Endoscopic retrosigmoid trans-petrosal fissure approach for vestibular schwannomas: case series.

The management of vestibular schwannoma (VS) remains one of the most formidable challenges in neurosurgery owing to the eloquent nature of surrounding anatomy. Although endoscopy-assisted microsurgery has recently gained momentum in cerebellopontine angle region surgery, the feasibility of pure endoscopic technique has been rarely reported. Here we present the operative technique and preliminary outcomes of fully endoscopic retrosigmoid trans-petrosal fissure approach (ER-TPFA) for VS surgery. Clinical data of 36 consecutive cases of VS treated with the ER-TPFA from March 2021 to March 2023 were analyzed. The patients were placed in a modified lateral park-bench position, with the Dandy incision and suboccipital craniotomy performed. With the endoscopic holder, endoscopic procedures were performed using standard two-hand microsurgical techniques by one surgeon. Arachnoidal dissection of the petrosal fissure was performed for identifying the brainstem end of facial nerve and separating the tumor from the cerebellum, without brain retraction seen in traditional microsurgical technique. The tumors had an averaged size of 3.0 cm in diameter. According to the Hannover classification, nearly all the tumors were grade III-IV (97.3%). Using ER-TPFA, 33 patients (91.7%) achieved gross total resection. Anatomic preservation of the facial nerve was achieved in 35 cases, with 33 patients (91.7%) retaining a House-Brackmann score of 1-2 postoperatively. Four out of ten patients still had serviceable hearing 6 months after operation. Postoperatively, there was no post-craniotomy hematoma, cerebellar edema, and new-onset cerebellar ataxia. With a better visualization of the cerebellopontine angle region, ER-TPFA may help preserve facial nerve function and maintain high gross total resection rate while minimizing complications. We believe this retractorless technique can be a safe and effective alternative for the management of VS with satisfactory clinical results.

Antiproliferative effects of Norartocarpetin isoflavone in human lung carcinoma cells are mediated via targeting Ras/Raf/MAPK signalling pathway, mitochondrial mediated apoptosis, S-phase cell cycle arrest and suppression of cell migration and invasion.

PURPOSE: The main purpose of the current research work was to investigate the anticancer activity of norartocarpetin - a plant derived isoflavone -in human lung carcinoma cells NCI-H460 and normal lung cell line MRC-9 along with studying its effects on cellular apoptosis, DNA damage, cell migration and invasion and Ras/Raf/MAPK signalling pathways. METHODS: Cell proliferation was examined by CCK-8 assay while effects on apoptosis were evaluated by acridine orange (AO)/ethidium bormide (EB) staining and Comet assay using fluorescence microscopy. In vitro wound healing assay was used for checking the effects on cell migration and transwell assay for invasion while western blot was used to evaluate the effects on the expression of Ras/Raf/MAPK proteins. RESULTS: The results showed that Norartocarpetin led to dose-dependent cytotoxic effects in NCI-H460 cells showing an IC50 value of 22 µM while in normal lung cells, the cytotoxic effects were much lower as shown by higher IC50 value of 85 µM. It also led to dose-dependent apoptosis and induced DNA damage as shown by fluorescence microscopy. This molecule also inhibited cell migration and invasion dose-dependently, along with inhibiting MMP-9 expression. Norartocarpetin treatment also led to inhibition of the expression of Ras/Raf/MAPK proteins and also caused S-phase cell cycle arrest in these cells. CONCLUSION: Norartocarpetin has a significant anticancer activity in lung carcinoma cells and these effects are mediated via targeting apoptosis, DNA damage, cell migration and invasion, cell cycle and inhibiting Ras/Raf/MAPK signalling pathways.

[Retrospective study on incomplete intestinal obstruction treated with the adjuvant therapy of acupuncture and moxibustion].

OBJECTIVE: To evaluate the clinical effects on incomplete intestinal obstruction treated with the adjuvant therapy of acupuncture and moxibustion. METHODS: Using the retrospective analysis, 80 patients of incomplete intestinal obstruction were divided into an observation group and a control group, 40 cases in each one. In the control group, the routine treatment was given, such as fasting, gastrointestinal decompression, parenteral nutrition, infection prevention with antibiotics and enema laxative. In the observation group, on the basis of the treatment as the control group, acupuncture was applied at bilateral Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39); moxibustion was used at left Yangchi (TE 4), Zhongwan (CV 12), Qihai (CV 6) and Guanyuan (CV 4). The treatment was given once a day, 30 min each time. The average days of treatment, the surgical transfer rate, the time to first flatus, the recovery time of defecation and the time of solid food intake were observed in the patients of the two groups. RESULTS: The average days of treatment in the observation group was obviously less than that in the control group (P<0.05). The surgical transfer rate in the observation group was obviously lower than that in the control group (P<0.05). The time to first flatus, the recovery time of defecation and the time of solid food intake were all obviously earlier than those in the control group (all P<0.05). CONCLUSION: The adjuvant therapy of acupuncture and moxibustion achieves the significant therapeutic effects on incomplete intestinal obstruction, shortens the treatment duration and reduces the surgical transfer rate and the patient's economic burden.