[Differential diagnosis and surgical management in chondrosarcoma of the jugular foramen].

Objective: To explore the diagnosis, surgical management and outcome of jugular foramen chondrosarcoma (CSA). Methods: Fifteen patients with jugular foramen CSA hospitalized in the Department of Otorhinolaryngology Head and Neck Surgery of Chinese PLA General Hospital from December 2002 to February 2020 were retrospectively collected,of whom 2 were male and 13 were female, aging from 22 to 61 years old. The clinical symptoms and signs, imaging features, differential diagnosis, surgical approaches, function of facial nerve and cranial nerves IX to XII, and surgical outcomes were analyzed. Results: Patients with jugular foramen CSA mainly presented with facial paralysis, hearing loss, hoarseness, cough, tinnitus and local mass. Computed tomography (CT) and magnetic resonance (MR) could provide important information for diagnosis. CT showed irregular destruction on bone margin of the jugular foramen. MR demonstrated iso or hypointense on T1WI, hyperintense on T2WI and heterogeneous contrast-enhancement. Surgical approaches were chosen upon the sizes and scopes of the tumors. Inferior temporal fossa A approach was adopted in 12 cases, inferior temporal fossa B approach in 2 cases and mastoid combined parotid approach in 1 case. Five patients with facial nerve involved received great auricular nerve graft. The House Brackmann (H-B) grading scale was used to evaluate the facial nerve function. Preoperative facial nerve function ranked grade Ⅴ in 4 cases and grade Ⅵ in 1 case. Postoperative facial nerve function improved to grade Ⅲ in 2 cases and grade Ⅵ in 3 cases. Five patients presented with cranial nerves Ⅸ and Ⅹ palsies. Hoarseness and cough of 2 cases improved after operation, while the other 3 cases did not. All the patients were diagnosed CSA by histopathology and immunohistochemistry, with immunohistochemical staining showing vimentin and S-100 positive, but cytokeratin negative in tumor cells. All patients survived during 28 to 234 months' follow-up. Two patients suffered from tumor recurrence 7 years after surgery and received revision surgery. No complications such as cerebrospinal fluid leakage and intracranial infection occurred after operation. Conclusions: Jugular foramen CSA lacks characteristic symptoms or signs. Imaging is helpful to differential diagnosis. Surgery is the primary treatment of jugular foramen CSA. Patients with facial paralysis should receive surgery in time as to restore the facial nerve. Long-term follow-up is necessary after surgery in case of recurrence.

[Correlational verification of drug-induced liver injury with HLA-B*35:01 allele due to Polygonum multiflorum].

In order to verify the correlation between Polygonum multiflorum-induced liver injury and HLA-B*35 : 01 alleles, six hospitalized patients diagnosed with Polygonum multiflorum-induced liver injury (PM-DILI) were selected, and their clinicopathological data were collected. Simultaneously, blood HLA-B* 35 : 01 allele detection was performed. Among the six PM-DILI cases, 4 were male, aged 38.83 ± 10.13 years old. The types of liver injury were hepatocellular injury types in all, and the severity of liver injury in five cases was grade 3. The histological presentations were acute hepatitis and acute cholestatic hepatitis. PM-DILI cases were all HLA-B*35:01 carriers, with a carrier rate of 100%. This finding indicates that PM-DILI is significantly correlated with HLA-B*35:01 alleles. Therefore, HLA-B*35 : 01 alleles can be used as an important predictive indicator for PM-DILI.

[Effect of Echinococcus multilocularis infections on mitochondrial functions of macrophages].

