Analysis of antibiotic use and rationality for children in primary healthcare institutions from Beijing / 中国药房

OBJE CTIVE To inv estigate the antibiotic use and rationality for children in community health service institutions from Beijing ，and to provide reference for promoting rational use of antibiotics in primary healthcare institutions. METHODS All the prescriptions for children from primary healthcare institutions in 2019 were extracted from prescription review system of community health service institutions in Beijing. The use of antibiotics was described according to the related indicators of the World Health Organization/International Network for Rational Use of Drug （WHO/INRUD）. The structure of antibiotics use was analyzed according to the anatomical therapeutic chemical （ATC）classification as well as the WHO AWaRe classification and diagnosis. RESULTS A total of 288 primary healthcare institutions and 10 422 prescriptions for children were included. The number of institutions in high-income areas ，middle-income areas and low-income areas were 119，80 and 89 respectively，and the number of prescriptions involved were 2 430，2 163 and 5 829 respectively，including 1 447 prescriptions involving antibiotics （13.9％）. Among 1 447 prescriptions，the rate of prescriptions involving combined use of antibiotics was 1.4％（20 pieces）；the rate of prescriptions involving antibiotics injection was 9.7％（141 pieces）；4.8％ antibiotics prescriptions were rated as unreasonable （69 pieces）. The three most commonly used antibiotics were the macrolides （40.2％），the second-generation cephalosporins （26.5％） and the third-generati on cephalosporins （23.4％）. The proportion of antibioti cs prescriptions from groups of access ，caution， reserve and not recommended were 9.1％，92.1％，0.3％，and 0， respectively. The rate of antibiotics prescriptions fortonsillitis was the highest （31.9％ ）. Among 69 irrationalantibiotics prescriptions ，main of them were irrational drug use （56 pieces，81.2％）. CONCLUSIONS The rate of antibiotics prescriptions for children in primary healthcare institutions from Beijing is lower than the standard of WHO antibiotics prescription rate （20.0％-26.8％），but the use rate of antibiotics at caution grade is too high.

The efficacy of ansa cervicalis anterior root for unilateral recurrent laryngeal nerve injury / 中华耳鼻咽喉头颈外科杂志

Objective@#To discuss the long-term efficacy of laryngeal reinnervation using the anterior root of the ansa cervicalis in the treatment of unilateral vocal fold paralysis (UVFP) caused by thyroid surgery.@*Method@#From January 2010 to January 2016, a total of 39 UVFP patients who underwent ansa cervicalis anterior root-to-recurrent laryngeal nerve (RLN) anastomosis and who had suffered nerve disfunction for 6 to 24 months were enrolled as UVFP group.Another 39 age and gender matched normal subjects served as control group. Videostroboscopy, vocal function assessment (acoustic analysis, perceptual evaluation and maximum phonation time), and laryngeal electromyography were performed preoperatively and postoperatively for assessing surgery efficacy. Paired sample t test was used for statistical analysis.@*Result@#Videostroboscopic reports indicated that the glottic closure, vocal fold edge, vocal fold position, phase symmetry and regularity were significantly improved in the UVFP group (P<0.01, respectively, postoperative vs. preoperative)and showed no statistical differences compared to the control group (P>0.05, respectively). Both the postoperative GRBAS assessment and acoustic parameters were also significantly improved in the UVFP group, Pre-operative acoustic parameters/Post-operative acoustic parameters were 1.68±0.82/0.39±0.27, 10.08±2.56/4.58±2.96, 0.203±0.216/0.018±0.038, 5.96±1.92/17.42±4.11(P<0.01, respectively) and Pre-operative acoustic parameters/Post-operative acoustic parameters were 0.39±0.27/0.32±0.19, 4.58±2.96/3.32±1.27, 0.018±0.038/0.014±0.027, 17.42±4.11/18.76±5.29, which showed no statistical differences compared to the control group (P>0.05, respectively).@*Conclusion@#Delayed laryngeal reinnervation with the anterior root of ansa cervicalis, it can restore the physiological laryngeal phonatory function to the normal or a nearly normal voice quality, which is a feasible and effective approach for the treatment of thyroid surgery-related UVFP.

