The Caspase family， short for cysteine-containing aspartate protein hydrolases， can be classified into inflammatory Caspases and apoptotic Caspases according to their role. It has been confirmed that Caspases promote myocyte apoptosis through multiple pathways in denervated skeletal muscle atrophy. In recent years， studies have shown that the pyroptosis pathway dominated by caspase-1 is activated in denervated myocyte atrophy， which is a new direction for exploration that is not mentioned in previous studies. This article reviews the role of the Caspase family in denervated skeletal muscle atrophy.
Denervation

Objective:To investigate the effect of posterior nasal neurectomy（PNN） with pharyngeal neurectomy （PN） on chronic sinusitis with nasal polyps （CRSwNP）complicated with perennial allergic rhinitis （PAR）. Methods:83 patients with perennial allergic rhinitis combined with chronic group-wide sinusitis with nasal polyps who attended our hospital from July 2020 to July 2021 were selected. All patients underwent conventional functional endoscopic sinusitis surgery（FESS）+ nasal polypectomy. Patients were divided according to whether they underwent PNN+PN. 38 cases in the experimental group underwent FESS combined with PNN+PN; 44 cases in the control group underwent conventional FESS alone. All patients underwent the VAS, RQLQ, and MLK before treatment, and at 6 months and 1 year after surgery. Meanwhile, other relevant data were collected and the preoperative and postoperative follow-up data were collected and analyzed to assess the differences between the two groups. Results:The total postoperative follow-up period was 1 year. The recurrence rate of nasal polyps at 1 year postoperatively and the nasal congestion VAS score at 6 months postoperatively were not statistically significant in the two groups（P>0.05）. However, the patients in the experimental group had statistically significantly lower effusion and sneezing VAS scores, MLK endoscopy scores and RQLQ scores at 6 months and 1 year postoperatively, and nasal congestion VAS scores at 1 year postoperatively compared to the control group（P<0.05）. Conclusion:For patients with perennial AR complicated with CRSwNP, the combination of the PNN+PN in FESS can significantly improve the short-term curative effect, and PNN+PN is a safe and effective surgical treatment.
Humans ; Nasal Polyps/surgery* ; Rhinitis, Allergic/surgery* ; Sinusitis/surgery* ; Rhinitis, Allergic, Perennial ; Endoscopy ; Denervation ; Chronic Disease ; Rhinitis/complications*

Objective: To explore the effect of vidian neurectomy and selective vidian neurectomy in the treatment of moderate and severe persistent allergic rhinitis (AR). Methods: A total of 60 patients with moderate-to-severe persistent AR treated in Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine from June 2018 to June 2020 were selected, including 28 males and 32 females. A total of 40 cases in the observation group were subjected to vidianneurectomy, while, 20 cases in the control group underwent selective vidianneurectomy. Patients in the two groups were followed up at 6 months, 1 year, and 2 years, respectively, and evaluated according to AR diagnostic and efficacy assessment criteria. Four symptoms of sneezing, clear runny nose, nasal congestion, and nasal itching were scored as efficacy indices before and at 6 months, 1 year, and 2 years after surgery. The regression of the lower turbinate swelling after surgery was assessed by nasal endoscopy or sinus CT. Postoperative tear secretion was followed up in both groups, and patients with dry eyes were counted in combination with ocular symptoms. SPSS 19.0 software was used to statistically analyze the data before and after the surgery and between the two groups. Results: The preoperative, 6-month, 1-year, and 2-year postoperative inferior turbinate signs were (2.73±0.45), (1.20±0.41), (1.25±0.49) and (1.30±0.56) points in the observation group and (2.75±0.44), (1.45±0.69), (1.75±0.72) and (1.90±0.85) points in the control group, respectively, with a statistically significant difference in the between-subjects effect test between the two groups (F=8.28, P<0.05), indicating a more durable surgical effect in the observation group. The total effective rate at 2 years after surgery was 95.0% (38/40) in the observation group and 50% (10/20) in the control group. The difference between the two groups by Fisher's exact test was statistically significant. No dry eye patient was found in either group at a 1.5-year postoperative follow-up. Conclusion: Both vidianneurectomy and selective vidianneurectomy have good recent treatment effects, vidianneurectomy has better long-term curative effects than selective vidianneurectomy.
Male ; Female ; Humans ; Treatment Outcome ; Rhinitis, Allergic/surgery* ; Turbinates/surgery* ; Denervation ; Nose Diseases

