Strategies in the clinical diagnosis and surgical treatment of OSAHS with multilevel obstruction.

OBJECTIVE: To examine the safety and effectiveness of individualized treatment strategies that include three principles (security, top-down and priority) for patients with obstructive sleep apnoea hypopnea syndrome (OSAHS) and multilevel obstruction who decline therapy with continuous positive airway pressure (CPAP). METHODS: Patients with OSAHS and upper airway obstruction who were diagnosed with multilevel obstruction were included in this retrospective study. Patients were evaluated for the degree of obstruction in each level. Three principles were followed in planning the appropriate intervention level and measures to reduce perioperative risks. Polysomnography indices and Epworth sleepiness scores were used to evaluate the efficacy of surgery and improvement in patients' sleepiness at ≥3 months post-surgery. RESULTS: Among 51 patients with OSAHS and multilevel obstruction, three were treated with CPAP, 41 were treated with nasopharyngeal surgery, and seven were treated with oropharyngeal surgery. No severe complications were reported. Following surgery, apnoea hypopnea index and Epworth sleepiness scores were significantly reduced, and the lowest oxygen saturation level was significantly increased. CONCLUSION: The three-principle strategy was safe and effective in planning surgical treatments for patients with OSAHS and multilevel obstruction.

[Observation of nasal obstruction symptom evaluation questionnaire and Epworth sleep score in nasal cavity ventilation expansion techniques for patients with obstructive sleep apnea hypopnea].

OBJECTIVE: To realize the application of nasal obstruction symptom evaluation (NOSE) and Epworth sleep score (ESS) before and after nasal cavity ventilation expansion techniques. METHOD: Forty-two OSAHS patients with nasal obstructive symptoms were diagnosed by clinical symptoms and polysomnography. Nasal cavity ventilation expansion technique was performed. Before and after the surgery, the NOSE and ESS were used to compare the difference. Postoperative data were obtained at least 3 months later. RESULT: Compared the data before and after operation, the NOSE and ESS were significantly decreased respectively (P<0. 05), there is no significant difference between 3 groups (P>0. 05). CONCLUSION: The result suggest that OSAHS patients taking nasal cavity ventilation expansion operations showed improvement in severity of nasal obstructive symptoms and daily sleepy.

[Tissue engineered tympanic membrane repairment materials with adipose-derived stem cells].

OBJECTIVE: To explore the morphology, proliferative activity and adhesion of adipose-derived stem cells (ASC) seeded in the polylactic-co-glycolic acid (PLGA) scaffold, and to provide experimental data for fabricating tissue engineered tympanic membrane repairment materials. METHODS: Wistar rats were selected, and the ASC were isolated and co-cultured with the PLGA scaffold. The morphology and proliferative activity of ASC in the scaffold were examined by immunofluorescence of Vimentin and Ki67 respectively. All the immunofluorescence signals were analyzed by a confocal laser scan microscopy system FLUOVIEW FV1000. The adhesion of ASC to the PLGA scalfold was determined by scanning electron microscopy. RESULTS: Immunofluorescence of vimentin showed rats ASC displayed normal morphology and grew orderly in the PLGA scalfold. Immunofluorescence of Ki67 showed the normal active proliferation of ASC in the scaffolds. The Ki67 mean positive index (x(-) ± s) of the ASC in the scalfold was (8.21 ± 1.76)%, while in control group (cultured without PLGA scalfold) was (9.06 ± 1.95)%. There was no statistic significance between the two groups (t = 1.03, P = 0.30). Scanning electron microscopy demonstrated ASC adhered well to the PLGA scalfold, the pseudopodia of ASC could also be observed and the proliferative cell conjunction was tight. CONCLUSION: ASC has good biocompatible to the PLGA scaffold and could normally adhere and proliferate in PLGA scaffold.

[Diagnosis and management of the acute attack of sphenoid and ethmoid fungal ball sinusitis].

OBJECTIVE: To improve the diagnosis and treatment of the acute attack of sphenoid and ethmoid fungal ball sinusitis based on the analysis of clinical features. METHOD: Eighteen patients with sphenoid and ethmoid fungal ball sinusitis were reviewed, and the main symptoms included headache and fever during acute attack. Endoscopy, nasal CT and MRI can provide useful information for diagnosis. Endoscopic sinus surgery was performed on thirteen patients after drug therapy, while the other 5 patients chose conservative therapy. RESULT: The pathological examination confirmed the fungal lesions and the 13 patients had a good recovery. The result of CT and MRI scanning had a good accordance with the intra-operative findings. One patient receiving conservative treatment had acute attack again 2.5 months later, and antibiotics and topical nasal drugs improved the symptoms. CONCLUSION: Clinical presentation and radiological imaging contribute to the differential diagnosis of the acute attack of sphenoid and ethmoid fungal ball sinusitis, then the targeted therapy can be taken.

[Experience in overlay tympanoplasty].