Treatment of bilateral vocal cord paralysis by hemi-phrenic nerve transfer / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the surgical effect of reinnervation of bilateral posterior cricoarytenoid muscles(PCA) with left hemi-phrenic nerve and endoscopic laser arytenoid resection in bilateral vocal cord fold paralysis(BVFP) and to analyze the pros and cons of the two methods.@*Methods@#One hundred and seventeen BVFP patients who underwent reinnervation of bilateral PCA using the left hemi-phrenic nerve approach (nerve group, n=52) or laser arytenoidectomy(laser group, n=65) were enrolled in this study from Jan.2009 to Dec.2015.Vocal perception evaluation, video stroboscopy, pulmonary function test and laryngeal electromyography were preformed in all patients both preoperatively and postoperative1y.Extubution rate was calculated postoperative1y.@*Results@#Most of the vocal function parameters in nerve group were improved postoperatively compared with preoperative parameters, albeit without a significant difference(P>0.05), while laser group showed a significant deterioration in voice quality postoperative1y(P<0.05). The two groups showed significant difference in voice quality postoperative1y(P<0.05). Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abductive movements (P<0.05). But the amplitude in nerve group was larger than that in laser group (P<0.05). 89% of the patients in nerve group were inhale physiological vocal cord abductions. Postoperative glottal closure showed no significant difference in nerve group (P>0.05), while showed various increment in laser group(P<0.05). Differences between the two groups were statistically significant(P<0.05). The pulmonary function in both groups was better after operation, reaching the reference value. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. The decannulation rate were 88.5% and 81.5% in nerve group and laser group respectively. In both groups, patients presented aspiration symptoms postoperatively, and rdieved soon, except 2 patients in laser group suffered repeated aspiration.@*Conclusions@#Reinnervation of bilateral PCA muscles using left hemi-phrenic nerve can restore inspiratory vocal fold abduction to a satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity, and do not affect swallowing function, greatly improving the quality of life of the patients.

Selective Reinnervation of Posterior Cricoarytenoidmuscles by Upper Root of Unilateral Phrenic Cerve / 听力学及言语疾病杂志

Objective To study the experimental results of selective reinnervation of posterior cricoarytenoid(PCA) muscles by upper root of unilateral phrenic nerve.Methods Eight beagle dogs were used in this experiment.The left recurrent laryngeal nerves (RLNs) were severed and anastomosed with upper root of phrenic nerve, and the intralaryngeal adductor branch was cut and sutured into the belly of the ipsilateral PCA muscle. The right RLNs were kept intact, and were used as control group.Videolaryngoscopy and electromyography (EMG) were performed at preoperative, immediately after surgery and 6 months after surgery.After completion of all physiologic testings,the dogs were sacrificed and bilateral PCA muscles and intralaryngeal part of recurrent laryngeal nerves were harvested, then histological examination was carried out.The laryngeal nerve was stained with toluidine blue and the morphology of the axons was observed under light microscope.Results Preoperatively, the movement of bilateral vocal folds were normal in all dogs.The left vocal folds were fixed immediately after surgery, 6 months after surgery, the left vocal folds in all 8 dogs recovered inspiratory abductive movement.Spontaneous and evoked electrical activities of the reinnervated PCA muscles could be recorded in all cases during inspiration preoperatively.The left PCA muscles were electrical silent during normal inspiration, and evoked activities were not induced immediately after surgery.Spontaneous electrical activities and evoked electrical activities were recorded 6 months after surgery, and had no significant difference when compared with those of postoperative (P>0.05).There was no significant difference in the cross-sectional area of the bilateral posterior cricoarytenoid muscles fibers after the masson staining.Muscle collagen relative cross-sectional area and collagen relative cross-sectional area and muscle/collagen cross-sectional area ratio difference were not statistically significant(P>0.05).Nerve pulp numbers of left and right sides of the recurrent laryngeal nerves had no significant difference (P>0.05).Conclusion Selective reinnervation of posterior cricoarytenoid muscles by the upper root of unilateral phrenic nerve can restore inspiratory vocal fold abduction to a satisfactory extent and avoid aberrant regeneration.

