Effectiveness of Acupoint Application in Patients with Pharyngeal Pain: Evidence from CHUNBO, A Prospective Real-World Study / 中国结合医学杂志

OBJECTIVE@#To assess the outcomes after acupoint application in patients with pharyngeal pain in a real-world settings, and analyze the characteristics of effective population and prescription characteristics of acupoint application.@*METHODS@#Based on CHUNBO platform, patients with pharyngeal pain who were candidates for acupoint application on the basis of physician-evaluation, were enrolled in a nationwide, prospective, 69-week multicenter observational study from August 2020 to February 2022. Propensity score matching (PSM) was used to match the confounding factors and the association rules were used to analyze the characteristics of effective population and prescription characteristics of acupoint application. Outcome assessments included the disappearance rate of pharyngeal pain (within 3, 7, and 14 days), disappearance time of pharyngeal pain, as well as adverse events.@*RESULTS@#Of 7,699 enrolled participants, 6,693 (86.9%) received acupoint application and 1,450 (21.7%) with non-acupoint application. After PSM, there were 1,004 patients each in the application group (AG) and non-application group (NAG). The disappearance rate of pharyngeal pain in the AG at 3, 7, and 14 days were all higher than those in the NAG (P<0.05). The disappearance time of pharyngeal pain in the AG were shorter than that in the NAG (logrank P<0.001, hazard ratio=1.51, 95% confidence interval: 1.41-1.63). The median age of effective cases was 4 years, mainly 3-6 years old (40.21%). The disappearance rate of pharyngeal pain in the application group with tonsil diseases was 2.19 times higher than that in the NAG (P<0.05). The commonly used acupoints for the effective cases were Tiantu (RN 22), Shenque (RN 8) and Dazhui (DU 14). The commonly used herbs for the effective cases were Natrii sulfas, Radix et Rhizoma Rhei, and Herba Ephedrae. Among them, Natrii sulfas was applied to RN 8 most frequently (support 84.39%). A total of 1,324 (17.2%) patients experienced AEs, and mainly occurred in the AG, with significant difference in the incidence of AEs between goups (P<0.05). All AEs reported were the first grade, and the average regression days of AEs was 2.8 days.@*CONCLUSIONS@#Acupoint application in patients with pharyngeal pain resulted in improved effective rate and shortened duration, especially children aged 3-6 years old, and those with tonsil diseases. Acupoint of RN 22, RN 8 and DU 14, Natrii sulfas, Radix et Rhizoma Rhei, and Herba Ephedrae were the most commonly used herbs in the treatment of pharyngeal pain.

Clinical application of Visual throat forceps in the removal of hypopharyngeal foreign body / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the feasibility of using self-made visual throat forceps to remove hypopharyngeal foreign bodies. Methods:The throat forceps were combined with the endoscope and connected to a monitor via a data cable resulting in a visual throat forceps apparatus. This device was utilized to examine and treat the hypopharyngeal foreign bodies. Results:Among 53 patients, foreign bodies were detected in 51,with 48 cases involving hypopharyngeal foreign bodies. All were successfully extracted using the visual throat forceps. Three cases, diagnosed as esophageal foreign bodies by electronic gastroscopy, were treated using the same method. Conclusion:Visual throat forceps can be used to examine the hypopharynx and remove foreign bodies. It has the advantages of simple operation, rapid operation, and high success rate of foreign body removal from the hypopharynx. It is worthy of clinical application.

