Examination of Oral Candida Infection in Primary Sjögren's Syndrome Patients

Primary Sjögren's syndrome (pSS) is an autoimmune disease characterized by symptoms such as dry mouth, dry eyes, and other systematic symptoms. Due to the hyposalivation experienced by pSS patients, oral dysbacteriosis often occurs. A common complication of pSS is the oral Candida infection. In this article, the authors describe systematic methods that can effectively diagnose oral Candida infection and identify the Candida strains using saliva, oral mucosal swabs, or mouthwash from pSS patients. The Sabouraud's Dextrose Agar (SDA), hyphal formation assay, potassium hydroxide (KOH) smear test, and calcofluor white (CFW) staining assay are used for the diagnosis of oral Candida infection. A Candida diagnostic agar is used for the identification of Candida strains. Finally, antifungal susceptibility testing is used to determine appropriate antifungal drug treatment. This standardized method can enhance the diagnosis, treatment, and future research of pSS-related oral Candida infections. Early diagnosis, using this method, can also prevent any complications arising due to delay in receiving appropriate treatment.

LUBAC promotes angiogenesis and lung tumorigenesis by ubiquitinating and antagonizing autophagic degradation of HIF1α.

Hypoxia-inducible factor 1 (HIF1) is critically important for driving angiogenesis and tumorigenesis. Linear ubiquitin chain assembly complex (LUBAC), the only known ubiquitin ligase capable of catalyzing protein linear ubiquitination to date, is implicated in cell signaling and associated with cancers. However, the role and mechanism of LUBAC in regulating the expression and function of HIF1α, the labile subunit of HIF1, remain to be elucidated. Herein we showed that LUBAC increases HIF1α protein expression in cultured cells and tissues of human lung cancer and enhances HIF1α DNA-binding and transcriptional activities, which are dependent upon LUBAC enzymatic activity. Mechanistically, LUBAC increases HIF1α stability through antagonizing HIF1α decay by the chaperone-mediated autophagy (CMA)-lysosome pathway, thereby potentiating HIF1α activity. We further demonstrated that HIF1α selectively interacts with HOIP (the catalytic subunit of LUBAC) primarily in the cytoplasm. LUBAC catalyzes linear ubiquitination of HIF1α at lysine 362. Linear ubiquitination shields HIF1α from interacting with heat-shock cognate protein of 70 kDa and lysosome-associated membrane protein type 2 A, two components of CMA. Consequently, linear ubiquitination confers protection against CMA-mediated destruction of HIF1α, increasing HIF1α stability and activity. We found that prolyl hydroxylation is not a perquisite for LUBAC's effects on HIF1α. Functionally, LUBAC facilitates proliferation, clonogenic formation, invasion and migration of lung cancer cells. LUBAC also boosts angiogenesis and exacerbates lung cancer growth in mice, which are greatly compromised by inhibition of HIF1α. This work provides novel mechanistic insights into the role of LUBAC in regulating HIF1α homeostasis, tumor angiogenesis and tumorigenesis of lung cancer, making LUBAC an attractive therapeutic target for cancers.

In vivo antioxidant activity of Cinnamomum cassia leaf residues and their effect on gut microbiota of d-galactose-induced aging model mice.

BACKGROUND: To thoroughly explore the values of Cinnamomum cassia leaf residues (CcLR), their antioxidant activity in vivo and the relationship with gut microbiota were investigated using d-galactose-induced aging mice. RESULTS: Results showed that CcLR extract treatment exerted antioxidant activity by increasing the levels of superoxide dismutase (P < 0.01) and glutathione peroxidase (P < 0.05), as well as inhibiting the formation of malondialdehyde (P < 0.01). Meanwhile, the inflammatory response was also alleviated as the ratio of pro-inflammatory tumor necrosis factor-α (P < 0.01) and interleukin-1ß (P < 0.01))/anti-inflammatory cytokines (interleukin-10; P < 0.05) in serum was decreased and the contents of inflammatory markers (induced nitrogen monoxide synthase and nitric oxide) in brain and liver tissues (P < 0.01) were reduced. Moreover, through inhibiting acetylcholinesterase activity and improving choline acetyltransferase activity, the cholinergic system in aging mice recovered to levels comparable to the normal control group. In addition, 16S rRNA sequencing results demonstrated that CcLR extract promoted the growth of beneficial bacteria. In particular, Spearman correlation analysis revealed that the abundance of Colidextribacter was negatively correlated with serum superoxide dismutase (P < 0.05, R = -0.943), and Helicobacter displayed a positive correlation with the content of brain nitric oxide (P < 0.05, R = 0.899), suggesting that regulating gut microbiota might be one of the mechanisms for reducing oxidative stress, thus postponing the aging process. CONCLUSION: It is suggested that CcLR extract could be used as a novel antioxidant and anti-aging resource in the pharmaceutical and food industries. © 2022 Society of Chemical Industry.

