The correlation between the severity of hypoxic-ischemic brain damage in neonatal rats and subsequent abnormal neurobehavior / 中国新生儿科杂志

Objective:To assess the severity of hypoxic-ischemic brain damage (HIBD) in neonatal rats and predict the occurrence of subsequent neurobehavioral abnormalities after brain injury by scoring and magnetic resonance imaging (MRI).Methods:7-day-old of 60 Sprague-Dawley (SD) rats were randomly divided into control group (14 rats), sham operation group (14 rats) and HIBD model group (32 rats). HIBD model was established by right common carotid artery dissection with Rice-Vannucci method and hypoxia. Within 24 h after modeling, the rats in the model group were evaluated by general condition score and Longa score, and the surviving rats with moderate and severe HIBD were selected for the experiment. 24 h after modeling, 5 rats of the model group were randomly selected for 2,3,5-triphenyltetrazole chloride staining to verify cerebral infarction. 1 week after modeling, 6 rats from each group were randomly selected for hematoxylin-eosin staining to observe HIBD brain injury. 4 weeks after modeling, 4 rats were randomly selected from the control group and the sham operation group, and 8 rats from the remaining model group were used to evaluate the volume of brain damage by MRI. 5-6 weeks after modeling, the remaining 8 rats from each group were subjected to the Cylinder test, and at 13 weeks, they underwent the Morris water maze test to evaluate their neurobehavior.Results:In HIBD model group, 19 rats with moderate to severe HIBD were selected from 32 rats. 24 h after modeling, cerebral infarction was verified in all rats, indicating moderate to severe HIBD. Brain tissue pathology observed 1 week after modeling revealed predominantly gray matter brain damage. MRI showed that 7 out of 8 rats had moderate to severe HIBD. Compared to the control and sham operation groups, the model group exhibited a significant decrease in the usage rate of the left forelimb in the Cylinder test at 5-6 weeks after modeling ( P<0.05), and the latency period in Morris water maze test was significantly prolonged at 13 weeks after modeling ( P<0.05), and the times of crossing platform quadrant were significantly reduced ( P<0.05). There was no significant difference in the right brain injury volume between 24 h and 4 weeks model group ( P>0.05). The brain injury volume in model group was negatively correlated with the usage rate of left forelimb in cylinder test at 5-6 weeks and the times of crossing platform quadrant in Morris water maze test at 13 weeks ( P<0.05), and positively correlated with latency period in Morris water maze test at 13 weeks ( P<0.05). Conclusions:Within 24 h of HIBD modeling, the severity of brain injury can be preliminarily predicted by general condition score and Longa score. 4 weeks after modeling, in the chronic phase of brain injury, MRI was proved to be an excellent predictor for mid-term and long-term neurobehavioral abnormalities in HIBD rats.

Temporal bone anatomy via transcanal endoscopy / 中华耳鼻咽喉头颈外科杂志

Based on anatomy and clinical operation, this article discussed the anatomical structure of temporal bone and its contiguous relationship under oto-endoscope, through two approaches: the natural external auditory canal and the enlarged external auditory canal. To give an account of the anatomical characteristics of temporal bone under oto-endoscope.

Progress in middle ear dysventilation research / 中华耳鼻咽喉头颈外科杂志

Disfunction of Eustachian tube will cause negative pressure of middle ear, which may result in tympanic membrane retraction pocket. Severe pocket can consequently cause cholesteatoma. In clinical practice it is not uncommon to find a cholesteatoma limited to epitympanum, with an otherwise normal pars tensa and mesotympanum. This review explains the theory of "selective epitympanic dysventilation syndrome" developed by endoscopic technique. In the majority of the patients, the only ventilation pathway to the epitympanum is through the tympanic isthmus. Even if Eustachian tube function has recovered, an isthmus blockage with selective epitympanic dysventilation may lead to common attic cholesteatoma.

