Endoscopic Repair of the Injured Internal Carotid Artery Utilizing Oxidized Regenerated Cellulose and a Free Fascia Lata Graft.

OBJECTIVE: To introduce appropriate surgical procedures for the endoscopic repair of the internal carotid artery (ICA) injury. METHODS: Two patients with ICA injury during the endoscopic endonasal approach surgery were reviewed. RESULTS: Internal carotid artery injury during the endonasal skull-base approach was a rare complication. Once ICA injury occurred, 2 large bore suctions were placed immediately for drainage and the bleeding point was located. Then, an oxidized regenerated cellulose was quickly pressed onto the bleeding point and was held there to stop the bleeding. Afterward, a free graft of fascia lata was inserted and the free fat graft was compressed for repair. Absorbable packing materials were used for nasal packing. CONCLUSIONS: Endoscopic repair utilizing oxidized regenerated cellulose and a free fascia lata graft is a safe and feasible surgical option for ICA injury.

Endonasal Endoscopic Resection and Radiotherapy in Skull Base Chordomas.

OBJECTIVES: This study evaluates the impact combined endonasal endoscopic resection and radiotherapy for skull base chordomas. METHODS: Thirty-two patients with skull base chordomas between July 2006 and June 2015 were divided into 2 groups: the surgery alone group and the surgery with radiation therapy group. RESULTS: Gross total resection was achieved in 9 (28.1%) patients with skull base chordoma, subtotal resection was achieved in 16 (50.0%) patients, and partial resection was achieved in 7 (21.9%) patients. The progression-free survival (PFS) rate at 3 and 5 years was 44.0% and 16.5%, respectively. The overall survival (OS) rate at 3 and 5 years was 79.4% and 69.5%, respectively. Kadish staging predicted PFS and OS with statistical significance when the extent of resection was categorized into gross total resection, subtotal resection, and partial resection (P = 0.035 and P = 0.003, respectively). There was a significant OS advantage for the surgery plus radiation group compared with the surgery alone group (P = 0.035). CONCLUSION: Gross total resection can achieve very good results for the treatment of skull base chordomas. Postoperative adjuvant radiation therapy is recommended for all skull base chordomas, as it offered a higher OS rate.

Extranodal sinonasal Rosai-Dorfman disease: a clinical study of 10 cases.

Sinonasal Rosai-Dorfman disease (S-RDD) is a rare form of RDD limited to the sinonasal cavity. Multipatient studies of Chinese S-RDD and documentation of its clinical spectrum are rare. This study aimed to identify the clinical profiles of Chinese S-RDD. Medical records of and tissue sections from 10 patients diagnosed with S-RDD between 2007 and 2014 were reviewed. Data on clinical presentations, endoscopy signs, imageological change, treatment and outcome were analyzed. The mean age of five male and five female patients at the first visit was 40.3 years and the mean follow-up period was 58.6 months. Based on the lesion sites, five cases were divided into an anterior sinonasal group, accompanied by symptoms of epistaxis, nasal obstruction and nasal dorsal deformity. Five other cases were divided into a posterior sinonasal group, accompanied by symptoms of hyposmia, epistaxis and nasal obstruction. Endoscopy signs and imageological changes in the anterior group showed diffuse infiltration of the RDD lesion under the septum mucosa, but in the posterior group the RDD lesions often showed as formations on polyps. At the end of follow-up, only one case spontaneously resolved without surgery; two cases in the anterior sinonasal group and three cases in the posterior sinonasal group recurred after endoscopic surgery, but surgery can result in short-term symptomatic control and restoration of function in all cases. S-RDD of the anterior and posterior sinonasal cavity may have different clinical characteristics; endoscopic surgery is effective for short-term symptomatic control and restoration of function for S-RDD.

Impact of different surgical and postoperative adjuvant treatment modalities on survival of sinonasal malignant melanoma.