Effect of denervating duration on the surgical outcome of laryngeal reinnervation in patients with unilateral vocal fold paralysis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the effect of denervating duration on the surgical outcome of laryngeal reinnervation in patients with unilateral vocal fold paralysis (UVFP).</p><p><b>METHODS</b>The charts of 467 consecutive patients with UVFP were reviewed retrospectively. Preoperative and postoperative data, including videostroboscopy, perceptual evaluation of voice (GRBAS scale), acoustic analysis, maximum phonation time (MPT) and laryngeal reinnervation were collected. Multivariable logistic regression analysis was used to identify possible influential factors including the age of patient, gender, degree of nerve injury and duration of nerve injury. Then stratification analysis was performed on the variable-duration of nerve injury, to study how the duration of nerve injury could affect the surgical outcome of laryngeal reinnervation.</p><p><b>RESULTS</b>Multivariable logistic regression analysis showed that the age of patient, degree of nerve injury and duration of nerve injury were significant variables. Stratification analysis on duration of nerve injury demonstrated that in each subgroup postoperative data were significantly improved. When compared among the three subgroups, postoperative data in group with a duration of 6-12 months and group with a duration 12-24 months were significantly better than group with a duration more than 24 months. However, there were no significant differences between group with a duration of 6-12 months and 12-24 months.</p><p><b>CONCLUSION</b>Surgical outcome of laryngeal reinnervation is better in patients those with a duration of nerve injury less than 2 years than in those with a duration of nerve injury more than 2 years.</p>

A Prospective Study of the Surgical Outcome of Simple Uvulopalatopharyngoplasty (UPPP), UPPP Combined With Genioglossus Advancement or Tongue Base Advancement for Obstructive Sleep Apnea Hypopnea Syndrome Patients With Multilevel Obstruction

The editorial board and publication ethics committee of the CEO decided to retract this paper from our journal.

Conservative treatment and surgical treatment of cervical cellulitis combineing mediastinal pleural abscess / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the diagnosis, treatment and curative effect of cervical cellulitis combineing mediastinal pleural abscess. Method:Clinical data of 37 patients with the cervical cellulitis and mediastinal pleural abscess were analyzed, all patients were confirmed using ultrasond, X-ray, CT, puncture and microbiology examination. The result will analysis the diagnosis, treatment and curative effect through the comparison of conservative treatment and surgical treatment. Result:Twenty-three cases of patients were underwent tracheotomy because of difficulty in breathing and successfully extubated after treatment. Nine cases of patients were given anti-infection treatment and recovered after conservative treatment. Twenty-one cases of neck multiple pus cavity were underwent cavity incision, full removal of necrotic tissue and pipe flushing; 7 cases of patients with neck and mediastinal abscess and within which 2 cases were with toxic shock were underwent adequate drainage of lavage and abscess incision through jugular joint path; the companion of pyothorax in 2 cases were underwent the chest closed drainage. All patients were giving sensitive antibiotic after drug sensitive test, anti-shock treatment and supportive treatment. All the patients were recovered and discharged. The average hospitalization days with conservative treatment of these patients were 15.7 days, and the average hospitalization days with surgical treatment of patients were 25.3 days. Conclusion:The condition of cervical cellulitis is complex, a few case can be cured with conservative treatment. The others progress rapidly when merging mediastinal pleural abscess can cause serious complications, surgical treatment is risky, fully abscess incision, lavage drainage and combine with sensitive antibiotics and supportive treatment are the keys to therapy.

