Quality of life after hemifacial spasm surgery: French versions of the HFS-8 and HFS-30 questionnaires

ObjectivesThe aim of the present study was to assess quality of life before and after surgery for hemifacial spasm, in order to validate two specific quality of life scales translated in French. Surgical results and complications were reported.Material and methodsTwenty-three patients with hemifacial spasm treated by microvascular decompression were retrospectively included. The HFS-8 and HFS-30 quality of life scales were translated from English into French using a forward-backward method and implemented on patients at least one year after surgery.ResultsMedian HFS-8 and HFS-30 values were respectively 16 ± 12.5 (range: 8–20.5) and 38 ± 38.5 (range: 23–61.5) before surgery and 0.5 ± 4.5 (range: 0–4.5) and 5 ± 17.5 (range: 1–18.5) after surgery, showing significant improvement in quality of life (P < 0.001). The internal consistency of both scales was excellent (Cronbach's alpha > 0.9), and they were significantly correlated (Pearson coefficient = 0.95; 95% CI [0.91; 0.98]; P < 0.0001). Success rates were 83% and 91%, respectively, after primary and revision surgeries. Complications were transient with minor consequences in 80% of cases, but could impact quality of life when lasting.ConclusionsThese results support the validity of the French versions of HFS-8 and HFS-30. Microvascular decompression is a safe and effective treatment for hemifacial spasm, and these scales are reliable tools to assess postoperative quality of life.     

Intraoperative bleeding during endoscopic sinus surgery and microvascular density of the nasal mucosa

PurposeTo evaluate the correlation between quality of the surgical field, intraoperative bleeding during endoscopic sinus surgery (ESS) and the density of microvasculature of the nasal mucosa.Material/methodsNasal mucosa of 30 patients, operated for chronic rhinosinusitis, was biopsied to assess expression of CD34 antigen on vascular endothelium. Quality of surgical field was evaluated with Fromm-Boezaart scale at mean arterial pressure (MAP) of 70–80 mmHg. If at this MAP surgical field quality was not satisfactory further reduction of hemodynamic parameters was performed until ‘bloodless surgical field’ (grade 2 or lower) was achieved. The rate of intraoperative bleeding was calculated from the ratio of total blood loss and the operative time. The extent of the disease was assessed according to computed tomography findings using Lund-Mackay staging system.ResultsSignificant positive correlation (Spearman correlation test; p < 0.05) was found between CD34 antigen expression and quality of surgical field at MAP between 70 and 80 mmHg as well as the rate of intraoperative bleeding. More intense reduction of MAP was necessary to achieve ‘bloodless surgical field’ in patients with high CD34 expression than in those with moderate and low expression. Lund-Mackay score correlated with quality of surgical field but not with the rate of intraoperative bleeding.ConclusionDuring ESS, it is microvascular density of the nasal mucosa rather than the extent of the disease that contributes to the intensity of intraoperative bleeding, although both factors negatively influence the quality of surgical field.     

Involvement of PKCα–MAPK/ERK-phospholipase A2 pathway in the Escherichia coli invasion of brain microvascular endothelial cells

Escherichia coli K1 is the most common Gram-negative organism that causes neonatal meningitis following penetration of the blood–brain barrier. In the present study we demonstrated the involvement of cytosolic (cPLA₂) and calcium-independent phospholipase A₂ (iPLA₂) and the contribution of cyclooxygenase-2 products in E. coli invasion of microvascular endothelial cells. The traversal of bacteria did not determine trans-endothelial electrical resistance (TEER) and ZO-1 expression changes and was reduced by PLA₂s siRNA. cPLA₂ and iPLA₂ enzyme activities and cPLA₂ phosphorylation were stimulated after E. coli incubation and were attenuated by PLA₂, PI3-K, ERK 1/2 inhibitors. Our results demonstrate the role of PKCα/ERK/MAPK signaling pathways in governing the E. coli penetration into the brain.     

