河南地区不明原因感音神经性聋95例SLC26A4基因热点突变筛查

目的:调查河南地区不明原因感音神经性聋病因学情况,探明本地区大前庭水管综合征(large ves-tibular aqueduct syndrome,LVAS)基因SLC26A4 2168A>G的突变率。方法:收集河南地区聋校、聋儿康复中心及2005年2月~2006年5月至郑州大学第一附属医院耳鼻咽喉科门诊的感音神经性聋患者95例,进行耳聋病因问卷调查、听力学测试,抽取患者血样提取基因组DNA,运用直接测序法对突变热点2168A>G进行筛查。对突变阳性者行颞骨CT检查。结果:热点突变基因检测显示,2168A>G在不明原因感音神经性耳聋患者的突变率为6.32%,对所有检测到突变的患者行颞骨CT检查,其前庭导水管扩大率为83.3%。结论:河南地区不明原因感音神经性耳聋患者中存在较高的2168A>G遗传性耳聋发生率;通过聋病分子诊断,可达到防聋、指导聋儿康复及评估耳聋预后等积极效果。     

颞骨畸形和非综合征性耳聋SLC26A4基因

先天性颞骨畸形(主要为大前庭水管综合征)所致耳聋是儿童感音神经性聋的常见原因,与SLC26A4基因突变有密切关系。SLC26A4基因突变的临床特点和发生频率在不同国家、地区、不同种族之间有很大的差异。本文就SLC26A4基因及其突变热点的分子流行病学研究情况做一综述。     

颞骨畸形和非综合征性耳聋SLC26A4基因

先天性颞骨畸形（主要为大前庭水管综合征）所致耳聋是儿童感音神经性聋的常见原因，与SLC26A4基因突变有密切关系。SLC26A4基因突变的临床特点和发生频率在不同国家、地区、不同种族之间有很大的差异。本文就SLC26A4基因及其突变热点的分子流行病学研究情况做一综述。     

新疆地区汉族和维吾尔族耳聋基因突变的比较研究

目的:分析中国新疆地区汉族和维吾尔族耳聋患者的常见耳聋基因突变,为该地区耳聋患者的临床基因诊断提供理论依据。方法:调查对象为新疆地区乌鲁木齐和库尔勒特教学校的125例耳聋患者,其中汉族64例,维吾尔族61例,听力检查全部为重度-极重度感音神经性聋。所有受检者均采集外周血并提取DNA,进行GJB2全序列、包含SLC26A4IVS7-2A>G、线粒体DNA12SrRNA1494和1555位点的突变分析。结果:新疆地区汉族耳聋患者GJB235delG和SLC26A4IVS7-2的等位基因频率分别为7.4%和10.1%,维吾尔族耳聋人群未发现GJB235delG和SLC26A4IVS7-2突变,两者比较差异有统计学意义。而GJB2235delC、299-300delAT及线粒体DNAA1555G、C1494T维吾尔族和汉族比较差异无统计学意义。结论:新疆地区汉族和维吾尔族GJB235delG和SLC26A4IVS7-2A>G有不同的等位基因频率,新疆地区汉族和维吾尔族常见耳聋基因突变存在异同。     

52例听力损失儿童及其父母耳聋基因芯片筛查结果分析

目的：对非综合征性先天性重度及以上感音神经性听力损失儿童及其父母进行耳聋相关基因检测,探讨耳聋基因芯片筛查在临床中应用的有效性和可行性。方法选择来自医院听力检测中心的47个听障儿童家庭,包括52例非综合征性先天性感音神经性听力损失患儿及其父母,应用遗传学耳聋基因芯片对47个家庭进行GJB2、GJB3、SLC26A4、线粒体12S rRNA4个常见耳聋基因9个检测位点的基因检测。结果146例受检者中,17个家庭的43例筛查结果阳性,其中16例听力损失患儿筛查阳性,筛查阳性率为30.8%。GJB2基因235delC位点纯合突变8例,GJB2基因235delC位点杂合突变20例,GJB2基因235delC位点和SLC26A4基因IVS7-2A〉G位点杂合突变1例,SLC26A4基因IVS7-2A〉G位点纯合突变2例,SLC26A4基因IVS7-2A〉G位点杂合突变10例,SLC26A4基因2168A〉G位点杂合突变2例。结论应用耳聋基因芯片检测技术能快速、高效地检测非综合征性耳聋患者的遗传性致病基因,适用于大规模群体耳聋基因的筛查,有助于临床医生从病因学角度辅助耳聋诊断,引入正确的康复干预措施,并为具有聋病易感基因的听力损失儿童家庭提供针对性的遗传咨询指导。     

