The Short-term and Mid-term Outcomes of Elderly Patients With Valvular Heart Disease Undergoing Valve Replacement With Biological or Mechanical Prostheses / 中国循环杂志

Objectives: To compare the short-term and mid-term outcomes of elderly patients (>60 years old) with valvular heart disease (VHD) underwent bioprosthetic or mechanical valve replacement. Methods: Between January 2007 and December 2010, 559 elderly patients underwent valve replacement in Fuwai Hospital, clinical data of these patients were analyzed retrospectively (319 cases with bioprostheses vs 240 cases with mechanical prostheses). After matching, data from 192 cases in each group were compared. Results: The mortality within 30 postoperative days were similar (2.1% in both groups). All-cause death during follow up was also similar between the two groups (13.6% vs 13.7%, P=0.98). There was no statistically significant difference on the hospital readmission rate between the two groups (25.5% vs 35.9%, P=0.17). No significant difference was found on thromboembolic and hemorrhagic events free survival between the two groups (144 cases vs 138 cases, P=0.78). Conclusions: Short-term and mid-term survival and readmission rate are similar for the elderly VHD patients receiving bioprosthetic or mechanical valve replacement.

Clinical analysis of arytenoid cartilage reposition with snake mouth forceps for the arytenoid cartilage dislocation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To investigate the clinical effect of the arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia.@*METHODS@#Data of twenty-six cases accepted arytenoid cartilage reposition under intravenous general anesthesia were analyzed, nineteen cases accepted laryngeal CT scan and cricoarytenoid joint reconstruction, all patients underwent endolaryngeal muscle electromyography examination. According to the position of cartilage dislocation prompted by laryngoscope and CT, the arytenoid cartilage was repositoned under the visual laryngoscope using special snake mouth reduction forceps. If bilateral arytenoid cartilage were still asymmetrically at the end of the surgery, patients needed repeated reposition 1 to 2 times 1 week after operation. The efficacy was evaluated 4 weeks later.@*RESULTS@#All patients had a hoarse and breathing voice preoperative. Under laryngoscope, there were different degrees of vocal cord movement disorders accompanied by incomplete glottis closure, 22 cases happened in left side and 4 in right side. The arytenoid cartilage was dislocated anteromedially in 25 cases and posterolaterally in 1 case. CT showed that 15 cases of arytenoid cartilage were tilted anteromedially; the interval of the cricoarytenoid joint was widened. In axial CT images, there were no direct signs of the arytenoid cartilage dislocation in the 4 cases, but the abnormal position was seen in the reconstruction images. The laryngeal electromyography indicated that 7 cases were abnormal, duration of motor unit potential were visible and the raising potential were mixed. There were 4 patients with normal voice in the first day after surgery, and 19 cases underwent twice and 3 cases underwent three times surgery. Vioce became normal in 4 weeks. Swallowing pain and bucking were all disappeared. Vocal cords movement were recovered to normal level in 25 cases. In 1 case with neck strangulation, the vocal cord movement was slightly worse than health side, but significantly better than that before operation.@*CONCLUSIONS@#The arytenoid cartilage reposition using snake mouth reduction forceps under general anesthesia was an effective method for the treatment of the cricoary-tenoid joint dislocation.

MicroRNAs regulate epithelial-mesenchymal transition of supraglottic laryngeal cancer / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study microRNAs (miRNAs) expression profiles associated with epithelial-mesenchymal transition (EMT) in lymph node metastasis of supraglottic laryngeal squamous cell carcinomas(SGLSCC).</p><p><b>METHODS</b>Primary tumor tissue samples of 12 SGLSCC patients were collected, including 6 patients clinically diagnosed with lymph nodes metastasis (N(+)) and 6 patients with lymph nodes metastasis-free (N0), for miRNA microarray gene-expression profiling to identify the differences between N(+) and N0 groups. Differentially expressed miRNAs was verified using quantitative real-time PCR in 20 patients with N(+) and 20 patients with N0. Target genes for the miRNAs associated with EMT in SGLSCC metastasis were analyzed.</p><p><b>RESULTS</b>Ten miRNAs differentially expressed between N(+) group and N0 group were determined. Comparing with N0 group, nine miRNAs were over-expressed and one miRNA was expressed at lower level in N(+) group. The genes for miR-192, miR-143, miR-409 and miR-634 were predicted as target genes that could promote EMT of laryngeal cancer cells by targeted inhibiting Krüppel-like factor 17(KLF17), E-cadherin and phosphatidylinositol 3 kinase (PI3K).</p><p><b>CONCLUSIONS</b>The miRNAs over-expressed in group N(+) can be used to predict cervical lymph node metastasis in SGLSCC. The miRNAs as new markers could improve the diagnosis and treatment of SGLSCC.</p>