BACKGROUND: The role of postoperative adjuvant treatment for sinonasal malignant melanoma remains unclear. This study evaluates the impact of three different surgical and postoperative adjuvant treatment modalities: surgery alone(open and endoscopic approaches), surgery plus radiotherapy and surgery, radiotherapy plus chemotherapy on survival of patients with primary sinonasal malignant melanoma (SMM). METHODS: The data of 69 patients who underwent primary surgical treatments at Eye & ENT hospital of Fudan University between January 1st, 2000 and December 31st, 2010 were retrospectively reviewed. Survival comparison of different surgical and postoperative adjuvant treatment modalities (surgery alone, surgery plus radiotherapy and surgery, radiotherapy plus chemotherapy), as well as survival comparison between open and endoscopic surgical approaches were performed. Curves depicting survival were performed using Kaplan-Meier method. Statistical analysis was performed using log-rank test software SPSS19 and p < .05 is considered as statistically significant. RESULTS: The median overall survival time was found to be 18 months for surgery alone (27 cases), 32 months for surgery plus radiotherapy (24 cases), 42 months for surgery, radiotherapy plus chemotherapy (18 cases). The 3 and 5 year survival rates for groups mentioned above were 14.8% and 5.6%, 45.1% and 31.6%, 55% and 32.1%, respectively. Statistical significances were found not only between surgery alone and surgery plus radiotherapy treatment group (P = 0.012), but also surgery alone and surgery, radiotherapy plus chemotherapy group (P = 0.002). There was no statistically significant survival difference found between the two different surgical approaches (41 cases for open approach and 28 cases for endoscopic approach). CONCLUSIONS: Sinonasal malignant melanoma is a disease with a poor prognosis. Patients who underwent surgery plus radiotherapy or surgery, radiotherapy plus chemotherapy had better survival outcomes than those underwent surgery alone. Endoscopic approach provided similar survival outcome as an open approach.

Testing homogeneity of stratum effects in stratified paired binary data.

For paired binary data, McNemar's test is widely used to test marginal homogeneity or symmetry for a 2 by 2 contingency table. In this article, we extend McNemar's test by considering a series of paired binary data in which the series is defined by a stratification factor. We provide a test for testing homogeneous stratum effects. For illustration, we apply our test to a cancer epidemiology study. Finally, we conduct simulations to show that our test preserves the nominal type I error level and evaluate the power of our test under various scenarios.

Association of Comorbid Asthma and the Efficacy of Bioabsorbable Steroid-eluting Sinus Stents Implanted After Endoscopic Sinus Surgery in Patients with Chronic Rhinosinusitis with Nasal Polyps.

OBJECTIVE: To identify factors affecting the efficacy of steroid-eluting sinus stents implanted after endoscopic sinus surgery (ESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS: We performed a post-hoc analysis of a randomized self-controlled clinical trial on post-operative implantation of bioabsorbable steroid-eluting stents in patients with CRSwNP. Univariate logistic regression analysis was conducted to identify which of the following factors affect the response to post-operative stent implantation: sex, serum eosinophil levels, history of prior surgery, endoscopic scores, and comorbid conditions (asthma and allergic rhinitis). The primary outcome was the rate of post-operative intervention on day 30, and the secondary outcome was the rate of polypoid tissue formation (grades 2-3) on days 14, 30, and 90. RESULTS: A total of 151 patients with CRSwNP were included in the post-hoc analysis. Asthma was identified as the only risk factor for a poor response to steroid-eluting sinus stents on post-operative day 30, with an odds ratio of 23.71 (95% CI, 2.81, 200.16; P=0.004) for the need for post-operative intervention and 19 (95% CI, 2.20, 164.16; P=0.003) for moderate-to-severe polypoid tissue formation. In addition, the asthmatic group showed higher rates of post-operative intervention and polypoid tissue formation than the non-asthmatic group on post-operative day 30. Blood eosinophil levels were not identified as a risk factor for poor outcomes after stent implantation. CONCLUSION: Comorbid asthma, but not blood eosinophil level, impairs the efficacy of steroid-eluting sinus stents in the short term after ESS in patients with CRSwNP.

Enhanced oxidative stress is associated with tissue neutrophilia and poor steroid response in chronic rhinosinusitis with nasal polyps.