Clinical application of endoscope combined with microscope for the microvascular decompression in hemifacial spasm / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the effectiveness and safety of the endoscope combined with microscope for the microvascular decompression in hemifacial spasm.@*Methods@#A total of 26 patients underwent endoscope combined with microscopic facial nerve microvascular decompression through retrolabyrinthine approach from January 2013 to December 2016 were retrospectively reviewed in Ear Institute, Shanghai Jiaotong University School of Medicine. Among them, 9 were male and 17 were female, with a mean age of (51.9±11.4) years;15 cases of left side and 11 of right side patients were followed up for 1-3 years. The pre-and post-operative Cohen Classification was used for hemifacial spasm, House-Brackmann Grade for facial nerve function, hearing level and complication rates were reviewed. SPSS 19.0 software was used to analyze the data.@*Results@#All 26 patients were operated successfully. No recurrence was seen during 1-3 year follow-up. Post-operative Cohen Grade were as follows: 25 cases with Cohen Grade I and 1 case with Cohen Grade II. The difference in Cohen grade between pre-and post-operative was statistically significant (Z=-4.87, P<0.01). Post-operative facial nerve function was satisfactory in all patients (House-Brackmann Grade I-II in all patients). No hearing loss was observed. No facial paralysis and other lower cranial nerve dysfunction were observed. No postoperative complications such as cerebrospinal fluid leakage occurred.@*Conclusions@#Using an angled endoscope combined with microscope in microvascular decompression in hemifacial spasmis is safe and effective.

Evaluation of the safety and effect of the endoscopic stapes surgery: a multi-center study / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the safety of endoscopic stapes surgery, and to compare the results with stapes surgery under microscopic approach.@*Methods@#This was a retrospective study. One hundred and thirty seven patients from Eye Ear Nose and Throat Hospital of Fudan University and other seven hospitals were enrolled in this study. Eighty eight patients, in whom 29 were male, and 59 were female, aged from 29 to 66 years old, with an average of 40.1±10.7, underwent endoscopic stapedotomy and 49 patients, in whom 17 were male, and 33 were female, aged from 32 to 64 yeas old, with an arerage of 38.7±9.2, underwent microscopic stapedotomy for otosclerosis. Interventions included endoscopic and microscopic stapes surgeries. Main outcome measures consisted of operating time, preoperative and postoperative hearing, intraoperative findings, and postoperative complications. SPSS 16.0 software was used to analyzed the date (t test and χ2 test) .@*Results@#Patients in the group who underwent endoscopic stapes surgery showed a mean operative time of (74.1±26.0) min. Patients in the group treated by microscopic approach had a mean operative time (66.5±15.9) min. Statistical difference was evident (t=1.279, P<0.05) . The average operative time of endoscopic surgery became shorter as the cases increased. The average duration of the last 10 cases was shorter than that of the first 10 cases in both groups. The differences were significant (t value was 3.028, 3.610, both P<0.05). No statistical difference was found in air conduction threshold improvement (t=1.074, P=0.289) , air-bone gap closure (t=-0.135, P=0.893) and bone conduction improvement (t=1.222, P=0.228) between the two groups. No difference regarding the incidence of the postoperative complications (chorda tympanum damage: 6 cases vs 2 cases, χ2=0.08,P>0.05; vertigo:18 cases vs 9 cases,χ2=0.09, P>0.05; facial paralysis: 0 case vs 0 case) between the two groups was found.@*Conclusion@#Audiological outcomes achieved by endoscopic surgery are similar to the results obtained through a microscopic approach. Endoscopic stapes surgery is safe.

