Controlled clinical trial with the combination therapy with metformin, thiazolidinediones, glucagon-like peptide 1 analog in patients with type 2 diabetes and metabolic syndrome / 中华内分泌代谢杂志

Objective@#The aim of this study was to compare the efficacy and safety of metformin/thiazolidinediones (TZDs) / glucagon-like peptide 1 (GLP-1) analogs (triple therapy) with conventional glucose-lowering therapy(conventional therapy) for patients with type 2 diabetes and metabolic syndrome.@*Methods@#A prospective randomized-controlled 26-week study was carried out. A total of 82 patients with type 2 diabetes and metabolic syndrome were randomized to receive either triple therapy protocal or just conventional therapy, altogether with 41 cases in each group.@*Results@#HbA1C value was significantly reduced in triple therapy group versus the conventional therapy group [(2.23±1.75)% vs (1.48±1.59)%, P<0.05]. Values of body mass index, waist circumference, and visceral fat area were significantly reduced in triple therapy group as compared to those of conventional therapy group [(2.50±1.81 vs 0.92±1.82)kg/m2, (6.75±4.92 vs 1.66±3.25)cm, (24.10±19.10 vs 10.02±20.10)cm2, all P<0.01, respectively]. Control rates of HbA1C and fasting plasma glucose for triple therapy were higher than those for conventional therapy (both P<0.05). No hypoglycemia occurred in triple therapy group. Subjects receiving triple therapy experienced more frequent gastrointestinal side effects than those in conventional therapy group (18.87% vs 3.92%, P<0.05). The most common side event was mild nausea (90%).@*Conclusion@#Combination therapy with metformin/TZDs/GLP-1 analogs had statistically significant advantages in the control of body weight, waist circumference, and visceral fat area in addition to the control of blood glucose over conventional glucose-lowering therapy in our patient cohort, it seems to be an optimized therapeutic regimen for patients with type 2 diabete and metabolic syndrome.

Controlled clinical trial with the combination therapy with metformin, thiazolidinediones, glucagon-like peptide 1 analog in patients with type 2 diabetes and metabolic syndrome / 中华内分泌代谢杂志

Objective The aim of this study was to compare the efficacy and safety of metformin/thiazolidinediones (TZDs) / glucagon-like peptide 1 (GLP-1) analogs (triple therapy) with conventional glucose-lowering therapy ( conventional therapy ) for patients with type 2 diabetes and metabolic syndrome. Methods A prospective randomized-controlled 26-week study was carried out. A total of 82 patients with type 2 diabetes and metabolic syndrome were randomized to receive either triple therapy protocal or just conventional therapy, altogether with 41 cases in each group. Results HbA1C value was significantly reduced in triple therapy group versus the conventional therapy group [(2.23 ± 1.75)％ vs (1.48 ± 1.59)％, P<0.05]. Values of body mass index, waist circumference, and visceral fat area were significantly reduced in triple therapy group as compared to those of conventionaltherapygroup[(2.50±1.81vs0.92±1.82)kg/m2,(6.75±4.92vs1.66±3.25)cm,(24.10±19.10vs 10.02±20.10)cm2, all P<0.01, respectively]. Control rates of HbA1C and fasting plasma glucose for triple therapy were higher than those for conventional therapy ( both P<0. 05 ) . No hypoglycemia occurred in triple therapy group. Subjects receiving triple therapy experienced more frequent gastrointestinal side effects than those in conventional therapy group ( 18. 87％ vs 3. 92％, P<0. 05 ) . The most common side event was mild nausea ( 90％) . Conclusion Combination therapy with metformin/TZDs/GLP-1 analogs had statistically significant advantages in the control of body weight, waist circumference, and visceral fat area in addition to the control of blood glucose over conventional glucose-lowering therapy in our patient cohort, it seems to be an optimized therapeutic regimen for patients with type 2 diabete and metabolic syndrome.

