and evaluate the efficacy of this procedure. METHODS: This retrospective study was conducted at an otorhinolaryngology department. Seven consecutive patients with subglottic hemangiomas who failed to respond to pharmacologic treatment were treated by microdebrider removal under suspension laryngoscopy. Respiratory symptoms and hemangioma status were assessed preoperatively and postoperatively. RESULTS: The mean age of patients at disease onset was 68 days (range, 24-120 days), and their mean age at the time of surgical treatment was 132 days (range, 55-195 days). Their initial pharmacologic treatment included steroids, propranolol, and/or antibiotics. The mean percentage of airway obstruction was initially 36% (range, 30-50%), and this value changed to 61% (50-80) before surgery. Microdebrider removal of hemangiomas was successful in all patients without any intraoperative or postoperative complication. The mean operative time was 30 min (range, 21-47 min). Three patients required orotracheal intubation for 12 or 24h after surgery, and no reintubation or tracheotomy was required in this series. Symptoms such as stridor and inspiratory retraction were resolved approximately 72 h after surgery, but wheezing was generally resolved at a later time point. One year later, no respiratory symptom was noted in these patients, and endoscopic examination revealed a sufficient glottis opening. CONCLUSIONS: Surgical removal with a microdebrider is advantageous as a routine surgical technique for small and moderate pediatric subglottic hemangioma.

[Facial nerve function and hearing preservation experience in middle fossa approach removal of small acoustic tumor surgery].

OBJECTIVE: The aim of this study was to investigate the hearing and facial nerve preservation in the middle fossa approach surgery for the removal of small acoustic tumor (vestibular schwannomas, VS). METHODS: A prospective database was established, and data were retrospectively reviewed. Between January 2004 and February 2013, 13 patients with acoustic tumor underwent surgery via middle fossa approach for hearing preservation. The patients consisted of six men and seven women with a mean age of 48 years. Tumor size ranged from 0.8 cm to 1.5 cm. Hearing loss was categorized as American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) class A, class B, class C and class D. Facial nerve function was evaluated according to House-Brackmann (HB) Grade I-VI. RESULTS: Gross-total resection was accomplished in 12 of 13 patients. Preoperative hearing as class A in ten, class B in two, and class C in one patient respectively. Postoperatively, hearing was graded as class A in eight patients, class B in 3, and class C in 2 patients. Facial nerve function was House-Brackmann (HB) grade I in twelve patients, grade II in one patient preoperatively. Postoperatively, facial nerve function was HB Grade I in twelve patients and Grade III in one patient. The overall hearing preservation rate was at least 80% (8/10) and HB Grade I facial nerve outcome of 100% (12/12) . All cases were followed up for 0.5 to 5 years, no complications were observed. CONCLUSIONS: The middle fossa approach for the resection of small VS with hearing preservation is a viable and relatively option. It should be considered among the various options available for the management of small and growing VS.