Influence on cell proliferation by small interfering RNA of Cyclin Y expression in laryngeal cancer cells / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The effects of lentivirus-mediated suppression of Cyclin Y (CCNY) expression on the proliferation of laryngeal cancer cells were investigated in vitro.</p><p><b>METHODS</b>The lentivirus vectors containing a small hairpin RNA (shRNA) to target CCNY were constructed.Hep-2 cells were divided into the following two experimental groups:the negative control group (control lentivirus infected cells) and CCNY knockdown group (CCNY shRNA-expressing lentivirus infected cells). After Hep-2 cells were infected, Real-time PCR was used to measure CCNY expression. The influence of CCNY on the proliferation of laryngeal cancer cells were assessed using MTT and colony formation experiments.Each experiment was performed in triplicate and repeated three times.</p><p><b>RESULTS</b>Lentiviruses expressing shRNA against CCNY were constructed and Hep-2 cells were infected with above mentioned lentivirus at MOI (Multiplicity of infection) of 120.Real-time PCR analysis showed that the mRNA expression of CCNY in Hep-2 cells in the knockdown group was significantly decreased (P < 0.05); the mRNA level of CCNY was 75.3% lower in the si-CCNY group than in the si-CTRL group. After 5 days of lentiviral infection, the cell viability was significantly lower in cells infected with the CCNY-shRNA lentivirus compared to cells infected with the control lentivirus following a 6-day incubation. The colony number was decreased by 60% in Hep-2 cells infected with the CCNY-shRNA-lentivirus infected cells following a 10-day incubation.</p><p><b>CONCLUSIONS</b>The results suggested that lentivirus-mediated downregulation of CCNY expression decreased the proliferation and growth potency of laryngeal cancer cells.Lentiviruses delivering shRNA against CCNY may be a promising tool for laryngeal cancer therapy.</p>

Removal of Schwannoma in the pterygopalatine and infratemporal fossa via endoscopic prelacrimal recess approach / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To sum up and analyze the results of surgical removal of Schwannoma in the pterygopalatine and infratemporal fossa (PPF and ITF) through postero-lateral wall via prelacrimal recess approach (PLRA). The surgical technique and indications were presented and discussed.</p><p><b>METHODS</b>Six patients aged from 29-59 year-old with Schwannoma in the PPF and ITF, who received the tumor resection via PLRA under endoscope, were enrolled in this paper. Three were female and 3 were male. All of them received preoperative CT and MRI. The PPF and ITF were approached via prelacrimal recess endoscopically under general anesthesia. Schwannoma was histopathologically confirmed after surgery. The postoperative periodical CT and MRI follow up was conducted.</p><p><b>RESULTS</b>The tumors were removed completely in these 6 patients. No recurrence was found during 19.3 months follow up on the average. Three patients had obvious numbness in the V2 innervation area 1 or 2 weeks after operation and disappeared afterwards. Only 1 patient had mild altercation numbness at the end of follow up.</p><p><b>CONCLUSIONS</b>Schwannoma involved PPF and ITF can be removed endoscopically via PLRA. The lateral wall of nasal cavity might be kept intact. It is a novel minimally transnasal invasive approach to PPF and ITF with less damage and complications.</p>

