Longitudinal faster anxiety progression of GBA variant carriers in the early Parkinson's disease cohort.

Objective: Anxiety symptoms are prevalent neuropsychiatric manifestations in Parkinson's disease (PD) and impact the development of motor complications. Our aim was to evaluate the association of GBA variants with the anxiety development in early PD cohort. Methods: This cohort study used data from the Parkinson Progression Marker Initiative. The primary outcome anxiety was assessed by State-Trait Anxiety Inventory (STAI). The association between GBA and longitudinal change in the STAI total score was examined using linear mixed-effects model, and the association between GBA and anxiety progression was examined using Cox survival analysis. Results: A total of 385 patients with PD were included in this study, 39 of them were GBA variant carriers and 346 were idiopathic PD without GBA variants. Patients with GBA variants had faster annual increase in anxiety score (ß = 0.44; 95% CI, 0.18 to 0.71; p < 0.001) and were at higher risk of anxiety progression (HR 1.87; 95% CI, 1.03 to 3.41; p = 0.03,). Higher baseline scores for Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT), which indicated the autonomic dysfunction, also independently predicted faster increase in anxiety score (ß = 0.48; 95%CI, 0.19 to 0.69; p < 0.001) and higher incidence of anxiety development (HR = 1.05; 95% CI, 1.01 to 1.08; p = 0.008). Interpretation: These findings suggest that longitudinal anxiety symptoms worsening was faster in PD patients who were GBA variant carriers and have dysautonomia, and this association was enhanced if they have both.

Clinical analysis of delayed epistaxis following endoscopic sinus surgery.

OBJECTIVE: To investigate the clinical characteristics and treatment methods associated with delayed epistaxis following endoscopic sinus surgery. METHODS: The clinical data of 46 patients with delayed epistaxis following endoscopic sinus surgery were retrospectively analyzed. To explore the clinical features, pathogenesis, and treatment plan for delayed epistaxis, the postoperative bleeding time, bleeding inducements, systemic complications, surgical approach, the hemorrhage locations and responsible vessels, and treatment methods were analyzed. RESULTS: The average bleeding time was 16.34 ± 9.05 days after the operation, and 76.6% of the cases occurred 6-20 days after the operation. Sphenopalatal artery hemorrhage accounted for 69.6% (32/46), the most common of which was a posterior nasal septal artery hemorrhage (17/32). A total of 45 patients received endoscopic low-temperature plasma hemostasis following ineffective nasal packing, and no rebleeding in the ipsilateral nasal cavity was observed during the postoperative follow-up for 3 to 6 months. CONCLUSIONS: The peak of hemorrhaging in delayed epistaxis following endoscopic sinus surgery occurred at 6-20 days post-operatively. Bleeding of the posterior nasal septal artery from the sphenopalatine artery was the most common. Surgical methods were closely related to delayed postoperative hemorrhage. Treatment with low temperature plasma hemostasis under nasal endoscope was found to be effective.

[Clinical analysis of 11 cases of CD20 positive extranodal NK/T cell lymphoma].

Objective:To explore the clinical features and prognosis of CD20-positive extranodal NK/T cell lymphoma. Methods:To analyze the clinical characteristics and prognosis of 11 ENKTL patients admitted to this hospital. Results:Among the 11 patients, 6 cases with elevated LDH, 6 cases of anemia, and 8 cases with Ki-67≥50%. Two cases survived; 1 case lost contact; 8 cases died, and the average survival time of 8 cases was 22.5 months. Conclusion:The diagnosis of CD20 positive ENKTL is difficult, which requires a combination pathomorphology, immunohistochemistry, EBER and gene rearrangement detection and improve the understanding of the disease.Early diagnosis and active treatment is important.

[Perioperative airway management of nasal endoscopic surgery].

