Gehua Zhang

Outcome of Adenotonsillectomy for Obstructive Sleep Apnea Syndrome in Children

Objectives: We evaluated the outcome of adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) in children using polysomnography (PSG) data and a quality-of-life (QOL) instrument. Methods: We enrolled children (4 to 14 years of age) who had OSAS diagnosed by overnight PSG and who underwent both adenoidectomy and tonsillectomy between January 2003 and February 2008. All of them had completed postoperative PSG and a paired Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire (OSA-18) survey. The statistical analyses were performed with a statistical software package. Results: The study included 84 children with a mean age of 7.1 years. The mean preoperative apnea-hypopnea index (AHI) for the study population was 24.6, and the mean postoperative AHI was 3.8 episodes per hour. The percentage of children who had normal PSG parameters after adenotonsillectomy ranged from 69.0% to 86.9% because of fluctuation of the criteria used to define OSAS. Nine children (30%) with severe preoperative OSAS had persistent OSAS (an AHI of at least 5) after surgery. Improvements in QOL were comparable in the cured and not-cured groups (p > 0.05). Risk factors for persistent OSAS were obesity and a high preoperative AHI, on multiple logistic regression analysis. Conclusions: Adenotonsillectomy is associated with improvements in PSG, behavior, and QOL in children with OSAS. However, it may not resolve OSAS in all children. The efficacy and role of additional therapeutic options require more study.

The therapeutic efficacy of endoscopic optic nerve decompression and its effects on the prognoses of 96 cases of traumatic optic neuropathy.

BACKGROUND: Traumatic optic neuropathy (TON) is an important cause of severe loss of vision due to blunt or penetrating head trauma. The pathogenesis of TON remains unclear, and there are several potential causes for the observed loss in vision. Endoscopic optic nerve decompression (EOND) has been reported to improve the visual prognosis in TON cases, but its efficacy remains controversial. It is important to investigate the therapeutic efficacy of EOND in the treatment of TON and to evaluate the relevant prognostic factors. METHODS: A retrospective study was conducted to analyze the clinical characteristics and prognoses of 96 TON cases. The &khgr;2 test and multiple logistic regression analyses were used to evaluate potential prognostic factors. RESULTS: The overall rate of EOND effectiveness was 40.6% (39 of 96). A significantly higher effective rate (83.3%) was observed for patients with light perception compared with those without light perception (26.4%, p < 0.05). Univariate and multiple logistic regression analyses identified three variables (no light perception, undergoing EOND 3 days after trauma, and hemorrhage within the ethmoid and/or sphenoid sinus) that were significantly associated with unrecovered visual acuity. Age, loss of consciousness, optic canal fracture, preoperative steroid megadose treatment, and optic nerve sheath incision were all factors that showed no significant correlation with therapeutic efficacy. However, patients with fractures in a single medial wall of the optic canal appeared to have better prognoses than patients with multiple fractures or those with a single fracture in a lateral wall. CONCLUSIONS: The overall therapeutic efficacy of EOND for the treatment of TON is far from satisfactory, especially for patients without light perception. The factors that impact TON prognoses are complex and may be interrelated. The indication for EOND must be individualized. LEVEL OF EVIDENCE: III, epidemiological study.

The Treg/Th17 Imbalance in Patients with Obstructive Sleep Apnoea Syndrome

Obstructive sleep apnoea syndrome (OSAS) is a chronic inflammatory disease regulated by T lymphocytes. Our purpose is to assess the pattern of Th17 cells and CD4+CD25+Foxp3+ regulatory T (Treg) cells in peripheral blood of patients with OSAS. Fourty-four OSAS men and 20 healthy volunteers were enrolled. Twenty-three patients were classified into mild to moderate group and 21 cases were classified into severe group according to the severity of OSAS. We detected the frequencies of Th17 and Treg and related serum cytokines secretion and expressions of key transcription factors. OSAS patients revealed significant increase in peripheral Th17 number, Th17-related cytokines (IL-17 and IL-6), and RORγt mRNA levels. They also presented a significant decrease in Treg number, Treg-related cytokines (TGF-β 1), and Foxp3 mRNA levels as compared with normal persons. As a result, the Th17/Treg ratios were markedly more upregulated in OSAS patients than those in control group. Furthermore, the Th17/Treg ratio was positively related to the severity of OSAS and serum levels of C-reactive protein. The development of OSAS may be associated with peripheral Th17/Treg imbalance and characterized by a proinflammatory cytokine microenvironment. These results opened an alternative explanation for the substantial activation of immune cells in OSAS and the development of related complications.