Patterns and incidence of sinonasal malignancy with orbital invasion / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sinonasal malignancy with orbital invasion is rare. The objective of the current study was to evaluate the clinical and pathological features, treatment outcomes and survival rates for these malignancies.</p><p><b>METHODS</b>Ninety-three patients who were treated between 1997 and 2007 were retrospectively reviewed. Age, life style, symptoms, location of lesions, previous occurrences, histological subtypes, and treatment modalities were analyzed.</p><p><b>RESULTS</b>Ninety-three patients were evaluated, including 51 men and 42 women: the gender ratio was 1.2 men to 1.0 women. The median age was 40.5 years old. The nasal cavity (34.4%), the maxillary sinus (29.0%) and the ethmoid sinus (19.4%) were the most common primary malignant tumor sites. Almost half of the patients, 44.1% had squamous cell carcinoma, 13.9% had neuroectodermal carcinoma, 11.7% had rhabdomyosarcoma, 9% had adenocarcinoma and salivary gland-type carcinoma, and 11% had other malignancy. The majority of patients presented with T3/T4 (99%), N0 (93.1%), M0 (98%) disease. The distant metastasis rate was 20.9%. The overall survival and disease-free survival rates were 68.1% and 40.9% at three years, respectively. When the overall survival rate was computed according to the epicenter of the original malignant tumor, patients with nasal cavity malignancy and maxillary sinus had the best survival, and patients with ethmoid sinus malignancy had the worse survival (P = 0.03). According to their pathology classification, patients with rhabdomyosarcoma had worse overall survival than those with squamous cell carcinoma, or neuroendocrine carcinoma (P < 0.001). Squamous cell carcinoma and rhabdomyosarcoma invaded the orbit more often and malignancy of the nasal cavity invaded the orbit more than malignancy of the nasal sinus.</p><p><b>CONCLUSIONS</b>For nasal orbital tumors early diagnosis is crucial. Orbital exenteration and postoperative rehabilitation should be carefully considered. The current data suggest that surgical resection with postoperative radiation therapy may offer durable local control.</p>

Use of preoperative ultrasound in designing the true pectoralis major myocutaneous island flap / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Traditional techniques used for harvesting the pectoralis major myocutaneous (PMMC) flap have accompanying disadvantages, such as the necessity for an upper chest skin incision, the bulkiness of myocutaneous tissue at the pedicle of the flap, and the risk of total or partial necrosis of flap tissue. The aim of this study was to develop a safe and fast method for preparing PMMC island flaps using preoperative ultrasonography for vessel detection.</p><p><b>METHODS</b>Forty-one PMMC island flaps were used for one-stage reconstruction of head and neck defects, including 21 cases in the treatment group and 20 cases in the control group. In the treatment group, ultrasonography was used to mark out the course of the thoracic branches of the thoracoacromial artery and the lower end of this artery perforating from the fascia into the muscles, as well as the largest perforating branch of the fourth or fifth internal mammary artery entering the PMMC flap. A line, from the lower end of the thoracic branch to the largest perforating branch of the fourth or fifth internal mammary artery, was drawn to determine the axis of the PMMC flap. In the control group, PMMC island flaps were designed according to conventional methods without using ultrasonography.</p><p><b>RESULTS</b>According to the ultrasonic marks, the distance from lower end of thoracic branch to the midpoint of the margin of the inferior clavicular was (5.1 ± 1.2) cm. The time from designing to transferring the island flap was significantly shorter in the treatment group ((51.0 ± 10.5) minutes) compared with the control group ((78.0 ± 13.9) minutes, P < 0.01). The rate of partial necrosis was 4.7% (1/21) in the treatment group and 35.0% (7/20) in the control group. There was one case of flap failure in the control group due to vascular injury during vascular pedicle dissection.</p><p><b>CONCLUSION</b>Preoperative vessel detection by ultrasonography facilitates easy and safe harvesting of the true PMMC island flap.</p>

Gasless endoscopic surgery through the upper chest in treatment of thyroid tumor / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.</p><p><b>METHODS</b>A total of 68 patients (64 women and 4 men) underwent the surgery. Their ages ranged from 18 to 65 years, with a mean age of (34 ± 3) years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.</p><p><b>RESULTS</b>All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation. The patients were satisfied with the cosmetic results of the surgery.</p><p><b>CONCLUSION</b>The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.</p>