Objective:To evaluate the perioperative airway management process of nasal endoscopic surgery, and find clinical evidence for accelerating recovery and reducing respiratory complications. Methods:The perioperative airway management process for nasal endoscopic surgery was developed according to the patient's preoperative risk factors and preoperative pulmonary function. 512 patients who entered the airway management process from March 2019 to May 2020 were included. The improvement of pulmonary function and the occurrence of adverse respiratory events during the perioperative period were analyzed. Results:265 of 512 patients showed abnormal pulmonary function, including 203 cases with ventilatory dysfunction; 103 cases with positive bronchial provocation test; 59 cases with positive bronchodilation test. Patients with abnormal lung function were treated with aerosol inhalation for 3 to 5 days before surgery, the pulmonary function indicators were greatly improved（P<0.01）. After individualized airway management, patients were then treated with surgery, and there was no perioperative dyspnea event. Conclusion:Perioperative airway management can improve pulmonary function and reduce the risk of nasal endoscopic surgery.

[Nasal manifestations of Sjogren's syndrome].

We reported a case of a 43-year-old female patient with nasal Sjogren's syndrome（SS）. She complained of dry and tingling nose for 5 months. Physical examination: bilateral nasal stenosis, swelling of the mucosa at the front of the nasal septum, dry oral mucosa, and strawberry tongue. Sinus CT showed: bilateral nasal cavity stenosis, nasal septal mucosa and bilateral nasal mucosa hypertrophy. Salivary gland dynamic imaging: the maximum excretion percentage of the left salivary gland is 4.05%, and the maximum excretion percentage of the right salivary gland is 1.81%. Labial gland biopsy showed that the salivary gland lobular structure existed, and multiple lymphocyte foci（>50/each foci） were seen in the focal interstitium, which was consistent with the labial gland performance of SS. Immunohistochemistry showed: CD3+, CD20+, AE1/AE3+, Ki-67+, IgG+. After symptomatic treatment, the patient's dry nose and tingling symptoms disappeared. The swelling of the nasal mucosa disappeared, and the bilateral nasal cavity was well ventilated. Follow-up for half a year, no symptoms of nasal manifestations about Sjogren's syndrome has occurred.

[Clinical treatment experience of perioperative nasal endoscopic surgery in patients with cardiovascular disease].

Objective:To investigate the perioperative management of endoscopic nasal surgery in patients with cardiovascular disease. Method:Sixty-two patients with cardiovascular disease underwent endoscopic sinus surgery. Individualized medical treatment was used according to the patient's perioperative condition, followed by functional endoscopic surgery. Result:Two patients had cardiovascular complications after endoscopic surgery and were transferred to internal medicine. One patient developed massive hemorrhage after operation, and hemostasis was performed again under nasal endoscopic surgery. The remaining 59 patients had no adverse cardiovascular events after operation. There are no complications such as massive hemorrhage, visual impairment, and cerebrospinal fluid rhinorrhea. All patients were followed up for more than half a year, 39 cases（62.90%） of nasal sinus disease were completely controlled, 18 cases（29.03%） of nasal sinus disease were partially controlled, and the effective rate was 91.94%. Conclusion:Reasonable perioperative management measures can reduce the risk of nasal sinus surgery in patients with cardiovascular disease, ensure the successfully implementation of surgery and achieve a successful prognosis.

Insulinoma-associated protein 1 controls nasopharyngeal carcinoma to radiotherapy by modulating cyclin D1-dependent DNA repair machinery.

Insulinoma-associated protein 1 (INSM1), a zinc finger transcriptional factor, is proven to be deregulated in several types of cancers. However, comprehension of the molecular mechanism of INSM1-mediated tumor progression remains poor. Here, we show that the radioresistant nasopharyngeal carcinoma (NPC) patients have higher expressions of INSM1 that correlated with poor prognosis. Genetic manipulation of INSM1 expression sufficiently controls the response of NPC cells to irradiation (IR). Mechanistically, cells exposed to IR, increased intracellular INSM1 competitively disrupts the interaction of cyclin D1 and CDK4 resulting in cell survival by the cyclin D1-dependent DNA repair machinery. Moreover, knockdown of INSM1 sensitives NPC cells to IR in vivo and protects xenograft mice from mortality. Taken together, these results indicate that INSM1 modulates NPC to radiotherapy by controlling cyclin D1-dependent DNA repair machinery that could be manipulated as a novel molecular target for NPC therapy.

[The expression and role of MIF, NF-κB and IL-1ß in nasal polyps].