Analysis of long-term effect of juvenile-onset recurrent respiratory papillomatosis / 中华耳鼻咽喉头颈外科杂志

Objective@#To observe the clinical course of children with juvenile-onset recurrent respiratory papillomatosis (JORRP) until 14 years old.@*Methods@#The clinical data of one hundred and twenty cases treated between Januray 1, 2002 and September 30, 2017 in Beijing Tongren Hospital were analyzed retrospectively. Excluding the deaths and the lost, patients who could be ≥ 5 years without recurrence, were defined as the cured group, and < 5 years with recurrence defined as the recurrent group. Furthermore, using statistical methods to analyze the differences of the age of initial operation, total number of operations, invasive lesion, HPV infection, tracheotomy, airway dissemination after tracheotomy and time of tube wear between the two groups.@*Results@#One hundred and three cases were followed up, except for the six deaths.Numbers of operations in eight cases were ≤2, and ≥3 in eighty nine cases.Peak of the primary surgical age were about 4.5 years old, while the self-healing trend occurred at nine years old. In the cured group, forty three cases were cured, with a curative rate of 41.7% (43/103), and there were all fifty four survivors in the recurrent group.The total number of operations, invasive cases, HPV positive cases and the G score of hoarseness in the recurrent group were higher than those in the cured group (F=13.02, χ2=13.04, χ2=17.37, Z=-4.59, P<0.05). The number of tracheal dissemination caused by tracheotomy in the recurrent group (66.7%, 27.8%)was more than that in the cured group (χ2=16.01, P<0.05). Compared with the time of wearing a tracheostomy tube in cured group, the recurrent group was longer ((3.4±3.1) years vs (8.3±6.7) years, χ2=7.19, P<0.05).@*Conclusions@#41.7% of the patients had no relapse for at least five years.There exsisted differences between the cured and recurrent group in the following aspects: the total numbers of surgery, the agression of the lesions, tracheal intratracheal dissemination after tracheotomy, the time of tracheotomy, the HPV typing and the G grading of hoarseness.

Laryngotracheal resection and reconstruction for the treatment of acquired laryngotracheal stenosis / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the efficacy of laryngotracheal resection and reconstruction for acquired laryngotracheal stenosis, and to discuss the prevention of complication.@*Methods@#The clinical outcomes of seventy patients with acquired laryngotracheal stenosis, treated with laryngotracheal resection and reconstruction were retrospectively reviewed between January 2007 and December 2016. The degree of stenosis was classified according to Myer-Cotton classification as follows: grade Ⅱ(n=7), grade Ⅲ(n=38) and grade Ⅳ(n=27). The stenostic extension ranged from 0.5-4.0 cm (median 2.0 cm), the resection extension ranged from 1.0-5.0 cm (median 3.0 cm). Fifty-three stenosis originated from iatrogenic (endotracheal tubes and/or tracheostomy), 17 originated from cervical trauma.@*Results@#Thirty patients were treated by the resection of tracheal and primary anastomosis. Twenty-nine patients were treated by resection and reconstruction and supported by T-tube. Eleven patients with subglottic stenosis were treated by complete resection of tracheal lesion and the arch of cricoid cartilage, together with trachea and thyroid cartilage anastomosis with tracheotomy. Six months after surgery, the outcome was good to satisfactory in 65 patients (92.9%). Five patients failed(3 were tracheotomized and 2 were supported by T-tube). Complications included granulation tissue formation(n=15), anastomoticseparation(n=9), restenosis of anastomosis(n=9), wound infection(n=5) and subcutaneous emphysema(n=7). In 15 patients with granulation tissue, 10 patients needed endoscopic resection, and 5 patients resulted in anastomotic stenosis. No injury to recurrent laryngeal nerve was found. Three patients with trachoesophageal fistula were repaired.@*Conclusion@#Laryngotracheal resection and reconstruction is an effective surgical method for acquired laryngotracheal stenosis, which has a higher successful rate and shorter therapeutic period.

Surgical excision and botulinum toxin A injection for vocal process granuloma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the efficacy of treatment with microsurgery in combination with local injection of type A botulinum toxin for vocal process granuloma.@*METHOD@#28 patients with vocal process granuloma received endotracheal intubation under general anesthesia. The lesion was removed with micro-scissor and CO2 laster under a self-retaining laryngoscope and microscope. The incision and mucous membrane surrounding the wound was closed with 8-0 absorbable suture. 4-point injection of botulinum toxin type A 8-15 u was then performed along the thyroarytenoid muscle and arytenoid muscle of the same side. Postoperative medication was administered based on disease causes.@*RESULT@#All patients experienced vocal cord dyskinesia of the injected side 2-3 days after surgery. At 1 month after the surgery, wound healing was good in all the 28 patients, and the vocal cord movement was limited at the injected side. At 3 months, movement of the bilateral vocal cords was normal, and the vocal cord process mucosa was smooth. Patients were followed up for more than a year, and only one patient had recurrence in 2 months after surgery. The cure rate was 96. 4%.@*CONCLUSION@#Combination of laryngeal microsurgery and type A botulinum toxin local injection can shorten the treatment course of vocal process granuloma.

