Processed Multiparameter Electroencephalogram-Guided General Anesthesia Management Can Reduce Postoperative Delirium Following Carotid Endarterectomy: A Randomized Clinical Trial.

Background: Patients undergoing carotid endarterectomy (CEA) for severe carotid stenosis are vulnerable to postoperative delirium, a complication frequently associated with poor outcome. This study investigated the impact of processed electroencephalogram (EEG)-guided anesthesia management on the incidence of postoperative delirium in patients undergoing CEA. Methods: This single-center, prospective, randomized clinical trial on 255 patients receiving CEA under general anesthesia compared the outcomes of patient state index (PSI) monitoring [SEDLine Brain Function Monitor (Masimo, Inc, Irvine, CA)] (standard group, n = 128) with PSI combined with density spectral array(DSA) -guided monitoring (intervention group, n = 127) to reduce the risk of intraoperative EEG burst suppression. All patients were monitored by continuous transcranial Doppler ultrasound (TCD) and near-infrared spectroscopy (NIRS) to avoid perioperative cerebral hypoperfusion or hyperperfusion. According to the surgical process, EEG suppression time was calculated separately for three stages: S1 (from anesthesia induction to carotid artery clamping), S2 (from clamping to declamping), and S3 (from declamping to the end of surgery). The primary outcome was incidence of postoperative delirium according to the Confusion Assessment Method algorithm during the first 3 days post-surgery, and secondary outcomes were other neurologic complications and length of hospital stay. Results: There were no episodes of cerebral hypoperfusion or hyperperfusion according to TCD and NIRS monitoring in either group during surgery. The incidence of postoperative delirium within 3 days post-surgery was significantly lower in the intervention group than the standard group (7.87 vs. 28.91%, P < 0.01). In the intervention group, the total EEG suppression time and the EEG suppression time during S2 and S3 were shorter (Total, 0 "0" vs. 0 "1.17" min, P = 0.04; S2, 0 "0" vs. 0 "0.1" min, P < 0.01; S3, 0 "0" vs. 0 "0" min, P = 0.02). There were no group differences in incidence of neurologic complications and length of postoperative hospital stay. Conclusion: Processed electroencephalogram-guided general anesthesia management, consisting of PSI combined with DSA monitoring, can significantly reduce the risk of postoperative delirium in patients undergoing CEA. Patients, especially those exhibiting hemodynamic fluctuations or receiving surgical procedures that disrupt cerebral perfusion, may benefit from the monitoring of multiple EEG parameters during surgery. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03622515.

MicroRNA expression in the hippocampal CA1 region under deep hypothermic circulatory arrest.

Using deep hypothermic circulatory arrest, thoracic aorta diseases and complex heart diseases can be subjected to corrective procedures. However, mechanisms underlying brain protection during deep hypothermic circulatory arrest are unclear. After piglet models underwent 60 minutes of deep hypothermic circulatory arrest at 14°C, expression of microRNAs (miRNAs) was analyzed in the hippocampus by microarray. Subsequently, TargetScan 6.2, RNA22 v2.0, miRWalk 2.0, and miRanda were used to predict potential targets, and gene ontology enrichment analysis was carried out to identify functional pathways involved. Quantitative reverse transcription-polymerase chain reaction was conducted to verify miRNA changes. Deep hypothermic circulatory arrest altered the expression of 35 miRNAs. Twenty-two miRNAs were significantly downregulated and thirteen miRNAs were significantly upregulated in the hippocampus after deep hypothermic circulatory arrest. Six out of eight targets among the differentially expressed miRNAs were enriched for neuronal projection (cyclin dependent kinase, CDK16 and SLC1A2), central nervous system development (FOXO3, TYRO3, and SLC1A2), ion transmembrane transporter activity (ATP2B2 and SLC1A2), and interleukin-6 receptor binding (IL6R) - these are the key functional pathways involved in cerebral protection during deep hypothermic circulatory arrest. Quantitative reverse transcription-polymerase chain reaction confirmed the results of microarray analysis. Our experimental results illustrate a new role for transcriptional regulation in deep hypothermic circulatory arrest, and provide significant insight for the development of miRNAs to treat brain injuries. All procedures were approved by the Animal Care Committee of Xuanwu Hospital, Capital Medical University, China on March 1, 2017 (approval No. XW-INI-AD2017-0112).

