[Clinical application of endoscope combined with microscope for the microvascular decompression in hemifacial spasm].

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.

Strategy for facial nerve management during surgical removal of benign jugular foramen tumors: Outcomes and indications.

OBJECTIVE: Classical surgical management of jugular foramen (JF) tumors usually requires facial nerve rerouting which results in permanent facial palsy in most patients. The purpose of the article is to study the outcomes of different rerouting techniques, and to discuss their indications. MATERIAL AND METHODS: We retrospectively reviewed 98 patients with JF tumors operated at our center between January 2008 and December 2016 using different surgical approaches with the following procedures for facial nerve management: total anterior rerouting (TR), partial anterior rerouting (PR), and fallopian bridge (FB) technique. The data for facial nerve management, surgical outcome and postoperative facial nerve function were collected from the medical records. RESULTS: In the study, there were 48 males and 50 females. Of them, 61 (62.2%) were jugular paragangliomas, 22 (22.4%) schwannomas, and 15 (15.3%) meningiomas. Total tumor removal was achieved in 95 (96.9%) patients, while near-total removal was achieved in 3 (3.1%) paragangliomas. TR was applied in 31 (31.6%) patients with PR in 26 (26.5%) patients, and FB in 41 (41.8%) patients. The mean follow-up duration was 39.4±22.6 months, and 2 recurrences of paragangliomas were observed. Seventy-five patients (76.5%) had good facial function (HB I-II) at 1 year after surgery, the patients who received a TR approach presented significantly less HB I-II FN function (48.4%) than those with PR (82.6%, P<0.05) or those with FB technique (95.1%, P<0.001). 21 patients (21.4%) presented new-onset lower cranial nerve dysfunction of which 13 recovered at 1 year after surgery. CONCLUSION: Facial nerve management in JF tumors should be tailored individually. No-rerouting methods, such as the fallopian bridge technique, bring significantly better results in terms of facial nerve function, which might be performed first during surgery; its indication is based mainly on the tumor type and extent.

Simultaneous supervision by microscope of endoscope-assisted microsurgery via presigmoid retrolabyrinthine approach: A pilot study.

OBJECTIVE: To examine the impact of integrated hybrid operating rooms for endoscope-assisted microsurgery using the presigmoid retrolabyrinthine (RL) approach, and to determine the value of simultaneous supervision of skull base endoscopic procedures by microscope. MATERIAL AND METHODS: We retrospectively reviewed endoscope-assisted surgery using the RL approach at our institution between September 2013 and January 2017. The simultaneous supervision of endoscopic procedures by microscope was realized using the integrated hybrid system. Intra- or postoperative complications and surgical outcomes were analyzed. All patients were followed for at least 1 year. RESULTS: In total, 32 patients were studied: 4 vestibular schwannomas, 5 cholesteatomas, 8 hemifacial spasms, 5 glossopharyngeal neuralgias, and 10 Ménière's disease. In patients with vestibular schwannoma or cholesteatoma, complete removal was performed in all patients. In patients with Ménière's disease, hemifacial spasm or glossopharyngeal neuralgia, satisfactory symptom relief was achieved in all patients. Two (6.3%) patients had hearing loss after surgery which did not recover. One (3.1%) patient with vestibular schwannoma had mild facial palsy (HB III) at 2 weeks after the operation and recovered to near normal facial nerve function (HB II) at 1 year after surgery. No permanent or transient dysfunction of the trigeminal nerve or the lower cranial nerves was observed during follow-up. No complications such as cerebrospinal fluid (CSF) leakage or meningitis were observed. CONCLUSION: The endoscope provided a clearer and larger view, which solved the limitations of surgery using the RL approach. Endoscopic surgery under simultaneous supervision by microscope was safe and efficient in hearing preservation as well as in preservation of facial nerve function. An integrated operation room provided better support and the ability to switch quickly between these various complex devices.

Long non-coding RNA TUSC7 expression is independently predictive of outcome in glioma.

OBJECTIVE: Down-regulation of long non-coding RNA tumor suppressor candidate 7(TUSC7) contributes to tumorigenesis in several human cancers including glioma. However, the prognostic value of TUSC7 in glioma remains unclear. The present study aimed to investigate the clinicopathological and prognostic value of TUSC7. PATIENTS AND METHODS: The expression level of TUSC7 in glioma tissues and matched normal tissues were detected by qRT-PCR. Then, the association of serum TUSC7 expression level with various important clinicopathological parameters and survival rates was evaluated. The Cox regression analysis was used to evaluate the effect of independent prognostic factors on survival outcome. RESULTS: The relative level of TUSC7 was significantly lower in glioma tissues compared to the adjacent normal brain tissues (p < 0.01). In addition, a lower expression of TUSC7 was observed in high-grade glioma tissues than in low-grade glioma tissues (p < 0.01). Furthermore, the low expression of TUSC7 was associated with poor clinicopathological characteristics of glioma, including WHO grade (p = 0.002) and KPS (p = 0.026). Then, the low TUSC7 level was correlated with shorter disease free survival (DFS) and overall survival (OS) than low level (both p = 0.05). Finally, univariate and multivariate Cox analysis showed that TUSC7 was an independent prognostic indicator for OS and DFS. CONCLUSIONS: These results provided evidence that TUSC7 may be a potential biomarker in the prognosis of glioma.