Porphyromonas gingivalis and Lactobacillus rhamnosus GG regulate the Th17/Treg balance in colitis via TLR4 and TLR2.

OBJECTIVES: CD4+ T cells are the key to many immune-inflammatory diseases mediated by microbial disorders, especially inflammatory bowel disease (IBD). The purpose of this study was to explore how pathogenic and probiotic bacteria directly affect the T helper (Th)17 and T regulatory (Treg) cell balance among CD4+ T cells to regulate inflammation. METHODS: Porphyromonas gingivalis (Pg; ATCC 33277) and Lactobacillus rhamnosus GG (LGG; CICC 6141) were selected as representative pathogenic and probiotic bacteria, respectively. Bacterial extracts were obtained via ultrasonication and ultracentrifugation. Flow cytometry, RT-qPCR, ELISAs, immunofluorescence and a Quantibody cytokine array were used. The dextran sodium sulphate (DSS)-induced colitis model was selected for verification. RESULTS: The Pg ultrasonicate induced the apoptosis of CD4+ T cells and upregulated the expression of the Th17-associated transcription factor RoRγt and the production of the proinflammatory cytokines IL-17 and IL-6, but downregulated the expression of the essential Treg transcription factor Foxp3 and the production of the anti-inflammatory factors TGF-ß and IL-10 via the TLR4 pathway. However, LGG extract maintained Th17/Treg homeostasis by decreasing the IL-17+ Th17 proportion and increasing the CD25+ Foxp3+ Treg proportion via the TLR2 pathway. In vivo, Pg-stimulated CD4+ T cells aggravated DSS-induced colitis by increasing the Th17/Treg ratio in the colon and lamina propria lymphocytes (LPLs), and Pg + LGG-stimulated CD4+ T cells relieved colitis by decreasing the Th17/Treg ratio via the JAK-STAT signalling pathway. CONCLUSIONS: Our findings suggest that pathogenic Pg and probiotic LGG can directly regulate the Th17/Treg balance via different TLRs.

Identification and Regulation of TCRαß+CD8αα+ Intraepithelial Lymphocytes in Murine Oral Mucosa.

TCRαß+CD8αα+ intraepithelial lymphocytes (IELs) are abundant in gastrointestinal (GI) tract and play an important role in regulation of mucosal immunity and tolerance in the gut. However, it is unknown whether TCRαß+CD8αα+ IELs exist in the oral mucosa and if yes, what controls their development. We here identified and characterized TCRαß+CD8αα+ IELs from the murine oral mucosa. We showed that the number and function of TCRαß+CD8αα+ IELs were regulated by TGF-ß. We further revealed that oral TCRαß+CD8αα+ IELs could be altered under systemic inflammatory conditions and by antibiotic treatment at the neonatal age of the mice. Our findings have revealed a previously unrecognized population of oral IELs that may regulate oral mucosal immune responses.

miR-449c-5p availability is antagonized by circ-NOTCH1 for MYC-induced NOTCH1 upregulation as well as tumor metastasis and stemness in gastric cancer.

Gastric cancer (GC), identified as the most common gastrointestinal malignancy, is one of the primary causes of cancer-related mortality in the world. Although surgery and chemotherapy for GC treatment have been improved, the 5-year overall survival rate is still unsatisfactory. Circ-NOTCH1 is a novel circular RNA derived from its host gene NOTCH1, and has not been studied in any cancers. Here we explored the potential role and mediatory mechanism of circ-NOTCH1 in GC. In this study, circ-NOTCH1 exhibited increased expression in GC tissues and cells. Suppression of circ-NOTCH1 inhibited cell migration, invasion, tumor spheroids number, and side population ratio. Circ-NOTCH1 also promoted GC growth and metastasis in vivo. Additionally, it was found that circ-NOTCH1 could bind to miR-449c-5p. Circ-NOTCH1 promoted metastasis and stemness in GC through sponging miR-449c-5p. Subsequently, MYC was identified as a downstream gene of miR-449c-5p. MYC could bind to the promoter of NOTCH1 to regulate GC progression. Furthermore, rescue assays demonstrated that NOTCH1 knockdown reversed the effects of overexpression of MYC in metastasis and stemness in AGS cells/sh-circNOTCH1. Above findings explained that circ-NOTCH1 promoted metastasis and stemness in GC by targeting miR-449c-5p/MYC/NOTCH1 axis, suggesting the possibility of circ-NOTCH1 as a therapeutic marker for GC.