Effect of Bimaxillary Orthognathic Surgery on Pharyngeal Airway Volume / Efecto de Cirugía Ortognática Bimaxilar en el Volumen de la Vía Aérea Faríngea

SUMMARY: Subjects with maxillary skeletal classes II and III not only express alterations in the hard and soft maxillofacial tissues, but also in the morphology and dimensions of the upper airway. A small space in the upper airway has been associated with sleep disorders, such as snoring and mainly obstructive sleep apnea/hypopnea syndrome (OSAHS). Consequently, interest has increased due to the influence of orthognathic surgery in the airway space. Although there are studies in the literature that have compared upper airway spaces, most have evaluated the changes using two-dimensional images, mainly lateral skull X-rays. The present study aimed to determine the airway volume in subjects with skeletal classes II and III who underwent bimaxillary orthognathic surgery. 80 CBCT exams from 40 subjects obtained before and 6 months after surgery were used. There were 20 class II and 20 class III subjects. For the volumetric analysis, a 3D rendering of the upper airway was made in previously established segments, and then the airway volume was calculated using the 3D Slicer® software version 4.11 (Slicer, USA). The statistical analysis by t-test of related samples revealed statistically significant volumetric increases in the nasopharynx, laryngopharynx, and total volume in class II patients. However, in class III patients, there were significant increases in the nasopharynx and total volume, while the volume was maintained in the oropharynx and laryngopharynx.

Sujetos con clases esqueletales II y III maxilares, no solamente expresan alteraciones en los tejidos duros y blandos maxilofaciales, sino también en la morfología y dimensiones de la vía aérea superior. Un espacio reducido a nivel de la vía aérea superior se asocia a trastornos del sueño como ronquidos y principalmente el síndrome de apnea/hipoapnea obstructiva del sueño (AOS); debido a esto, ha aumentado el interés por la influencia de la cirugía ortognática en el espacio de la vía aérea. Si bien existen en la literatura estudios que han comparado los espacios de la vía aérea superior, la mayoría de los estudios han evaluado los cambios utilizando imágenes bidimensionales, principalmente radiografías laterales de cráneo. El objetivo del presente estudio fue determinar el volumen de la vía aérea en sujetos con clases esqueletales II y III sometidos a cirugía ortognática bimaxilar. Se utilizaron 80 exámenes CBCT pertenecientes a 40 sujetos obtenidos previo a la cirugía y 6 meses después de realizada. Veinte sujetos clase II y 20 clase III. Para el análisis volumétrico se realizó un renderizado 3D de la vía área superior en segmentos previamente establecidos y posteriormente se calculó el volumen de dicha vía aérea con la utilización del software 3D Slicer ®versión 4.11 (Slicer, USA). El análisis estadístico realizado por t-test de muestras relacionadas, arrojó en pacientes clase II aumentos volumétricos estadísticamente significativos en nasofaringe, laringofaringe y volumen total. Mientras que en pacientes clase III, se observó aumentos significativos en Nasofaringe y volumen total y mantención de volumen en orofaringe y laringofaringe.

A Master Mind Game Code Algorithm Approach to Help Surgical Decision-Making between Retropharyngeal Fat Grafting and Pharyngoplasty for the Treatment of Velopharyngeal Incompetence

Abstract Introduction Velopharyngeal insufficiency (VPI) is a controversial pathology with many surgical options. Objectives To compare pharyngoplasty and retropharyngeal fat grafting and to build a prognostic tool to achieve perfect speech. Methods Retrospective observational cohort study of 114 patients operated for VPI from 1982 to 2019 in a single tertiary center. The instrumental assessment was made using an aerophonoscope and nasofibroscopy. The variables sex, age, genetic syndromes, and type of diagnosis were analyzed with logistic regression model adjusted with propensity score. To generalize results and to build a surgical predictive tool, a marginal analysis concludes the study. Results Among the patients (median [range] age 7 [4-48]), 63 (55.26%) underwent pharyngoplasty and 51 (44.74%) graft. The graft group had no complication, but it had a failure rate of 7.84%. The pharyngoplasty group had no failure, but one patient had postoperative obstructive sleep apnea. The marginal analysis demonstrated that age lower than 7 years, cleft lip and palate, absence of syndrome, and intermittent VPI were important predictive factors of good result regardless of surgical technique. Conclusions Without a statistical demonstration of the superiority of pharyngoplasty over graft, and in the uncertainty of literature background, our perfect-speech patient profile represents an important tool for a postoperative forecast of results in which, like in the Master Mind game, every feature has to be considered not individually but as a pattern of characteristics whose association contributes to the outcome.

