Expression of Innate Immunity Genes in Epithelial Cells of Hypertrophic Adenoids with and without Pediatric Chronic Rhinosinusitis: A Preliminary Report / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Adenoid hypertrophy (AH) is associated with pediatric chronic rhinosinusitis (pCRS), but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS), including antimicrobial peptides and pattern recognition receptors (PRRs). The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS.</p><p><b>METHODS</b>Nine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction (RT-qPCR) was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS: Human β-defensin (HBD) 2 and 3, surfactant protein (SP)-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain (NOD)-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-κB (NF-κB). RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests.</p><p><b>RESULTS</b>The relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs. AH 1.21 ± 0.15; P = 0.0173, t = 2.654). The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group.</p><p><b>CONCLUSIONS</b>Down-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process of pCRS.</p>

Clinical classification and treatment of leukokeratosis of the vocal cords / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Leukokeratosis of the vocal cords is a clinical descriptive diagnosis, which includes a group of squamous intraepithelial lesions of the vocal cord mucosa. We investigated the clinical classification and treatment efficacy of leukokeratosis of the vocal cords.</p><p><b>METHODS</b>We conducted a retrospective analysis of the medical history, laryngoscopic examinations, morphological features under a surgical microscope, and pathology results of 360 cases of leukokeratosis of the vocal cords to examine correlations among treatment modalities, therapeutic effects, and clinical features.</p><p><b>RESULTS</b>All cases were divided into four types based on symptoms, examination results, and treatment efficacies as follows: 21 patients had type I inflammatory leukoplakia and their vocal cord morphology and voice quality recovered after conservative therapies; 76 patients had type II frictional polyps and received CO2 laser submucosal cordectomy; 68 patients had type III sulcus vocalis and received mucosal slicing with dredging; and 195 cases had type IV simple leukokeratosis and received partial subligamental cordectomy with CO2 lasers or transmuscular cordectomy. Our treatment achieved a surgical cure rate of 90.9% (308/339), with a recurrence rate of 9.1% (31/339) and malignant transformation rate of 6.5% (22/339). All cancerous transformations occurred in type IV patients.</p><p><b>CONCLUSION</b>Choosing conservative or CO2 laser surgery based on the morphological characteristics of squamous epithelial lesions of keratinized vocal cord mucosa can maximally protect voice quality, reduce complications, and improve the cure rate.</p>

Clinical classification and management of squamous intraepithelial lesions of the vocal cord / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the clinical classification of the squamous intraepithelial lesions (SILs) of vocal cord and their outcomes after different therapeutic procedures.</p><p><b>METHODS</b>Three hundred and forty-three patients with the SILs of vocal cord were enrolled. Based on the history of the diseases, macroscopic appearance by video rhino aryngoscopic, stroboscopic and microlaryngoscopic examination, and pathological findings, the correlation of clinical features, treatment modalities and treatment effect of the vocal cord SILs were discussed.</p><p><b>RESULTS</b>According to the morphological characteristics, 343 patients were divided into four types. TypeI, leukoplakia combined with inflammation (n = 19); type II, leukoplakia combined with polyps by friction (n = 72); type III, leukoplakia combined with sulcus vocalis (n = 64); type IV, keratosis (n = 188). Patients with type I lesions were treated by medications. The vocal cord configuration and the voice of the patients in type I returned to normal after treatment. Patients with type II, III, IV lesions were treated by CO(2) laser. Type II were treated by subepithelial cordectomy, type III by mucosa slicing with dredging, type IV by sub ligament cordectomy or trans muscular cordectomy. The cure rate of patients with type II, III, IV lesions was 90.7% (294/324) after single surgery, the recurrent rate was 9.3% (30/324). Twenty-one patients (11.2%), all in type IV, developed carcinogenesis. Eight cases were diagnosed in the first surgery and 13 cases in the second. Among the 13 cases diagnosed in the second surgery, 2 cases had partial laryngectomy for the third surgery.</p><p><b>CONCLUSIONS</b>Since the squamous intraepithelial lesions of vocal cord manifested differently, conservative treatment or CO(2) laser surgery should be used. In this way, a less invasive procedure, better recovery of the voice and less complication could be expected.</p>