OBJECTIVE: To investigate the expression of MIF, NF-κB p65 and IL-1ß in the tissue of nasal polyps and normal inferior turbinate, to analyze their relevance, and to explore their role in nasal polyps. METHOD: The infiltrating results of EOS and others inflammatory cells in 48 cases diagnosed as nasal polyps (nasal polyps group) were detected by HE staining, and the expression of MIF, NF-κB p65 and IL-1ß were investigated by immunohistochemistry. Twenty-one patients who were performed septoplasty orthotics were included as the control group; the VAS and Lund-Kennedy score were used to evaluate the degree of nasal polyps in patients and the correlation analysis was conducted between the disease severity and the expression levels of this three factors. RESULT: (1) The infiltrating results of EOS and the expression level of MIF, NF-κB p65, IL-1ß in nasal polyps group are obviously higher than these in the control group (P < 0.05); Spearman correlation analysis shows that MIF, NF-κb p65 and IL-1ß are positively correlated with each other (r = 0.74, 0.66, 0.60, P < 0.05); the nuclear activation rate of NF-κB p65 is positively correlated with MIF, IL-1ß (r = 0.67, 0.63, P < 0.05); the infiltration degree of EOS is positively correlated with MIF, IL-1ß (r = 0.49, 0.55, P < 0.05), but has no correlation with the NF-κB p65 and its nuclear activation rate. (2) The VAS grade of the nasal polyps group is 8.24 ± 1.72 and the nasal endoscopic examination grade is 8.63 ± 3.81. Spearman correlation analysis shows that the VAS grade is positively correlated with the level of MIF (r = 0.71, P < 0.05), but had no correlation with NF-κB p65, its nuclear activation rate and IL-1ß. The nasal endoscopic examination grade is positively correlated with MIF and the nuclear activation rate of NF-κB p65 (r = 0.79, 0.73, P < 0.05), but has no correlation with the level of NF-κB p65 and IL-1ß (P > 0.05). CONCLUSION: MIF, NF-κB p65 and IL-1ß may promote the development of the nasal polyps, and there may exist the IL-1ß--NF-κB--MIF approach in nasal polyps; MIF and NF-κB may participate in maintaining physiological function of inferior turbinate and have relations with the lightest sustained inflammation of inferior turbinate. The MIF and NF-κB p65 nuclear activation rate can be used as a standard of the nasal polyp severity and the judgement prognosis.

[The perioperative observation under endoscopic sinus surgery with asthma].

OBJECTIVE: Aimed to discuss the perioperative treatment of the patient with asthma under endoscopic sinus surgery, to reduce the complications, adverse events and improve cure rate. METHOD: One hundred and fifty-two patients with asthma under nasal endoscopic surgery were analyzed retrospectively. RESULT: After specification of perioperative treatment, all patients with good control of asthma were in good condition before surgery. One hundred and sixteen patients were safely backed to ward after surgery. There were 13 cases had asthma attack of different degrees. The other 35 patients were send to ICU for observation of 24 to 48 h. One case had an acute attack after returned from ICU. One patient had instantly attacks of asthma after extubation. All patients improved after treatment,and recovered well after 1 year's follow-up. CONCLUSION: We should pay more attention to the close relationship of CRS and asthma, standardize the perioperative treatment, master the principles of management of acute attack of asthma. As long as to make sufficient perioperative preparation, the nasal endoscopic surgery with asthma is safe, and it can have good efficacy.

[A case of giant cavernous hemangioma of the nasal septum].

To report a case of an adult male with a huge cavernous hemangioma arising from the nasal septum, and the lesion was widely spread to hard palate, sphenoid sinus, ethmoid sinus and right maxillary sinus. After giving embolization, it was completely excised via transnasal endoscopic approach and lateral rhinotomy, histologic examination reported cavernous hemangioma. There was no recurrence at 1 year's follow-up.

[Isolated sphenoid sinus disease: a clinical analysis of 159 cases].