Comparative Analysis of the Quality of Life in the Pretreatment of Head and Neck Cancer Patients According to Tumor Site

Abstract Introduction Head and neck cancer (HNC) and its treatment can cause physical, psychological, and quality of life (QoL) damage, because it can disturb the physiology of eating, breathing, speaking, and compromise self-image. Objective To evaluate the QoL of the pretreatment of patients diagnosed with head and neck cancer according to the anatomical location of the tumor. Methods A descriptive, cross-sectional study was performed on a sample of 144 patients undergoing pretreatment for cancer from February 2017 to July 2019. The University of Washington QoL Questionnaire (version 4) was used to assess the QoL. The anatomical location data were obtained from medical records. The ANOVA test was used to compare the differences in QoL according to tumor location. Results A total of 144 participants were included, 66 (45.5%) of whom had the primary tumor located in the mouth. The median age of the patients was 62 years, with a higher prevalence of male (75.7%), Black (78.5%), single/divorced/widowed people (59%), and illiterates (32.6%); most of them were smokers (84.7%) and alcohol drinkers (79.2%). The mean QoL score was 830 for mouth cancer, 858 for pharynx cancer, and 891 for laryngeal cancer patients. Conclusion Based on the results of this study, it can be concluded that the QoL of patients with head and neck cancer was not influenced by tumor location. The most affected domains in the three groups were pain, appearance, chewing, swallowing, and speech (p < 0.05).

Intestinal and pharyngeal microbiota in early neonates: an analysis based on high-throughput sequencing / 中国当代儿科杂志

OBJECTIVES@#To investigate the distribution characteristics and correlation of intestinal and pharyngeal microbiota in early neonates.@*METHODS@#Full-term healthy neonates who were born in Shanghai Pudong New Area Maternal and Child Health Hospital from September 2021 to January 2022 and were given mixed feeding were enrolled. The 16S rRNA sequencing technique was used to analyze the stool and pharyngeal swab samples collected on the day of birth and days 5-7 after birth, and the composition and function of intestinal and pharyngeal microbiota were analyzed and compared.@*RESULTS@#The diversity analysis showed that the diversity of pharyngeal microbiota was higher than that of intestinal microbiota in early neonates, but the difference was not statistically significant (P>0.05). On the day of birth, the relative abundance of Proteobacteria in the intestine was significantly higher than that in the pharynx (P<0.05). On days 5-7 after birth, the relative abundance of Actinobacteria and Proteobacteria in the intestine was significantly higher than that in the pharynx (P<0.05), and the relative abundance of Firmicutes in the intestine was significantly lower than that in the pharynx (P<0.05). At the genus level, there was no significant difference in the composition of dominant bacteria between the intestine and the pharynx on the day of birth (P>0.05), while on days 5-7 after birth, there were significant differences in the symbiotic bacteria of Streptococcus, Staphylococcus, Rothia, Bifidobacterium, and Escherichia-Shigella between the intestine and the pharynx (P<0.05). The analysis based on the database of Clusters of Orthologous Groups of proteins showed that pharyngeal microbiota was more concentrated on chromatin structure and dynamics and cytoskeleton, while intestinal microbiota was more abundant in RNA processing and modification, energy production and conversion, amino acid transport and metabolism, carbohydrate transport and metabolism, coenzyme transport and metabolism, and others (P<0.05). The Kyoto Encyclopedia of Genes and Genomes analysis showed that compared with pharyngeal microbiota, intestinal microbiota was more predictive of cell motility, cellular processes and signal transduction, endocrine system, excretory system, immune system, metabolic diseases, nervous system, and transcription parameters (P<0.05).@*CONCLUSIONS@#The composition and diversity of intestinal and pharyngeal microbiota of neonates are not significantly different at birth. The microbiota of these two ecological niches begin to differentiate and gradually exhibit distinct functions over time.

