Exosomal MicroRNA-223, MicroRNA-146, and MicroRNA-21 Profiles and Biochemical Changes in Laryngeal Cancer.

Laryngeal squamous cell carcinoma (LSCC) is one of the most aggressive cancers, and its early diagnosis is urgent. Exosomes are believed to have diagnostic significance in cancer. However, the role of serum exosomal microRNAs, miR-223, miR-146, and miR-21, and phosphatase and tensin homologue (PTEN) and hemoglobin subunit delta (HBD) mRNAs in LSCC is unclear. Exosomes were isolated from the blood serum of 10 LSCC patients and 10 healthy controls to perform scanning electron microscopy and liquid chromatography quadrupole time-of-flight mass spectrometry analyses to characterize them and to undergo reverse transcription polymerase chain reaction to identify miR-223, miR-146, miR-21, and PTEN and HBD mRNA expression phenotypes. Biochemical parameters, including serum C-reactive protein (CRP) and vitamin B12, were also obtained. Serum exosomes of 10-140 nm were isolated from LSCC and controls. Serum exosomal miR-223, miR-146, and PTEN were found to be significantly decreased (p < 0.05), in contrast to serum exosomal miRNA-21 (p < 0.01), and serum vitamin B12 and CRP (p < 0.05) were found to be significantly increased, in LSCC vs controls. Our novel data show that the combination of reduced serum exosomal miR-223, miR-146, and miR-21 profiles and biochemical alterations in CRP and vitamin B12 levels may be useful indicators of LSCC that could be validated by large studies. Our findings also suggest a possible negative regulatory effect of miR-21 on PTEN in LSCC, encouraging a more extensive investigation of its role.

Excessive noise levels are noted in kindergarten classrooms in the island of Crete.

Ambient noise in classrooms may present a serious obstacle to the academic achievement of children. There is relatively little information on noise levels in teaching facilities in Greece and particularly in the island of Crete. The purpose of this study was to provide objective data on the internal noise levels inside kindergartens in Crete. The study was conducted in the city of Heraklion in the island of Crete, Greece. Ten kindergartens were selected and a total of 18 classrooms were chosen. Noise levels were measured in occupied and unoccupied classrooms. Noise levels in occupied classrooms ranged from 71.6 to 82.9 dBA with an average of 75.8 dBA. Noise levels in empty classrooms varied from 48.2 to 59.6 dBA with an average of 53.1 dBA. All values are well above international standards. Excessive classroom noise seems to be very common in kindergartens. Results may indicate that school facilities are not built in compliance with international standards. School administrators and local authorities should become aware of the problem, and make any necessary interventions to improve the learning capabilities of children.

Intraoperative recurrent laryngeal nerve monitoring in revision thyroidectomy.

Recurrent laryngeal nerve (RLN) palsy is one of the most important complications after thyroid and parathyroid surgery. There is controversy in the literature regarding whether or not intraoperative nerve monitoring decreases the risk of injury. We report our experience using Nerve Integrity Monitoring (NIM) system in cases of revision thyroidectomy, providing clear indications for its use. A series of 97 patients who underwent revision thyroidectomy with and without intraoperative NIM alternately was evaluated. There were 121 RLN patients at risk. Use of NIM during revision thyroidectomy was not statistically significant compared to revision operation without monitoring (p value = 0.059). Furthermore, comparison of operative times either with or without NIM showed that use of NIM led to statistically significant prolonged operation time (p value <0.001). There is no strict indication to use RLN monitoring during thyroid surgery, especially as there is no statistical evidence that the use of this technique decreases the incidence of RLN palsy, although there is a trend especially in difficult revision cases.

Nasal packing aspiration in a patient with Alzheimer's disease: a rare complication.