A multi-center retrospective study of ossiculoplasty surgery under oto-endoscope in 45 cases of conductive hearing loss with intact tympanic membrane / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the efficacy of ossiculoplasty surgery under oto-endoscope in patients of conductive hearing loss with intact tympanic membrane.@*Methods@#A retrospective study was conducted. The clinical data of 45 patients with conductive hearing loss who had undergone simple ossiculoplasty surgery between October 2015 and December 2017 from five hospitals in China (West China Hospital of Sichuan University, General Hospital of the People′s Liberation Army, Shanghai Ninth People′s Hospital, Shanghai JiaoTong University School of Medicine, Xijing Hospital, Fourth Military Medical University and Shenzhen Sixth People′s Hospital) were collected. There were 28 males and 17 females, with the age ranging from 12 to 69 years old. The tympanic membranes of those patients were intact before surgery. The lesion only occurred in the ossicular chain from CT and intraoperative exploration. The cases of otosclerosis, tympanosclerosis, cholesteatoma of middle ear, chronic suppurative otitis media, and tumor of middle ear were excluded. The postoperative complications, hearing improvements and operation time were observed. SPSS 23.0 software was used for statistic analysis.@*Results@#There was neither sensorineural hearing loss nor facial paralysis after surgery in this group. Seven patients had transient mild tinnitus after surgery and gradually relieved during the follow-up period. Nine patients developed dysgeusia after surgery. Two patients developed dizziness after surgery, and the symptoms were mild and relieved during 1 week without special intervention. The air-bone gap (ABG) range of pre-operation was 22.5-45.7 dB, and the average ABG was (25.3±8.6) dB. The ABG range in the third month after surgery was 5.7-26.8 dB, and the average ABG was (9.3±8.6) dB. The mean value of ABG was significantly lower in the third month after surgery compared with that of pre-operation (t=2.31, P<0.05). The operation time of the surgeons in each research center was similar. The overall average of operation time was (43.56±18.25) min. There was no significant difference in the duration of operation between the centers (F=3.26, P>0.05).@*Conclusion@#The ossiculoplasty surgery under oto-endoscope has good efficacy.

Management of 242 patients with middle ear cholesteatoma by otoendoscopic surgery and the postoperative effect analysis / 中华耳鼻咽喉头颈外科杂志

Objective@#To summarize and discuss the characteristics of endoscopic approach to manage the middle ear cholesteatoma, and to evaluate the operative safety and outcomes based on the data from the multicenter study.@*Methods@#The data of 242 cases diagnosed with the middle ear cholesteatoma and received operation through endoscopic approach between June 2016 and June 2017 in six tertiary hospitals in China were analyzed in this work. There were 130 males and 112 females, with the age ranging from 3 to 72 years old. We evaluated the strategy about how to manage the cholesteatoma, discussed the detailed techniques about how to remove the cholesteatoma and to improve the efficiency under endoscopic visualization. Meanwhile, the recurrence rate and residual rate of cholesteatoma as well as the complications in endoscopic approach were summarized.@*Results@#A total of 158 cases were operated in exclusively endoscopic transcanal approach, 72 cases operated in combined approach, and 12 cases operated majorly under microscope and minorly under endoscope. 219 cases were operated in one stage surgery, 23 cases received second look. In the second look, 3 cases were detected with residual cholesteatomas. Among them, 2 cases were found by MRI-DWI examination after the first-stage operation. With endoscopic examination after operation, 17 cases showed retracted pocket recurrence (7%,17/242). With introduction of endoscope in cholesteatoma, 153 cases were achieved canal wall-up operation (63%, 153/242). The complications in endoscopic approach included chord tympani never injury in 27 cases, skin injury of ear canal in 11 cases, tinnitus in 13 cases, vertigo in 7 cases, external ear canal stenosis in 1 case.@*Conclusions@#Using otoendoscope in cholesteatoma surgery would help keeping the normal structures of middle ear as much as possible, benefit to remove the hiding pathologies, help reducing residual cholesteatoma and lowering the rate of canal wall-down operation as well. This study showed good safety of otoendoscopic cholesteatoma surgery, however, strict evaluation of indication and quite good surgical techniques and skills are necessary for avoiding unexpected complication.