A novel route for double-layered encapsulation of probiotics with improved viability under adverse conditions.

To improve the survivability of probiotics under the harsh conditions, a novel double-layered vehicle, which was developed by a one-step coaxial electrospinning procedure, was here used to encapsulate the probiotics. The morphology characterization analysis revealed that the electrospun fiber had a beaded morphology and core-shell structure. Probiotic cells were successfully encapsulated in the fibers (107 CFU/mg) and exhibited an oriented distribution along the fiber. Additionally, the encapsulation of core-shell fiber mat enhanced the tolerance of probiotic cells to simulated gastrointestinal conditions and no significant loss of viability was found (p > 0.05). Besides that, the encapsulated cells exhibited better thermal stability under heat moisture treatment, lower loss of viability (0.32 log CFU/mL) was occurred when compared with the free cells or encapsulated cells in uniaxial fiber mat. In conclusion, this double-layered vehicle presents a great potential in probiotic encapsulation and improving their resistant ability to the harsh conditions.

High Glucose Intake Exacerbates Autoimmunity through Reactive-Oxygen-Species-Mediated TGF-ß Cytokine Activation.

Diet has been suggested to be a potential environmental risk factor for the increasing incidence of autoimmune diseases, yet the underlying mechanisms remain elusive. Here, we show that high glucose intake exacerbated autoimmunity in mouse models of colitis and experimental autoimmune encephalomyelitis (EAE). We elucidated that high amounts of glucose specifically promoted T helper-17 (Th17) cell differentiation by activating transforming growth factor-ß (TGF-ß) from its latent form through upregulation of reactive oxygen species (ROS) in T cells. We further determined that mitochondrial ROS (mtROS) are key for high glucose-induced TGF-ß activation and Th17 cell generation. We have thus revealed a previously unrecognized mechanism underlying the adverse effects of high glucose intake in the pathogenesis of autoimmunity and inflammation.

Combination of apoptotic T cell induction and self-peptide administration for therapy of experimental autoimmune encephalomyelitis.

BACKGROUND: Clinical trials on multiple sclerosis with repeated injections of monoclonal antibodies depleting CD4+ T cells have not resulted in much success as a disease therapy. Here, we developed an immunotherapy for EAE in mice by combining a transient depletion of T cells together with the administration of neuron derived peptides. METHODS: EAE was induced in SJL and C57BL/6 mice, by proteolipid protein peptide PLP139-151 (pPLP) and myelin-oligodendrocyte glycoprotein MOG35-55 (pMOG) peptides, respectively. Anti-CD4 and anti-CD8 antibody were injected intraperitoneally before or after peptide immunization. EAE scores were evaluated and histology data from brain and spinal cord were analyzed. Splenocytes were isolated and CD4+, CD4+CD25- and CD4+CD25+ T cells were purified and cultured in the presence of either specific peptides or anti-CD3 antibody and proliferation of T cells as well as cytokines in supernatant were assessed. FINDINGS: This experimental treatment exhibited therapeutic effects on mice with established EAE in pPLP-susceptible SJL mice and pMOG-susceptible C57BL/6 mice. Mechanistically, we revealed that antibody-induced apoptotic T cells triggered macrophages to produce TGFß, and together with administered auto-antigenic peptides, generated antigen-specific Foxp3+ regulatory T cells (Treg cells) in vivo. INTERPRETATION: We successfully developed a specific immunotherapy to EAE by generating autoantigen-specific Treg cells. These findings have overcome the drawbacks of long and repeated depletion of CD4+ T cells, but also obtained long-term immune tolerance, which should have clinical implications for the development of a new effective therapy for multiple sclerosis. FUND: This research was supported by the Intramural Research Program of the NIH, NIDCR.

Extracellular Vesicles from Apoptotic Cells Promote TGFß Production in Macrophages and Suppress Experimental Colitis.