Complications of CO₂ laser surgery in the treatment of laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the complications of CO2 laser surgery in the treatment of laryngeal carcinoma, to analyze related factors and to propose preventive measures.</p><p><b>METHODS</b>Retrospective analysis of 912 cases of laryngeal carcinoma (35 cases of supraglottic cancer and 877 cases of glottic cancer) treated only with laser surgery in Tongren Hospital was carried out. Among the glottic cancer, carcinoma in situ (Tis), T1, T2 and T3 were 53, 659, 158 and 7 cases. The follow-up period ranged from 2 to 18 years, with a median follow-up time of 9.3 years.</p><p><b>RESULTS</b>Of 912 cases, 824 cases were still alive, 29 cases failed to be followed-up (taken into dead number), and 59 cases were dead. The recurrent rate was 9.4% (86/912). Three year survival rate was 95.6% (775/811) and five year survival rate was 87.9% (518/589). The incidence of surgery complications was 9.1% (83/912). Incidence of complications in supraglottic carcinoma and glottic carcinoma were 17.1%(6/35) and 8.8% (77/877), respectively, with no difference between the two groups (χ(2) = 2.85, P > 0.05). Incidence of complications of Tis, T1, T2 and T3 cases of glottic cancer were 5.7%(3/53), 7.8% (51/659), 13.3% (21/158) and 28.6% (2/7) respectively, with significant difference (χ(2) = 8.97, P < 0.05). Incidence of complications of glottic carcinoma with and without anterior commissure incision were 12.8%(31/242) and 7.2%(46/635) respectively, with significant difference between the two groups (χ(2) = 6.78, P < 0.05). Incidence of complications in the patients underwent type II, III, IV, V cordectomy were 3.8% (4/105), 7.0% (20/287), 9.7% (22/226) and 12.0% (31/259) respectively, with significant difference (χ(2) = 7.96, P < 0.05).</p><p><b>CONCLUSIONS</b>There are some potential risks and complications intra- and post-operatively, according to the sites and extent of the primary tumors and the range and depth of removed tissues. It needs to take active preventive measures to reduce the incidence of complications.</p>

Transoral carbon dioxide laser surgery for treatment of hypopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and curative effects of transoral CO2 laser in treatment of hypopharyngeal carcinoma.</p><p><b>METHODS</b>The retrospective analysis included 24 cases of hypopharyngeal carcinoma from 1994 to 2005 in the Department of Head and Neck. All cases were treated with endoscopic laser surgery and adjuvant selective neck dissection or radiotherapy. The follow-up period was more than 3 years. Twenty-four patients (21 male, 3 female) were classified as follows: 14 cases were T1N0M0, 4 were T1N1M0, 1 was T1N2bM0, 3 were T2N0M0 and 2 were T2N2bM0.</p><p><b>RESULTS</b>Kaplan-Meier survival analysis showed the overall 5-year survival rate was 74.9%, and the 5-year survival rate of T1 lesions and T2 lesions was 78.8% and 60.1%, respectively. The overall 5-year local control rate was 82.1% and 5-year larynx preservation rate was 87.0%. Six of 7 patients with local-regional recurrences underwent salvage surgery and radiotherapy. Finally 4 of them died of recurrence again and 2 were survival. The other one of 7 patients had distant metastasis, and died after radiochemotherapy. One patient died of non-neoplastic diseases. Two patients experienced minor complications with conventional ambulatory treatment without sequelae. All survival patients had laryngeal preservation except the one who received salvage surgery of the hypopharynx and larynx.</p><p><b>CONCLUSIONS</b>Endoscopic CO2 laser surgery with adjuvant selective or modified radical neck dissection and radiotherapy is an alternative for the treatment of selected hypopharyngeal carcinoma, associated with satisfying curative effects and a high larynx preservation rate.</p>

Treatment of supraglottic carcinoma with carbon dioxide laser / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and curative effects of CO2 laser in treatment of supraglottic carcinoma.</p><p><b>METHODS</b>The retrospective analysis included 32 case of supraglottic carcinoma from February 1995 to June 2005, TNM classified as follows: T1N0M0: 20 cases, T1N1M0: 2 cases, T2N0M0: 8 cases and T2N1M0: 2 cases. The patients were treated with endoscopic laser surgery and selective neck dissection (12 cases) or functional neck dissection (4 cases). The follow-up period was more than 3 years.</p><p><b>RESULTS</b>Kaplan-Meier survival analysis shows the overall 5-year survival rate was 90.6%, and the 5-year survival rate of T1 lesions and T2 lesions was 95.6% and 78.2%, respectively. The overall 5-year local control rate was 96. 8%. The 5-year local-regional control rate was 90.3%. With T1 90.9% and T2 89.0% respectively. Two patients had local recurrences, one underwent salvage supraglottic horizontal laryngectomy, another one underwent total laryngectomy. Two cases with regional recurrences underwent radical neck dissection. One of them with concurrent local recurrence was survival after salvage operation. Another one with only regional lesion died of recurrence and pulmonary metastasis after treatment. Four patients experienced minor complications without sequelae. All survival patients had laryngeal preservation except the one who received total laryngectomy.</p><p><b>CONCLUSIONS</b>The results of this study show that endoscopic CO2 laser surgery is highly effective in the treatment of selected supraglottic carcinoma. It shows reliable curative effects and a high larynx preservation rate.</p>