A multi-center clinical retrospective study on the therapeutic effect of endoscopic myringoplasty / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the therapeutic effect of endoscopic myringoplasty.@*Methods@#A retrospective analysis of 523 patients with chronic otitis media who underwent endoscopic myringoplasty between June 2016 and June 2017 in eight tertiary hospitals in China. Among all the patients, 256 were male and 267 were female, aged from 18 to 68 years old. The grafts used to repair the tympanic membrane were all tragus cartilage-perichondrium complex. All patients were followed up at 1 month, 3 months, 6 months, 9 months, and 12 months after surgery, at least 3 months. The closure rate of tympanic membrane perforation by different factors, the hearing results, and the incidence of postoperative complications were analyzed. SPSS 21.0 software was used to analyze the data.@*Results@#Three months after operation, the closure rates of anterior, inferior, posterior and subtotal perforation were 92.4% (109/118), 94.9% (93/98), 95.6% (129/135), and 89.0% (153/172) respectively, the difference was not statistically significant (χ2=5.779, P=0.123). The closure rates of small, medium and large perforations were 100.0% (82/82), 93.7% (178/190) and 89.2% (224/251) respectively. The difference was statistically significant (χ2=10.927, P=0.004). The closure rates of dry ear and wet ear tympanic membrane perforation were 93.1% (392/421), 90.2% (92/102), the difference was not statistically significant (χ2=1.011, P=0.915). The preoperative pure tone audiometry(PTA) was (38.4±5.3) dBHL, while, the 3-month postoperative PTA was (25.1±5.7) dBHL. The difference was statistically significant (t=39.079, P<0.001). The preoperative air bone gap (ABG) was (22.4±4.3) dB, while 3 months postoperative ABG was (9.1±3.8) dB. The difference was statistically significant (t=53.004, P<0.001). Of all 523 patients, 14 (2.7%) had middle ear infection, 8 (1.5%) had dislocated tympanic membrane, 12 (2.3%) had parageusia, 35 (6.7%) had tinnitus, 28 (5.4%) had hearing loss, 26 (5.0%) had vertigo,33 (6.3%) had reperforation, 2 (0.4%) had secondary cholesteatoma, and none had facioplegia.@*Conclusions@#Endoscopic myringoplasty is a safe and effective surgical method with good postoperative outcome.

Preliminary study on the application of real-time anatomical demonstration in the theoretical teaching of otorhinolaryngology-head and neck surgery / 中华医学教育探索杂志

Objective@#To investigate the effects of real-time anatomical demonstration and traditional teaching in otorhinolaryngology-head and neck surgery.@*Methods@#Students who studied this course from Shanghai Jiao Tong University School of Medicine were divided into two groups: clinical students in 5-year program (n=22) were assigned to the experimental group and students from"5+3" stomatology major (n=35) were assigned to control group. Both groups had two class hours, with the same teacher teaching at the same day. Students in the experimental group were taught with theoretical teaching combined with real-time anatomical demonstration, while students in the control group was taught with traditional theoretical teaching with multimedia content. Students in the two groups completed the questionnaire and received quiz; SPSS 19.0 was used to perform the independent-samples T test of between-group data.@*Results@#According to the questionnaire, scores for different items of the teaching method in the experimental group were higher than those in the control group. But according to the examination scores, average scores of the theoretical examination in the control group was (85.143±8.268), which was obviously higher than that of (64.545±11.434) in the experimental group, with statistically significant differences (t=7.885, P=0.000).@*Conclusion@#Teaching effect combined with real-time anatomical demonstration is not obvious to short-term examination, which may be related to the short-term understanding and absorption of knowledge for students in different majors, but it is coherent with the difference of entrance-examination scores of students from the two groups. This teaching model can stimulate students' interest in learning, and help them choose their professions, which may have certain advantages in the future long-term teaching effect.

Preliminary study on the application of real-time anatomical demonstration in the theoretical teaching of otorhinolaryngology-head and neck surgery / 中华医学教育探索杂志

Objective To investigate the effects of real-time anatomical demonstration and traditional teaching in otorhinolaryngology-head and neck surgery.Methods Students who studied this course from Shanghai Jiao Tong University School of Medicine were divided into two groups:clinical students in 5-year program (n=22) were assigned to the experimental group and students from"5+3" stomatology major (n=35) were assigned to control group.Both groups had two class hours,with the same teacher teaching at the same day.Students in the experimental group were taught with theoretical teaching combined with real-time anatomical demonstration,while students in the control group was taught with traditional theoretical teaching with multimedia content.Students in the two groups completed the questionnaire and received quiz;SPSS 19.0 was used to perform the independent-samples T test of between-group data.Results According to the questionnaire,scores for different items of the teaching method in the experimental group were higher than those in the control group.But according to the examination scores,average scores of the theoretical examination in the control group was (85.143 ± 8.268),which was obviously higher than that of (64.545 ± 11.434) in the experimental group,with statistically significant differences (t=7.885,P=0.000).Conclusion Teaching effect combined with real-time anatomical demonstration is not obvious to short-term examination,which may be related to the short-term understanding and absorption of knowledge for students in different majors,but it is coherent with the difference of entrance-examination scores of students from the two groups.This teaching model can stimulate students' interest in learning,and help them choose their professions,which may have certain advantages in the future long-term teaching effect.