The clearance of apoptotic cells is an essential process to maintain homeostasis of immune system, which is regulated by immunoregulatory cytokines such as TGFß. We show here that Extracellular Vesicles (EVs) were highly released from apoptotic cells, and contributed to macrophage production of TGFß in vitro and in vivo. We further elucidated mechanistically that phosphatidylserine in EVs was a key triggering-factor, and transcription factor FOXO3 was a critical mediator for apoptotic EV-induced TGFß in macrophages. Importantly, we found that macrophages pre-exposed to EVs exhibited an anti-inflammatory phenotype. More strikingly, administration of EVs in vivo promotes Tregs differentiation and suppresses Th1 cell response, and ameliorates experimental colitis. Thus, apoptotic-EV-based treatment might be a promising therapeutic approach for human autoimmune disease.

Bone Morphogenetic Protein 6 Inhibits the Immunomodulatory Property of BMMSCs via Id1 in Sjögren's Syndrome.

Mesenchymal stem cells (MSCs) treatment has emerged as a promising approach for treating Sjögren's syndrome (SS). Impaired immunoregulatory activities of bone marrow mesenchymal stem cells (BMMSCs) are found in both SS patients and animal models, and the underlying mechanism is poorly understood. Increased expression of BMP6 is reported to be related to SS. The aim herein was to determine the effects of BMP6 on BMMSCs function. BMMSCs were isolated from SS patients and NOD mice and showed a high level of BMP6 expression. The effects of BMP6 on BMMSCs function were investigated using in vitro BMMSCs differentiation and in vitro and in vivo T cell proliferation and polarization assays. BMP6 increased osteogenic differentiation of BMMSCs and inhibited the immunomodulatory properties of BMMSCs. BMP6 enhanced T cell proliferation and Th1/Th17 differentiation in a T cell-BMMSC coculture system. Mechanistically, BMP6 downregulated PGE2 and upregulated IFN-gamma via Id1 (inhibitor of DNA-binding protein 1). Neutralizing BMP6 and knockdown of Id1 could restore the BMMSCs immunosuppressive function both in vitro and in vivo. The present results suggest a novel role of Id1 in BMP-mediated MSCs function, which may contribute to a better understanding of the mechanism of action of MSCs in treating autoimmune diseases.

A rapidly recoverable shape memory polymer with a topologically well-controlled poly(ethyl methacrylate) structure.

Many of the unique properties of a conventionally crosslinked shape memory network are not found at the same time, and this is a large challenge for the development of advanced shape memory functional materials. In this work, a topologically well-controlled network shape memory poly(ethyl methacrylate) (CN-SMPEMA) is designed and fabricated by introducing two tetra-armed functional structures simultaneously as well-defined structure units to promote switch segment and net-point uniform distribution via the combined technology of the unique controllable atom transfer radical polymerization (ATRP) and copper(i)-catalyzed azide-alkyne cycloaddition (CuAAC). Compared with conventionally crosslinked networks, the as-prepared CN-SMPEMA not only exhibits a combination of excellent mechanical properties, shape fixity, shape recovery ratios and outstanding cycling stability, but also displays rapid recoverability. Additionally, a feasible molecular mechanism for the shape memory effect of the CN-SMPEMA system is analyzed and proposed. We anticipate that such a topologically well-defined network shape memory material with multiple excellent properties will broaden the practical application range of acrylate-based shape memory polymer materials.

Effect of Bone Morphogenetic Protein 6 on Immunomodulatory Functions of Salivary Gland-Derived Mesenchymal Stem Cells in Sjögren's Syndrome.

Sjögren's syndrome (SS) is characterized by autoimmune activation and loss of function in the salivary glands. Recent studies reported that bone morphogenetic protein 6 (BMP6), which is a member of transforming growth factor beta (TGF-ß) superfamily, was highly expressed in SS patients. To investigate the role of BMP6 in SS, we treated the salivary gland-derived mesenchymal stem cells (SGMSCs) with BMP6 and found that BMP6 could impair immunomodulatory properties of normal SGMSCs by downregulating the Prostaglandin E2 synthase through DNA-binding protein inhibitor-1. Neutralizing the BMP6 could significantly restore the SGMSC's immunoregulatory function in vitro and delay the SS disease activity in vivo. In conclusion, BMP6 could not only affect the secreting function of epithelial cells in the salivary gland but also influence the immunomodulatory properties of SGMSCs, which may trigger or enhance the autoimmune reflection in SS.

High-strain slide-ring shape-memory polycaprolactone-based polyurethane.