OBJECTIVE: Aimed to observe and analyse the diagnostic and therapeutic methods of the isolated sphenoid sinus disease, achieve earlier diagnosis and timelier intervention for this easily neglected disease and decrease the occurrence of misdiagnoses. METHOD: A retrospective study was conducted in 159 patients with isolated sphenoid sinus disease. RESULT: Headache was the most common presenting symptom (79.87%,127/159). Among the 159 cases, 60 (37.74%) had mucocele, 44 (27.67%) isolated sphenoiditis, 31 (19.50%) fungal sinusitis, 5 (3.14%) polyp, 3 (1.89%) fibrous dysplasia, 2 (1.26%) inverted papilloma, 3 (1.89%) chordoma, 3 (1.89%) squamous carcinoma, 3 (1.89%) malignant lymphoma, 2 (1.26%) neuroendocrine carcinoma, 2 (1.26%) olfactory neuroblastoma, and 1 (0.63%) malignant fibrohistiocytoma. A follow-up of 10 months to 4 years post-surgery showed good prognosis in most of the patients who underwent surgical therapy. CONCLUSION: The sphenoid sinus disease is often vague and nonspecific in its clinical presentation. The most common clinical symptom is headache, followed by vision changes. Endoscopic sphenoidotomy is the primary therapy for isolated sphenoid sinus disease.

[Inflammatory myofibroblastic tumor in the maxillary sinus: a case report and review of literature].

OBJECTIVE: To investigate the clinical feature, diagnostic and therapeutic methods of inflammatory myofibroblastic tumor(IMT). METHOD: One case of IMT was reported and the relevant literatures were reviewed. RESULT: The computed tomography scan showed irregular soft tissue density shade and aggressive bone destruction with unclear boundary. Pathological findings showed variable numbers of inflammatory cells and myofibroblastic spindle cells. Tumor cells were immunoreactive for vimentin and smooth muscle actin, but negative for desmin et al. CONCLUSION: IMT of the maxillary sinus is very rare. The diagnosis of IMT base on histopathology and immunohistochemistry. The genesis and development of IMT result from chromosomal translocations that often cause an overexpression of anaplastic lymphoma kinase. IMT are clinical and pathological distinct entities and its biological behavior is still uncertain.

[Expression and correlational research of mTOR and 4EBP1 in laryngeal carcinoma].

OBJECTIVE: This study aimed to explore the expression and their correlation of mammalian target of rapamycin (mTOR) and EIF4E binding protein1 (4EBP1) in laryngeal squamous cell carcinoma (LSCC). METHOD: MTOR and 4EBP1 expression was studied using immunohistochemical methods in LSCC tissues of 77 cases and adjacent tissues of 18 cases,and then the relationship of their expression and clinical pathological factors were analyzed. RESULT: The positive expression rates of mTOR and 4EBP1 were 54.5% and 48.1% in laryngeal carcinoma, which was significantly higher than those in para-carcinoma (P < 0.05). Expression of mTOR and 4EBP1 was associated with metastases to lymph nodes and histopathology classification (P < 0.05), but was not associated with clinic stages (P > 0.05). There was significant positive correlation between the expression level of mTOR and 4EBP1 in LSCC (P < 0.05). CONCLUSION: (1) The high expression of mTOR and 4EBP1 is closely related with clinicopathology and lymph node metastases. It may play an important role in the development and progression of laryngeal carcinoma. (2) The positive correlation on expression level of mTOR and 4EBP1 in LSCC tissue shows that it has clinical significance on clinical therapy and prognosis.

[Changes in DNA repair enzymes in rat ventroposterior nucleus of the thalamus after cerebral cortex infarction].

