内耳转基因表达的实验研究

目的 了解内耳转基因表达的可行性。方法 将人复制缺陷重组腺病毒基因(Adenoviruses，Ad，含大肠杆菌β-半乳糖苷酶基因LacZ基因，Ad5．LacZ)经豚鼠耳蜗蜗窗接种到鼓阶外淋巴后，观察在不同时间、不同内耳组织中LacZ基因的表达(X-Gal染色)及Ad对豚鼠声反应(听性脑干反应)、听毛细胞(扫描电镜)的影响。结果 Ad介导的LacZ基因在内耳组织中的表达至少可持续4周，其中在螺旋神经节细胞表达稳定，Corti器、前庭囊斑、壶腹嵴的毛细胞等也有较强的表达。Ad未对豚鼠声反应(≤8000Hz)造成明显的损伤，除耳蜗底回外，其余各回未见明显的毛细胞缺失。结论 腺病毒载体可成功地将LacZ基因转导致豚鼠内耳组织中，并且未对豚鼠声反应(低、中频)及听毛细胞造成明显损伤，这对未来的内耳基因治疗研究可能具有重要的参考价值。     

豚鼠耳蜗的转基因表达及其意义

目的:探讨耳蜗转基因表达的方法及意义。方法:经圆窗将复制缺陷重组腺病毒(含β-半乳糖苷酶基因,Ad.LacZ)注入豚鼠一侧耳蜗(接种耳)鼓阶,1周后观察接种耳及对侧耳蜗(非接种耳)转基因表达及听力情况。结果:接种耳蜗及对侧耳蜗均有Ad.LacZ表达,其分布相似,但对侧耳蜗中Ad.LacZ基因表达相对较弱,双侧耳接种Ad.LacZ前后听力无明显改变。结论:对侧耳蜗的转基因表达可能对某些内耳疾病的转基因治疗具有重要意义。     

腺病毒携带的LacZ基因在豚鼠耳蜗中的表达

目的 带有LacZ基因的腺病毒注入豚鼠耳蜗后,观察不同时间段LacZ基因的表达和分布情况及手术操作对听力的影响,为内耳基因治疗提供理论依据。方法 24只白色豚鼠术前及术后行听性脑干反应(ABR)检查。空白对照组经圆窗注入人工外淋巴液,实验组注入带有LacZ基因的腺病毒。分别于2天、l周、2周后取材。耳蜗标本经β-半乳糖苷酶(X-Gal)组织化学染色后做石蜡切片和耳蜗铺片。结果 腺病毒注入耳蜗后对听力影响不大。经X-Gal染色后整个耳蜗被染成蓝色。2天组表达产物最高,l周后逐渐降低。表达产物主要分布于柯蒂器的内外毛细胞、螺旋神经节细胞、基底膜下的间皮细胞。对照组均未着色。结论 通过圆窗注入腺病毒对听力没有影响,单一位点的接种就能使因子通过耳蜗液扩散到整个耳蜗。有效的基因转移在耳蜗是可行的,但表达相对短暂。     

豚鼠耳蜗的转基因表达及其意义

目的：探讨耳蜗转基因表达的方法及意义。方法：经圆窗将复制缺陷重组腺病毒（含β－半乳糖苷酶基因，Ad.LacZ）注入豚鼠一侧耳蜗（接种耳）鼓阶，1周后观察接种耳及对侧耳蜗（非接种耳）转基因表达及听力情况。结果：接种耳蜗及对侧耳蜗均有Ad.LacZ表达，其分布相似，但对侧耳蜗中Ad.LacZ基因表达相对较弱，双侧耳接种Ad.LacZ前后听力无明显改变。结论：对侧耳蜗的转基因表达可能对某些内耳疾病的转基因治疗具有重要意义。     

内耳疾病基因治疗方法的研究

目的:探讨一种高效、安全和简便的内耳疾病基因转移和导入方法。方法:将30只健康豚鼠随机分为A、B、C 3组,每组10只。用Ad—GFP报告基因分别由圆窗、耳蜗底回和脑脊液三种途径导入30只豚鼠内耳,在术前和术后测定听性脑干反应(ABR)阈值和畸变产物耳声发射(DPOAE)振幅改变。再行耳蜗铺片,观察AdGFP在内耳组织中的转染表达和耳蜗毛细胞的形态结构。结果:三种途径导入Ad—GFP在耳蜗螺旋神经节、血管纹和Corti器上均有转染和表达。在术后3 d的表达产物最高,7 d后减弱,10 d后更弱。圆窗和耳蜗底回钻孔导入手术可引起蜗内出血,凝血块淤积在耳蜗顶回的中阶,造成顶回毛细胞损害。而脑脊液给药途径无此现象。ABR阈值在各组动物手术前后无明显改变,而圆窗和耳蜗底回给药途径造成DPOAE幅度明显下降,脑脊液给药组无DPOAE改变。结论:应用腺病毒载体进行基因转移通过圆窗和耳蜗底回钻孔途径可引起蜗内出血,影响DPOAE幅度,而应用脑脊液给药途径则相对安全和方便。     

