The endoscopic transnasal approach in management of the sinonasal tumor invading the anterior skull base / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the feasibility of the endoscopic transnasal approach (ETA) and to analyze the outcomes and factors of this surgical technique in the management of the tumor invading the anterior skull base. Methods: A retrospective analysis was performed on 42 patients (31 males and 11 females, with mean age of 49 years) with sinonasal tumor invading the anterior skull base, who underwent ETA from June 2015 to April 2019 in Eye, Ear, Nose and Throat Hospital of Fudan University. Pathologically, there were 15 cases of squamous carcinoma (14 patients with T4bN0M0 and 1 patient with T4bN1M0) and 27 of olfactory neuroblastomas with Kadish stage C. Anterior skull base reconstruction was performed using the vascular pedicled nasoseptal mucoperiosteal flap and fascia lata. Brain non-contrast-enhanced CT was performed on the first postoperative day to exclude massive pneumocephalus, relevant brain edema and subarachnoid hemorrhage. Sinonasal contrast-enhanced MR was performed to assess the extent of the tumor removal. Kaplan-Meier analysis was used to calculate the overall survival (OS) and Cox multivariate regression analysis was used to determine the prognostic factors. Results: The mean duration of the surgery was 452 minutes. Total resection was performed in 36 patients (85.7%), subtotal resection in 2 patients (4.8%) with orbital involvement, partial resection in one patient (2.4%) with injury of the internal carotid artery. One patient (2.4%) underwent the second resection because of the tumor residual, two patients (4.8%) with unsure tumor residual. Mean follow-up was 20 months, with 17 months of median follow-up. One-, two-and three-year overall survival was 86.5%, 76.9% and 64.5%, respectively. For squamous carcinoma, one-, two-and three-year overall survival was 86.2%, 86.2% and 57.4%, respectively. For olfactory neuroblastomas, One-, two-and three-year overall survival was 86.9%, 75.3% and 67.8%, respectively. Multivariate analysis showed that tumor residual (P=0.001) and recurrence (P<0.01) were independent prognostic factors for survival. Conclusions: The ETA is safe and feasible in selected patients with sinonasal tumor invading the anterior skull base. Tumor residual and recurrence are independent prognostic factors for survival.

Comparison of functional parameters of small airways between patients with typical asthma and cough-variant asthma / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the functional parameters of the small airways and clinical characteristics between patients with typical asthma (TA) and cough-variant asthma (CVA).</p><p><b>METHODS</b>Forty-three newly diagnosed asthmatic patients were enrolled, including 15 with TA and positive bronchial provocation test [TA BPT(+)], 12 with TA and positive bronchial dilation test [TA BDT(+)] and 16 with CVA, and 27 healthy subjects served as the control group. All the subjects were required to complete data acquisition, asthma control test, asthma control test scale, fractional exhaled nitric oxide, airway resistance and pulmonary function tests, BPT or BDT.</p><p><b>RESULTS</b>The interval from onset to a definite diagnosis of TA BDT(+) was longer than that of TA BPT(+), while that of CVA was the shortest (P=0.022). The pulmonary functional parameters of TA BDT (+) was significantly lower than those of the other 3 groups (P<0.05). MMEF, MEF, MEF, and MEFin patients with TA BDT(+), TA BPT(+) and CVA were significantly lower than those in the control group (P<0.01). The resonant frequency, respiratory impedance, resistance at 5 Hz, resistance at 20 Hz, and reactance at 5 Hz were significant higher in patients with TA BDT (+) than in the control subjects, while these parameters showed no significant differences among TA BPT (+), CVA and control groups. The airway resistance in TA BPT(+), CVA, and control groups increased after BPT, and the patients with TA BPT(+) showed greater changes in airway resistance than those in CVA and control groups. In CVA patients, FeNO showed a strong positive correlation with respiratory impedance (r=0.523, P=0.038), resistance at 5 Hz (r=0.542, P=0.030), and resistance at 20 Hz (r=0.524, P=0.037), and the airway responsiveness showed a strong positive correlation with resistance at 20 Hz (Rho=-0.512, P=0.043).</p><p><b>CONCLUSION</b>CVA is the early stage of TA, and CVA, TA BPT(+), and TA BDT(+) may represent different stages of asthma. Uncontrolled, prolonged CVA may evolve into TA BPT (+), whose further progression can cause damages of the pulmonary function and small airway function and leads eventually to TA BDT (+).</p>