Reduced E-cadherin expression is associated with lymph node metastases in laryngeal squamous cell carcinoma

OBJECTIVE To investigate the expression of E-cadherin and its relationship with clinicopathological parameters in laryngeal squamous cell carcinoma (LSCC). METHODS Sixty-four patients who had previously undergone complete resection of tumor for LSCC were studied retrospectively. The level of E-cadherin expression in tumor tissues and paired nontumor tissues were determined by immunohistochemistry. RESULTS The expression of E-cadherin in tumor tissues was significantly lower than nontumor tissues (P<0.001). Reduced E-cadherin expression was significantly correlated with lymph node metastases (P<0.001). Kaplan-Meier survival estimates showed a significant correlation between E-cadherin expression and patient survival rate (log-rank P<0.05). Multivariate Cox proportional hazards model analysis confirmed that lymph node metastases (P=0.001) and tumor stage (P=0.013) were statistically significant, independent predictor of prognosis. CONCLUSION Expression of E-cadherin is an independent predictor of lymph node metastases in LSCC. However, it does not appear to be a better prognostic predictor than other established markers in LSCC.

Clinical Prognostic Factors of Chronic Rhinosinusitis after Endoscopic Sinus Surgery

Objective: We aimed to determine the clinical prognostic factors of chronic rhinosinusitis after endoscopic sinus surgery (ESS) in order to better guide the management of patients. Methods: A total of 254 patients with chronic rhinosinusitis after ESS with a follow-up of 24 months were evaluated retrospectively. Clinical grouping, hyperplasia of the ethmoid bone, anatomic variations, allergy, polyps, previous sinonasal surgery and recurrent polyps were analyzed. Results: The success rates were 64.4 and 91.9% with and without hyperplasia of the ethmoid bone, 87.6 and 86.4% with and without anatomic variations, 67.9 and 92.0% with and without allergy, 81.0 and 94.0% with and without polyps, 72.8 and 93.6% with and without history of surgery and 52.3 and 94.3% with and without recurrent polyps. In logistic multiple regression analysis, allergy (p = 0.0002; estimate, –4.2094), nasal polyps (p = 0.0007; estimate, –3.6393) and history of surgery (p < 0.0001; estimate, –5.0938) were found to reach a statistically significant level. Conclusions: We propose that allergy, polyps and history of surgery might be significant indicators of poor prognosis after ESS.