Multi-center clinical study on the treatment of the low-middle frequency sudden hearing loss / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate and compare the short-term outcome of patients with low-middle frequency sudden deafness treated with alone or combination treatment.</p><p><b>METHODS</b>From August 2007 to October 2011, 205 patients with the diagnosis of low-middle frequency sudden deafness who were from 33 different clinical centers were recruited. All patients were followed up for four weeks from the initial examination. Patients were treated with steroid , Ginaton, batroxobin respectively, or Ginaton and steroid combination treatment.</p><p><b>RESULTS</b>The total effective rate was 90.73%. In Ginaton group, the total effective rate was 87.27%, 89.19% in steroid group, 87.80% in batroxobin group, and 95.83% in Ginaton and steroid group. Considering the total effective rate, there was no statistical difference between four groups (χ(2) = 7.98, P = 0.54). The clinical cure rate for steroid alone was 81.01%, Ginaton alone 76.36%, batroxobin alone 68.29%, and Ginaton and steroid combination treatment 80.56%. There were no clinically significant differences between the different treatments (P > 0.05).</p><p><b>CONCLUSIONS</b>The low-middle frequency sudden deafness tends to have a relatively favorable prognosis. The steroid played a good effect in the treatment. But different treatments either improving the microcirculation of inner ear or alleviating edema blood has undifferentiated results. Therefore the combination therapy may be more effective.</p>

Mechanism of radiosensitization of 3-methyladenine in human hypopharynx cancer cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the radiosensitizing effect and its mechanism of 3-MA in human hypopharynx cancer cells.</p><p><b>METHODS</b>5 mmol/L of 3-MA combined with 2 Gy or 4 Gy of X-ray was utilized to deal with Fadu cells, and the cell livability (cloning efficiency) and DNA lesion severity (tail moment) of each groups was examined by clonogenic survival assay and comet assay, then differences were compared between groups by independent-sample T test. Fadu cells were then treated with different dose of 3-MA (1, 2, 5, 10 mmol/L), the alteration of cell cycle distribution was detected by flow cytometer, and differences among groups were analyzed through one-way analysis of variance. The expression of p62 and cyclinB1 in each group was examined by western blot.</p><p><b>RESULTS</b>The livability and DNA lesion severity of cells treated with 3-MA alone showed no notable variation. Compared with non-3-MA groups, the cloning efficiency of cells treated with 3-MA decreased much more after irradiated with 2 Gy or 4 Gy of X-ray (t = 13.41 or 13.98, P < 0.001), and the cells showed a more serious DNA lesion (t = 7.07 or 6.91, P < 0.001). The G2/M percentages of cells in the control group and groups treated with 1, 2, 5, 10 mmol/L of 3-MA were 17.10 ± 1.20, 23.30 ± 2.3, 39.90 ± 3.12, 58.47 ± 1.65, 76.13 ± 3.51 and differences among groups were statistically significant (F = 278.4, P < 0.05). The expression of p62 in cells treated with 3-MA showed a dose-dependent increase, while cyclinB1 showed a dose-dependent decrease.</p><p><b>CONCLUSIONS</b>The autophagy inhibitor 3-MA could enhance radiosensitivity of human hypopharynx cancer cells by inducing G2/M arrest and enhancing irradiation-induced DNA damage.</p>

A comparison of endoscopy-assisted and conventional partial-superficial parotidectomy / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy.</p><p><b>METHODS</b>38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial parotidectomy. Two short incisions, which were 2 to approximately 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach.</p><p><b>RESULTS</b>The tumors were successfully resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group (P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients (66.6%). Transient facial paralysis happened in 1 case and relieved 1 month later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 to approximately 50 months (mean, 39 months) without relapse.</p><p><b>CONCLUSIONS</b>Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.</p>

Comparative study on gasless endoscopic versus conventional thyroid surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficiency, feasibility and safety of gasless endoscopic thyroid surgery through compared research.</p><p><b>METHODS</b>From July 2001 to Oct. 2005, 83 cases that had received gasless endoscopic thyroid surgery were compared with 80 cases that had received conventional surgery and analyzed on operating time, blood loss, cosmetic effects, complications and costs.</p><p><b>RESULTS</b>Compared with conventional thyroid surgery, endoscopic thyroid surgery group had better cosmetic effects. There was only minimal neck wound or even no neck wound. The cost of hospitalization in the endoscopic group was higher than that in the conventional group (10,844 +/- 2373) RMB and (7585 +/- 1081) RMB respectively (t = -7.23, P < 0.001). The endoscopic group had less blood loss than the conventional group (25 +/- 21) ml and (36 +/- 23) ml respectively (t = 3.160, P < 0.01), but had longer operating time (107 +/- 30) min and(79 +/- 19) min respectively (t = -7.225, P < 0.01). However, when the surgeon had got more experiences and applied the advanced harmonic scalpel, the operative time and blood loss reduced obviously.</p><p><b>CONCLUSIONS</b>Compared with conventional thyroid surgery, gasless endoscopic thyroid surgery has the major advantage that it has cosmetic effect and has small or no scar left on neck. It can be concluded that this technique was efficiency, feasibility and safety. It can offer another choice for the thyroid neoplasms patients.</p>