Objective: To analyze the oxidative stress status and its association with tissue neutrophilia and oral steroid response in chronic rhinosinusitis with nasal polyps (CRSwNP) patients. Methods: The levels of total oxidant status (TOS) were detected in the sinonasal tissues by using specific assay kits. Tissue neutrophil was examined by immunohistochemical staining, and oxidant status index (OSI) was evaluated in polyps tissues, and the messenger RNA (mRNA) levels of superoxide dismutase 2 (SOD2), aldehyde dehydrogenase 1 (ALDH1A1), and microsomal glutathione S-transferase 1 (MGST1) were examined using quantitative real-time polymerase chain reaction in the sinonasal tissues. The receiver operating characteristics (ROCs) curve of ALDH1A1, MGST1, and SOD2 mRNA levels were evaluated to determine the steroid response of CRSwNP patients. Results: The levels of TOS and OSI were significantly higher in CRSwNP and CRSsNP than in normal controls, and OSI in polyps tissues was positively associated with tissue neutrophilia and poor steroid response. The ALDH1A1, MGST1, and SOD2 mRNA levels showed comparable accuracy as predictors of poor steroid response indicated by the area under the curve. Conclusion: These findings provided evidence that the increased level of oxidative stress contributes to enhanced tissue neutrophilia and poor steroid response in CRSwNP patients.

Nontraumatic and postirradiated intracavernous carotid hemorrhage: an unusual case of epistaxis and review of the literature.

Intracavernous carotid hemorrhage is a rare cause of epistaxis. We present a case of epistaxis caused by postradiotherapy and nontraumatic cavernous internal carotid artery (ICA) hemorrhage. An 80-year-old man was admitted to our hospital with a one week history of recurrent left-sided epistaxis and a past history of radiotherapy after radical maxillectomy. Emergent angiography revealed a leak in the cavernous segment of the ICA and subsequent detachable balloon occlusion embolization of the left internal carotid artery was performed without sequelae. We conclude that carotid artery hemorrhage must be considered in the differential diagnosis of profuse and recurrent epistaxis, especially for patients after craniofacial radiotherapy. ICA embolization is the definitive treatment provided cross circulation is adequate.

Diagnosis and management of esthesioneuroblastoma.

AIMS: Our purpose was to evaluate the diagnosis and combined modality treatment of esthesioneuroblastoma treated at 1 institution. METHODS: A retrospective analysis of clinical information regarding presentation, immunohistochemical results, treatment and outcome was performed on 21 patients with esthesioneuroblastoma. RESULTS: Two patients had Kadish A, 12 had Kadish B and 7 had Kadish C disease. The mean follow-up was 41.9 months. Immunohistochemical stains were performed in 17 cases, and the tumors were focal positive or showed positive immunoreactivity to neuron-specific enolase (17/17, 100%), synaptophysin (13/17, 76.5%), S-100 protein (8/17, 47.1%), epithelial membrane antigen (5/17, 29.4%), chromogranin A (4/17, 23.5%), vimentin (3/17, 17.6%) and cytokeratin (2/17, 11.8%). Generally, the patients were treated with preoperative radiotherapy (Kadish A and Kadish B) and preoperative chemoradiotherapy (Kadish C) after the initial biopsy, followed by surgery. Surgical approaches (n = 21) consisted of 12 lateral rhinotomies, 5 craniofacial resections, 3 endoscopic sinus surgeries and 1 midfacial degloving approach. The 5-year crude overall survival rate was 76.2%. CONCLUSIONS: Esthesioneuroblastoma is an uncommon malignant tumor. Thorough histological evaluation is the key to correct diagnosis and differentiation. Preoperative radiotherapy or chemoradiotherapy can give surgeons the chance to choose different surgical approaches, especially the endoscopic surgical techniques, in the future.

Localized amyloidosis affecting the lacrimal sac managed by endoscopic surgery: A case report.

BACKGROUND: Here we present a rare case of localized amyloidosis involving the nasolacrimal duct and lacrimal sac which was managed by endoscopic surgery. CASE SUMMARY: A 50-year-old man whose medical history included bilateral ventricular fold and vocal cord amyloidosis complained of bilateral epiphora. Magnetic resonance imaging revealed a neoplasm within the nasolacrimal sac. Characteristic positivity for Congo red staining and birefringence under a polarized microscope proved the diagnosis of amyloidosis. Dacryocystorhinostomy via an endoscope obtained a favorable result. A one-year follow-up found no recurrence. CONCLUSION: There are few reports on amyloidosis involving the lacrimal outflow system, and management and outcome are not clear. Endoscopic dacryocystorhinostomy can be a choice to relieve symptoms. Regular follow-up and monitoring of systemic diseases are highly recommended.