Study on Chemical Constituents in Ethanol Extract from the Stem of Miao Medicine Rubus multibracteatus / 中国药房

OBJECTIVE:To study the chemical constituents in ethanol extract from the stem of Miao medicine Rubus multibracteatus. METHODS:The ethanol extract from the stem of Miao medicine R. multibracteatus was isolated and purified by silica gel column,preparative liquid chromatography and Sephadex LH-20 gel column,etc. The structure of compounds were analyzed and identified according to physicochemical properties and spectrum data(MS,hydrogen spectrum and carbon spectrum). RESULTS:Ten compounds were isolated from the ethanol extract of R. multibracteatus stem,i.e. 5,4′-dihydroxy-8-(3,3-dimethylally)-2″, 2″-dimethylpyrano [5,6∶6,7] isoflavone(1),3-hydroxy-1-(4′-hydroxy-3′-methoxyphenyl)propan-1-one(2),3β-hydroxysitost-5-en-7-one (3),Lupeol(4),Coniferaldehyde(5),E-p-hydroxy-coumaric acid(6),Genistein(7),1-O-p-coumaroylglycerol(8),Scopoletin(9), and Kaempferol(10). CONCLUSIONS:Compound 1-9 are isolated from the plants of R. multibracteatus for the first time,and Compound 2,5,8 are isolated from the plants of Rubus L. for the first time. The study lays the foundation for further development and utilization of R. multibracteatus.

Safety and early curative efficacy of lipocyte bioactive secretion in preventing white matter injury of premature infants / 中华实用儿科临床杂志

Objective To explore the safety and efficacy of intrathecal administration of adipose stem cells de-rived from bioactive secretome (ASCBS)in treatment of whiter matter injury (WMI)in the preterm infants. Methods Sixty - three cases of WMI were recruited according to the uniform standards from multiple medical centers and they were divided into 3 gestational age (GA)subgroups,which were 21 cases in group A (GA 24 - 28 + 6 ),20 cases in group B (GA 29 - 32 + 6 ),and 22 cases in group C (GA 33 - 36 + 6 ). The patients were randomly divided into treatment groups and control groups by tossing coins. The treatment groups received lumbar puncture followed with ASCBS intra-thecal injection once daily for 3 consecutive days. Follow - up study included Neonatal Behavioral Neurological Assess-ment (NBNA)at term - equivalent age and neurodevelopment at corrected age of 6 - month. Neurodevelopment was assessed by using the Bayley Scales of Infant Development and Peabody Developmental Motor Scale. The survival rates, NBNA scores,mental development index (MDI),psychomotor develop index (PDI),total motor development quotient, gross motor development quotient and fine motor development among each subgroup were compared. Results Sixty -three cases were recruited,including 31 in the treatment group and 32 in the control group. Only 1 case in the treatment groups lost in the follow - up. No clinical side effects were found in the treatment groups. There was no significant diffe-rence in the survival rate and complication in the preterms in all subgroups of the treatment group and control group (all P > 0. 05). The gross and total motor development quotient in the treatment group A was higher than that in the control group A(gross motor development quotient:98. 330 ± 6. 282 in treatment group A,90. 330 ± 3. 777 in control group A, P = 0. 040;total motor development quotient:97. 330 ± 4. 803 in treatment group A,91. 000 ± 4. 472 in control group A,P = 0. 023). The rest findings showed no significant difference between groups. Conclusion The treatment of WMI in preterm infants with ASCBS is safe and can promote the motor development of preterm infants with GA in 24 - 28 weeks.