Investigation for the Knowledge of Drug Use and Medication Habits of Teachers in A Senior High School in Beijing / 中国药房

OBJECTIVE:To reflect the representative problems existing in the medication safety of public from the side,and provide reference for conducting the following public survey in a large area. METHODS:Questionnaires were used to investigate the knowledge of drug and medication habits of teachers in a senior high school in Beijing,and the received data was statistically analyzed. RESULTS:Totally 88 questionnaires were issued in this investigation,84 effective questionnaires were acquired,with ef-fective recovery of 95.45%. A few teachers had blind faith in intravenous infusion and preferred using antibiotics without doctor's di-agnosis when they caught a cold and fever;48.81%of the respondents barely understood or only partly understood the drug instruc-tions;34.52% didn't know that more serious adverse reactions induce by intravenous infusion were more serious than by oral treat-ment;46.43% rarely checked the period of validity of reserved drugs at home;38.10% didn’t following directions when taking drugs;80.95% had never received the education of medication safety,and 21.43% of them had no intention to accept this educa-tion;when taking drugs for a long time,79.76% of them didn’t do regular examinations of blood routine,renal and liver function tests. CONCLUSIONS:The knowledge of drug use of the respondents in the school is poor,there are many misunderstandings ex-isted in the medication habit,which prompts hidden trouble also exists in medication safety,and reflects hidden trouble commonly exists in medication safety for public from the side.

The comparison of arytenoid resection surgical effect between endoscopic laser approach and external cervical approach for bilateral vocal cord fold paralysis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the surgical effect and complications of arytenoid resection in bilateral vocal cord fold paralysis(BVFP) patients via endoscopic laser approach and external cervical approach.@*METHOD@#A total seventy-eight BVFP patients who underwent arytenoid resection surgery via endoscopic laser approach (laser group, n=30) or external cervical approach (external cervical group, n=48) were enrolled in this study. Videostroboscopy, vocal perception evaluation, maximum phonation time (MPT) text were preformed in all patients both preoperatively and postoperatively. The decannulation rate was also calculated.@*RESULT@#Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abductive movements (P 0. 05). Postoperative videostroboscopy showed no significant difference in vocal fold position and glottal closure between these two groups(P>0. 05). Vocal perceptual evaluation(RBH score) showed a significant deterioration in voice quality postoperatively in both groups respectively (P. 05). However, they were significantly shorten/shorter than preoperative ones in these two groups respectively (P<0. 05). The overall decannulation rate were 90. 0% and 95. 8% for laser group and external cervical group respectively. In Both groups, patients presented aspiration symptoms postoperatively, except one patient of external cervical group who developed pneumonia due to recurrent aspiration.@*CONCLUSION@#Arytenoid resection surgery via both endoscopic laser approach and external cervical approach can both enlarge glottic area so as to solve respiration problems, in BVFP patients. Two kinds of surgery have obvious voice damage.

A Prospective Study of the Surgical Outcome of Simple Uvulopalatopharyngoplasty (UPPP), UPPP Combined With Genioglossus Advancement or Tongue Base Advancement for Obstructive Sleep Apnea Hypopnea Syndrome Patients With Multilevel Obstruction

OBJECTIVES: To investigate the surgical outcomes of different uvulopalatopharyngoplasty (UPPP). METHODS: All subjects underwent overnight polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Quebec sleep questionnaire and the snoring scale at the baseline and 3 and 12 months following operation. The primary endpoint was the overall effective rate representing the sum of the surgical success rate and effective rate. RESULTS: The overall effective rate at 12 months post surgery was 55.6% for simple UPPP, 95.8% for UPPP+GA, and 92.3% for UPPP+TBA. The surgical success rate at 3 and 12 months postoperation for UPPP+GA or UPPP+TBA was significantly higher than simple UPPP (P<0.05). Marked improvement was observed in all patients in the snoring scale score and the ESS score 3 and 12 months following surgery compared to the baseline (P<0.05 in all). CONCLUSION: UPPP, UPPP+GA, and UPPP+TBA are all effective in improving the surgical outcome of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with multilevel obstruction. UPPP+TBA appears to be the most effective in treating OSAHS patients.