Epithelial­mesenchymal transition in chronic rhinosinusitis (CRS) and the prognostic value of α­SMA in postoperative outcomes of patients with CRS.

Tissue remodeling is the pathological basis of the symptoms encountered in chronic rhinosinusitis (CRS). Epithelial­mesenchymal transition (EMT) may participate in this process. The present study was designed to investigate the involvement of EMT in CRS. In addition, the prognostic value of the EMT biomarker α­smooth muscle actin (α­SMA) was assessed in patients with CRS who underwent endoscopic sinus surgery (ESS). A total of 13 patients with CRS without nasal polyps (CRSsNP), 13 patients with CRS with nasal polyps (CRSwNP) and 13 control subjects were enrolled. The expression of EMT markers was determined in sinonasal specimens by qPCR, western blot and immunofluorescence assays. EMT features were evaluated in primary nasal epithelial cells (NECs) with transforming growth factor (TGF)­ß1 stimulation. The associations were assessed between α­SMA expression and the clinical features of CRS. Epithelial and mesenchymal markers were overexpressed in the sinonasal specimens of both CRSsNP and CRSwNP patients. Alterations in the expression pattern were more apparent in the CRSsNP patients. Following incubation of primary NECs with TGF­ß1, a mesenchymal shape was acquired. In addition, NECs that co­expressed α­SMA and cytokeratin were readily detected and the protein levels of α­SMA were elevated. In contrast to α­SMA, the levels of E­cadherin were decreased. The protein levels of α­SMA were negatively correlated with endoscopic scores and several postoperative symptoms. In conclusion, partial EMT occurred in patients with CRS, notably in CRSsNP patients. Moreover, primary NECs could undergo EMT following TGF­ß1 treatment in vitro. In addition, α­SMA could be considered an efficient predictor for postoperative endoscopic and symptomatic outcomes in patients with CRS treated with ESS.

Endoscopic optic nerve decompression for the treatment of traumatic optic nerve neuropathy.

OBJECTIVE: We aimed to investigate the efficacy of endoscopic optic nerve decompression in patients with traumatic optic neuropathy. METHODS: We performed a retrospective analysis of 46 patients with traumatic optic neuropathy in the Shanghai Eye, Ear, Nose and Throat Hospital between March 2002 and September 2005. All patients were first treated with methylprednisolone for 6 days. Forty-four patients (46 eyes) that did not improve with methylprednisolone treatment were offered endoscopic optic nerve decompression. RESULTS: In 38 eyes with no light perception vision preoperatively, 21 eyes (45.6%) had improvement in visual acuity. These patients had postoperative light perception in 17 eyes, hand movement in 3 eyes and 60/200 in 1 eye. Four of 5 eyes with light perception preoperatively had postoperative vision for hand movement in 2 eyes, finger counting in 1 eye and 20/200 in 1 eye. For 3 eyes with preoperative visual acuity of hand movement, the postoperative visual acuities were 60/200, 60/200 and 120/200. Neither worsening of vision nor major complications was encountered in our series. CONCLUSIONS: We conclude that endoscopic optic nerve decompression in experienced surgeons' hands can improve visual acuity in traumatic optic nerve neuropathy with minimal morbidity. Our results also demonstrate that even patients initially without light perception may benefit from optic nerve decompression.

A novel ultrasonic-assisted method for enhanced yield of light oil in the thermal cracking of residual oil.