OBJECTIVE: To investigate the damage within the ventroposterior nucleus (VPN) of the thalamus after focal cortical infarction and its mechanism, and explore the effect of ebselen on the oxidative damage after cerebral cortex infarction in hypertensive rats. METHODS: Middle cerebral artery occlusion (MCAO) was induced in stroke-prone renovascular hypertensive rats (RHRSP), and the rats were divided into four groups by table of random number: sham operation group, model group, vehicle group and ebselen group, each group consisted of 8 rats. In animals subjected to sham surgery the middle cerebral artery was exposed only. Ebselen (5 ml/kg) or vehicle (a mixed solvent consisting of 0.5% carboxymethyl cellulose and 0.02% Tween 20, 5 ml/kg) was given by gastric gavage starting 24 hours after cerebral cortical infarction. Two weeks after the MCAO, the rats were sacrificed, and VPN from each group was sectioned and stained with hematoxylin-eosin (HE), and apurinic/apyrimidinic endonuclease (APE) and Escherichia coli MutY DNA glycosylase (MYH) were determined by immunohistochemistry. RESULTS: HE staining showed that ebselen ameliorated the VPN damage induced by ischemia. Immunohistochemical imaging analysis revealed a distinct nuclear staining of APE and nuclear and cytoplasm distribution of MYH in the entire region of the VPN. Compared with sham operation group, the number of APE and MYH positive cells decreased in model group and vehicle group (APE: 57.0±14.7, 49.4±12.5 vs. 101.0±13.6, MYH: 15.0±4.7, 10.4±2.5 vs. 56.0±13.2, all P<0.05). Compared with model group and vehicle group, the number of APE and MYH positive cells increased significantly in ebselen group (APE: 72.2±7.6 vs. 57.0±14.7, 49.4±12.5, MYH: 32.2±7.6 vs. 15.0±4.7, 10.4±2.5, all P<0.05); the difference of the number of APE and MYH positive cells between model group and vehicle group showed no statistical significance. CONCLUSION: After 2 weeks of MCAO, there is a marked decrease of APE and MYH in VPN; ebselen can obviously increase the level of APE and MYH, and ebselen may protect the VPN of the thalamus from damage after focal cortical infarction in rats.

[Expression of hypoxia inducible factor-1alpha and BNIP3 in human laryngeal carcinoma and their relationship].

OBJECTIVE: To investigate the expression of Hypoxia inducible factor-1alpha (HIF-1alpha)and the Bcl-2/adenovirus E1B 19 kDa-interacting protein 3 (BNIP3) in human laryngeal carcinoma and their relationship. METHOD: The expression of HIF-1ALPHA and BNIP3 were detected by SP immunohistochemical method in 45 cases with laryngeal carcinoma tissues and 12 adjacent normal laryngeal tissue. RESULT: The expression of HIF-1alpha and BNIP3 were mainly in cytoplasm and nucleus. Their expression was higher in laryngeal tissue than in adjacent normal laryngeal tissue (P < 0.05). The expression of HIF 1alpha was positively related to that of BNIP3 in laryngeal carcinoma tissues (P < 0.05). CONCLUSION: The high expression of HIF-1alpha and BNIP3 were closely related in laryngeal carcinomas, both of them played important role in the carcinogenesis and development of laryngeal carcinoma. HIF-1alpha might induce the expression of BNIP3. HIF-1alpha and BNIP3 might to be two potential therapeutic targets in laryngeal squamous, cell carcinomas.

[Distribution of basic fibroblast growth factor in inner ear of guinea pigs injected by different drug-approaches].

OBJECTIVE: To investigate the approach of basic fibroblast growth factor(bFGF) entering inner ear, as well as its the protective mechanism to inner ear and nerve tissue in pathological situation. METHODS: 125I-bFGF was injected into guinea pigs body via the lateral ventricle and muscle under physical situation as well as pathological situation. Then the per minute gamma-radioactive in blood, liver, thyroid gland, brain, cochlear and perilymph fluid was counted, and the distribution and metabolism of bFGF in the inner ear and autoradiography of the cochlea were also observed. RESULTS: Gamma-radioactive cpm of blood and liver increased significantly, while it did not change in brain, cochlea and perilymph after 125I-bFGF intramuscular injections. Gamma-radioactive cpm in blood, liver, brain, perilymph and cochlea had increased and autoradiography granules was found in the cochlea in 30 min after 125I-bFGF injected into CSF. In brain, perilymph and cochlea, a maximal value of gamma-radioactive cpm was obtained between 2 h and 4 h, while that in 8 h decreased significantly. Autoradiography granules still were seen in 8 h. gamma-radioactive cpm in 12 h was still higher than that in control group, but autoradiography granules can't be seen. The result in 24 h was similar to that in control group. The time course of cpm in the blood, cochlea and perilymph always parallel changed. CONCLUSIONS: bFGF has some difficulties in getting across blood-labyrinth barrier (BLB) and blood-brain barrier (BBB) under physical and pathological situation, such as acute anoxia, aminoglycoside-induced deafness. bFGF can reach inner ear, perilymph fluid, brain tissue and blood rapidly when it is injected into CSF and excreted slowly in those tissues. Permeability of BBB and BLB to bFGF is similar and has orientation.