Analysis of the Effects of Antibacterial Special Rectification Activities in Tertiary Hospitals of Six Regions as Beijing / 中国药房

OBJECTIVE:To provide reference for rational use of antibacterials. METHODS:Taking 69 hospitals of Beijing, Tianjin,Shanghai,Hangzhou,Guangzhou,Chengdu as samples,the data about the purchase and application of antibacterials in outpatient department were collected during 2009 to 2013,and analyzed in terms of the proportion of the amount of antibacterials in all chemical drugs,the number of antibacterials among top 80% chemical drugs in the list of consumption sum and their variet-ies number,the utilization rate of antibacterials in outpatient prescription,the percentage of two and more antibiotics combination in outpatient antibiotics prescriptions,the proportion of antibiotics use,etc. RESULTS:The proportion of average purchase amount of antibacterials in chemical drugs decreased from 20.97 % in 2009 to 14.17 % in 2013;the number of antibacterials among top 80% chemical drugs in the list of consumption sum decreased from 43 in 2009 to 34 in 2013;the average utilization rate of outpa-tient antibacterials decreased from 23.22 % in 2009 to 16.11 % in 2013;there was statistical significance(P<0.05). The varieties of antibacterials decreased from 78 kinds in 2009 decreased to 54 kinds in 2012(P<0.05),but rise to 66 kinds in 2013;the per-centage of two and more antibacterials combination in outpatient antibacterials prescriptions decreased fron 9.02% in 2009 to 7.35% in 2012 (P<0.05),rise to 12.89% in 2013. The utilization ratio of antibacterials injection in outpatient antibacterials pre-scriptions had no significant change. The utilization of antibacterials in tertiary hospitals from 6 districts was analyzed;cephalospo-rin had ranked the first place,and almost occupied half part of antibacterials but declined;the utilization rate of antibacterials for special use was on the rise. CONCLUSIONS:After 3 years of antibacterials special rectification,and the utilization of antibacteri-als in 6 districts as Beijing have been improved significantly;however,several index have little improvements,and some rebound-ed in 2013,so this activities needs to establish long-term mechanism of continuous supervision.

The Morphology Observation of Posterior Cricoarytenoid Muscle Myofiber in Patients with Idiopathic Vocal Fold Paralysis / 听力学及言语疾病杂志

Objective To investigate the morphology change of posterior cricoarytenoid muscle myofiber in patients with idiopathic vocal fold paralysis and to provide experimental evidence for the clinical treatment of idio‐pathic vocal cord paralysis .Methods Thirty -nine cases of vocal fold paralysis patients were recruited into and di‐vided into 2 groups :idiopathic vocal cord paralysis group(n=16) ,and traumatic vocal cord paralysis group(n=23) . Both groups were further divided into 3 subgroups:0 .5~1 year(5 cases and 7 cases) ,>1~2 years(5 cases and 10 cases) ,>2 years(6 cases and 6 cases) .Part of posterior cricoarytenoid muscle(PCAM ) were acquired from all of vo‐cal cord paralysis patients .Normal human posterior cricoarytenoid muscles were treated as the control group (n=5) . They were all stained with Masson three-color staining ,the fiber crosssectional area of muscle tissue and collagen connective tissue were quantitatively analyzed with the image pro plus analysis system .Differences of two observa‐tion indexes were compared with each other among groups and subgroups .Results The number of myofibers was decreased ,but the numbers of the collagen fibers was increased with the onset time course extension ,the ratio of cross sectional area of myofibers to those of collagen fibers was progressively decreasd with increased time course of denervation and more decrease within 1 year .There was obvious difference between the control group and 0 .5~1 year ,>1~2 years ,>2 years subgroup of idiopathic vocal cord paralysis (P1~2 years subgroup and >2 years subgroup ,the trend of shrinking still existed .Com‐pared two observation indexes of traumatic vocal cord paralysis with the same period subgroup indexes of idiopathic vocal fold paralysis ,there was no significant difference about these two observation indexes (P>0 .05) .In some special cases with 10 years duration in idiopathic vocal cord paralysis group ,the posterior cricoarytenoid muscle at‐rophy fibrosis was not serious .However ,in some case which the course lasted for only 1 .5 years ,the muscle atrophy was very obvious .There were great individual differences among idiopathic vocal cord paralysis patients .Conclusion If there is no recovery after half year treatment ,for PCA muscle function recovery ,the recurrent laryngeal nerve injury repair surgery could be considered to carry out within 1 year .In some cases with long disease duration (>2 years) ,they may still have the muscle morphological basis for nerve repair .