In this work, a novel ultrasonic-assisted thermal cracking method for improving the yield of light oil from the thermal cracking of Huizhou atmospheric residue (HAR) is proposed and demonstrated. To achieve this, a self-developed autoclave ultrasonic reactor (20 kHz; 200 W) was designed. Gas chromatography (GC), and elemental analyser (EA) were employed to analyse the composition of gaseous and liquid products after the cracking of residual oil. Compared to the traditional thermal cracking process under similar conditions (430 °C; 8 MPa; 2 h), the ultrasonic-based process produced lower gas products (ca. 0.6%), higher gasoline and diesel fractions (ca. 10%), vacuum residue, and lower yield of coke yield (ca. 4%). In addition, coke produced by the ultrasonic-assisted thermal cracking method exhibited spherical morphology with narrow size distribution and smooth surface with small amounts of adsorbents attached to it. The derivative characteristic peak (101 crystal face) at 2θ of 43.56° belonged to α-graphite. The abnormal high local temperature and pressure conditions produced by ultrasonication were the key factors for the thermal cracking of residual oil. The experimental results indicated that the ultrasonic-assisted thermal cracking can dramatically lead to higher yield of light oil, higher degree of cleavage, and more favourable reactions under the same conditions (as those of traditional thermal cracking). Therefore, compared to the traditional delayed coking process, the proposed ultrasonic-assisted technology can significantly decrease the power consumption. This study has vital significance in predicting and enhancing the performance of thermal cracking on a large scale.

Entities of Chronic and Granulomatous Invasive Fungal Rhinosinusitis: Separate or Not?

BACKGROUND: Chronic and granulomatous invasive fungal rhinosinusitis are important causes of blindness and craniocerebral complications. However, the classification of these 2 diseases remains controversial. METHODS: We retrospectively analyzed patients with chronic and granulomatous invasive fungal rhinosinusitus in a Chinese tertiary hospital from 2009 to 2017, with a focus on classification and comparisons. RESULTS: Among 55 patients enrolled in our study, 11 (11/55, 20%) had granulomatous invasive fungal rhinosinusitis (GIFRS) and 44 (44/55, 80%) had chronic invasive fungal rhinosinusitis (CIFRS). Aspergillus fumigatus and Dematiaceous hyphomycetes were identified in 2 patients with GIFRS. Compared with granulomatous type, CIFRS was more frequently encountered in immunocompromised patients (P = .022), and the time from onset to diagnosis was much shorter (P = .001). Proptosis and orbital apex syndrome showed no significant difference between granulomatous and CIFRS in our study. The treatment options and prognosis of both diseases also showed no significant difference. CONCLUSIONS: Despite the consensus on histopathology, the classification of the chronic and granulomatous types may need further evaluation in clinical considerations.

7-Acetyl-amino-2,4-dimethyl-1,8-naphthyridine.

The air-stable title compound, C(12)H(13)N(3)O, which is of inter-est due to its anti-bacterial properties, is an almost planar mol-ecule in which the ten atoms forming the 1,8-naphthyridine ring have an r.m.s. deviation of 0.03 Šfrom the least-squares plane calculated using the ten atoms. The plane of the acetyl-amino group is slightly inclined [11.7 (2)°] to the plane of the 1,8-naphthyridine ring.

Silver(I) Complexes of Diphenylpyridines: Crystal Structures, Luminescence Studies, Theoretical Insights, and Biological Activities.

A series of simple two-coordinated cationic silver(I) complexes, namely, [Ag{4-(4-R1 -phenyl)-2,6-diphenylpyridine}2 ]X (X=ClO4 - , BF4 - , or SO3 CF3 - ), with different electron-donating or -withdrawing groups (e.g., R1 =N(Me)2 , Me, H, Cl, and Br) on the phenyl ring, were successfully prepared. Extensive characterization of these complexes by various NMR spectroscopy techniques and mass spectrometry was further corroborated by single-crystal XRD analyses. Detailed photophysical investigations of [Ag{4-(4-N,N-dimethylaminophenyl)-2,6-diphenylpyridine}2 ]ClO4 (C1) displayed a strong room-temperature fluorescence in solution with an anomalously high luminescence quantum yield of 0.83. The effects of distinct substituent groups (C2-C5), π-conjugated aromatic rings (C6 and C7), and anions (C8 and C9) on the photoluminescence properties were evaluated. Furthermore, DFT and time-dependent DFT calculations were performed to discern the composition of the excited state, as well as to confirm the obtained relative emission energies upon substitution with electronically different ligands. These results indicated that the strong electron-donating substituent of N,N-dimethylamine played an important role in the unprecedented high luminescence quantum yield of C1. In addition, preliminary antimicrobial studies and confocal microscopy fluorescent imaging of HeLa cells labeled with these complexes reveal their potential applications in biological activities.