不同基因转染方法对小鼠内耳毛细胞转染效率的比较

目的对比不同的基因转染方法对小鼠内耳毛细胞的转染效率,以探寻简便、高效转染耳蜗毛细胞的方法。方法分离111只新生昆明小鼠(P2)耳蜗螺旋韧带及感染上皮,分别采用电穿孔法介导质粒载体(pGPHI/GFP/Neo)、腺病毒载体(Ad5/CMV/GFP)和慢病毒载体(LV/CMV/GFP)3种方法转染小鼠内耳毛细胞,于转染48小时后在荧光显微镜下观察并比较三种方法基因转染后小鼠内耳毛细胞绿色荧光蛋白(green fluorescence protein,GFP)的表达。结果电穿孔法介导质粒载体转染组和慢病毒载体转染组GFP阳性细胞极少;腺病毒载体转染组效率最高,耳蜗中回外毛细胞GFP阳性率为90.0%±4.1%,内毛细胞GFP阳性率为5%±0.4%。结论腺病毒载体能更有效地将外源基因导入耳蜗毛细胞内表达,是基因转染耳蜗毛细胞的理想载体。     

碱性成纤维细胞生长因子真核表达载体的构建及其在内耳基因治疗中的实验研究

目的　观察碱性成纤维细胞生长因子 (basicfibroblastgrowthfactor,bFGF)双顺反子真核表达载体在豚鼠耳蜗中的表达 ,及噪声损伤后对毛细胞的保护作用。方法　利用脑炎心肌炎病毒的内部核糖体进入位点 (internalribosomeentrysite,IRES) ,构建人bFGF与增强型绿色荧光蛋白 (enhancegreenfluorescenceprotein ,EGFP)基因真核表达载体pIRES bFGF EGFP。采用硬脂胺 (stearylamine ,SA)脂质体介导bFGF基因转染豚鼠内耳 ,噪声暴露即刻通过圆窗向豚鼠耳蜗注入含有bFGF基因作为治疗基因的真核表达载体 ;或在噪声暴露前 7d ,作为保护因子转导转染豚鼠耳蜗。结果　构建的pIRES bFGF EGFP在转染 2 4h后开始表达 ,48h达到最高 ,表达时间可持续 1个月。治疗组在噪声后听性脑干反应平均阈值均低于噪声组 ,在保护组 :pIRES bFGF EGFP对耳蜗毛细胞有明显的保护作用。结论本研究成功地构建了pIRES bFGF EGFP真核共表达载体 ,具有bFGF、EGFP的双重活性 ,IRES可引导外源基因bFGF在内耳毛细胞表达     

听力学

20030451腺病毒携带GFP在豚鼠耳蜗基因转导的形态结构与功能改变/王晓侠…//西安医科大学学报一2002,23(2)一121一124,188 目的:带有绿色荧光蛋白(GFP)基因的腺病毒注人豚鼠耳蜗后,观察不同时间段GFP基因的表达和分布情况及手术操作对听力的影响,为内耳基因治疗提供理论依据。方法:15只杂色豚鼠术前及术后行听性脑干反应(ABR)和畸变产物耳声发射(DP()AE)检查,空白对照组经圆窗或底回钻孔注人人工外淋巴液。实验组注入带有GFP基因的腺病毒。分别于3、5、7和lod后取材,耳蜗标本经硝酸银染色后铺片。结果:腺病毒注人耳蜗后对听阂影响不…     

神经营养因子3基因转染对庆大霉素性耳聋保护作用的实验研究

目的 :探讨阳离子脂质体介导的神经营养因子 3(NT3)基因转染对豚鼠庆大霉素性耳聋的保护作用。方法 :将携带外源性基因NT3的重组真核表达载体 pIRES2 EGFP NT3与阳离子脂质体复合物注入豚鼠耳蜗 ,术后给予庆大霉素肌肉注射 (12 0mg/kg) 14d ,分别于停药后 1d、2周进行听性脑干反应 (ABR)及畸变产物耳声发射 (DPOAE)测听并观察转染基因在耳蜗的表达和分布及耳蜗毛细胞受损情况。结果 :NT3组DP gram幅值降低较对照组明显减轻 ,ABR阈值升高亦无对照组显著 (P <0 .0 5 )。耳蜗基底膜FITC phalloidin染色见NT3组耳蜗毛细胞的缺失较对照组明显减轻。结论 :阳离子脂质体介导的NT3基因转染对豚鼠庆大霉素性耳聋具有一定程度的保护作用。     