河南两地区聋儿教育机构患者大前庭水管相关SLC26A4基因热点突变筛查分析

目的　分析河南郑州和南阳地区聋儿教育机构儿童感音神经性聋患者中SLC26A4基因热点突变IVS7-2A＞G和2168A＞G发生频率,初步探讨大前庭水管相关的SLC26A4基因热点突变在河南地区聋病残疾人群中的分子诊断意义,为地区聋病防治工作的有效开展奠定理论基础。方法　收集南阳聋校、郑州聋儿康复中心的感音神经性聋患者76例,进行聋病病因问卷调查、听力学测试,抽取患者血样提取基因组DNA,运用直接测序法对SLC26A4基因的热点突变IVS7-2A＞G和2168A＞G进行检测,对突变阳性者行颞骨CT检查,并对其发生频率进行分析。结果　热点突变基因检测显示,在76例聋病患者中,携带SLC26A4基因IVS7-2A＞G和2168A＞G突变的例数共计21例,总阳性检出率为27.63%（21/76）。IVS7-2A>G纯合突变5例,IVS7-2A>G杂合突变12例,2168A>G杂合突变2例,2168A>G/IVS7-2A>G复合杂合突变2例。研究对象中SLC 26A4基因2168A＞G/IVS7-2A＞G双等位基因的突变率为9.21%（7/76）,IVS7-2A＞G突变率为25.00%（19/76）,2168A>G突变率为5.26%（4/76）,对所有检测到突变的患者行颞骨CT检查,17例存在前庭导水管扩大,前庭导水管扩大率为80.95%（17/21）。结论　河南地区聋儿教育机构的不明原因感音神经性聋患者中存在较高的IVS7-2A＞G、2168A>G遗传性聋发生率;IVS7-2A＞G和2168A＞突变检测阳性对患儿父母的婚配、生育具有一定的指导意义。     

两个大前庭水管综合征家系的临床及SLC26A4基因的检测分析

目的分析两个非综合征型前庭水管扩大耳聋家系的临床特征和SLC26A4基因检测特点。方法对两个非综合征型前庭水管扩大耳聋小家系进行临床表型分析,并对两个家系中的6例耳聋患者、6例听力正常者及1例胎儿进行SLC26A4基因全编码序列的检测。结果第一个家系共3代9人,其中仅第三代2人为耳聋患者,2例均为语后感音神经性聋,颞骨CT显示均为前庭水管扩大,1例胎儿。第二个家系共三代14人,其中4人为耳聋患者,1例为语后感音神经性聋,3例为语前感音神经性聋。颞骨CT显示均为前庭水管扩大。两个家系共发现SLC26A4基因1022delC、c.919-2A>G、p.G497S、p.H723R、p.T410M五种不同的已知致病突变,耳聋患者均为双等位基因突变,1例胎儿为携带者,6例听力正常者为携带者。结论两个家系的6例耳聋患者分别由SLC26A4基因不同复合杂合突变导致前庭水管扩大,1例胎儿为携带者,加强耳聋基因的孕前及产前诊断对防止此类耳聋患儿的出生有重大意义。     