Expressions of IL-17, IL-21 and IL-23 in the Serum of Allergic Rhinitis Patients

Expressions of IL-17, IL-21 and IL-23 in the Serum of Allergic Rhinitis Patients The present study aimed to investigate the expressions of interleukin-17 (IL-17), IL-21 and IL-23 in the serum of allergic rhinitis (AR) patients and to explore their relationship with special IgE (sFgE) in the serum. AR patients (n=24) and healthy subjects (n=12) were recruited and serum samples were collected. The serum level of IgE specific for inhalant allergens was determined using the automatic quantitative immunofluorescence analysis system, and the contents of IL-17, IL-21 and IL-23 in the serum were detected using ELISA. The level of serum IgE in the healthy individuals was categorized as grade 0 and that in the AR patients as grade 2-6. The mean contents of IL-17, IL-21 and IL-23 were 164.71 ±39.37 pg/mL, 199±97.86 pg/mL and 78.94±26.33 pg/mL, respectively, in the AR patients, and 67.75±18.24 pg/mL, 7.58±5.49 pg/mL and 13.58± 3.93 pg/mL, respectively, in the healthy subjects. Statistical analysis showed the serum levels of IL-17 and IL-23 in the AR patients were markedly higher than those in the healthy subjects, however, no significant difference was noted in the content of IL-21. Furthermore, the IL-17 level was positively related to the levels of IL-23 and IgE and the IL-23 level was positively related to the IgE level among AR patients, but no relations were observed between the IL-21 level and levels of IL-17, IL-23 and IgE. Our study indicates IL-17 and IL-23 may play an important role in the pathogenesis of AR and maybe IL-21 is not involved in the occurrence of AR. Ekspresija IL-17, IL-21 I IL-23 u Serumu Pacijenata sa Alergijskim Rinitisom Cilj ove studije bio je da se utvrdi ekspresija interleukina-17 (IL-17), IL-21 i IL-23 u serumu pacijenata sa alergijskim rinitisom (AR) kao i da se ispita njihov odnos sa specifičnim IgE u serumu. Obuhvaćeni su pacijenti sa AR (n=24) i zdravi ispitanici (n=12) od kojih su uzeti uzorci seruma. Nivo IgE specifičnog za inhalatorne alergene u serumu određen je pomoću sistema za automatsku kvantitativnu imunofluorescentnu analizu, dok su količine IL-17, IL-21 i IL-23 u serumu utvrđene pomoću ELISA. Nivo IgE u serumu zdravih osoba obeležen je kao nulti stupanj a kod pacijenata sa AR stupnjevima od 2 do 6. Srednje vrednosti IL-17, IL-21 i IL-23 bile su 164,71±39,37 pg/mL, 199±97,86 pg/mL i 78,94±26,33 pg/mL kod pacijenata sa AR, i 67,75±18,24 pg/mL, 7,58±5,49 pg/mL i 13,58±3,93 pg/mL kod zdravih ispitanika. Statistička analiza pokazala je da su nivoi IL-17 i IL-23 u serumu pacijenata sa AR bili značajno viši nego kod zdravih ispitanika, dok za vrednosti IL-21 nije uočena značajna razlika. Štaviše, nivo IL-17 pokazao je pozitivnost u odnosu sa nivoima IL-23 i IgE, dok je nivo IL-23 imao pozitivan odnos sa nivoom IgE kod pacijenata sa AR, ali nije utvrđena povezanost između nivoa IL-21 i nivoa IL-17, IL-23 i IgE. Naša studija ukazuje na potencijalno važnu ulogu IL-17 i IL-23 u patogenezi AR, dok IL-21 možda ne učestvuje u nastanku AR.

Targeting Rad50 sensitizes human nasopharyngeal carcinoma cells to radiotherapy

BackgroundThe Mre11-Rad50-Nbs1 (MRN) complex is well known for its crucial role in initiating DNA double strand breaks (DSBs) repair pathways to resistant irradiation (IR) injury and thus facilitating radioresistance which severely reduces radiocurability of nasopharyngeal cancer (NPC). Targeting native cellular MRN function would sensitize NPC cells to IR.MethodsA recombinant adenovirus containing a mutant Rad50 gene (Ad-RAD50) expressing Rad50 zinc hook domain but lacking the ATPase domain and the Mre11 interaction domain was constructed to disrupt native cellular MRN functions. The effects of Ad-RAD50 on the MRN functions were assessed in NPC cells lines using western blot, co-immunoprecipitation and confocal microscopy analyses. The increased radiosensitivity of transient Ad-RAD50 to IR was examined in NPC cells, including MTT assay, colony formation. The molecular mechanisms of radiosensitization were confirmed by neutral comet assay and western bolts. Nude mice subcutaneous injection, tumor growth curve and TUNEL assay were used to evaluate tumor regression and apoptosis in vivo.ResultsRad50 is remarkably upregulated in NPC cells after IR, implying the critical role of Rad50 in MRN functions. The transient expression of this mutant Rad50 decreased the levels of native cellular Rad50, Mre11 and Nbs1, weakened the interactions among these proteins, abrogated the G2/M arrest induced by DSBs and reduced the DNA repair ability in NPC cells. A combination of IR and mutant RAD50 therapy produced significant tumor cytotoxicity in vitro, with a corresponding increase in DNA damage, prevented proliferation and cell viability. Furthermore, Ad-RAD50 sensitized NPC cells to IR by causing dramatic tumor regression and inducing apoptosis in vivo.ConclusionOur findings define a novel therapeutic approach to NPC radiosensitization via targeted native cellular Rad50 disruption.