Neuroprotective effect of paracrine extracts derived from human adipose stem cells on white matter injury of neonatal rats / 中国新生儿科杂志

Objective To explore the effect of paracrine extracts derived from human adipose stem cells on white matter injury of neonatal rats and to compare the difference of therapeutive effect between the cerebellum medulla oblongata pool injection and the jugular vein injection.Method A total of 73 three-day-old SD rats were chosen to establish the model of white mater injury.After 24 hours,the 73 rats were randomized into the experimental group (n =46) and the control group (n =27).Then the experimental group was reclassified into ventricular group (n =23) and intravenous group (n =23).In the ventricular group,the paracrine extracts of human adipose stem cells was injected locally into the cerebellum medulla oblongata pool injection,while the extracts was injected into the jugular vein in the intravenous group.The control group was reclassified ventricular control group (n =15) and intravenous control group (n =12),and equivoluminal saline was injected the same way as the experimental group.Frozen sections of the brain tissue from 3 rats of each experimental group one day after injection were stained with fluorescein-conjugated streptavidin to study the distribution of the extracts.The brain tissue of 3 rats from each subgroup 3 days after injection were stained with hematoxylin eosin (HE) to observe the pathomorphological changes.While 7 days later,myelin basic protein (MBP) of white matter which was obtained from 7 rats of each group was detected by immunofluorescence staining.28 days after injection,the remaining rats were assessed by neurobehavior tests.For the rats that died during the experiment,the same number of the rats would be substituted in this study.Result The paracrine extracts were found to transfer to the brain lesion area,and the amount of the extracts was more in the ventricular group.The results of the HE staining showed that the white matter injury was more severe in the ventricular control group,and extensive area of infarction were found in this group.White matter injury was mild in the experimental group,and the structure of the corpus callosum was more complete in the ventricular group.MBP semi-quantitative scores of the ventricular group (0.7 ± 0.3) and intravenous group (1.7 ± 0.3) were lower than those of ventricular control group (3.4 ± 0.4)and intravenous control group(3.3 ±0.3).And the MBP scores of ventricular group was significantly lower than that of intravenous group (P ＜ 0.05).The scores of the neurobehavioral tests of the experimental group were significantly higher than those of the control group,while the scores of the ventricular group were significantly higher than those of the intravenous group (P ＜ 0.05).Conclusion The paracrine extracts derived from adipose stem cells could improve the prognosis of white matter injury,and cerebellum medulla oblongata pool injection showed better curative effect than the jugular vein injection.

Raptor induces migration and invasion of breast cancerthrough epithelial-mesenchymal transition / 中国药理学通报

Aim To study the molecular mechanism of Raptor in the migration and invasion of breast cancer cells and provide the clinical theory basis for prevention of breast cancer invasion and metastasis.Methods Western blot was used to detect the expression of Raptor protein in MCF-7 cells and MDA231 cells.The siRNA plasmids were used to transfect MDA231 cells.At the same time,the plasmid pcDNA3.1-Raptor was transfected into MCF-7 breast cancer cells.And Western blot was used to analyze the protein expression level of E-cadherin and Vimentin.Transwell was used to test the ability of invasion.Nucleus mass separation experiment was used to test the expression of Snail.Results The expression of Raptor protein in MDA231 cells was higher than in the MCF-7 cell.When the control group of Scr/MDA231 cells compared with siRaptor/MDA231,Raptor protein expression was decreased obviously after plasmid transfection interference,accompanied by reduction of Vimentin protein expression and increase of E-cadherin protein expression.Compared with MCF-7/Con,Raptor protein expression significantly increased in MCF-7/Raptor,accompanied by increase of Vimentin protein expression and reduction of E-cadherin protein expression.The number of cells through the artificial basilemma Transwell in siRaptor/MDA231 cells was significantly reduced(P<0.05),and the number of cells through the Transwell chambers artificial basilemma was significantly increased in MCF-7/Raptor(P<0.05).Nucleus mass separation experiment results showed that the expression of Snail decreased obviously in the siRaptor/MDA231 than in the Scr/MDA231,however,the expression of Snail was obviously higher in the MCF-7/Raptor.Conclusions Raptor can promote the occurrence of EMT in breast cancer,thus it promotes invasion and metastasis of breast cancer.