Dexamethasone decreases IL-29 expression in house dust mite-stimulated human bronchial epithelial cells / 华中科技大学学报（医学）（英德文版）

The aim of this study was to explore the effect of IL-29 on the progression of airway allergic disease by detecting the level of IL-29 in airway allergic cell models stimulated by house dust mite (HDM) in the presence or absence of dexamethasone (DEX). The same batch of human bronchial epithelial cells in exponential growth phase was randomly divided into five groups: blank group (A), 300 ng/mL HDM group (B), 1000 ng/mL HDM group (C), 3000 ng/mL HDM group (D), and 300 ng/mL HDM+100 ng/mL DEX group (E). The IL-29 mRNA expression was detected by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The IL-29 protein expression in cell suspension was detected by ELISA. The results showed that after stimulation with HDM for 24 h, the expression of IL-29 was increased significantly, and after co-stimulation with HDM and DEX for 24 h, the expression of IL-29 in group E was significantly lower than that in the groups stimulated by HDM alone but higher than that in the group A. The differences between the different groups were significant (F=132.957, P<0.01). Additionally, the higher the concentration of HDM was, the more significant the increase in the IL-29 expression was. In conclusion, IL-29 may play a role in the progression of airway allergic disease including asthma.

Invasive airway aspergillosis in immunocompetent host: a case report

Invasive airway aspergillosis [IAA] is a rarely reported type of invasive pulmonary aspergillosis [IPA]. In most patients, IAA is associated with immune dysfunction or other underlying diseases. It is very rare in patients with normal immune function and without pre-existing diseases. We describe here, a previously healthy 58-year-old male farmer who presented to our department with cough and bloody sputum associated with shortness of breath and who was diagnosed with IAA despite having no apparent immunodeficiency

Effect of polyI: C on secretion of thymic stromal lymphopoietin and airway inflammation in mice with respiratory syncytial virus-induced asthma exacerbation / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of polyinosinic-polycytidylic acid (polyI:C) on the production of thymic stromal lymphopoietin (TSLP) and airway inflammation in mice with exacerbated asthma induced by respiratory syncytial virus (RSV).</p><p><b>METHODS</b>Thirty-two female BALB/c mice were randomly divided into 4 groups, namely the PBS control group, OVA group, OVA/RSV group, and OVA/RSV/polyI:C group. In the latter 3 groups, the mice were sensitized by OVA and stimulated with nebulized OVA. RSV was inoculated into the nasal cavity of the sensitized mice and polyI:C (1 mg/kg) was intramuscularly administered. The airway response to metacholine was examined, and the serum levels of IL-4, IL-5, IL-13, and IFN-γ and TSLP in the supernatants of bronchoalveolar lavage fluid (BALF) were detected using ELISA. The total BALF cells, eosinophils, lymphocytes and neutrophils were counted. The lung specimens were collected to observe the inflammation with HE staining, and immunohistochemistry was employed to determine TSLP production in the airway epithelial cells.</p><p><b>RESULTS</b>The mice in RSV/OVA/polyI:C group showed a significantly lower airway responsiveness to metacholine than those in OVA/RSV group (P<0.01). Compared with OVA/RSV group, RSV/OVA/polyI:C group showed significantly lower serum levels of IL-4, IL-5, IL-13 and TSLP in BALF (P<0.05), with also lower total BALF cells, eosinophils and lymphocytes (P<0.05) and lessened infiltration of the airway inflammatory cells. Immunohistochemistry of TSLP also demonstrated a lower production of TSLP in the airway epithelial cells in RSV/OVA/polyI:C group than in OVA/RSV group.</p><p><b>CONCLUSIONS</b>polyI:C can inhibit the increase in TSLP production in the airway epithelial cells after RSV infection and relieve airway inflammation in mice with RSV-induced asthma exacerbation.</p>