Risk factors of juvenile onset recurrent respiratory papillomatosis in the lower respiratory tract / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Juvenile onset recurrent respiratory papillomatosis (JORRP) is a relatively rare disease. It affects the larynx in most cases. Because reports on JORRP to the lower respiratory tract (LRT) are few, we investigated clinical features of patients with a history of JORRP to analyze the risk factors of this disease.</p><p><b>METHODS</b>Data from 208 JORRP patients admitted to Beijing Tongren Hospital from January 2008 to December 2010 were reviewed. Gender, age at onset of symptoms, age at first surgery, duration of symptoms before the first surgical procedure, the number of surgical procedures, mean interval between surgical interventions, and the number of tracheotomies in patients with and without LRT spread of JORRP were analyzed. The data from patients with and without tracheotomy were recorded and compared. Two cases of primary tracheal papillomatosis were reviewed.</p><p><b>RESULTS</b>Papillomas extension down to the LRT was observed in 46 children (22.1%). Patients with LRT papillomatosis had a shorter time from the onset of the symptoms until the first surgery, required significantly more surgical procedures, and had a shorter mean surgical interval. Tracheotomy was performed in 13/162 (8.0%) children with laryngeal papillomatosis vs. 36/46 (78.3%) children with LRT papillomatosis. After tracheotomy, 36/49 (73.5%) children developed LRT papillomatosis and 10/157 (6.4%) children who did not have a tracheotomy developed LRT papillomatosis. Patients with tracheotomy required a significantly higher number of surgical procedures. The younger the patient had a tracheotomy, the longer the duration of cannulation was.</p><p><b>CONCLUSIONS</b>JORRP patients with LRT spread are prone to develop more aggressive disease. Tracheotomy resulted in a significant increase of LRT involvement.</p>

Fibrovascular polyp of the hypopharynx and esophagus / 中华医学杂志(英文版)

Fibrovascular polyp of the hypopharynx and esophagus, a rare, benign, intraluminal and submucosal tumor, is most commonly originated from the proximal esophagus. We discussed four cases with regurgitation, respiratory symptom or the feeling of a mass in the throat. All the patients were examined with laryngoscope under general anesthesia. A transverse cervical incision was performed in one patient and the polyps were excised under laryngoscope with CO2 laser in the other three patients. All the lesions were removed successfully. Diagnostic and therapeutic principles involved in these cases are presented and discussed. The recognition of fibrovascular polyp of the hypopharynx and esophagus as a potential cause of regurgitation is paramount. Surgical excision is recommended because of the satisfactory outcome.

Strategy of surgical management of juvenile on-set recurrent respiratory papillomatosis with trachea or bronchia involvement / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the strategy of surgical management of juvenile on-set recurrent respiratory papillomatosis (JORRP) with trachea/bronchia involvement so as to decrease the complications of the surgery.</p><p><b>METHODS</b>Twenty four JORRP patients undergone surgery in Beijing Tongren Hospital were studied between January 2006 and February 2009. All of them had JORRP with trachea/bronchia involvement. Suspension laryngoscopic surgeries were performed using rigid bronchoscope and micro-debrider. High frequency jet ventilator was used to maintain the ventilation in general anesthesia. Excision of tumors, suction of the blood and ventilation were preformed alternately. A total of 149 times of surgeries were analyzed.</p><p><b>RESULTS</b>The age of the patients was from 3 to 16 years old (median 6 years old). The age at diagnosis was from eight months to 10 years old (median 1.5 years old). Twenty of them had undergone tracheostomy and the age at tracheostomy was from 1 to 4 years old (median 2 years old). Twenty two of them had been graded as two-degree dyspnea preoperatively, one graded as three-degree dyspnea and one four-degree dyspnea. All subjects underwent more than one surgery. Two cases were intubated and sent to intensive care unit because of postoperative hypercapnia. One was sent to intensive care unit postoperatively because of preoperative phypoxemia and hypercapnia. All subjects were discharged without dyspnea. No death and complications occurred.</p><p><b>CONCLUSIONS</b>Suspension laryngoscopic surgery using rigid bronchoscope and micro-debrider was a safe and effective strategy for the treatment of JORRP with trachea/bronchia involvement.</p>