Factors of hearing preservation in acoustic neuroma surgery / 中华耳鼻咽喉头颈外科杂志

Over the past 50 years, the focus of acoustic neuroma surgery has shifted from low mortality and tumor resection to retention of neurological function. Hearing preservation is another point in addition to facial nerve function preservation. Hearing preservation rates overall ranged from 2% to 93% in recent studies. Characteristics such as approach, pre-operative neurological function, tumor size, nerve of origin and fundal fluid of the internal auditory canal have been reported as possible influencing factors. This review provides a summary of recent studies and describes the prognostic factors that predict hearing preservation.

A combination use of endoscope and microscope in cerebral pontine angle surgery / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the application of combination use of microscope and endoscope in cerebral pontine angle (CPA) surgery.@*Methods@#A total of 72 patients undergone lateral skull base surgeries via endoscope under microscopic control from January 2006 to January 2015 was reviewed respectively. The patients including 35 males and 37 females were composed of 22 cases of vestibular swannnomas, 45 cases of cranial neuropathy and 5 cases of CPA chelesteatoma. Twenty cases of vestibular swannnomas, 15 cases of cranial neuropathy and 2 cases of CPA chelesteatoma undergone the surgery via retrosigmoid approach, while other cases undergone the surgery via retrolabyrinthine approach. Surgical procedures were accomplished under the control of microscope and different angular endoscope with imaging fusion. The surgical results were evaluated according to subjective and objective criteria, and all patients were followed up for 15 years.@*Results@#The symptoms was disappeared in the cranial neuropathy patients, without facial paralysis, complication of other nerves or hearing loss. Twenty-two patients with vestibular schwannomas got total tumor removal without facial palsy or neurological deficits; useful hearing was preserved in 16 of 22 patients (72.7%), and no tumor recurrence was found during 1-5 years follow-up. There was also no facial palsy or other complications in 5 cases of CPA chelesteatoma, which gained completely surgical removal; useful hearing was preserved in 3 of 5 cases of these patients and no recurrence was occurred during 1-1.5 years follow-up.@*Conclusions@#A combination use of endoscope and microscope could combine advantages and avoid disadvantages of two techniques. It can provide better exposure with minimal invasion in CPA surgery, and is especially applicable in surgery for cranial neuropathy, vestibular schwannoma and CPA cholesteatoma, which should be performed through retrosigmoid approach and retrolabyrinthine approach.

Clinical analysis of non-acoustic lesions in internal auditory canal and cerebellopontine angle / 中国耳鼻咽喉头颈外科

OBJECTIVE To analyse the diagnosis of non-acoustic lesions in internal auditory canal(IAC) and cerebellopontine angle(CPA),and discuss the effects of imaging examinationon differential diagnosis.METHODS A retrospective study was carried out in 185 patients with non-acoustic lesions of IAC and CPA from January 2001 to December 2016,in which lower cranial schwannoma,facial nerve tumor,meningioma,cholesteatoma,malignant tumor,trigeminal schwannoma,cavernous hemangioma,arachnoid cyst,lipoma were diagnosed in 65,55,25,9,9,8,6,5 and 3 patients,respectively.All patients were performed surgeries,and preoperative diagnosis and surgical approach were decided according to clinical manifestation,CT and MRI findings.Postoperative diagnosis were confirmed by pathological examination.RESULTS Total removal of lesion was achieved in 185 patients [96 men and 89 women,11-77 years old,mean age (46.4±25.6) years] and mean follow-up time was (5.1 ±3.2) years.Postoperative complication was leakage of cerebrospinal (4 patients,2.2％).4 patients with malignancy were dead and 1 patient with cholesteatoma was found recurrent during the follow-up.All kinds of non-acoustic lesions in IAC and CPA had its characteristic imaging findings.Preoperative diagnostic accuracy rate was 93.5％(173/185).CONCLUSION Accurate preoperative diagnosis has great significance in developing treatment strategy for IAC and CPA lesions;Preoperative diagnosis should be achieved according to clinical manifestation,CT and MRI findings,which can significantly improve the accuracy rate of diagnosis.