OBJECTIVE: To investigate the changes of mitochondrial metabolic functions of macrophages following Echinococcus multilocularis infections, so as to provide insights into the pathogenesis of alveolar echinococcosis. METHODS: Two groups were assigned according to different treatment methods. In the culture group, mouse leukemic monocyte macrophage RAW264.7 cells were cultured with 2 000 E. multilocularis at a ratio of 500∶1, while RAW264.7 cells in the control group were given no treatment. Then, both the culture and control groups were further divided into the 24 h and 72 h subgroups. Mitochondria were stained with MitoTracker® Deep Red FM and the mean fluorescence intensity of macrophage mitochondria was measured with the Cytation 5 Cell Imaging Multi-Mode Reader. The mitochondrial DNA copy number was quantified using the quantitative real-time PCR (qPCR) assay, and the mitochondrial energy metabolism was monitored using the Seahorse XF assay. In addition, the mitochondrial reactive oxygen species and mitochondrial membrane potential were detected using flow cytometry. RESULTS: The mean fluorescence intensities of macrophage mitochondria were significantly lower in the 24 h (15 341 ± 2 532 vs. 17 823 ± 3 429; t = 6.379, P < 0.01) and 72 h (18 102 ± 3 505 vs. 21 511 ± 5 144; t = 17.680, P < 0.01) culture subgroups than in the corresponding control subgroups, and lower mitochondrial DNA copy numbers were measured in the 72 h culture subgroup than in the 72 h control group [(3.23 × 109 ± 1.78 × 107) vs. (4.39 × 109 ± 3.70 × 107); t = 8.85, P < 0.001]. The oxygen consumption rates were significantly greater in the 24 h [(241.70 ± 73.13) pmol/min vs. (69.05 ± 52.30) pmol/min; t = 7.89, P < 0.01] and 48 h culture groups [(249.50 ± 42.06) pmol/min vs. (60.28 ± 40.66) pmol/min; t = 8.64, P < 0.01] than in the corresponding control groups, and a higher extracellular acidification rate was seen in the 48 h culture group than in the 48 h control group ([ 111.6 ± 17.49) mpH/min vs. (35.05 ± 7.57) mpH/min; t = 16.90, P < 0.01]. In addition, flow cytometry detected higher mean fluorescence intensity of mitochondrial reactive oxygen species (58 264 ± 10 087 vs. 4 307 ± 97; t = 12.930, P < 0.01) and lower mitochondrial membrane potential (9.833% ± 2.285% vs. 2.667% ± 0.208%; t = 6.645, P < 0.01) in the 72 h culture group than in the control group. CONCLUSIONS: E. multilocularis infection may impair mitochondrial functions and inhibit oxidative phosphorylation of macrophages, resulting in increased macrophage glycolysis. It is speculated that the alteration of macrophage metabolic states may contribute to the mechanisms underlying the development and progression of alveolar echinococcosis.

[The diagnosis and treatment of vagal paraganglioma in the parapharyngeal space].

Objective: To study the clinical features, diagnosis and treatment of vagal paraganglioma in parapharyngeal space. Methods: Nine cases with vagal paraganglioma in parapharyngeal space were retrospectively analyzed who were diagnosed and treated between January 2006 and December 2018 in Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital and the First Medical Center, Chinese PLA General Hospital. There were 6 males and 3 females, aged from 24 to 50 years old. The main symptoms in the 9 patients were hoarseness and neck mass, and the secondary symptoms were irritating cough, cough on drinking and dysphagia. The main sign was a well-circumscribed round mass, tough in texture, with or without ipsilateral lateral oropharyngeal wall uplift and vocal cord paralysis. The tumors were located between the bifurcation of the carotid artery and the jugular foramen in 7 cases and intruded into jugular fossa in 2 cases. All the 9 patients underwent head and neck enhancement CT and MRI and 7 cases received digital subtraction angiography (DSA) examination and balloon occlusion test. The imaging features were tumors with rich blood supply in the parapharyngeal space of the upper neck, and the tumors were heterogeneous enhanced with contrast CT scan and enhanced MRI, which were closely related to the internal carotid artery, external carotid artery and jugular vein. Results: Among these 9 patients, 8 underwent surgical resection of tumors, including complete tumor resection in 7 cases and partial tumor resection in 2 case. One patient underwent partial tumor resection after being transferred to vascular surgery. There was no recurrence in 7 patients with complete tumor resection and slow growth was shown in 2 patients with partial tumor resection. Posterior cranial nerve injury occurred in 2 patients and stroke in 1 patient due to intraoperative ligation of internal carotid artery. Conclusions: Vagal paraganglioma in the parapharyngeal space is rich in blood supply and closely related to the internal and external carotid arteries, internal jugular vein and posterior cranial nerves. Surgical resection is the first choice for treatments. Choosing a reasonable operative approach for fully exposing the operative field and completely removing the tumor while protecting the internal carotid artery are the keys to successful surgery.