Humans ; Denervation ; Rhinitis, Vasomotor ; Endoscopy

Objective: To propose total posterior nasal neurectomy with transection of sphenopalatine neurovascular bundle from anatomy for the treatment of allergic rhinitis, and to explore its clinical application. Methods: Two fresh cadaveric heads (4 sides) were dissected through endoscopic transnasal middle meatus approach at Otorhinolaryngology Anatomy Laboratory of China-Japan Friendship Hospital. The structures of the craniofacial bone related to the surgical approach were observed. Twelve patients with allergic rhinitis who treated in Department of Otorhinolaryngology, China-Japan Friendship Hospital from Feb. 1 2019 to Jun. 10 2021 were selected. All the patients were treated by posterior nasal neurotomy with the technique of complete transection of sphenopalatine neurovascular bundle and followed up for 1 year after sugery. During the follow-up, 2 patients were lost. The other 10 patients included 4 males and 6 females, aging from 29 to 69 years. Visual Analogue Scale (VAS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) were used to evaluate the effect of the surgery. SPSS 25.0 software was used for statistical analysis. Results: Important anatomic landmarks of transnasal middle meatus approach were obtained during anatomy, such as ethmoid crest, sphenopalatine foramen/notch, palatine orbital process and sphenopalatine process. The postoperative VAS scores of nose, eye, pharynx, ear and whole body and total VAS scores were significantly lower than those before operation, with statistically significant difference (nose 2.50±1.70 vs 6.47±2.17, eyes 1.15±0.89 vs 3.60±2.57, pharynx 1.30±1.36 vs 4.25±3.64, ear 1.10±1.03 vs 2.67±2.00, whole body 1.08±1.24 vs 3.60±1.17, total 7.13±4.31 vs 20.58±9.05, all P<0.05). The postoperative RQLQ scores of sleep, nose, eyes, practical problems, emotion, activity and the total RQLQ scores of patients were significantly lower than those before operation, with statistically significant difference (sleep 0.80±0.69 vs 2.93±1.33, nose 1.38±1.18 vs 3.93±1.50, eyes 0.58±0.66 vs 1.80±1.25, practical problems 1.10±1.22 vs 3.03±1.84, emotion 1.00±1.81 vs 2.58±2.00, activity 2.77±2.93 vs 6.00±1.85, total 8.99±8.92 vs 22.42±8.69, all P<0.05). There was no significant difference in preoperative and postoperative scores of non-nasal/ocular symptoms (1.37±1.60 vs 2.16±1.12, P=0.166). There was no other complication except 2 cases with short-term postoperative numbness. Conclusions: Total posterior nasal neurectomy with transection of sphenopalatine neurovascular bundle is a safe, effective and feasible method for the treatment of intractable allergic rhinitis, and its long-term efficacy needs further observation.
Denervation/methods* ; Female ; Humans ; Male ; Nose/surgery* ; Quality of Life ; Rhinitis, Allergic/surgery* ; Treatment Outcome

No abstract available.
Arrhythmias, Cardiac ; Denervation ; Myocardial Infarction

BACKGROUND AND OBJECTIVES: Antiarrhythmic effect of renal denervation (RDN) after acute myocardial infarction (AMI) remains unclear. The goal of this study was to evaluate the effect of RDN on ventricular arrhythmia (VA) after AMI in a porcine model.METHODS: Twenty pigs were randomly divided into 2 groups based on RDN (RDN, n=10; Sham, n=10). After implanting a loop recorder, AMI was induced by occlusion of the middle left anterior descending coronary artery. Catheter-based RDN was performed for each renal artery immediately after creating AMI. Sham procedure used the same method, but a radiofrequency current was not delivered. Electrocardiography was monitored for 1 hour to observe VA. One week later, the animals were euthanized and the loop recorder data were analyzed.RESULTS: Ventricular fibrillation event rate and the interval from AMI creation to first VA in acute phase were not different between the 2 groups. However, the incidence of premature ventricular complex (PVC) was lower in the RDN than in the Sham. Additionally, RDN inhibited prolongation of the corrected QT (QTc) interval after AMI. The frequency of non-sustained or sustained ventricular tachycardia, arrhythmic death was lower in the RDN group in the early period.CONCLUSIONS: RDN reduced the incidence of PVC, inhibited prolongation of the QTc interval, and reduced VA in the early period following an AMI. These results suggest that RDN might be a therapeutic option in patients with electrical instability after AMI.
Animals ; Arrhythmias, Cardiac ; Autonomic Denervation ; Coronary Vessels ; Denervation ; Electrocardiography ; Humans ; Incidence ; Methods ; Myocardial Infarction ; Renal Artery ; Swine ; Tachycardia, Ventricular ; Ventricular Fibrillation ; Ventricular Premature Complexes