Application of fiberoptic endoscopic examination of swallowing combined with dye test in silent aspiration after stroke / 中国康复理论与实践

ObjectiveTo explore the diagnostic value of fiberoptic endoscopic examination of swallowing (FEES) combined with dye test in patients with post-stroke dysphagia and silent aspiration. MethodsFrom December, 2021 to June, 2022, 50 stroke patients in the Rehabilitation Department of Xuzhou Central Hospital were selected. They were assessed with FEES and videofluoroscopic swallowing study (VFSS), and compared. ResultsThe detection rate of aspiration was higher with FEES than with VFSS (χ2 = 7.000, P < 0.05), and especially for liquid food (χ2 = 4.000, P < 0.05). There was a good consistency when consuming paste food (κ = 0.941, P < 0.001) and solid food (κ = 0.779, P < 0.001). There was a good consistency in the food residue site between two methods (κ = 0.818, P < 0.001), as well as for all the three food types (κ ≥ 0.862, P < 0.001). There was no significant difference in the scores of Penetration Aspiration Scale of three food types between two methods (Z < 0.667, P > 0.05). ConclusionFEES combined with dye test can be used for evaluating silent aspiration after stroke.

Wrist-ankle acupuncture combined with rehabilitation for dysphagia caused by achalasia of cricopharyngeal muscle after stroke / 中国基层医药

Objective:To investigate the clinical efficacy of wrist-ankle acupuncture combined with rehabilitation for dysphagia caused by achalasia of the cricopharyngeal muscle after stroke.Methods:Sixty patients with dysphagia caused by achalasia of the cricopharyngeal muscle after stroke who received treatment in Wenzhou Hospital of Traditional Chinese Medicine from June 2019 to March 2020 were included in this study. They were randomly divided into a treatment group and a control group ( n = 30). All patients received routine drug treatment and swallowing rehabilitation training. The control group underwent routine acupuncture treatment. The treatment group received wrist-ankle acupuncture based on routine acupuncture treatment. Both groups were treated for 4 consecutive weeks. The clinical efficacy in the two groups was evaluated using the Video Fluoroscopic Swallowing Study (VFSS), Standardized Swallowing Assessment (SSA), and Swallow Quality-of-Life Questionnaire (SWAL-QOL). Results:Before treatment, there were no significant differences in VFSS, SSA, and SWAL-QOL scores between the two groups. After treatment, VFSS, SSA, and SWAL-QOL scores in the treatment group were (8.21 ± 0.77) points, (21.19 ± 1.42) points, (200.24 ± 11.12) points, and they were (6.01 ± 0.36) points, (23.31 ± 1.45) points, and (182.37 ± 12.06) points in the control group ( t = 3.26, 5.50, 6.31, all P < 0.05). Conclusion:Wrist-ankle acupuncture combined with rehabilitation is an effective treatment method for dysphagia caused by achalasia of the cricopharyngeal muscle after stroke. It can alleviate dysphagia and improve quality of life.

Cone beam computed tomography with oral contrast for accurate diagnosis and surgical planning of pharyngeal leakage and fistula: a case series

Abstract Objective: Pharyngocutaneous fistula is one of the severe complications related to head and neck surgeries. Detecting the accurate three-dimensional location of both the fistula and leakage is essential for surgical treatment. Videofluoroscopy is usually used for locating these; however, its imaging is two-dimensional. We evaluated pharyngeal leakage and fistulae using Cone Beam Computed Tomography (CBCT), known for its three-dimensional high spatial resolution imaging, taken in a sitting position, with oral contrast (contrast CBCT). Methods: Pharyngeal leakage and fistulae were evaluated in a total of 31 subjects by sequentially performing videofluoroscopy and contrast CBCT. The detection accuracy of videofluoroscopy and contrast CBCT for leakage and fistula, as well as the ability to determine the extent and depth for surgical planning, were investigated and compared. Results: Videofluoroscopy and contrast CBCT showed suspicious leakage and/or fistula in six and three of the 31 subjects, respectively. Surgical findings revealed the presence of leakage and/or fistula in three of the 31 subjects. The positive predictive values of videofluoroscopy and contrast CBCT were 50% (3/6) and 100% (3/3), respectively. Contrast CBCT provided more precise images, showing the extent and depth of leakage and fistula in three-dimensions. Conclusion: The present study's results indicate the usefulness of contrast CBCT in terms of accurate diagnosis of leakage and fistula, due to its three-dimensional imaging being performed with the patient in a sitting position. Level of evidence: 4.