To enable shape-memory polymer networks to achieve recoverable high deformability with a simultaneous high shape-fixity ratio and shape-recovery ratio, novel semi-crystalline slide-ring shape-memory polycaprolactone-based polyurethane (SR-SMPCLU) with movable net-points constructed by a topologically interlocked slide-ring structure was designed and fabricated. The SR-SMPCLU not only exhibited good shape fixity, almost complete shape recovery, and a fast shape-recovery speed, it also showed an outstanding recoverable high-strain capacity with 95.83% Rr under a deformation strain of 1410% due to the pulley effect of the topological slide-ring structure. Furthermore, the SR-SMPCLU system maintained excellent shape-memory performance with increasing the training cycle numbers at 45% and even 280% deformation strain. The effects of the slide-ring cross-linker content, deformation strain, and successive shape-memory cycles on the shape-memory performance were investigated. A possible mechanism for the shape-memory effect of the SR-SMPCLU system is proposed.

D-mannose induces regulatory T cells and suppresses immunopathology.

D-mannose, a C-2 epimer of glucose, exists naturally in many plants and fruits, and is found in human blood at concentrations less than one-fiftieth of that of glucose. However, although the roles of glucose in T cell metabolism, diabetes and obesity are well characterized, the function of D-mannose in T cell immune responses remains unknown. Here we show that supraphysiological levels of D-mannose safely achievable by drinking-water supplementation suppressed immunopathology in mouse models of autoimmune diabetes and airway inflammation, and increased the proportion of Foxp3+ regulatory T cells (Treg cells) in mice. In vitro, D-mannose stimulated Treg cell differentiation in human and mouse cells by promoting TGF-ß activation, which in turn was mediated by upregulation of integrin αvß8 and reactive oxygen species generated by increased fatty acid oxidation. This previously unrecognized immunoregulatory function of D-mannose may have clinical applications for immunopathology.

Impact of prechlorination on organophosphorus pesticides during drinking water treatment: Removal and transformation to toxic oxon byproducts.

Prechlorination is commonly used to minimize operational problems associated with biological growth as well as taste and odor control during drinking water treatment. However, prechlorination can also oxidise micropollutants into intermediate byproducts. This could impose profound effects on the safety of the finished water if the transformed byproducts are more toxic and less removable. This study investigated the effect of prechlorination on decomposition and subsequent removal of the four organophosphorus pesticides (OPPs): chlorpyrifos, diazinon, malathion and tolclofos-methyl using a simulated conventional water treatment process of powdered activated carbon assisted coagulation-sedimentation-filtration (PAC-CSF) and postchlorination. It was found that, following prechlorination, not only did the percentage of OPPs oxidation vary significantly, but also the concentration of transformed oxons, which are more toxic than their parent compounds, increased as the major identified oxidation byproducts in water. Removal of these oxons proved to be more difficult by the PAC-CSF than their parent OPPs, because they are more water soluble and more hydrophilic. Both the OPP oxidation and oxon formation increased with chlorine dose during prechlorination. Meanwhile, the continuing chlorination of OPPs by residual free chlorine during PAC-CSF further complicated the pesticide removal processes, generally resulting in a gradually increased formation of oxons. Moreover, in the final treatment stage of postchlorination, the more chlorine-reactive pesticides, malathion and diazinon, were completely oxidised and the formation of corresponding oxons was increased with the prechlorine dose. In contrast, a certain amount of the less chlorine-reactive pesticide tolclofos-methyl still remained in solution after postchlorination, accompanied by an increased formation of tolclofos-methyl oxon with prechlorine dose. Since the oxons are resistant to further oxidation and less adsorbable during the PAC-CSF process, the gross removal of these pesticides and their oxons decreased with increase of the prechlorine dose. This led to an accumulation of the more toxic oxons in the finished water, especially at higher chlorine doses during prechlorination. The significance of this work is the demonstration that, under circumstances where prechlorination is used and source water contains traces of OPPs, alternative practices should be prioritized to avoid the potential risks involved in consumption of the treated water.