PURPOSE: Chronic testicular pain remains an important challenge for urologists. At present there are many treatment modalities available for chronic orchialgia. Some patients remain in pain despite a conservative treatment. Microsurgical denervation of spermatic cord appears to be successful in relieving pain in patients who fail conservative management. We assessed the long-term efficacy, complications and patient perceptions of microsurgical denervation of the spermatic cord in the treatment of chronic orchialgia. MATERIALS AND METHODS: A prospective study was conducted from January 2007 to January 2016 which included men with testicular pain of >3 months duration, failure of conservative management, persistent of pain for >3 months after treating the underlying cause. Total 48 patients with 62 testicular units (14 bilateral) showed the response to spermatic cord block and underwent Microsurgical Denervation of Spermatic Cord. RESULTS: Out of 62 testicular units (14 bilateral) which were operated, complete 2 years follow-up data were available for 38 testicular units. Out of these 38 units, 31 units (81.57%) had complete pain relief, 4 units (10.52%) had partial pain, and 3 units (7.89%) were non-responders. Complications were superficial wound infection in 3 units (4.83%), hydrocele in 2 units (3.22%), subcutaneous seroma in 2 units (3.22%), and an incisional hematoma in 1unit (1.61%) out of 62 operated testicular units. CONCLUSIONS: Idiopathic chronic orchialgia remains a difficult condition to manage. If surgery is considered, microsurgical denervation of spermatic cord should be considered as a first surgical approach to get rid of pain and sparing the testicle.
Chronic Pain ; Denervation* ; Follow-Up Studies ; Hematoma ; Humans ; Male ; Pain Management ; Prospective Studies ; Scrotum ; Seroma ; Spermatic Cord* ; Testis ; Wound Infection

The aim of this study was to validate the effectiveness of targeted microsurgical spermatic cord denervation (MSCD) of the trifecta nerve complex in comparison to traditional full MSCD with complete skeletonization of the spermatic cord in men with chronic orchialgia. Retrospective chart review was performed by a single fellowship-trained microsurgeon between 2011 and 2016. Patients had follow-ups at 6 weeks, 6 months, and 1 year postoperatively. Thirty-nine men with chronic orchialgia underwent full MSCD between 2011 and 2013. In July 2013, after the publication of an anatomic study with identification of Wallerian degeneration of the trifecta nerve complex in men with chronic orchialgia, the technique was changed to targeted MSCD. From July 2013 to March 2016, 43 men underwent targeted MSCD. When comparing the full MSCD group to the targeted MSCD group, there was no significant difference in resolution of pain (66.7% vs 69.8%, P = 0.88), no difference in partial relief of pain (17.9% vs 23.3%, P = 0.55), and no difference in failure to respond rates (15.4% vs 7.0%, P = 0.22) between the two groups. There was no difference in mean change of visual analog pain scale scores between the two groups (P = 0.27). Targeted MSCD had a shorter operative time (53 min vs 21 min, P = 0.0001). Targeted MSCD offers patients comparable outcomes to traditional full MSCD, with a shorter operative time, a less technically challenging surgery, and potentially less risk to cord structures which should be preserved.
Adult ; Aged ; Denervation/methods* ; Humans ; Male ; Microsurgery/methods* ; Middle Aged ; Pain/surgery* ; Spermatic Cord/innervation* ; Testicular Diseases/surgery* ; Treatment Outcome ; Young Adult

This study aimed to investigate the functional and morphological changes in the corpus cavernosum after cavernous nerve (CN) injury or neurectomy and then reveal whether treatment with the angiotensin II Type 1 receptor antagonist losartan would improve erectile function as well as its potential mechanisms. A total of 48 10-week-old Sprague-Dawley male rats, weighing 300-350 g, were randomly divided into the following four groups (n = 12 per group): sham operation (Sham) group, bilateral cavernous nerve injury (BCNI) group, losartan-treated BCNI (BCNI + Losartan) group, and bilateral cavernous neurectomy (Neurectomy) group. Losartan was administered once daily by oral gavage at a dose of 30 mg kg^-1 day^-1 for 4 weeks starting on the day of surgery. The BCNI and the Neurectomy groups exhibited decreases in erectile response and increases in apoptosis and oxidative stress, compared with the Sham group. Treatment with losartan could have a modest effect on erectile function and significantly prevent corporal apoptosis and oxidative stress. The phospho-B-cell lymphoma 2 (Bcl-2)-associated death promoter (p-Bad)/Bad and phospho-the protein kinase B (p-AKT)/AKT ratios were substantially lower, while the Bcl-2-associated X protein (Bax)/Bcl-2 ratio, nuclear factor erythroid 2-related factor 2 (Nrf2)/Kelch-like ECH-associated protein 1 (Keap-1), transforming growth factor-β 1 (TGF-β 1) and heme oxygenase-1 (HO-1) levels, and caspase-3 activity were higher in the BCNI and Neurectomy groups than in the Sham group. After 4 weeks of daily administration with losartan, these expression levels were remarkably attenuated compared with the BCNI group. Taken together, our results suggested that early administration of losartan after CN injury could slightly improve erectile function and significantly reduce corporal apoptosis and oxidative stress by inhibiting the Akt/Bad/Bax/caspase-3 and Nrf2/Keap-1 pathways.
Angiotensin II Type 1 Receptor Blockers/pharmacology* ; Animals ; Apoptosis/drug effects* ; Denervation ; Disease Models, Animal ; Erectile Dysfunction/metabolism* ; Losartan/pharmacology* ; Male ; Oxidative Stress/drug effects* ; Penile Erection/drug effects* ; Penis/metabolism* ; Rats ; Rats, Sprague-Dawley