Effects of different factors on the expression of thymic stromal lymphopoietin in respiratory syncytial virus-infected human airway epithelial cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effects of different factors on the expressions of thymic stromal lymphopoietin (TSLP) in respiratory syncytial virus (RSV)-infected human airway epithelial cell line 16HBE cells.</p><p><b>METHODS</b>RSV amplified by infecting Hep-2 cells was identified for its virulence. 16HBE cells were divided into six groups, namely the control group, RSV group, RSV/anti-TLR3 group, RSV/IFN-gamma group, RSV/IL-4 group and RSV/dexamethasone group with corresponding treatments. Real-time RT-PCR was used to examine the expression of TSLP mRNA in the cells 6 h after RSV infection. Western blotting was used to examine TSLP protein expression in the cells 24 h after the infection.</p><p><b>RESULTS</b>The expression of TSLP mRNA in 16HBE cells 6 h after RSV infection increased by 1.63-/+0.08 folds as compared to the expression level in the control cells. The expression of TSLP mRNA was significantly decreased in RSV-infected cells treated with anti-TLR3 antibody (P=0.034) and recombinant human IFN-gamma (P<0.001), but increased with the treatment by recombinant human IL-4 (P=0.025). Dexamethasone significantly inhibited the expression of TSLP mRNA in RSV-infected cells (P<0.001). The production of TSLP protein in 16HBE cells increased by 1.9 folds (P<0.001) 24 h after RSV infection, but underwent no significant changes after treatment with anti-TLR3 antibody (P=0.114). Recombinant human IFN-gamma significantly decreased while IL-4 enhanced the expression of TSLP protein in the infected cells (P=0.020 and 0.014, respectively). Dexamethasone significantly inhibited the increment of TSLP protein expression in RSV-infected cells (P<0.001).</p><p><b>CONCLUSIONS</b>RSV infection can enhance the expressions of TSLP in human airway epithelial cells. IFN-gamma, anti-TLR3 and dexamethasone can inhibit the elevation of TSLP expression induced by RSV infection, but IL-4 synergistically enhances its expression.</p>

Effect of continuous femoral nerve block in analgesia and the early rehabilitation after total knee replacement / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the benefit and safety of continuous femoral nerve block in patients undergoing total knee arthroplasty.</p><p><b>METHODS</b>From December 2008 to August 2009, 80 patients with total knee arthroplasty were randomly divided into two groups, 40 patients in each group. In group A the pain-control was dominanted by continuous femoral nerve block, there were 5 males adn 35 females with an average age of (65.0 +/- 4.2) years old; In group B the pump of vein odynolysis was used, there were 5 males and 35 females with an average age of (64.7 +/- 8.5) years old. The treatment of relieve pain continued for 3 days. The pain of visual analog scale (VAS), sleep condition, early-stage rehabilitation and adverse effects were recorded.</p><p><b>RESULTS</b>The VAS scores of group A was lower than that of group B at 2, 6, 24, 36, 48, 56, 72 h after operation (P < 0.05 or P < 0.01); The sleep condition and early-stage rehabilitation of group A were better than that of group B. The complications of group B occurrenced more than group A; The analgetica of group B were used more than that of group A.</p><p><b>CONCLUSION</b>The continuous femoral nerve block is an effective pain relieve method and is benefical to rehabilitation from total knee arthroplasty early.</p>

