Primary experience and discussion on the treatment of esthesioneuroblastoma / 中华耳鼻咽喉头颈外科杂志

Objective: To summarize the preliminary experience in the treatment of esthesioneuroblastoma (ENB) and to explore the effect of age, chemotherapy, modified Kadish stage and pathological grade on the prognosis of ENB. Methods: The clinical data of 87 ENB patients from the First Affiliated Hospital of Sun Yat-sen University and Sun Yat-sen University Cancer Center between June 2002 and November 2017 were retrospectively analyzed. The modified Kadish stage was used to evaluate the extent of the lesions, and the Hyams grading system was used for pathological grading. The patients were followed up regularly to evaluate the recurrence and metastasis of the tumor. Cox proportional hazard model was used for univariate and multivariate analyses. Prognostic factors with P<0.05 in univariate analysis were included in multivariate analysis. After controlling the confounding factors, the model coefficients were used to calculate the hazard ratio (HR) and 95% confidence interval (CI). Results: The median follow-up time of ENB patients was 29 months, and the 5-year overall survival rate was 39.3%. In univariate analysis, age, chemotherapy, modified Kadish stage and pathology grade were independent predictors of overall survival, while gender, radiotherapy and surgery were not prognostic factors. Multivariate analysis showed that modified Kadish stage and pathology grade were independent predictors of overall survival rate after excluding confounding factors. Conclusions: Age, chemotherapy, modified Kadish stage and pathological grade are taking important role in the overall survival rate of patients with ENB. Modified Kadish stage and pathological grade are independent predictors of overall survival rate.

Up-regulation of miR-133a expression attenuates myocardial fibrosis in spontaneously hypertensive rats / 中国病理生理杂志

AIM:To investigate the effect of up-regulated expression of microRNA-133a (miR-133a) on myo-cardial fibrosis in spontaneously hypertensive rats (SHR). METHODS:Wistar-Kyoto (WKY) rats with homologous nor-mal blood pressure served as the normal control group. SHR were divided into SHR group, SHR+ adeno-associated virus (AAV) group and SHR+miR-133a-AAV group randomly. miR-133a carried by miR-133a-AAV was transfected into SHR heart by coronary perfusion. The rat tail artery pressure was monitored. The myocardial collagen deposition was observed by Masson staining. The expression of miR-133a in myocardial tissue was detected by real-time PCR. The protein levels of transforming growth factor-β1 (TGF-β1) and connective tissue growth factor (CTGF) were determined by immunohisto-chemistry and Western blot. RESULTS:Compared with the WKY rats, the tail artery pressure of the SHR increased sig-nificantly. The expression of miR-133a in heart decreased, and the expression levels of TGF-β1 and CTGF increased (P<0.05), and myocardial fibrosis occurred. After up-regulating the expression level of miR-133a in the heart of SHR, the myocardial fibrosis was significantly reduced, and the expression levels of TGF-β1 and CTGF decreased (P<0.05). CONCLUSION:Up-regulation of the miR-133a expression improves myocardial fibrosis induced by hypertension, which may be related to inhibiting the protein expression of TGF-β1 and CTGF in myocardium.

Humoral and Cellular Immunity Changed after Traumatic Brain Injury in Human Patients.

Previous studies have suggested that there is a disproportionally higher risk of infection following traumatic brain injury (TBI). This predisposition to infection may be driven by a poorly understood, brain-specific response in the immune system after TBI. However, there is a lack of studies that have fully characterized TBI patients to understand the relationship between TBI and peripheral immune function. In the present study, markers for humoral immunity and cellular immunity were measured for up to 2 weeks in the peripheral blood of 37 patients with TBI in order to elucidate the time course and the type of the peripheral immune response following TBI. 12 relatively healthy individuals without TBI and other neurological diseases were enrolled into the control group. Our data indicated that TBI could induce significant changes in humoral immunity characterized by a decrease in IgG and IgM levels and an increase in the complements C3 and C4 levels in comparison with the control group. Moreover, compared with the control group, a significant reduction in peripheral blood CD3+ and CD3+CD4+ lymphocyte counts occurred early (days 1-3) following the onset of trauma. These results provide evidence that TBI is associated with substantial changes in humoral immunity and cellular immunity, which may explain the high incidence of infection encountered in these patients.