Coronary vasospasm is an unlikely cause of Takotsubo syndrome,although we should keep an open mind

This viewpoint pertains to the still elusive pathophysiology of the Takotsubo syndrome (TTS), maintaining the position that this affliction is not the result of coronary vasospasm (CV) involving one or more coronary arteries. Although CV has been rarely encountered in the acute stage of TTS, or elicited via provocative testing in the subacute stage of the disease, it does not appear to be the cause of TTS as shown by the bulk of the published relevant literature. The author provides some speculations to explain the spontaneous appearance of CV, or its artificial elicitation, in some patients with TTS. However while we are striving to unravel the pathophysiology of TTS, we should keep an open mind about a possible role for CV in the causation of TTS.     

双胎输血综合征宫内治疗后供血胎和受血胎预后的比较

[目的]评价双胎输血综合征(TTTS)经不同治疗方式,包括羊水减量术(SA)、双极脐带电凝减胎术(BCC)和胎盘吻合血管激光凝固术(LCPV)后,供血胎和受血胎的临床结局.[方法]回顾性分析2008年1月至2013年12月在我院诊断治疗的双胎输血综合征93例,追踪妊娠结局和新生儿情况,分析比较供血胎和受血胎的临床结局.[结果]不同治疗方式组中严重的TTTS(TTTSⅢ期及以上)所占比例分别是:羊水减量术组50.0％(27/54),脐带电凝减胎术组93.9％(31/33),胎盘吻合血管激光凝固术组83.3％(5/6),P＜0.001,因此,3种治疗方式妊娠结局比较时仅纳入TTTSⅢ期及以上病例.SA组、BCC组和LCPV组双胎总体存活率分别是53.7％、24.2％和60.0％,P=0.002.SA组、BCC组和LCPV组分娩孕周中位数分别是31e(20+3～38+2)、28+5(20+2～38+6)和27+6((23+3～37+4)周,其差异无统计学意义(P=0.204).SA组胎膜早破的发生率是29.6％而BCC组和LCPV组胎膜早破的发生率分别是32.3％和60.0％,P=0.410.LCPV组28周前分娩的比例较SA组和BCC组高(分别是60.0％、18.5％和48.4％;P=0.033).TTTS双胎中受血胎存活率是44.1％(41/93)而供血胎存活率是46.2％(43/93),P=0.768;受血胎神经系统发育迟缓发生率是2.4％(1/41)而供血胎神经系统发育迟缓发生率是11.6％(5/43),其差异无统计学意义(P=0.202).[结论]胎盘吻合血管激光凝固术可提高TTTS的总体存活率;TTTS受血胎和供血胎的预后无明显差异.     

关木通致急性肾小管坏死患者肾间质微血管病变的研究

目的探讨肾间质微血管病变在关木通致急性肾小管坏死肾间质纤维化中的作用及发生机制。方法取4例关木通致急性肾小管坏死患者(A组)、5例抗生素致急性肾小管坏死患者(B组)、5例非IgA型轻度系膜增生性肾小球肾炎患者(C组)肾活检标本,免疫组化SP法观察肾小管上皮血管内皮生长因子(VEGF)表达及肾小管周围毛细血管(PTC)密度及形态改变,电镜观察微血管内皮细胞和基底膜的结构变化。结果(1)A组PTC数目明显少于B组及C组(P<0.01),并可见管腔扩张变形或缩小、血管壁断裂。(2)A组电镜见PTC内皮细胞肿胀,有胞质空泡、致密颗粒,细胞局部与基底膜分离。基底膜有皱缩及增厚。(3)A组肾小管上皮VEGF表达明显少于B组,但2组VEGF表达均多于C组。(4)A、B组PTC密度与肾小管VEGF表达呈正相关(均r=0.793,P<0.01),与肾小管上皮再生呈正相关(r分别为0.880、0.802,P值均小于0.01)。结论关木通致急性肾小管坏死存在原发性肾间质微血管损伤,肾小管VEGF低表达可能参与了损伤过程。关木通致急性肾小管坏死中的微血管病变可能是肾小管中毒性损伤后修复不良及病变慢性化进展的原因之一。