Construction of Human Hepatocyte Growth Factor Gene Recombinant Lentivirus Vectors and Its Expression in MyobIasts / 听力学及言语疾病杂志

Objective To construct a gene recombinant lentiviral vector pCMV -G -U6 -hHGF and detect its expression in C2C12 myoblast cells .Methods hHGF gene fragments were obtained and purified by RT -PCR method ,and were cloned to pCMV -G&NR -U6 ,then the restructured lentiviral vector was transformed into e . coli DH5 alpha ,the positive colonies were identified by BamHI and Hind Ⅲ enzyme digestion .The selected positive colonies were tested by PCR and sequencing analysis .The expression plasmids and packing plasmids were co -trans_fected into 293 T cells ,and virus titer was observed under the fluorescence microscope .Furthermore ,transfected C2C12 cells with lenti virus ,and the expression of HGF was detected by PCR and WB methods .ResuIts PCR and sequencing analysis showed that the lentiviral vector was constructed correctly and successfully ,the virus titer was above 1 x 109 IU/mL .The results of PCR and WB showed that HGF expression level in the lentiviral vector group was much higher than those of in blank control and negative control groups ,and yet the expression was stable after 72 hours .ConcIusion The lentiviral vector pCMV -G﹠NR -U6 -hHGF has been successfully constructed ,and stable expressed in C2C12 cells .It provides references for experimental study in the fields of the denervated skeletal muscle fibrosis and nerve regeneration treatment .

Mechanism of inhibition effect of HGF on the expression of CTGF in myotubes induced by TGF-β1 / 实用医学杂志

Objective To study the influence and mechanism of hepatocyte growth factor (HGF) on myotube phenotype by myotube transdifferentiation induced by transforming growth factor-β1 (TGF-β1). Methods C2C12 cells were cultured in differentiation medium to induce myotubes formation. The cells were randomly devided into 3 groups. The control group without growth factor interruption. The induction group was supplemented with TGF-β1 (5 ng/mL) while the inhibition group was supplenmented with both TGF-β1 (5 ng/mL) and HGF (30 ng/mL). After 12 hours, the expressions of connective tissue growth factor (CTGF) protein in myotubes were detected by Western blot, the levels of CTGF mRNA were measured by RT-PCR. Results Compared to the control group, the protein and mRNA levels of CTGF significantly increased in TGF-β1 treated group , whereas the protein and mRNA levels of CTGF were significantly lower in inhibition group than those in induction group (P < 0.05). Conclusion HGF can inhibit the effect of TGF-β1 on the expression of CTGF in myotubes , which provides the evidences on the study of skeletal muscle cell transdifferentiation.

Designing A New Chinese Mandarin Version of Speech Sample Text for Perceptual Assessment of Voice Disorders / 听力学及言语疾病杂志

Objective To design a new Chinese mandarin version of speech sample text for perceptual assessment .Meth-ods The speech sample text included all phonemes and limit number of words .The correlation analysis of the constituent rati-os of all phonemes was performed between the speech text and the ones in Chinese language reported by the institute of Acous-tics Chinese Academy of Sciences using Pearson's correlation coefficient and Spearman correlation coefficient .And their differ-ences were tested by paired sample t test and Wilcoxon signed rank test .Legibility was alsotested .Results Our speech sarrple text contained 21 vowel ,38 consonant and 4 tones .The proportions of vowel ,consonant and tone in the speech text had high correlation with those in Chinese language (for proportions of vowel ,the Pearson's correlation coefficient was 0 .908 and Spearman correlation coefficient was 0 .775 ,P0 .2) .The value of legibility was 2 , indicating legibility of the speech sample text was good .Conclusion The new Chinese mandarin version of speech sample text can be used in perceptual assessment .The value for perceptual assessment still needs further clinical research .