Carga por mortalidad del cáncer de labio, cavidad bucal y faringe

Fundamento: un análisis de la tendencia al cambio en la mortalidad del cáncer de labio, cavidad bucal y faringe y la cuantificación del impacto sobre la esperanza de vida en la población cubana puede ayudar a los investigadores y a los responsables de la formulación de políticas de Salud Pública a tener una visión integral de este problema. Objetivo: estimar la carga por mortalidad de cáncer de labio, cavidad bucal y faringe, por sexo, en Cuba en el período comprendido de 2005- 2020. Método: se realizó un estudio descriptivo, de corte transversal en el que se utilizaron series de datos quinquenales. El universo estuvo conformado por todas las muertes por cáncer de labio, cavidad bucal y faringe para los años estudiados. Se utilizó, para cada año y causas, el número de defunciones, se calcularon tasas por 100 000 habitantes y los años de vida potencialmente perdidos por mortalidad. Se calculó, el promedio y se estimó del cambio porcentual anual. Resultados: las tasas de mortalidad fueron entre 7,62 y 12,23 en hombres y 2,60 y 3,74 en mujeres, por 100 000 habitantes. En cuanto a los años de vida dejados de vivir temparanamente, por cáncer de labio, cavidad bucal y faringe se observó que en hombres las tasas asciendieron de 131 en el 2005 a 169 en el 2020 y de 40 a 52 en las mujeres. Concluciones: la carga por cáncer de labio, cavidad bucal y faringe en Cuba ha aumentado, fue superior en hombres, la tendencia es creciente en ambos sexos, por cáncer nasofaríngeo tanto hombres como mujeres fallecieron a edades más tempranas que, por otras localizaciones estudiadas, el cambio porcentual fue superior por cáncer faríngeo.

Background: an analysis of the trend of change in the mortality of cancer of the lip, oral cavity and pharynx and the quantification of the impact on life expectancy in the Cuban population can help researchers and those responsible for formulating health policies. Public to have a comprehensive view of this problem. Objective: to estimate the mortality burden of cancer of the lip, oral cavity and pharynx, by sex, in Cuba in the period 2005-2020. Method: a descriptive, cross-sectional study was carried out in which five-year data series were used. The universe was made up of all deaths from cancer of the lip, oral cavity and pharynx for the years studied. For each year and causes, the number of deaths was used; rates per 100,000 inhabitants and the years of life potentially lost due to mortality were calculated. The average was calculated and the annual percentage change was estimated. Results: mortality rates were between 7.62 and 12.23 in men and 2.60 and 3.74 in women, per 100,000 inhabitants. Regarding the years of life lost early, due to cancer of the lip, oral cavity and pharynx, it was observed that in men the rates rose from 131 in 2005 to 169 in 2020 and from 40 to 52 in women. Conclusions: the burden of cancer of the lip, oral cavity and pharynx in Cuba has increased, it was higher in men, the trend is growing in both sexes, both men and women died at younger ages due to nasopharyngeal cancer than, due to other locations studied, the percentage change was higher for pharyngeal cancer.