Intensive insulin therapy for preventing postoperative infection in patients with traumatic brain injury: A randomized controlled trial.

OBJECTIVE: To assess the effect of intensive insulin therapy (IIT) for preventing postoperative infection in patients with traumatic brain injury (TBI). METHODS: In total, 88 patients with TBI were randomly divided into 2 groups, 44 in each group. One group (group ITT) received IIT and the other group (group CIT) received conventional insulin therapy (CIT). This study was conducted between February 2013 and January 2016. Outcomes included infection rate, mortality, and neurological outcome (measured by the Glasgow Outcome Scale [GOS]). RESULTS: A total of 81 patients completed the study. IIT showed greater efficacy than CIT, with a decreased infection rate in the IIT group compared to the CIT group (31.9% vs 52.3%, P = 0.03), and also a reduced duration of stay in intensive care unit (ICU) (IIT group, 4.5 ±â€Š2.1 days vs CIT group, 5.7 ±â€Š2.8 days, P = 0.02). In addition, a significant difference in scores on the GOS scale was observed between the 2 groups (P = 0.04). The mortality rates in hospital and at the 26-week follow-up were similar between the 2 groups. CONCLUSION: IIT leads to a reduced infection rate, shorter stays in ICU, and improved neurological outcome.

Decompressive craniectomy in neurocritical care.

Recently, several randomized controlled trials (RCT) investigating the effectiveness of decompressive craniectomy in the context of neurocritical illnesses have been completed. Thus, a meta-analysis to update the current evidence regarding the effects of decompressive craniectomy is necessary. We searched PUBMED, EMBASE and the Cochrane Central Register of Controlled Trials. Other sources, including internet-based clinical trial registries and grey literature, were also searched. After searching the literature, two investigators independently performed literature screening, assessing the quality of the included trials and extracting the data. The outcome measures included the composite outcome of death or dependence and the risk of death. Ten RCT were included: seven RCT were on malignant middle cerebral artery infarction (MCAI) and three were on severe traumatic brain injury (TBI). Decompressive craniectomy significantly reduced the risk of death for patients suffering malignant MCAI (risk ratio [RR] 0.46, 95% confidence interval [CI]: 0.36-0.59, P<0.00001) in comparison with no reduction in the risk of death for patients with severe TBI (RR: 0.83, 95% CI: 0.48-1.42, P=0.49). However, there was no significant difference in the composite risk of death or dependence at the final follow-up between the decompressive craniectomy group and the conservative treatment group for either malignant MCAI or severe TBI. The present meta-analysis indicates that decompressive craniectomy can significantly reduce the risk of death for patients with malignant MCAI, although no evidence demonstrates that decompressive craniectomy is associated with a reduced risk of death or dependence for TBI patients.

Clinical characteristics of cerebral venous sinus thrombosis.

OBJECTIVE: To investigate the risk factors, clinical presentation, neuroimaging features, treatment, and prognosis of patients with cerebral venous sinus thrombosis (CVST). METHODS: We retrospectively analyzed the data of 19 patients with a diagnosis of CVST admitted to Beijing Chao-Yang Hospital affiliated to Capital Medical University, Beijing, China between January 2010 and December 2013. RESULTS: There were 9 men and 10 women (age range: 27-75 years). Headache (84.2%) and focal signs (57.9%) were the 2 most common symptoms. Direct evidence of thrombosis was found on CT in 42.1%, and on MRI in 52.6%. Two or more sinuses were involved in 78.9% of cases, in which the transverse sinus plus sigmoid sinus were the most commonly involved combination. All patients received anticoagulant therapy. Most patients (84.2%) had no neurological sequelae at discharge, and only 3 patients (15.8%) recovered with sequelae. CONCLUSION: Our study provides detailed information on the clinical manifestations, neuroimages, management, outcome, and risk factors of the patients with CVST.