Primary study on glycan structure in pathopoiesis mechanism of recurrent respiratory papillomatosis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the molecular basis difference between recurrent respiratory papillomatosis (RRP) and vocal cord polyp, to analyze the expression of glycan structural genes, and to discuss the pathopoiesis mechanism of RRP.</p><p><b>METHODS</b>The gene expressing profile between the 3 groups papilloma and the vocal cord polyp regarded as normal larynx epithelium were compared using mRNA parallel amplify and the human genome gene expressing microarray. Through cluster analysis, Gene Ontology function gene annotation and path way analysis, the relative gene of RRP and HPV infection were acquired.</p><p><b>RESULTS</b>According to three microarrays results, total 567 expression changed genes related to HPV induce RRP were acquired. A serial change of glycan structure biosynthesis and degradation pathways was significant. The expression of dolichyl-phosphate mannosyltransferase polypeptide 1 (DPM1), asparagine-linked glycosylation 1 homolog (ALG1), fucosyltransferase 8 (FUT8) and alpha-mannosidase 1A (MAN1A) were regulated and beta-hexosaminidase (HEXB), beta1-galactosidase (GLB1), exostoses 1 (EXT1), fucosyltransferase (FUT) reduced expression and heparan sulfate 3-O-sulfotransferase 1 (HS3ST3A1) increased expression. The two related enzymes of the glycosphingolipids which is the main composed of the cell membrane, beta-3-N-acetylglucosaminyltransferase 4 (B3GNT4) and UDP-glucose ceramide glucosyltransferase (UGCG) increase expression, HEXB and GLB1 reduced expression.</p><p><b>CONCLUSIONS</b>The alteration of the coding genes of glycan structure biosynthesis and degradation pathways were significantly and characteristically in pathopoiesis mechanism of RRP. This abnormality may be the beginning of tumor form HPV infection.</p>

Association between genetic polymorphisms in methylenetetrahydrofolate reductase and risk of laryngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To determine whether genetic variations in methylenetetrahydrofolate reductase (MTHFR) are associated with the risk of laryngeal squamous cell carcinoma (LSCC) in a Chinese population.</p><p><b>METHODS</b>Two hundred and seven cases with LSCC and 400 matched health controls were genotyped for the MTHFR 677C > T and 1298A > C polymorphisms by PCR-restriction fragment length polymorphism (PCR-RFLP) methods. The relation between these genotypes and risk of LSCC and gene-environment interaction were analyzed. The adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated by using unconditional Logistic regression model.</p><p><b>RESULTS</b>The individuals with 677CT and 677TT genotype had a 1.66-fold (95% CI 1.08-2.52) and 3.35-fold (95% CI 2.07-5.54) increased risk of developing LSCC compared with those who had 677CC genotype. The individuals with MTHFR 1298A > C genotype was not significantly different between the two groups. Furthermore, cigarette smoking was also found to interact with MTHFR 677C > T polymorphism in increasing the risk to LCSS further demonstrating the role of gene-environment interaction in development of LSCC.</p><p><b>CONCLUSIONS</b>These findings suggested that the MTHFR 677C > T polymorphism may contribute to the risk of developing LSCC among Chinese population.</p>

Eight cases report of segmental bronchi foreign body / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To review the clinical features and the treatment of segmental bronchi foreign bodies cases.</p><p><b>METHODS</b>Rigid bronchoscope and endoscope were applied to all 8 cases under general anesthesia. The foreign bodies shape and position were well evaluated under direct view, and the metal ones were located with X ray.</p><p><b>RESULTS</b>Generally, the foreign bodies in segmental bronchi are small size and have a long history, the symptoms are non typical and may be accompanied with recurrent lung infection and haemoptysis. The foreign bodies were successfully removed in 6 patients with bronchoscopy, and the foreign bodies in other 2 cases were removed with thoracotomy. No complications occurred in all cases.</p><p><b>CONCLUSIONS</b>For the segmental bronchi foreign body cases, the non typical history should be well reviewed and a detailed investigation should he performed. Suitable surgical instruments should be well selected so to get higher success rate and effectively prevent potential compilations.</p>