碱性成纤维细胞生长因子真核表达载体的构建及其在内耳基因治疗中的实验研究

目的：观察碱性成纤维细胞生长因子（basic fibroblast growth factor,bFGF)双顺反子真核表达载体在豚鼠耳蜗中的表达，及噪声损伤后对毛细胞的保护作用。方法：利用脑炎心肌炎病毒的内部核糖体进入位点（internal ribosome entry site,IRES),构建人bFGF与增强型绿色荧光蛋白（enhance green fluorescence protein,EGFP)基因真核表达载体pIRES-bFGF-EGFP。采用硬脂胺（stearylamine,SA)脂质体介导bFGF基因转染豚鼠内耳，噪声暴露即刻通过圆窗向豚鼠耳蜗注入含有bFGF基因作为治疗基因的真核表达载体；或在噪声暴露前7d,为保护因子转导转染豚鼠耳蜗。结果：构建的pIRES-bFGF-EGFP在转染24h后开始表达，48h达到最高，表达时间可持续1人月。治疗组在噪声后听性脑干反应平均阈值均低于噪声组，在保护组：pIRES-bFGF-EGFP对耳蜗毛细胞有明显的保护作用。结论：本研究成功地构建了pIRES-bEGF-EGFP真核共表达载体，具有bFGF、EGFP的双重活性，IRES可引导外源基因bFGF在内耳毛细胞表达。     

One‐stop neck lump clinic: phase 2 of audit. How are we doing?

One‐stop neck lump clinic: phase 2 of audit. How are we doing? Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one‐stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral.     

A Decrease in Maxillary Sinus Pressure,as Seen in Upper Airway Allergy or Infection,Results in an Increase in Upper Airway Nitric Oxide Levels

The paranasal sinuses are connected to the nasal cavity via small osties. Ostial occlusion, caused by mucosal swelling, will result in a slowly increasing negative pressure inside the sinus cavity. In parallel, the oxygen content in the sinus will decrease, resulting in the development of relative hypoxia. Hypoxia is a powerful inducer of nitric oxide (NO) synthase, and inducible NO synthase has been shown to be present in considerable amounts in the upper airways, including the sinuses. The present study was designed to investigate whether a reduction in sinus pressure would affect upper airway NO production. Thirteen healthy volunteers were investigated. A pressure chamber was used to lower the ambient pressure to-4.9 kPa. NO was sampled from one nostril or via a drainage tube inserted into the maxillary sinus before, during and after the hypobaric exposure. When the pressure was decreased, NO levels increased from 256 &#45 15 to 316 &#45 19 ppb ( n =13, p <0.001). The NO levels remained elevated (282 &#45 21 ppb; p <0.05) when measurements were repeated 20 min after leaving the chamber. The nasal airway resistance (V2 tot ) also increased as a result of the chamber session (from 16 &#45 2° before to 21 &#45 3° after; p <0.05). An increase in NO levels was also found when the experiments were repeated with NO sampled directly from the maxillary sinus (225 &#45 6 before and 265 &#45 9 ppb after; n =6, p <0.001). For control purposes the nasal analyses were repeated again, this time under hyperbaric conditions (+4.9 kPa). This resulted in a slight decrease in the NO levels (from 273 &#45 22 to 241 &#45 17 ppb; n =10, p <0.001), but there was no change in the nasal airway resistance. We conclude that a reduction in sinus pressure, as seen in upper airway allergy or infection, may result in an increase in upper airway NO production.     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

A simple objective evaluation and grading for facial paralysis outcomes

Matrix metalloproteinase (MMP)-2 and -9 degrade type IV collagen, which is one of the major components of the basement membrane in normal tissue and expressed in the surroundings of the cancer nest in squamous cell carinoma. The degeneration of type IV collagen is an essential step in the metastasis to lymph nodes and distant organs. In this study, we examined MMP-2 and -9 levels of cancer tissue and serum obtained from patients with head and neck squamous cell carcinoma (HNSCC) in order to evaluate the relationship between the clinicopathologic features and MMPs. We examined the production of MMP-2 and -9 in cancer tissue homogenates of 73 patients who had HNSCC and the serum MMP levels of 16 patients with HNSCC and 8 healthy volunteers. We also studied the localization of MMP-2 in the carcinoma using an immunohistochemical approach. The concentrations of MMP-2 and -9 in the tissue homogenates and serum were measured by means of a sandwich enzyme immunoassay using a monoclonal antibody. Immunohistochemical analyses were performed with monoclonal antibody to MMP-2. The concentration of MMP-2 in the tumor tissue homogenates was unrelated to tumor size, but that in patients with lymph node metastases was significantly higher than in those without lymph node metastases. The concentration of MMP-9 was unrelated to lymph node metastasis and tumor size. The levels of both MMP-2 and -9 in serum were unrelated to lymph node metastasis. Immunohistochemistry indicated that MMP-2 was mainly expressed in cancer cells. Because MMP-2 degrades type IV collagen, the level of MMP-2 in carcinomas may be a useful indicator of the degree of invasion and metastasis.     

A case of cortical deafness and anarthria

The nasal epithelium protects the underlying tissue from damage. Epithelial cell growth is controlled by epidermal growth factor (EGF) and is possibly affected by toxic proteins, e.g. eosinophil cationic protein (ECP). The aims of this study were to examine nasal fluid epithelial cell counts and their relations to EGF, eosinophils and ECP in 23 patients with seasonal allergic rhinitis and 20 healthy controls. Nasal fluid epithelial cell counts were lower in patients than in controls. EGF levels did not differ between patients and controls, and correlated with epithelial cell counts in controls but not in patients. Eosinophils and ECP were higher in patients than in controls, but did not correlate with epithelial cell counts. The role of growth factors, such as EGF, in regulating epithelial cells merits further study.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.