Stereotactic aspiration versus craniotomy for primary intracerebral hemorrhage: a meta-analysis of randomized controlled trials.

BACKGROUND: A wealth of evidence based on the randomized controlled trials (RCTs) has indicated that surgery may be a better choice in the management of primary intracerebral hemorrhage (ICH) compared to conservative treatment. However, there is considerable controversy over selecting appropriate surgical procedures for ICH. Thus, this meta-analysis was performed to assess the effects of stereotactic aspiration compared to craniotomy in patients with ICH. METHODS: According to the study strategy, we searched PUBMED, EMBASE and Cochrane Central Register of Controlled Trials. Other sources such as the internet-based clinical trial registries, relevant journals and the lists of references were also searched. After literature searching, two investigators independently performed literature screening, assessment of quality of the included trials and data extraction. The outcome measures included death or dependence, total risk of complication, and the risk of rebleeding, gastrointestinal hemorrhage and systematic infection. RESULTS: Four RCTs with 2996 participants were included. The quality of the included trials was acceptable. Stereotactic aspiration significantly decreased the odds of death or dependence at the final follow-up (odds ratio (OR): 0.80, 95% confidence interval (CI): 0.69-0.93; P = 0.004) and the risk of intracerebral rebleeding (OR: 0.44, 95% CI: 0.26-0.74; P = 0.002) compared to craniotomy with no significant heterogeneity among the study results. CONCLUSIONS: The present meta-analysis provides evidence that the stereotactic aspiration may be associated with a reduction in the odds of being dead or dependent in primary ICH, which should be interpreted with caution. Further trials are needed to identify those patients most likely to benefit from the stereotactic aspiration.

Hypertonic saline in the traumatic hypovolemic shock: meta-analysis.

BACKGROUND: A wealth of evidence from animal experiments has indicated that hypertonic saline (HS) maybe a better choice for fluid resuscitation in traumatic hypovolemic shock in comparison with conventional isotonic saline. However, the results of several clinical trials raised controversies on the superiority of fluid resuscitation with HS. This meta-analysis was performed to better understand the efficacy of HS in patients with traumatic hypovolemic shock comparing with isotonic saline. MATERIALS AND METHODS: According to the search strategy, we searched the PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, which was completed on October 2013. After literature searching, two investigators independently performed the literature screening, assessment of quality of the included trials, and data extraction. Disagreements were resolved by consensus or by a third investigator if needed. The outcomes included mortality, blood pressure, fluid requirement, and serum sodium. RESULTS: Six randomized controlled trials were included in the meta-analysis. The pooled risk ratio for mortality at discharge was 0.96 (95% confidence interval [CI], 0.82-1.14), whereas the pooled mean difference for the change in systolic blood pressure from baseline and the level of serum sodium after infusion was 6.47 (95% CI, 1.31-11.63) and 7.94 (95% CI, 7.38-8.51), respectively. Current data were insufficient to evaluate the effect of HS on the fluid requirement for the resuscitation. CONCLUSIONS: The present meta-analysis was unable to demonstrate a clinically important improvement in mortality after the HS administration. Moreover, we observed HS administration maybe accompanied with significant increase in blood pressure and serum sodium.

[Surgical treatment of ruptured cerebellar arteriovenous malformations].