[Clinical study of postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy for locally advanced hypopharyngeal squamous cell carcinoma].

Objective: Using propensity score matching method (PSM) to investigate the clinical effect of postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy for locally advanced hypopharyngeal squamous cell carcinoma. Methods: From July 2007 to July 2018,174 postoperative patients with locally advanced hypopharyngeal squamous cell carcinoma were enrolled in pre-PSM cohort, including 168 males and 6 females, the median age was 60 years old (ranged from 37 to 79 years old).Loco-regional control (LRC),progression-free survival (PFS) and overall survival (OS) were compared and analyzed between the patients treated with postoperative adjuvant radiotherapy and postoperative concurrent chemoradiotherapy (cisplatin was given in a dose of 80 mg/m(2) on days 1, 22, and 43). After the propensity score matching (PSM), 61 sub-pairs of 122 patients were generated in post-PSM cohort. Survival rate were assessed with Kaplan-Meier method and Log-rank test. Results: After the propensity score matching(PSM), 61 sub-pairs of 122 patients were generated in post-PSM cohort.The patients were followed up for 3-135 months, the median follow-up was 42 months. No significant differences in 3-year and 5-year LRC, PFS, OS were observed between the two groups (P>0.05) . For postoperative patients who had high-risk factors (extracapsular extension of nodal disease, and/or vascular embolism, and/or lymph node metastasis≥2, and/or positive surgical margin, and/or perineural infiltration),there were significant differences between the two groups in 3-year PFS (60.99% vs 84.49%,P<0.05), 5-year PFS (35.47% vs 56.97%,P<0.05) and 5-year LRC (41.02% vs 68.50%, P<0.05), but no significant difference was found in OS between the two groups (P>0.05). Conclusion: Postoperative concurrent chemoradiotherapy was more efficacious than postoperative radiotherapy alone in terms of loco-regional control and PFS for high-risk postoperative patients with locally advanced hypopharyngeal squamous cell carcinoma.

[A retrospective study on combined modality therapy with or without surgery for advanced hypopharyngeal squamous cell carcinoma: an analysis of 119 cases].

Objective: To compare the treatment outcomes for locally advanced hypopharyngeal carcinoma between surgery plus radio(chemo) therapy(SRT) and non-surgery chemoradiotherapy(CRT). Methods: A total of 119 patients diagnosed with advanced hypopharyngeal carcinoma without distant metastases between 2010 and 2014 were identified in the Chinese People's Liberation Army General Hospital, and they were divided into 2 groups: 42 cases in SRT group and 77 cases in CRT group. Patients' clinical information was collected. Survival rates and prognostic factors were analyzed by the Kaplan-Meier method with SPSS 23.0 software. The survival rates, laryngeal preservation rates and complication rates were compared between the two groups using the chi-square test.Among the 119 patients, 112 were males and 7 were females. Age ranged from 27 to 78 years, with an average age of 57 years. Results: There were no significant difference between the SRT and CRT group for five-year disease-free survival (DFS, 53.9% vs. 45.1%, χ(2)=1.251, P=0.263) and overall survival (OS, 54.9% vs. 45.6%, χ(2)=1.749, P=0.186). Compared to SRT group, CRT group did not showed the significant increase of treatment complications (χ(2)=0.858, P=0.354), with a higher laryngeal preservation rate (50.0% vs. 71.4%, χ(2)=6.493, P=0.011). Conclusions: Advanced hypopharyngeal carcinoma is of high malignancy and poor prognosis. Combined modality treatment is a main approach for advanced hypopharyngeal cancer. SRT offers disease-free survival and overall survival rates equivalent to CRT, but with a higher laryngeal preservation rate.