Nucleus accumbens-associated protein-1 promotes glycolysis and survival of hypoxic tumor cells via the HDAC4-HIF-1α axis.

Nucleus accumbens-associated protein-1 (NAC1), a nuclear factor of the BTB/POZ gene family, has emerging roles in cancer. In this study, we identified the NAC1-HDAC4-HIF-1α axis as an important pathway in regulating glycolysis and hypoxic adaptation in tumor cells. We show that nuclear NAC1 binds to histone deacetylase type 4 (HDAC4), hindering phosphorylation of HDAC4 at Ser246 and preventing its nuclear export that leads to cytoplasmic degradation of the deacetylase. Accumulation of HDAC4 in the nuclei results in an attenuation of HIF-1α acetylation, enhancing the stabilization and transcriptional activity of HIF-1α and strengthening adaptive response of cells to hypoxia. We also show the role of NAC1 in promoting glycolysis in a mouse xenograft model, and demonstrate that knockdown of NAC1 expression can reinforce the antitumor efficacy of bevacizumab, an inhibitor of angiogenesis. Clinical implication of the NAC1-HDAC4-HIF-1α pathway is suggested by the results showing that expression levels of these proteins are significantly correlative in human tumor specimens and associated with the disease progression. This study not only reveals an important function of NAC1 in regulating glycolysis, but also identifies the NAC1-HDAC4-HIF-1α axis as a novel molecular pathway that promotes survival of hypoxic tumor cells.

Germline mutations and genotype-phenotype associations in head and neck paraganglioma patients with negative family history in China.

The aim of this study was to assess the frequency of germline mutations and to explore genotype-phenotype associations in Chinese head and neck paraganglioma (HNPGL) patients without family history. Twenty-six Chinese patients with a diagnosis of HNPGL（14 male and 12 female, respectively）were recruited, who were followed up from 2000 to 2012. Genomic DNA was obtained from resected tumor tissues and peripheral blood samples. Seven genes, Succinate dehydrogenase complex A,B,C,D (SDHA, SDHB, SDHC, SDHD), succinate dehydrogenase complex assembly factor 2 (SDHAF2), TMEM127 (transmembrane protein 127) and VHL (Von Hippel-Lindau), were screened by direct sequencing and multiplex ligation-dependent probe amplification (MLPA) was performed to search for potential large deletions or duplications of SDHB, SDHC, SDHD, SDHAF1 and SDHAF2. The total frequency of germline mutations was 30.8% (8/26), including 5 cases with missense mutation p.Met1Ile in SDHD, 1 case with missense mutation p.Tyr216Cys in SDHB, and 1 case with a novel truncation mutation p.Gln44Ter in SDHAF2. MLPA showed one patient with malignant HNPGL had heterozygous deletions of exon1, 2, 3, 7 and 8 in SDHB. Mutations in SDHD were the leading cause of HNPGL in this study. Mutation carriers were younger than non-mutation carriers (p < 0.01) and more likely to suffer from multiple tumors (p = 0.048), especially with mutations in SDHD. The presence of mutation was associated with the development of larger tumors (p = 0.021). This study confirmed that the missense mutation p.Met1Ile at the start codon in SDHD was a hotspot in chinese patients with HNPGLs. We recommend genetic analysis in patients below 45 years, especially SDHD gene.

Effect of miR-146a polymorphism on biochemical recurrence risk after radical prostatectomy in southern Chinese population.

Evidence has shown that miR-146a is involved in carcinogenesis and a common G/C variant (rs2910164) in the pre-miR-146a gene has been found to be associated with various cancers. We investigated the potential prognostic role of miR-146a polymorphism in prostate cancer after radical prostatectomy. Seventy-two southern Chinese with prostate cancer undergoing radical prostatectomy were included in this study. miR-146a polymorphism was analyzed by PCR-RFLP. Its prognostic role in biochemical recurrence was assessed using Kaplan-Meier analysis and Cox regression model. We did not find a significant association between miR-146a polymorphism and prostrate-specific antigen failure in the Chinese population [HR (95%CI): 0.83 (0.30-2.32) for CC vs GG/GC]. However, high Gleason score (over 8) was associated with increased biochemical recurrence and poorer PSA-free survival. This study was limited by the length of follow-up. Future studies with longer follow-up would allow evaluation of more direct metrics, such as disease-specific survival, metastasis-free survival, and overall survival.