Nasal bleeding is a frequent problem for patients receiving anticoagulant agents. Most cases are successfully managed with anterior or posterior nasal packing. However, the complications of nasal packing should be always considered. We report the case of a 78-year-old man with Alzheimer's disease who was treated for anterior epistaxis with anterior nasal packing using three pieces of antibiotic-soaked gauze. Two days later, the patient was admitted to the emergency department in respiratory distress. A chest x-ray demonstrated atelectasis of the right lung. During an examination of the nasal cavities, the nasal packing was removed, and one of the gauze pieces was missing. The patient underwent rigid bronchoscopy, and the missing gauze was found to be obstructing the right main bronchus. The patient's respiratory function improved considerably after removal of the foreign body. It is assumed that gauze packs should be used with caution in patients with an impaired level of consciousness and neurodegenerative diseases.

Investigation of angiogenetic pathways in nasal polyposis.

Tissue angiogenesis is a complex phenomenon that results in the growth of new blood vessels from the microcirculation. This process has been known to play a crucial role in tumor growth as well as several benign diseases. The aim of this study was to assess mRNA expression of various angiogenic factors and chemokines in nasal polyps and compare the results to normal nasal mucosa. mRNA expression was measured using real-time RT-PCR for the following angiogenic factors and chemokines: VEGF, VEGFR-1, Ang-1, Ang-2, Tie-2A, Tie-2B, SDF-1α, SDF-1ß, CXCR4 and YY1. Biopsy specimens from nasal polyps in the polyposis group and middle turbinates in the control group were studied. A total of 18 nasal polyposis patients were studied and compared to 10 control subjects. Results showed VEGF, VEGFR-1, Ang-1, Ang-2, Tie-2A, Tie-2B, SDF-1α and SDF-1ß mRNA expression to be significantly higher in nasal polyposis patients compared to the control group (p<0.05). The findings of this study support the role of angiogenic growth factors in the pathogenesis of nasal polyposis. Further studies are required to confirm these results and evaluate potential clinical implications.

The cochlear implant programme in Crete: a nine year experience.

The aim of this study was to present data of the cochlear implant programme in Crete. Our series consists of 51 patients, 35 adults and 16 children, in a nine year period. The average age of our patients was 31 years (range from three to 68). The average duration of deafness among our patients was seven years (range from two to 22). Our series included 32 postlingual patients and 19 prelingual patients. The cause of deafness in our series was unknown in approximately 40 per cent of cases. Standard selection criteria and operative techniques were used for all cases. Postoperative programming and rehabilitation were performed according to the individual needs of each patient. Implantation was successful in all patients except one who had to undergo a second operation with good results. No major postoperative complications were noted, while minor complications included temporary facial weakness and undesired stimulation of the facial nerve during implant function in two and three patients, respectively. All patients showed significant improvement in perception and discrimination of sound and speech. Better results have been noted in prelingual patients under the age of six, as well as in postlingual adults with a recent history of deafness. As cochlear implant technology evolves and surgical techniques continue to improve, our department will continue its efforts to provide effective hearing rehabilitation of deaf children and adults in Crete.

Microscopic endonasal surgery of nasal and paranasal cavities.

OBJECTIVE: To present the experience of our department on microscopic surgery of the nose and sinuses and compare our results with those of other standard approaches. Furthermore we attempt to specify the main indications for the use of the method. METHODS: During the period between January 1990 and December 2002, the prementioned technique was performed in a total of 250 patients. The preoperative evaluation, surgical technique and postoperative management of all patients are described in detail. RESULTS: Most common diagnoses included nasal polyps and chronic rhinosinusitis. The average age of patients was 42 years. Males accounted for 48%. No major postoperative complications were noted. Minor complications such as epistaxis and midfacial pain were observed in 24% of cases. While the majority of patients reported severe symptomatology preoperatively, 91% reported substantial improvement of their clinical condition within 3 months after surgery. CONCLUSION: Microscopic surgery is a technique which can be used alternatively to traditional procedures. It provides an excellent, clear, stereoscopic vision and allows the surgeon to work bimanually. Complications are rare and easily controlled. Our experience favors the use of microscopic technique compared to common endoscopic approaches, especially in cases of nasal polyps and chronic rhinosinusitis.