Analysis of Curative Effect of Vocal Cord Shallow Lamina Propria Resection on the Treatment of Vocal Cord Leukoplakia / 听力学及言语疾病杂志

Objective To study the curative effects and characteristics of vocal cord shallow lamina propria resection on the treatment of vocal cord leukoplakia .Methods A total of cases of vocal cord leukoplakia were re-ceived vocal cord mucosa stripping surgery (69 cases) and vocal superficial lamina propria resection with or without suture (69 cases) respectively during January 2006 - December 2011 ,and all cases were taken dynamic laryngosco-py and voice acoustic analysis before surgery ,at 2 weeks ,4 weeks ,6 weeks ,8 weeks ,3 months ,6 months ,and 12 months after surgery .We observed the curative effects and characteristics after operation of two different surgery on the treatment of vocal cord leukoplakia with precancerous lesions .Results Two week after operation ,the vocal cords mucous wave ,vocal cords vibration symmetry ,regularity ,total hoarseness degree (G) ,Jitter ,Shimmer , NHRvaluesinthe2groupsweresignificantlylowerthanthoseofpreoperation(P0 .05) .The three main index of dynamic laryngoscope ,voice acoustic parameters at 4 weeks after operation were significantly lower than those at 2 weeks after operation in the vocal cord mucosa stripping surgery group ,the difference were statistically significant (P0 .05) .The three main index of dynamic laryngoscope ,voice acoustic parameters at 6 weeks after operation were significantly lower than those at 2 ,4 weeks after operation in the vocal cord shallow lamina propria resection group ,the difference were statistically significant (P0 .05) .The voice restoration was faster in the vocal cord mucosa stripping surgery group .The recurrence rate was lower in the vocal cord shallow lamina propria resection group than those in the traditional vocal cord mucosa stripping surgery group ,the difference was statistically significant (P<0 .05) . Conclusion The vocal cord shallow lamina propria resection is a minimally invasive operation for the treatment of vocal cord leukoplakia ,with low recurrence rate and good the voice recovery .

Laryngeal reinnervation using ansa cervicalis for iatrogenic unilateral vocal fold paralysis / 中华普通外科杂志

ObjectiveTo evaluate long-term outcome of laryngeal reinnervation using the main branch of the ansa cervicalis for the treatment of unilateral vocal fold paralysis (UVFP) caused by thyroid surgery. MethodsFrom Oct.1990 to Jan.2010,a total of 325 UVFP patients who underwent main branch of ansa cervicalis-to-recurrent laryngeal nerve (RLN) anastomosis were enrolled in the study.We retrospectively analyzed the efficacy of the reinnervation surgery using videostroboscopy,vocal function assessment (acoustic analysis,perceptual evaluation and maximum phonation time ),and laryngeal electromyography. ResultsVideostroboscopy showed that the glottic closure,vocal fold edge,vocal fold position,phase symmetry and regularity were significantly improved postoperatively. The vocal function parameters (GRBAS scale,jitter,shimmer,noise to harmonics ratio and maximum phonation time) were also significantly improved postoperatively ( P ＜ 0.01 ),as compared to corresponding preoperative values.Voice recovered to a normal level in 93.5％(304/325)patients,and the effective rate was 98.8％ (321/325). Postoperative laryngeal electromyography confirmed successful reinnervation of laryngeal muscle. CondusionsLaryngeal reinnervation using the main branch of ansa cervicalis is a feasible and effective approach for treatment of UVFP patients caused by thyroid surgery,with satisfactory long-term results.