Voice assessment on patients with Reinke's edema of vocal fold by application of micro-suture techniques / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the vocal quality of patients with Reinke's edema before and after the endolaryngeal phonosurgery combined with micro-suture techniques.@*METHOD@#Twenty male patients with bilateral Reinke's edema were submitted to surgery. All patients received the endolaryngeal phonosurgery combined with micro-suture techniques on vocal fold and completed voice evaluation preoperative and postoperative 2 weeks, 3 months and 6 months. Acoustic voice parameters were compared with the control group without voice pathology.@*RESULT@#The result showed that at postoperative 2 weeks, compared with the preoperative evaluation the patients' subjective sound quality improved obviously. Acoustic voice parameters improved significantly (P0.05). At postoperative 6 months, voice quality still remain stable, all of the analyzed parameters had no obvious difference.@*CONCLUSION@#The phonosurgery combined with micro-suture techniques treat on the Reinke's edema, vocal cord postoperative recovery time is short, the sound quality receive basic recovery after 3 months.

Vocal cord mucosal flap for the treatment of acquired anterior laryngeal web / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Anterior glottic web is one type of laryngeal stenosis. Previous surgical methods had some drawbacks, such as large surgical trauma, long postoperative recovery time, and multiple-stage surgery. This study aimed to explore better treatment to repair anterior glottis web.</p><p><b>METHODS</b>We performed vocal cord mucosal flap procedure on 32 patients with anterior laryngeal webs. All subjects received vocal cord scar releasing and vocal cord mucosal flap repair and suture under general anesthesia with selfretaining laryngoscope.</p><p><b>RESULTS</b>All 32 patients completed surgery in one stage, without postoperative laryngeal edema, difficulty in breathing, or other complications. After the surgery, the anterior commissure of vocal cords recovered to a decent triangle shape in 28 patients; however, in four patients there were 2 to 3 mm adhesion residuals on the anterior ends of the vocal cords, accompanied by scar appearance of bilateral vocal cords. The GRB score, voice handicap index scores, and maximum phonation time score significantly improved in all patients after the surgery. There was no evidence of recurrent laryngeal webbing in the 6-month follow-up.</p><p><b>CONCLUSION</b>Vocal cords mucosal flap repair surgery has the advantages of less trauma, quick recovery, and significant improvement of the voice in the treatment of laryngeal webs.</p>

Effect of dexmedetomidine on tracheal extubation response in patients undergoing thyroid surgery after general anesthesia / 中国医师进修杂志

ObjectiveTo investigate the effect of dexmedetomidine on tracheal extubation response in patients undergoing thyroid surgery after general anesthesia.Methods Forty-two patients who ASA classification Ⅰ - Ⅱ,were performed thyroid surgery under total intravenous anesthesia.They were divided into dexmedetomidine group and control group by random number table with 21 cases each.Both groups patients anesthesia induction and maintenance with the same methods,dexmedetomidine group patients at 15 min before anesthesia induction with venous infusion dexmedetomidine 0.6 μ g/kg(finished 10 min infusion),followed by 0.4 μ g/(kg · h) continuous infusion,control group patients with pump equivalent in 0.9％ sodium chloride injection in the same way.Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR),surgery time,recovery time,extubation time,orientation recovery time,modified Aldrete score ≥9 scores time,rate of recovery from restlessness,tolerance score and recovery from any adverse effects were recorded.ResultsThere were no significant differences between two groups in surgery time,recovery time,extubation time,orientation recovery time,modified Aldrete score ≥ 9 scores time (P ＞0.05).SBP,DBP,HR at immediately and after extubation with 1,3,5 min of dexmedetomidine group were lower than those of control group(P ＜ 0.05 or ＜ 0.01 ).Tolerance score excellent rate of dexmedetomidine group was higher than that of control group[95.2％ (20/21) vs.28.6％ (6/21)] (P ＜ 0.05),the rate of recovery from restlessness of dexmedetomidine group was lower than that of control group[0 vs.28.6％(6/21 ) ] (P ＜ 0.05).ConclusionBefore anesthesia induction in patients with venous infusion dexmedetomidine 0.6 p g/kg(finished 10 min infusion),followed by 0.4 p g/(kg·h) continuous infusion can effectively reduce the patients' cardiovascular response to extubation,strengthen the patients' tolerance to endotracheal tube,reduce the patients' agitation and recover consciousness comfortable.