Respiratory syncytial virus infection promotes the production of thymic stromal lymphopoietin and accelerates Th2 inflammation in mouse airway / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of respiratory syncytial virus (RSV) infection on the production of thymic stromal lymphopoietin (TSLP) and Th1/Th2 balance in asthmatic mice.</p><p><b>METHODS</b>Thirty-two female BALB/c mice were randomly divided into 4 groups, namely the PBS group, ovalbumin (OVA) group, RSV group and OVA/RSV group. The mice were sensitized by OVA and then stimulated with nebulized OVA, and RSV was inoculated into the nasal cavity of the mice. BUXCO noninvasive lung function detection was performed to examine the airway response to metacholine, and enzyme-linked immunosorbent assay (ELISA) was used to detect the serum levels of IL-4, IL-5, IL-13, and IFN-gamma in the mice. The cells in the bronchoalveolar lavage fluid (BALF) were counted and classified, and the supernatants of the BALF were used for the detection of TSLP. Histopathological changes in the lung tissues of the mice were examined using HE staining, and immunohistochemistry using anti-mouse TSLP antibody was performed to examine TSLP expressions in the airway epithelial cells.</p><p><b>RESULTS</b>RSV infection promoted the production of TSLP in the asthmatic mice, and the concentration of TSLP in OVA/RSV group (2.13-/+0.05 ng/ml) was significantly higher than that in the other groups (P<0.01). RSV infection increased the serum levels of IL-4, IL-5, IL-13, and IFN-gamma in the mice. The total BALF cells, eosinophils, lymphocytes and neutrophils in OVA/RSV group were significantly higher than those in the other groups; noninvasive lung function examination showed higher Penh value in OVA/RSV group (318.66-/+50.87) than in the other groups when the inhaled metacholine increased to 6.25 mg/ml (P<0.01). More obvious and extensive airway inflammatory cell infiltration in OVA/RSV group were observed, and immunohistochemical staining also showed higher expression of TSLP in the airway epithelial cells of OVA/RSV group.</p><p><b>CONCLUSIONS</b>RSV infection promotes the production of TSLP in the airway epithelial cells and increases the level of Th2 cytokines in asthmatic mice. Concurrent RSV infection can exacerbate Th2 inflammatory reaction in asthmatic mice.</p>

Expression of interleukin-17A in asthmatic mice and its significance / 南方医科大学学报

<p><b>OBJECTIVE</b>To study the serum level of interleukin-17A (IL-17A) and its expressions in the lung, spleen and thymus in asthmatic mice.</p><p><b>METHODS</b>In 14 normal BALB/c female mice and 14 asthmatic mice, the changes in the airway pathology and the cell proportion in the bronchoalveolar lavage fluid (BALF) were observed. The serum level of IL-17A and IL-17A expressions in the tissue homogenates of the lung, spleen and thymus of the mice were detected by sandwich enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>The airway inflammation in the asthmatic mice was characterized mainly by eosinophil and neutrophil infiltration, which was not observed in the normal control group. Serum IL-17A levels and IL-17A expressions in the lung, spleen and thymus of the asthmatic mice were significantly higher than those in the normal control group (P<0.01). In the asthmatic mice, IL-17A expression in the lung tissues was positively correlated with the percentages of neutrophils (r=0.693, P=0.040) and eosinophils (r=0.733, P=0.030) in the BALF.</p><p><b>CONCLUSION</b>IL-17A is highly expressed in the serum, lung, spleen and thymus of asthmatic mice. IL-17A may be one of the major cytokines involved in exacerbation of bronchial asthma, and is probably associated with the recruitment of neutrophils and eosinophils into the airways.</p>

Assessment of early-stage physiological response to acute lung injury in canine models using balloon catheter system for measuring esophageal and gastric pressure / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore feasible and reliable methods for estnbolishment and of acute lung injury model in animal models.</p><p><b>METHODS</b>Twenty-four healthy adult mongrel dogs with oleic acid-induced acute lung injury were evaluated for early-stage physiological response to acute lung injury using a balloon catheter system for measuring esophageal and gastric pressure.</p><p><b>RESULTS</b>In canine models of early-stage oleic acid-induced acute lung injury that sustained spontaneous breathing, in terms of respiratory mechanics, some parameters obviously increased including the respiratory rate (RR), minute ventilation (VE), peak inspiratory volume (Vinsp, peak), mean inspiratory volume (VT/Ti), inspiratory airway resistance (Raw, insp) (P<0.001 for all the parameters), with also significantly increased peak transdiaphragmatic pressure (Pdi, peak, P=0.0185). The tidal volume (VT) and dynamic lung compliance (CL,dyn), however, were significantly decreased (P<0.001), and significant variation occurred in the ratio of inspiratory time to duration of one breath (Ti/Ttot, P=0.163). In terms of gas exchange, the pH, PaO(2), SaO(2), PaO(2)/FiO(2), and end tidal partial pressure of carbon dioxide (PETCO(2)) all evidently declined (P<0.001), but PaCO(2) and ratio of alveolar dead space to tidal volume [VD(alv)/VT] increased significantly (P<0.001).</p><p><b>CONCLUSION</b>Application of balloon catheter system for measuring esophageal and gastric pressures allows objective evaluation of the various physiological responses in early stage of acute lung injury.</p>