RNAi-mediated downregulation of oral cancer overexpressed 1 (ORAOV1) inhibits vascular endothelial cell proliferation, migration, invasion, and tube formation.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is one of the top ten tumors threatening human health. Oral cancer overexpressed 1 (ORAOV1) identified within chromosomal region 11q13, one of the most frequently amplified regions in OSCC, has been suggested as a novel candidate oncogene in OSCC, regulating cell cycle, apoptosis, and angiogenesis. In this study, we investigated the role of ORAOV1 in OSCC-induced angiogenesis in vitro. METHODS: EA.hy926 human endothelial cells were co-cultured with OSCC cells (HSC-3 and SCC-25) transfected with ORAOV1-specific shRNA to downregulate ORAOV1 expression, and analyzed for proliferation, migration, invasion, and tube formation by specific assays. RESULTS: EA.hy926 endothelial cells co-cultured with ORAOV1-deficient OSCC cells exhibited significantly lower proliferation, migration, and invasion, as well as the activity in tube formation compared to that in the control cells. CONCLUSIONS: Our results show, for the first time, that ORAOV1 expressed by OSCC cells promotes tube formation by endothelial cells, indicating its involvement in OSCC angiogenesis. Considering the importance of neovascularization in tumor development and metastasis, these findings suggest that targeting ORAOV1 may be a potential therapeutic strategy against OSCC.

Antibiotics in neonatal life increase murine susceptibility to experimental psoriasis.

Psoriasis is an inflammatory skin disease affecting ∼2% of the world's population, but the aetiology remains incompletely understood. Recently, microbiota have been shown to differentially regulate the development of autoimmune diseases, but their influence on psoriasis is incompletely understood. We show here that adult mice treated with antibiotics that target Gram-negative and Gram-positive bacteria develop ameliorated psoriasiform dermatitis induced by imiquimod, with decreased pro-inflammatory IL-17- and IL-22-producing T cells. Surprisingly, mice treated neonatally with these antibiotics develop exacerbated psoriasis induced by imiquimod or recombinant IL-23 injection when challenged as adults, with increased IL-22-producing γδ(+) T cells. 16S rRNA gene compositional analysis reveals that neonatal antibiotic-treatment dysregulates gut and skin microbiota in adults, which is associated with increased susceptibility to experimental psoriasis. This link between neonatal antibiotic-mediated imbalance in microbiota and development of experimental psoriasis provides precedence for further investigation of its specific aetiology as it relates to human psoriasis.

The mucosal immune system in the oral cavity-an orchestra of T cell diversity.

The mucosal immune system defends against a vast array of pathogens, yet it exhibits limited responses to commensal microorganisms under healthy conditions. The oral-pharyngeal cavity, the gateway for both the gastrointestinal and respiratory tracts, is composed of complex anatomical structures and is constantly challenged by antigens from air and food. The mucosal immune system of the oral-pharyngeal cavity must prevent pathogen entry while maintaining immune homeostasis, which is achieved via a range of mechanisms that are similar or different to those utilized by the gastrointestinal immune system. In this review, we summarize the features of the mucosal immune system, focusing on T cell subsets and their functions. We also discuss our current understanding of the oral-pharyngeal mucosal immune system.

[Protection and functional repair of vagus nerve during the operation of cervical vagal paraganglioma].

OBJECTIVE: To explore the clinical anatomy and the methods to protect or reconstruct the continuity and function of vagus nerve during the operation of cervical vagal paraganglioma. METHOD: Six cases of vagal paraganglioma were reviewed. All tumors were identified to wrap the cervical vagus nerve stem and excised during surgery. The operative modality was to trace the vagus nerve stem inside the tumor as far as possible, to reconstruct the continuity by way of vagus nerve anastomosis (3/6) or alternatively, other motor nerve transplantation (3/6). Postoperative treatment included steroid, neurotrophic medication and voice and swallowing rehabilitation. RESULT: Two cases of the recurrent paraganglioma experienced aspiration during swallowing preoperatively and no aspiration after surgery. Choking was gradually reduced in four recurrent cases half to one year postoperatively. Hoarseness was improved in five cases (5/6) half to one year postoperatively, while one case remained prolonged obvious hoarseness. Three months postoperatively, the vocal cord fibrillation at the tumor-related side was observed during pronunciation in the end-to-end anastomosis cases (3/6), sublingual nerve-transplanted case (1/6) and deep cervical nerve-transplanted cases (1/6) under fiberoptic laryngoscope, and the mobility was even more obvious at the time of half an year postoperatively. While in another deep cervical nerve-transplanted case (1/6), the vocal cord demonstrated no obvious fibrillation. CONCLUSION: To carefully identify and preserve the vagus nerve fibers as much as possible during the operation of cervical vagal paraganglioma could significantly eliminate postoperative hoarseness and aspiration. End-to-end anastomosis, deep cervical nerve or sublingual nerve transplantation to resume the continuity of vagus nerve may improve the mobility of vocal cord thus the quality of voice and swallowing.