Relationship between clinical characters of acoustic neuroma and cellular immunity / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the relationship between the clinical characteristics of acoustic neuroma and the number ofT lymphocytes in tumor tissues.METHODS Clinical data of 65 patients diagnosed with VS were retrospectively collected.Peripheral blood samples of the patients were collected and the number of T lymphocytes were counted by flow cytometry.Immunohistochemistry was carried out with the fresh tumor samples compared with 8 normal cranial nerve controls.The expression level of each immune protein was analyzed its correlation with clinical characters was explored.RESULTS The CD3+,CD4+ and CD8+ T lymphocytes in the peripheral blood are not significantly correlated with clinical data.In the tumor tissues,the number of CD4+ and CD8+ T lymphocytes are much larger than those in normal cranial nerves,and negatively correlated with preoperative hearing.The number of CD8+ T lymphocytes has a negative relationship with postoperative facial nerve function.In addition,CD4 and CD8 expression levels in the tumor samples from patients younger than 40 are much higher than those in elder patients.Foxp3 is not detected in the normal cranial nerves.The number of Foxp3+ T lymphocytes is negatively correlated with preoperative hearing.CONCLUSION The CD4+ and CD8+ T lymphocytes mediated cellular immunity play an important role in the development of acoustic neuroma,as well as the reservation and restoration of nerve function.

Retrolabyrinthine approach for cerebellopontine angle region surgeries / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate the application ofretrolabyrinthine approach in cerebellopontine angel(CPA) region surgeries.METHODS A total of 42 patients underwent microscopic-endoscopic cooperative surgeries for CPA lesions via retrolabytinthine approach were reviewed.They were hospitalized from January 1st 2011 to January 1st 2016 in our institution.The microscopic-endoscopic technique was applied in all surgeries.RESULTS Complete removal was obtained in all tumor resections and satisfactory symptom-relief was achieved in all microvascular decompressions and neurectomies.In cases with acoustic neuroma and cholesteatoma,useful hearing (AAO-HNS classes A,B and C) was obtained in 66.7％(6/9) patients.No facial paralysis and postoperative complications such as cerebrospinal fluid leakage occurred during follow-up.In cranial nerve rhizopathies cases,complete relief was achieved in all patients.No facial paralysis and other lower cranial nerve dysfunction occurred.CONCLUSION With the preservation of labyrinthine structures,the microscopic-endoscopic cooperative surgeries for CPA lesions via retrolabytinthine approach could increase the hearing preservation level without facial nerve injury.Retrolabyrinthine approach is a good option for cranial nerve rhizopathies and tumors smaller than 15 mm in diameter without involvement of the fundus of internal auditory canal in the CPA region.

Combined application and evaluation of two types of auditory monitoring in acoustic neuroma surgery / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the significance of intraoperative auditory monitoring(IAMA) in surgery of acoustic neuroma and to compare the value of auditory brainstem response(ABR) and cochlear nerve action potential(CNAP) in auditory monitoring.METHODS Retrospective analysis of 12 cases of acoustic neuroma from January 2016 to December 2016 was performed.All patients have a practical hearing(AAO-HNS,grade class a,b),the ABR waveform can be elicited,wave v differentiation,All tumors were removed via posterior sigmoid sinus approach.RESULTS ABR waveform of all patients were prolonged with different degrees of change(0.68±0.41) ms compared with the preoperative data.Amplitude of CNAP diverse in different individuals,with an average prolong compared to the data before operation(0.25±0.16) ms.In all 12 cases,8 (66.7％) patients remained usable hearing after the operation,4 cases(33.3％) failed to have a usable hearing.Among these 4 patients,3 showed disappearance of wave v,1 patient showed wave v latency prolong in the ABR,meanwhile,2 patients showed P1 dissapear,2 patients showed P1 latency prolong in CNAP.The intraoperative auditory monitoring could play a role in preventing the hearing damage in the procedure.Drilling,noise,surgical nerve stretch or thermal injury may cause the hearing damage.A 5 minutes pause could get some degree of regain,with the amplitude rise again.CONCLUSION A combination use of the ABR and CNAP monitoring has a certain significance in surgery of acoustic neuroma.ABR waveform is stable and reliable,but costs longer time;CNAP stack quickly and improve monitoring sensitivity,but waveform varies.Vibration and noise caused by drilling,nerve stretch during operation and heat damage can be monitored timely.Combined use of ABR and CNAP monitoring can enhance the auditory preservation rate during acoustic neuroma surgery.