[Thyroid adenoma in the piriform fossa: a case report and literature review].

Objective: To explore the clinical characteristics of case of thyroid adenoma in the piriform fossa, and review the literatures of the congentital thyroid gland abnormality. Methods: A 44-year-old male had foreign body feeling in his pharynx for 3 years. A mass in his left piriform fossa was detected by the clinical and imaging examination. Biopsy report that the mass was thyroid papillary carcinoma. The resection of tumor with partial back thyroid cartilage through lateral neck and pharyngeal approach was performed. Results: The surgical wound healed in first-stage and no any surgical complication occurred. With postoperative pathological and immunohistochemical examination, the mass was finally diagnosed as thyroid gland adenoma. Staining for cytokerantin19 was negative. Conclusion: The symptomatic and neoplastic abnormal thyroid gland should be excised, but asymptomtic, non-neoplastic and functional abnormal thyroid gland should be retained with regular follow up.

[Clinical features of patients with head and neck malignant tumor concurrent with multiple primary carcinoma].

OBJECTIVE: To analyze the clinical characteristics of multiple primary cancers (MPC) associated with head and neck. METHODS: A total of 71 patients with MPC associated with head and neck treated from January 2008 to November 2015 were included in the retrospective study, of them 20 patients were synchronous MPC and 51 patients were metachronous MPC; 45 (63.4%) patients were field cancerization of head neck (FCHN) and 26 (36.6%) patients were non-field cancerization of head neck (NFCHN). For the synchronous MPC patients with an interval of 0 month, the lesion sites of FCHN were treated with combined chemotherapy and radiotherapy, the site of severe lesion of NFCHN received firstly a standard treatment. Other types of MPC were treated according to international guide lines or experts consensus. RESULTS: With the mean follow-up of 63.4 months, the 3-year and 5-year overall survival (OS) were 84.6% and 75.7% respectively. The 3-year and 5-year OS were 56.4% and 37.6% respectively in patients with synchronous MPC, and were 92.2% and 84.2% respectively in patients with metachronous MPC. There was significant difference in the OS between patients with metachronous MPC and patients with synchronous MPC (P=0.0002). The 3-year and 5-year OS were 85.7% and 77.9% respectively in patients with FCHN, and were 82.9% and 72.8% respectively in patients with NFCHN, with no significant difference between the two groups (P=0.297). CONCLUSION: With correct diagnosis and effective curative treatment, some of patients with MPC can get long-term survival, showing the better prognosis in metachronous MPC compared to synchronous MPC.

Parameters influencing augmentation of cerebral blood flow by cervical spinal cord stimulation.

BACKGROUND: Cervical spinal cord stimulation (SCS) has been shown to augment cerebral blood flow (CBF) and protect the brain from focal ischemia. However, the application of SCS in the treatment of cerebral ischemia requires a better understanding of the limits of the cerebrovascular effect and the optimal stimulation parameters. In the present study, we investigated the effects of various stimulation parameters on CBF augmentation, as well as the issue of tachyphylaxis of the CBF response. METHODS: SCS was performed in adult Sprague Dawley rats, and CBF was assessed using cortical laser Doppler flowmetry (LDF). In separate experimental series, stimulation amplitude, frequency, and pulse width were varied, and the effect on the LDF response was recorded. Finally, using the stimulation parameters found to elicit the strongest LDF response, we examined the effect of lengthening the period of SCS. FINDINGS: SCS elicited a robust increase in cortical LDF values as previously demonstrated. The magnitude of the response varied in a dose-dependent fashion with the stimulation amplitude. LDF values increased by more than 80% over baseline with an amplitude of 1.5 mA. The optimal pulse width and frequency of the stimulation were 0.25 ms and 50 Hz, respectively. Lengthening the stimulation period up to 20 minutes resulted in a persistent increase in cerebral LDF values during the entire stimulation period, although the magnitude of this effect diminished to approximately 50% over the baseline after 10 minutes. CONCLUSIONS: SCS elicits a robust augmentation in CBF, which lasts the entire stimulation duration. Stimulation parameters required for optimal cerebrovascular response are within normally used therapeutic ranges in the clinical settings. These results provide further evidence that SCS may provide a novel therapeutic strategy for the treatment of cerebral ischemia.