The hypoxia tolerance of children with recurrent respiratory papillomatosis in surgical procedures / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate hypoxia tolerance of children with recurrent respiratory papillomatosis with the spread of trachea in surgical procedures without ventilation via endotracheal tube intermittently under general anesthesia.@*METHOD@#Forty children with recurrent respiratory papillomatosis were enrolled in the observation. The duration of SpO2 from 100% to the points of 99%, 95%, 90%, 85%, the heart rate in each time point above. PaO2, PaCO2, pH valve when SpO2 was 85%, the duration of SpO2 back to 100% were recorded respectively.@*RESULT@#Duration of SpO2 from 100% down to 99%, 95%, 90%, 85% was (168.4 +/- 58.3)s, (204.6 +/- 56.4)s, (224.8 +/- 58.9)s, (239.9 +/- 60.6)s, respectively. Heart rate was (121.6 +/- 14. 6)bpm, (123.3 +/- 15.1) bpm, (124.1 +/- 14.8)bpm, (125.0 +/- 15.1)bpm, respectively. When SpO2 was 85%, pH value was 7.22 +/- 0.05, PCO2 was (69 +/- 8.7)mmHg, PO2 was (52 +/- 7.9)mmHg. Duration of SpO2 up to 100% was (28.6 +/- 2.5)s; When SpO2 back to 100%, pH value was 7.40 +/- 0.02, PCO2 was (40.5 +/- 2.0)mmHg, PO2 was (358 +/- 104.3)mmHg.@*CONCLUSION@#Intermittent apnea during the surgical procedures in RRP children with distal spread of papillomas was safe, hypercapnia and hypoxia caused by the apnea can be corrected soon after the re-ventilation. Duration of apnea should be controlled within 3--5 minutes in each apnea-reoxygenation cycle.

The application of micro-suture technology in laryngeal microsurgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the effect of micro-suture technology in laryngeal surgery.@*METHOD@#Sixty-one patients with benign laryngeal disease underwent microsurgery resection under general anesthesia, and the wound surface of the mucosa was sutured intermittently.@*RESULT@#The postoperative healing time was shortened, the cicatrix on the vocal cord mucosa was reduced, the voice quality was improved significantly and the recurrence rate was reduced.@*CONCLUSION@#The micro-suture technology is effective in improving the voice quality and surgery effect significantly.

The treatment of contact granuloma of larynx / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the clinical effect of excising the laryngeal contact granuloma with CO2 laser. METHODS Twenty three patients with laryngeal contact granuloma were excised by CO2 laser under general anesthesia. The wound was sewed under microscope. All patients were followed up for 6 months. RESULTS The wound of 18 patients scarred over well when counterchecked 1 month after operation. The cure rate was 87.3 %. Five cases recurred. Three cases of them were cured by conservative therapy for 2 months. And the other two were healed after reoperation. CONCLUSION The curative effect of excising the laryngeal contact granuloma by CO2 laser and sewing up the breakage under microscope is aff irmative. This method has a low rate of relapse.

The effect of CPAP treatment in short time on severe OSAHS patients with revised Uvulopalatoph aryngoplasty / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the effects of continuous positive airway pressure (CPAP) on patients with severe obstructive sleep apnea hypopnea syndrome (OSAHS) who underwent the revised uvulopalatopharyngoplasty (UPPP). METHODS 18 cases of severe OSAHS patients (therapy group) were selected for CPAP treatment in the 2nd week of postoperation. The average time of CPAP treatment was 34.3 days. The other 20 cases (control group) onlyunderwent operation. All patients were monitored with PSG before operation and in the 6 months postoperatively. RESULTS Compared with the result of pre-operative PSG, apnea hypopnea index (AHI) and Lowest SaO2 (LSaO_2) was improved (P＜0.001) in two groups. Compared with control group, LSaO_2 of the therapy group in the sixth month postoperatively was improved (P＜0.001), but the decreasing of AHI was not significant (P＞0.05). Contrast to the control group, the length of stage 1 and 2 decreased and that of REM increased. (P＜0.05). CONCLUSION For severe OSAHS patients who underwent uvulopalatopharyngo plasty, CPAP treatment for one month postoperatively could improve the hypoxia of patients, and prolong REM stage, shorten the stage 1 and 2 sleep. CPAP treatment in short time would be helpful for the severe OSAHS patients with revised UPPP.