Different bladder defects reconstructed with bladder acellular matrix grafts in a rabbit model.

OBJECTIVE: To evaluate the potential use of the bladder acellular matrix graft (BAMG), two different bladder defects in the rabbit model were reconstructed. MATERIALS AND METHODS: Two groups of rabbits underwent partial bladder wall cystectomy (group A, 30-40%; group B, 70-60%) and reconstruction of the defects with an equally sized BAMG. After 4, 12, and 24 weeks, bladder cystographs were performed. Then the rabbits were killed after uneventful postoperative periods, and the grafts were harvested for H&E staining and immunohistochemical staining. RESULTS: Two rabbits died on the postoperative days 3 and 6 in group A due to urinary peritonitis. At 24 weeks, in group A, the reconstructed bladders reached a mean volume of 94.39±0.54% of the precystectomy bladder capacity. Histologically, complete regeneration of smooth muscle and urothelium tissue was evident. Regenerated SMCs and urothelium stained positive for α-smooth muscle actin and AE1/AE3. In group B, the mean bladder volume was 64.5±3.19% of the precystectomy volume. Histologically, group B was characterized by multilayered urothelium without organized muscle tissue. CONCLUSION: The BAMG was an effective scaffold for bladder wall regeneration in the rabbit model. However, the use of BAMG reconstruction in larger bladder defects did not induce the same quality and quantity of bladder regeneration as the reconstruction of smaller bladder defects.

Comparison of dual-energy X-ray absorptiometry machines for measuring fat distribution changes of HIV-associated lipodystrophy.

BACKGROUND: Dual-energy X-ray absorptiometry (DXA) is regarded as a useful objective method for diagnosis of HIV-associated lipodystrophy (LD). OBJECTIVE: To determine whether the use of different DXA machines may affect the diagnosis of LD. METHODS: Body composition in 24 HIV-infected patients, 12 of whom had clinically diagnosed LD, was measured on two DXA machines (Lunar and Hologic). RESULTS: Hologic gave significantly higher values than Lunar DXA for total body fat percent (22.9 vs 20.5%, P<0.001), arm fat percent (27.9 vs 14.5%, P<0.001) and leg fat percent (23.4 vs 17.5%, P<0.001), and significantly lower values than Lunar for trunk fat percent (22.3 vs 24.7%, P<0.001) and trunk-to-limb fat percent ratio (0.89 vs 1.62, P<0.001). When measured by Lunar, patients with LD had significantly lower leg fat percent (13.5 vs 21.6%, P=0.04) and higher trunk-to-limb fat percent ratio (1.85 vs 1.38; P=0.012) than those without LD. When measured by Hologic, patients with LD had values of leg fat percent (20.1 vs 26.8%, P=0.11) and trunk-to-limb fat percent ratio (0.95 vs 0.85, P=0.43) that did not differ significantly from those without LD. There was a significant difference in the contribution to a composite LD score between Lunar and Hologic measurements. CONCLUSION: DXA machines from different manufacturers give major differences in measurements of body fat content and distribution, and this may affect the ability to distinguish patients with LD from those without LD. Further standardization of DXA technology is needed before widespread application in the clinical diagnosis of LD.

[Practicability of IFAT using Plasmodium cynomolgi and Plasmodium falciparum antigens in different malarious areas].

OBJECTIVE: To compare the practicability of IFAT in different malarious areas using Plasmodium cynomolgi(P.c.) and Plasmodium falciparum(P.f.) antigens. METHODS: This survey was carried out in Yaliang Township of Sanya City, Hainan Province, where a mixed malaria is endemic, and in Tongbo County, Henan Province where only vivax malaria is endemic, and in Weihui City, Henan Province where vivax malaria has been under effective control since 1994-1998. RESULTS: In Yaliang Township, 310 blood samples were examined, the antibody positive rates with P.c. and P.f. were 37.4% and 31.3%, respectively, the rate of coincidence being 83.9%. In Tongbo County, 300 blood samples were examined. The antibody positive rates with P.c. and P.f. were 23.0% and 9.7%, respectively (P < 0.01). Another 245 blood samples from children were examined in Weihui City and the antibody positive rates were below 1% with two antigens, while the positive antibody rate was 3.3% with P.f. antigen. CONCLUSION: Both P.f. and P.c. antigens could be used in malaria antibody surveillance in mixted endemic areas, while in vivax malaria endemic areas, P.c. antigen was recommended.