湖北地区306例极重度聋患儿基因芯片筛查分析

目的：通过检测湖北地区极重度感音神经性聋患儿常见耳聋基因突变情况,分析该人群的分子病因学特点,为临床耳聋防治和遗传咨询提供参考。方法：收集306例湖北地区极重度感音神经性聋患儿,抽取外周血,提取DNA,应用遗传性耳聋基因芯片检测GJB2、GJB3、SLC26A4和线粒体12SrRNA4个基因的9个突变热点。对所有携带SLC26A4基因突变患者进行颞骨CT扫描。结果：306名患儿中,132例（43．14％）检出携带不同基因突变,其中有2例携带双基因突变。GJB2基因突变检出率为29．41％（90／306）,SLC26A4基因突变检出率为13．72％（42／306）,线粒体12SrRNA基因突变检出率为O．65％（2／306）。本组患者未检出GJB3基因突变。36例携带SLC26A4基因突变者颞骨CT扫描显示前庭水管扩大。结论：GJB2基因和SLC26A4基因是本组患儿最主要的致聋基因,其中235delC突变为最常见的突变位点,其次为1VS7—2A〉G突变。筛查SLC26A4基因常见突变有助于大前庭水管综合征的诊断。     

大前庭水管综合征家系特征与SLC26A4基因分析

目的分析一个大前庭水管综合征家系的临床特征和SLC26A4基因检测特点。方法对一个大前庭水管综合征家系进行病史采集和听力学检测,绘制耳聋家系系谱图,提取受检者的基因组DNA,对所有家系成员进行耳聋基因芯片分析和SLC26A4基因全外显子及外显子侧翼序列的检测。结果该家系共5代合计30人(男17人,女13人),现存26人,其中第四代7人为耳聋患者,6人均为语前感音神经性聋。1人为语后感音神经性聋,颞骨CT显示均为前庭水管扩大,第五代1人为耳聋患者,表现为前庭水管扩大合并语前感音神经性聋。在家系中共发现SLC26A4基因c.754C>T、c.919-2A>G、c.1264-12T>A和c.1548_1549ins C四种已知致病突变类型。耳聋患者均为复合杂合突变。10人为SLC26A4基因携带者。结论该家系的8例耳聋患者由SLC26A4基因复合杂合突变导致前庭水管扩大,病因学分析可为患者提供预见性的临床措施,并为该家系的后代遗传咨询与婚育指导提供理论依据及科学手段,有效地防止聋儿后代出生。     

南京地区耳聋患者常见耳聋基因突变的分析

目的 通过对南京地区重度-极重度感音神经性聋患者进行常见耳聋基因检测,分析该类患者常见致聋基因和各位点发生频率,阐明该地区耳聋的遗传病因学。 方法 首先对患者进行病史采集、体格检查、高分辨颞骨CT以及临床听力学检查,然后采集128例患者的外周静脉血2~4 mL,对其标本进行4种常见基因21个突变位点的检测。 结果 128例患者中,39例(30.47%,39/128)检测到基因突变,其中携带双基因杂合突变1例、携带基因纯合突变14例。30例(23.44%,30/128)患者携带GJB2基因突变,其中 18例(14.06%,18/128)为纯合或复合杂合突变。235delC位点突变检出率为20.31%(26/128),299_300delAT位点突变检出率为4.69%(6/128),176_191del位点突变检出率为3.91%(5/128)。10例(7.81%,10/128)患儿携带SLC26A4基因突变,其中携带纯合和复合杂合突变4 例(3.13%,4/128)。IVS7-2 A>G突变检出率为7.03%。患者未检出线粒体12SrRNA基因和GJB3基因突变。患者中高分辨颞骨CT提示前庭导水管扩大者11例,其中检测出SLC26A4基因纯合或杂合突变10例,二者的吻合率为90.91%(10/11)。 结论 南京地区重度-极重度感音神经性聋患者中,GJB2基因为最主要的致聋基因,其最常见的突变位点是235delC,其次为SLC26A4基因,最常见的突变位点是IVS7-2 A>G。研究发现SLC26A4基因突变在大前庭水管综合征患者中检出率极高,筛查SLC26A4基因热点突变有助于大前庭水管综合征的诊断,但仍需结合高分辨颞骨CT检查,避免患者漏诊。     

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.     

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.     

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.     

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.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.