Repair of pharynx with acellular dermal matrix / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical use of acellular dermal matrix (ADM) in the repair of pharynx.</p><p><b>METHOD</b>From June 2003 to December 2004, 18 cases of laryngopharyngeal carcinoma or oropharyngeal carcinoma accepted treatment of surgery. Four of them had the tumor in the place of posterior wall of laryngopharynx or oropharynx. In the operation, the tumor was resected and the function of larynx was reserved, reconstruction of the posterior wall of laryngopharynx or oropharynx was made with ADM. Three of them had normal function of vocal cords and the tumor was in the place of posterior wall of pharynx and lateral wall of piriform fossa. These patients accepted resection of the tumor and the larynx was reserved. ADM was sutured to the prevertebral fascia to repair the pharynx, reinforcement was made with sternocleidomastoid muscle then. The other 11 patients had the tumor in the pharynx and cervico-esophagus and the vocal cords were fixed. These cases accepted total resection of the larynx and laryngopharynx. ADM was sutured to the prevertebral fascia to repair the posterior wall of laryngopharynx, musculo-cutaneous flap of pectoralis major muscle was made to repair the anterior and lateral walls. All these 18 patients accepted radiotherapy after the operation, the dosage was 60-70 Gy.</p><p><b>RESULTS</b>Among all these 18 cases, no rejection of ADM or formation of pharynx fistula happened after the operation. The allograft became normal mucosa finally. Two patients had subcutaneous infection. After the treatment of dressing change and antibiotics, the wound healing was satisfying. All the 18 patients had resumption of oral diet finally but 3 of them had light mis-swallowing. Seven patients whose larynx were reserved had the trachea cannula pulled out The follow-up periods after the operation lasted 12 months to 30 months. The middle follow-up period was 19. 38 months. Neither rejection nor scar formation of the allograft happened. The follow-up of 11 patients lasted more than 18 months, 3 of them had relapse of tumor. After the second operation 1 patient was still alive and 2 patients died of distant metastasis.</p><p><b>CONCLUSION</b>ADM can be easily obtained. Its histocompatibility were perfect The operative procedure were easy to perform. The complications of donor part can be totally avoided. The combined use of ADM and musculo-cutaneous flap of pectoralis major muscle or other neck tissue was safe and effective in the reconstruction of pharynx.</p>

Analysis of surgical treatment of nasopharyngeal angiofibroma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the individual surgical treatment of nasopharyngeal angiofibroma.</p><p><b>METHODS</b>Between Feb. 1989 and Oct. 2004, different kinds of surgical approaches in 51 patients with angiofibromas were retrospectively analysed. Using Fisch stage: thirty three cases were in stage I and II, 22 cases via palatal approach, 11 cases via endoscopic surgery;18 cases were in stage IIN and IV, 9 cases via lateral rhinotomy approach, 4 cases via midfacial degloving approach + Lefort I approach or modified maxillotomy, 5 cases via craniofacial approach. Twenty three cases accepted the embolization of the artery which feed the tumor, 7 cases in stage IV, 8 cases in stage IlI, 5 cases in stage II, 3 cases in stage I.</p><p><b>RESULTS</b>The average of blood loss was 1010 ml in operation but it became 200 - 870 ml (the average of blood loss was 485 ml) when had a selective preoperative embolization. The blood loss of none selective preoperative embolization was 500 - 3500 ml (the average of blood loss was 1600 ml), t = 7. 48, P < 0.05, the average of blood loss of selective preoperative embolization is less than the average of blood loss of none selective preoperative embolization. After 9 to 48 months of operation (the average time was 26.4 months), 8 cases recurred one time and 2 cases recurred two times.</p><p><b>CONCLUSIONS</b>The preoperative embolization could reduce the amount of bleeding during operation. In patients who are in stage I and II, searching endoscopic surgery could avoid the effect on craniofacial development which traditional surgical procedure did. For patient who are in stage III and IV, midfacial degloving approach and Lefort I approach or modified maxillotomy are not only good for exclusive resection of the tumor but also have less effect on articulation and beautiful cosmetic outlook.</p>