Evaluation of Traumatic Optic Neuropathy in Patients with Optic Canal Fracture Using Diffusion Tensor Magnetic Resonance Imaging: A Preliminary Report

Objective: To investigate the role of diffusion tensor magnetic resonance imaging (DT-MRI) in the evaluation of traumatic optic neuropathy (TON). Methods: Six patients with TON underwent DT-MRI prior to decompression surgery. DTV 2 and Volume One 1.44 software were used to measure the fractional anisotropy (FA) and the mean apparent diffusion coefficient (ADC) of the optic nerves. White matter fiber bundle tracking was used to display optic nerves. Results: Visual acuity was improved in 1 of the 6 patients after surgery. The mean FA of the injured eye declined significantly with regard to that of the normal eye (0.2438 ± 0.0670 vs. 0.4524 ± 0.0531; t = 8. 711; p = 0. 000). The mean ADC on the injured side increased significantly compared with that on the normal side [(1.4172 ± 0.1208) × 10–3 mm2/s vs. (1.0866 ± 0.1179) × 10–3 mm2/s; t = –5.316; p = 0. 003). The continuity of the intracanalicular segment of the optic nerve was interrupted in 3 patients without improved postoperative visual acuity. In 1 patient with improved postoperative visual acuity, the fiber bundle of the optic nerve was somewhat less dense in the injured eye than in the normal eye. Conclusions: DT-MRI provides valuable information for evaluating the fibers of optic nerves in TON.

CD4 + T-lymphocyte subsets in nonobese children with obstructive sleep apnea syndrome

Background:To characterize the distribution of both tonsillar and circulating CD4+T-lymphocyte subsets, and to explore their clinical relevance in nonobese children with obstructive sleep apnea syndrome (OSAS).Methods:A total of 53 children who underwent tonsillectomy for either OSAS (n = 25) or primary snoring (PS, n = 28) were prospectively enrolled. Nineteen healthy children without any symptoms were recruited as controls. We quantified the frequencies of CD4+T-lymphocyte subpopulations using flow cytometry, serum-related cytokines using enzyme-linked immunosorbent assay, and key transcription factors using quantitative polymerase chain reaction (qPCR).Results:Tonsillar distributions of CD4+T-lymphocyte subsets were comparable in the OSAS and PS subjects. The peripheral Th17/Treg ratio was positively correlated to severity as measured by apnea/hypopnea index (AHI), serum C-reactive protein and hypoxia-inducible factor-1α mRNA in the OSAS children (P < 0.05). And AHI was independently associated with the peripheral Th17/Treg ratio (P < 0.05). Furthermore, the response to surgery was associated with a significant reversal of the Th17/Treg imbalance and a concomitant relief of the proinflammatory profile in the OSAS subjects.Conclusion:Pediatric OSAS was associated with an altered Th17:Treg balance toward Th17 predominance. The changes in lymphocytic phenotypes that correlated with recurrent intermittent hypoxia in sleep apnea may contribute to the variance in systemic inflammation and downstream morbidities of pediatric OSAS.

Detection of nasopharyngeal carcinoma using deep NIR Raman spectroscopy

We compare depth information from below the mucosa of ex vivo tissue to diagnose nasopharyngeal carcinoma (NPC) by NIR Raman spectroscopy. Spectral diagnosis performed on a PCA-LDA model achieves a diagnostic sensitivity of 99.3% (149/150), 100% (150/150), 98% (147/150) and 96.7% (145/150), and a specificity of 96.7% (145/150), 96.7% (145/150), 96% (144/150) and 87.3% (131/150) from the surface to deeper levels using the zero separate lines, respectively. The spectra and discrimination results at different levels could reveal pathological development. Thus, the Raman spectra of deep level mucosa can be used to diagnose the stage of NPC from normal tissue.