OBJECTIVE: To analyze the clinical characteristics and surgical outcomes of ruptured cerebellar arteriovenous malformations (AVM). METHODS: The clinical data were retrospectively analyzed for 676 brain AVM patients. Among them, 616 cases were treated at Beijing Tiantan Hospital from January 2003 to December 2009 and 32 cases of them were of cerebellar AVM. Another 60 cases of intracranial AVM were managed at Beijing Chaoyang Hospital from January 2003 to December 2011 and there were 8 cases of cerebellar AVM. Microsurgery was performed to remove hematoma and excise AVM. And the postoperative outcomes were evaluated. RESULTS: Statistics analysis of activities of daily living (ADL) scores for 636 cases of cerebral AVM and 40 cases of cerebellar AVM showed no significant difference. Among 40 cases of cerebellar AVM, hemorrhage occurred first in 35 (87.5%) patients. Postoperative re-examinations of computed tomography revealed the resolution of hematoma and the absence of re-hemorrhage. Digital subtraction angiography (DSA) examinations were performed in 39 cases and no residual nidus was observed. Tonsillar herniation occurred preoperatively in 1 case and DSA was not re-examined. There were balance dysfunction (n = 3), dysarthria (n = 2) and dystaxia and dysphasia (n = 1). The postoperative ADL degrees were I(n = 26), II(n = 10), III(n = 3) and IV(n = 1). During a follow-up period of 6 months, no re-hemorrhage occurred and there was no worsening function of central nerve system. CONCLUSION: Emergency microsurgery is effective in the treatment of ruptured cerebellar AVM.

[Study on the risk factors of deep venous thrombosis in acute hospitalized stroke patients].

OBJECTIVE: To identify the risk factors of deep venous thrombosis (DVT) in hospitalized patients with acute stroke, under a perspective case-control study. METHODS: 488 cases with stroke, identified by CT or MRI and admitted to the department of neurology and neurosurgery in Beijing Chaoyang Hospital between December 2001 and December 2002 were consecutively studied. There were 328 male and 160 female patients (95.5% Hans) with a mean age of 65 +/- 11 years, ranging 22 - 93 years. The procedure of study would include: (1) General condition, possible risk factors, symptoms of DVT physical check-up to every eligible patient on first day of admission but the plasma concentrations of D-dimer (ELISA), thrombomodulin, antithrombin-III and blood routine examination were measured on the next morning. (2) The ultrasonography (US) was used for detecting both lower extremities at 7 - 10 days after the onset of stroke, and D-dimer and AT-III tests were repeated on the same or next day that the US was taken. (3) The ultrasound examination was repeated after a week in patients with high suspicion of DVT. (4) The therapy of stroke was recorded before the end of the study. Data of stoke patients with DVT was compared with those without DVT to identify the DVT risk factors. The effect of each variable on DVT was assessed by logistic regression analysis. RESULTS: The prevalence of DVT was 21.7% among the patients. In multivariate analysis, age >/= 65 years old (OR = 1.655, 95% CI: 1.005 - 2.725), being male (OR = 1.993, 95% CI: 1.221 - 3.253), bedridden (OR = 3.275, 95% CI: 1.653 - 6.486) and DVT assessment scores >/= 2 (OR = 5.019, 95% CI: 2.685 - 9.381) were independently associated with DVT in all the stroke patients. Being male (OR = 2.828, 95% CI: 1.242 - 6.438), white blood cell count > 10.0 x 10(9)/L (OR = 2.032, 95% CI: 0.897 - 4.602) and DVT assessment scores >/= 2 (OR = 8.809, 95% CI: 3.081 - 25.188) were the independent risk factors of DVT in hemorrhagic stroke group. Age >/= 65 years old (OR = 2.167, 95% CI: 1.072 - 4.381), bedridden (OR = 3.008, 95% CI: 1.435 - 6.307) and DVT assessment scores >/= 2 (OR = 2.600, 95% CI: 1.077 - 6.278) were the independent risk factors of DVT in ischemic stroke group. CONCLUSION: Patients hospitalized with acute stroke were under high risk of DVT. Data suggested that old age, female, bedridden and high DVT assessment scores >/= 2 were independent risk factors for DVT in acute stroke patients that called for supervision and prophylaxis on DVT.