Effects of cervical spinal cord stimulation on cerebral blood flow in the rat.

OBJECT: Spinal cord stimulation (SCS) is frequently used for the treatment of chronic pain. Although the mechanisms by which SCS alleviates pain are unclear, they are believed to involve changes within the dorsal horn of the spinal cord. Spinal cord stimulation has also been found to cause significant vasodilation in the peripheral vasculature. The mechanisms underlying this effect are thought to involve sympathetic blockade. A rostral vasodilatory effect has also been described, but changes in cerebral blood flow (CBF) have been poorly delineated. Using laser Doppler flowmetry (LDF), the authors examined the effects of cervical SCS on CBF in rats. METHODS: Cervical SCS was found to result in a significant increase in cortical LDF values (83 +/- 11% [mean +/- standard error of the mean]). The increase in cortical LDF values was not accompanied by a significant increase in systemic blood pressure. Stimulation of the upper cervical spinal cord was more effective in inducing LDF changes than was that of the lower cervical cord. Changes in SDS-induced LDF values were significantly attenuated after spinal cord transection at the cervicomedullary junction and by the administration of the sympathetic blocker hexamethonium. CONCLUSIONS: These results indicate that cervical SCS may induce cerebral vasodilation and that this effect may involve indirect effects on vasomotor centers in the brainstem as well as an alteration in sympathetic tone.

Renal squamous cell carcinoma: CT findings and clinical significance.

BACKGROUND: To study the biological behavior of renal squamous cell carcinoma (RSCC). METHODS: Fifteen cases of RSCC were retrospectively studied. These cases were classified as central (eight cases) and peripheral (seven cases) types by the tumor location. The clinical data and computed tomographic findings were analyzed and compared. RESULTS: High incidence (87%) of urolithiasis was observed. The prognosis of RSCC was very poor, with a median survival time of 3.5 months. The infectious symptoms, central location, and modified stage IV of the tumor were the poor prognostic factors of RSCC. Two types of RSCC were different in the presenting symptoms, lymph node metastasis, modified tumor staging, and survival time. CONCLUSION: The central and peripheral types of RSCC were different biologically. High index of suspicion should be maintained when identifying the subtle clues of malignancy in patients with urolithiasis.

Induction of hypercontractility in human cerebral arteries by rewarming following hypothermia: a possible role for tyrosine kinase.

Induction of hypothermia is used routinely in neurosurgical and cardiovascular operations to protect the brain from ischemic insult. However, despite a plethora of experimental evidence supporting the use of hypothermia to protect the brain from ischemia, clinical experience using deliberate hypothermia in humans has not shown a convincing benefit. The authors tested the hypothesis that hypothermia and rewarming alter tone in human cerebral vessels and may interfere with cerebral perfusion in the setting of deliberate hypothermia. They examined human cerebral arteries during hypothermia (32 degrees C and 17 degrees C) and during rewarming to delineate the direct effects of cooling and rewarming on cerebrovascular tone. Artery segments obtained from autopsy material and from specimens excised at elective temporal lobectomies were tested in tissue baths using isometric tension measurements. Temperature-induced changes in vascular tone were measured and quantified with respect to contractile responses to serotonin (5-HT; 10(-6) M). Cooling induced mild relaxation in cerebral vessels (-38 +/- 12% 5-HT response in 50 vessels from autopsy specimens, -69 +/- 10% 5-HT response in 51 vessels from lobectomy specimens). On rewarming, vessels contracted significantly beyond their baseline tone (108 +/- 18% 5-HT response in 50 vessels from autopsy specimens, 42 +/- 12% 5-HT response in 51 vessels from lobectomy specimens). Rewarming-induced hypercontractility was inhibited by the tyrosine kinase inhibitor genistein (-5 +/- 7% vs. 70 +/- 23% 5-HT response, genistein vs. control, 14 segments, p < 0.05) and enhanced by the tyrosine phosphatase inhibitor sodium orthovanadate (339 +/- 54% vs. 104 +/- 20% 5-HT response, sodium orthovanadate vs. control, five segments, p < 0.05), indicating a possible role for tyrosine kinase activation in the rewarming-induced contraction.