Management of nasopharyngeal angiofibroma in a 72-year-old male through a sublabial and buccolabial incision approach: A case report and literature review.

Nasopharyngeal angiofibroma (NA) primarily affects adolescent males. The incidence of NA in the elderly, however, is extremely low. The present study describes a 72-year-old male with NA that presented with typical symptoms and radiological findings. The location and extension of the tumor was too lateral and inferior to be effectively resected by an endoscopic approach. Therefore, a combination of endoscopic and open approaches was considered. The tumor was completely resected using an image-guided endoscopic-assisted sublabial and buccolabial incision approach. The post-operative histopathological and immunohistochemical analysis confirmed the diagnosis of NA. The present study demonstrated the occurrence of NA in the elderly, and highlighted the potential of an image-guided endoscopic-assisted sublabial and buccolabial incision approach for the treatment of NA in the elderly.

Fast onset of action of sublingual immunotherapy in house dust mite-induced allergic rhinitis: a multicenter, randomized, double-blind, placebo-controlled trial.

OBJECTIVES/HYPOTHESIS: To investigate how quickly an allergic rhinitis (AR) patients' symptoms will improve with sublingual immunotherapy (SLIT). STUDY DESIGN: Double-blind placebo study. METHODS: This is a multicenter, randomized, double-blind, placebo-controlled study of SLIT used to treat house dust mite-induced AR. A total of 120 AR patients, aged 4 to 60 years, were treated for 6 months and randomized into two groups: 1) SLIT with Dermatophagoides pteronyssinus (D.p.) and Dermatophagoides farina (D.f.) extract (n = 60) ; and 2) matched placebo controls (n = 60). Symptom, medications received, and a visual analog scale score were recorded during the whole study. Serum-specific IgE and IgG4 to D. p. and D. f. were assessed before and after the treatment. RESULTS: Eighty-five patients (70.8%) completed the study. Twelve patients (20%) chose to withdraw from the SLIT group, but none because of serious adverse effects. The total symptom and visual analog scores VAS in the SLIT group decreased significantly when compared to the placebo controls (P <0.05) after week 14, as well as for the significant (P <0.05) improvement of all individual AR symptoms in the SLIT group (e.g., sneezing, nasal discharge, itching, and nasal obstruction) after week 22. There was a significant (P <0.05) increase of IgG4 to both D.f. and D.p. in the SLIT, but not in the placebo group after treatment. CONCLUSION: SLIT with a mixture of D.f. and D.p. extract is an effective and safe treatment for patients with house dust mite-induced AR. Its onset of action can be observed as early as 14 weeks after treatment.

Endoglin (CD105) expression on microvessel endothelial cells in juvenile nasopharyngeal angiofibroma: tissue microarray analysis and association with prognostic significance.

BACKGROUND: The purpose of this study was to examine endoglin (CD105) expression on microvessel endothelial cells (ECs) in juvenile nasopharyngeal angiofibroma (JNA) and its relationship with recurrence. METHODS: Immunohistochemistry was performed to detect CD105 expression in a tissue microarray from 70 patients with JNA. Correlation between CD105 expression on microvessel ECs and clinicopathological features, as well as tumor recurrence, were analyzed. RESULTS: Immunohistochemistry revealed CD105 expression on ECs but not in stroma of patients with JNA. Chi-square analysis indicated CD105-based microvessel density (MVD) was correlated with JNA recurrence (p = .013). Univariate and multivariate analyses determined that MVD was a significant predictor of time to recurrence (p = .009). The CD105-based MVD was better for predicting disease recurrence (AUROC: 0.673; p = .036) than other clinicopathological features. CONCLUSIONS: MVD is a useful predictor for poor prognosis of patients with JNA after curative resection. Angiogenesis, which may play an important role in the occurrence and development of JNA, is therefore a potential therapeutic target for JNA.