The influence of denervation on myofiber morphology of the adductor and abductor in patients with recurrent laryngeal nerve paralysis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the influence of denervation on myofiber morphology of the adductor and the abductor in patients with recurrent laryngeal nerve (RLN) paralysis and to provide experimental evidence for the clinical feasibility of RLN repair.@*METHOD@#Adductor muscles were acquired from the lateral cricoarytenoid muscle (LCAM) and abductor muscles from the posterior cricoarytenoid muscle(PCAM). Normal human PCAM and LCAM are treated as control group (n = 7). Thirty-eight cases of PCAM with damaged RLN were divided into five groups according to the duration of their RLN damage: 0.5-1 year (7 cases), > 1-2 years (10 cases), > 2-3 years (8 cases), > 3-6 years (8 cases) and > 6 years (5 cases); twenty-nine cases of LCAM were also divided into five groups: 0.5-1 year (7 cases), > 1-2 years (6 cases); > 2-3 years (6 cases), > 3-6 years (6 cases) and > 6 years group(4 cases). They were all stained with HE and Masson three-color staining, the fiber cross-sectional area of muscle tissue and collagen connective tissue were quantitative analyzed. The changes of myofiber morphology of adductor and abductor muscles after the loss of the RLN were analyzed with image analysis system.@*RESULT@#The transverse areas of myofibers gradually decreased and those of collagen fibers gradually increased with the prolongation of denervation. (1) Difference between the denervated groups of LCAM of 0.5-1 year, > 1-2 years and > 2-3 years groups were not significant (P > 0.05). Fiber cross-sectional area of > 3-6 years group decreased most obviously with significantly difference compared with > 2-3 years group (P 1-2 years group, > 2-3 years group and > 3-6 years of PCAM(P 3-6 years and > 6 years of two kinds of laryngeal intrinsic muscle (P > 0.05); (4) Fiber cross-sectional area of each group of the LCAM after 1 year denervation were significantly greater than that of the PCAM under same conditions (P < 0.05).@*CONCLUSION@#The influence of denervation on myofiber morphology following denervation is different between the abductor and adductor owing to the different fiber type composition and functional properties. The rate of muscle atrophy of the adductor is slower than that of the abductor. To restore the structure and function of denervated laryngeal muscles better, the recurrent laryngeal nerve injury repair surgery for PCA muscle function recovery should be carried out within 1 year after denervation while the surgery for LCA muscle function recovery should be carried out within 3 years after denervation.

The expression of myosin heavy chain isoforms of human normal laryngeal muscles and the difference between the adductor and abductor / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of myosin heavy chain (MHC) in normal laryngeal muscle and the difference between the adductor and abductor.@*METHOD@#Seven patients with total laryngectomy were enrolled in this study. The adductor muscles were acquired from the lateral cricoarytenoid (LCA) muscle and the abductor muscles were acquired from the posterior cricoarytenoid (PCA) muscle. The expression of myosin heavy chain were detected with fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR) and immunofluorescence staining respectively.@*RESULT@#(1) MHC-II b was expressed in laryngeal muscles at mRNA levels, and not expressed at the protein level; (2) At both mRNA level and protein level, the expression of MHC-I was higher in the PCA muscles than in the LCA muscles while MHC-II level was higher in the LCA muscles than in the PCA muscles.@*CONCLUSION@#(1) MHC-II b protein was not expressed in human laryngeal muscles; (2) Phenotypic differences were significant in laryngeal adductor and abductor muscles based on their different functions. PCA contained larger percentage of MHC-I fibers, while LCA contained more MHC-II fibers.

Modified Arytenoid Adduction for Unilateral Vocal Fold Paralysis / 听力学及言语疾病杂志

Objective To evaluate the efficacy of modified arytenoid adduction in the management of patients with unilateral vocal fold paralysis(UVFP).Methods A retrospective review was performed on 22 patients who underwent modified arytenoid adduction for UVFP between February 2001 and December 2007.Pre-,and 3 months postoperative aspiration,perceptual(GRBAS),acoustic data(fundamental frequency,F_0,fundamental frequency perturbation,jitter,amplitude perturbation,shimmer,normalized noise energy,NNE)and aerodynamic(maximal phonatory time,MPT,mean airflow rate,MFR)were analyzed statistically.Results The ratings of postoperative aspiration were significantly decreased than that of the preoperation(P<0.0001).There was a significant decrease in GRBAS scales postoperatively versus preoperatively(P<0.0001).The mean values of voice acoustics parameters (F_0,jitter,shimmer,NNE)were significantly decreased,the maximum phonation time were significantly longer,and the mean airflow rate were significantly decreased after operation than that of the preoperation(P<0.001).Conclusion Modified arytenoid adduction is an effective medialization technique that can restore satisfactory speech and prevent aspiration in patients with UVFP.