[Inflammatory pseudotumor of nasal cavity].

Inflammatory pseudotumor is uncommon in the field of otorhinolaryngology. It is often misdiagnosed as a malignant tumor and undergone radical operation because of its extensive infiltration and bony destruction. Three cases of primary pseudotumor of the nose are reported in this paper. Two of them had involved the nasal cavity and sinuses, orbit and anterior cranial fossa. Reports of such extensive inflammatory pseudotumor has been few in Chinese and foreign literatures. The tumor is sensitive to cortical hormone therapy. An extensive lesion not being confirmed pathologically as a malignant neoplasm should be suspected of inflammatory pseudotumor and can be tentatively treated with cortical hormone, radical operation should be avoided until a diagnosis of malignant tumor is established.

Sonography and computed tomography of a gossypiboma and in vitro studies of sponges by ultrasound. Case report.

A case of retained surgical sponge was imaged by ultrasound and computed tomography (CT). Sonography revealed a hypoechoic mass with areas of high echoes and acoustic shadowing. An experiment revealed that the high echoes were attributed partly to the presence of numerous interfaces of sponges. The sonographic detection of a mass with high echoes casting acoustic shadows should alert radiologists to the possibility of retained surgical sponges even if there is no gas or calcification on CT scans.

[Repair of cerebrospinal rhinorrhea].

The present paper describes a new method for repairing the CSF rhinorrhea from the sella turcica using frontal muscle--galea aponeurotica--periosteum flap with blood vessel pedicle through cranial-nasal approach. This new method possesses the following advantages: short approach, clear field of vision, nose injury, few complications and less cosmetic influence. The flap, led into the sphenoid sinus Via the frontal sinus or the anterior cranial base and nasal roof, Survived and grew well due to its sufficient circulation and strong resistance to infection. For all the five cases described in this paper, among which three had accepted two or three repairs before, the CSF rhinorrhea ceased after only one procedure.

Effects of metal ions, including Mg2+ and lanthanides, on the cleavage of ribonucleotides and RNA model compounds.

The cyclization/cleavage of 3',5'-uridyluridine to form 2',3'-cyclic uridylic acid is very effectively catalyzed by Eu3+, and the cyclization/cleavage of the 1-p-nitrophenyl phosphate ester of propane-1,2-diol also shows strong metal ion catalysis by Eu3+, Tb3+, and Yb3+. It also shows moderate catalysis by Mg2+, but not by Ca2+; Zn2+ and Pb2+ are also good catalysts. Various ligands activate these reactions further, and imidazole apparently acts as an additional base catalyst. Some cyclodextrin derivatives act to bind both the substrate and the metal ion but, contrary to what is reported elsewhere, there is no strong selectivity among nucleotides that can be ascribed to cyclodextrin binding.

On the mechanism of action of ribonucleases: dinucleotide cleavage catalyzed by imidazole and Zn2+.

Cyclization/cleavage of the 2-(p-nitrophenyl) phosphate ester of propylene glycol is catalyzed by imidazole and, much more effectively, by Zn2+ with imidazole. In the latter case, the mechanism involves simultaneous Lewis acid/base catalysis. Similar Zn2+ and imidazole catalysis of cyclization/cleavage is seen with the dinucleotide 3',5'-UpU (uridylyluridine). Again, the zinc system is much more effective than is catalysis by imidazole alone, and in this case simultaneous Lewis acid/base catalysis substitutes for the sequential proton acid/base catalysis seen with polynucleotides or dinucleotides and imidazole buffer catalysts. A mechanism is proposed for catalysis of RNA cleavage by the enzyme ribonuclease A, and the relationship of that mechanism to the action of the enzyme model systems is discussed.