OBJECTIVE: To explore the experience and value of overlay tympanoplasty. METHODS: Sixty-three ears with overlay tympanoplasty were reviewed and followed up for the external auditory canal, tympanic membrane and hearing. RESULTS: The diseases of the patients included middle ear cholesteatoma in 25 ears and chronic suppurative otitis media in 38 ears. The surgical techniques involved three kinds: overlay tympanoplasty, overlay tympanoplasty with canal wall up mastoidectomy and overlay tympanoplasty with canal wall down mastoidectomy. In middle ear cholesteatoma and suppurative otitis media patients, the case received the three techniques are 4, 17, 4 ears and 19, 18, 1 ears respectively. All patients gained stage I incision cure. Followed up for 0.5 to 3.5 years respectively, the external auditory canal was wide and tympanic membrane gained a good shape. The hearing in all case kept intact or increased while hearing decrease did not occur. Complications were free in patients with punctual visit. CONCLUSIONS: Overlay tympanoplasty has positive significance in treating the chronic otitis media with the merits of standard procedure, sufficient operative field and thorough erosion elimination.

[Effects of CD4+ T cell transplantation on facial motoneuron survival in nude mice model with facial nerve axotomy].

OBJECTIVE: To investigate the specific T cell subpopulation and the relationship with facial motoneuron in immune deficiency mouse model with facial nerve paralysis, so as to find information for new strategy of facial palsy treatment. METHODS: Firstly, purifying the CD4+ T cell from wild type mouse and reestablishing the immune function of nude mouse by infusing the CD4+ T cell through the tail vein a week before the surgery. Then the all nude mouse (BALB/c background) and wild type mouse (BALB/c background) were subjected to a right facial nerve axotomy. Then the mouse was studied by application and assessment with fluorogold retro tracer at specific time. After collecting the slices of brain stem three days post the operation, the facial motoneurons was observed under fluorescence microscope, then analyzed and counted with the software Image Pro Plus5. 1. RESULTS: The number of survival facial motoneuron in the group with CD4+ T cell transplantation and control group was (3444.5 +/- 84.2, x +/- s) and (3013.2 +/- 65.3) respectively. There was significant difference of the number of survival facial motoneurons between nude mouse transplanted with CD4+ T cell and PBS at three days post the operation (t = 5.52, P = 0.0003). But there was no significant difference of survival facial motoneurons between nude mouse transplanted with CD4+ T cell and wild type mouse three days post the operation (t = 0.49, P = 0.6347). It was the transplantation of CD4+ T cell that rescued the survival facial motoneuron to the level of wild type. CONCLUSIONS: CD4+ T cell have the ability to rescue the injuring facial motoneuron from death. It may suggest that there is a critical role of the specific T cell subpopulation in facial nerve repair and regeneration.

Acid-sensing ion channel 2 contributes a major component to acid-evoked excitatory responses in spiral ganglion neurons and plays a role in noise susceptibility of mice.

Ion channels in the degenerin-epithelial sodium channel (DEG-ENaC) family perform diverse functions, including mechanosensation. Here we explored the role of the vertebrate DEG-ENaC protein, acid-sensing ion channel 2 (ASIC2), in auditory transduction. Contributions of ASIC2 to hearing were examined by comparing hearing threshold and noise sensitivity of wild-type and ASIC2 null mice. ASIC2 null mice showed no significant hearing loss, indicating that the ASIC2 was not directly involved in the mechanotransduction of the mammalian cochlea. However, we found that (1) ASIC2 was present in the spiral ganglion (SG) neurons in the adult cochlea and that externally applied protons induced amiloride-sensitive sodium currents and action potentials in SG neurons in vitro, (2) proton-induced responses were greatly reduced in SG neurons obtained from ASIC2 null mice, indicating that activations of ASIC2 contributed a major portion of the proton-induced excitatory response in SG neurons, and (3) ASIC2 null mice were considerably more resistant to noise-induced temporary, but not permanent, threshold shifts. Together, these data suggest that ASIC2 contributes to suprathreshold functions of the cochlea. The presence of ASIC2 in SG neurons could provide sensors to directly convert local acidosis to excitatory responses, therefore offering a cellular mechanism linking hearing losses caused by many enigmatic causes (e.g., ischemia or inflammation of the inner ear) to excitotoxicity.

Aspirin selectively augmented N-methyl-D-aspartate types of glutamate responses in cultured spiral ganglion neurons of mice.

Aspirin is commonly used to study tinnitus in animal models because of its ability to induce tinnitus in human subjects. However, the mechanism by which aspirin affects auditory function remains unclear. To investigate the effect of aspirin on the cochlear neurotransmission, we studied its interactions with major types of membrane channels and receptors regulating the excitability of cultured type I spiral ganglion (SG) neurons. Results showed that aspirin had little effect on voltage-gated sodium and potassium currents of SG neurons. In contrast, it selectively potentiated the N-methyl-D-aspartate (NMDA) subtype of the glutamate responses in SG neurons while showing little effect on the alpha-amino-3-hydroxy-5-methylisozazole-4-propionic acid and kainate types of glutamate responses. The aspirin-induced current in the presence of NMDA increased in a dose-dependent manner with a half maximal concentration of 2.2 mM, and it was blocked by NMDA receptor antagonist 2-amino-5-phosphonopentanoic acid or Mg(2+). These in vitro results suggested that aspirin could interfere with the glutamatergic neurotransmission in the cochlea by selectively amplifying NMDA-mediated responses.