Planificación quirúrgica de colgajo faríngeo a medida para insuficiencia velofaríngea secundaria a fisura de paladar: reporte de caso y revisión de literatura / Surgical planning of a tailor-made pharyngeal flap for velopharyngeal insufficiency secondary to a cleft palate: case report and literature review

Resumen La insuficiencia velofaríngea (IVF) es una de las principales secuelas estructurales tras la palatoplastía primaria en casos de fisura de paladar. La IVF se caracteriza por la ausencia de tejido suficiente para lograr un cierre adecuado del mecanismo velofaríngeo durante el habla, lo que conlleva a una resonancia hipernasal y la emisión nasal de aire durante la producción de sonidos orales. Al respecto, el tratamiento ideal para corregir la IVF es quirúrgico, dentro de los cuales el colgajo faríngeo de pedículo superior es uno de los procedimientos más utilizados en nuestro país. Para su realización es fundamental determinar el ancho necesario, lo cual puede ser determinado mediante una videofluoroscopía multiplano (VFMP). Por esto, con el objetivo de potenciar el trabajo multidisciplinario en la corrección quirúrgica de la IVF, a continuación, se presentan los procedimientos de evaluación fonoaudiológica, videonasofaríngoscopía flexible y videofluoroscopía multiplano utilizados para la planificación quirúrgica de un colgajo faríngeo en un adolescente chileno diagnosticado con IVF secundaria a fisura palatina operada. Además, se describe el uso de la VFMP en la planificación quirúrgica del colgajo faríngeo mediante una revisión de literatura.

Abstract Velopharyngeal insufficiency (VPI) is one of the main structural sequelae after primary palatoplasty in cases of cleft palate. VPI is characterized by the absence of sufficient tissue to achieve adequate closure of the velopharyngeal mechanism (VFM) generating hyper-nasal resonance and nasal emission during the production of oral sounds. In cases of cleft palate, the ideal treatment to correct VPI is surgery. The upper pedicle pharyngeal flap is one of the most widely used procedures. To plan it, is essential to determine the appropriate width, which can be determined by means of multiplane videofluoroscopy (MPVF). For this reason, and with the aim of promoting multidisciplinary approach in the surgical correction of VPI, the following procedures such as speech and language evaluation, flexible videonasopharyngoscopy and multiplane videofluoroscopy used for the surgical planning of a pharyngeal flap, in a Chilean adolescent diagnosed with VPI secondary to operated cleft palate, will be presented. In addition, the use of MPVF in pharyngeal flap surgical planning is described through a literature review.

Zenker Diverticulum: Does Size Correlate with Preoperative Symptoms?

Abstract Introduction Zenker diverticulum (ZD) usually affects adults after the 7th decade of life. Treatment for ZD is indicated for all symptomatic patients, but some patients prefer to defer surgical treatment until symptoms get worse and decrease their quality of life. Objective To evaluate the association of the preoperative symptoms in ZD patients with the size of the ZD. Methods A retrospective study design. Electronic medical records were used to identify patients diagnosed with ZD and treated over 11 years. Data collection included the chief complaints and symptoms, medical history, and findings on radiologic swallow evaluations of the patients. The diverticulum size was stratified into 3 groups: small (< 1 cm), moderate (1-3 cm), and large (> 3 cm). Results A total of 165 patients were enrolled and stratified by diverticulum size (48 small, 67 medium, and 50 large). Dysphagia, cough, and regurgitation were the most prevalent symptoms. Dysphonia was more frequent among patients with a small pouch. Logistic regression analysis showed that dysphagia and choking were associated with large and medium diverticulum size (p < 0.05). Additionally, dysphonia was significantly associated with the presence of a small-sized ZD (p < 0.04). Conclusion Upper gastrointestinal symptoms such as dysphagia and choking may be associated with a ZD > 1 cm and should always be evaluated. Additionally, the presence of dysphonia was found to be correlated with a ZD < 1 cm, suggesting that a prompt and appropriate fluoroscopic evaluation must be considered in those patients in whom no other clear cause of dysphonia is evident.

Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation / Carcinoma da parede posterior da hipofaringe: tratamento cirúrgico com preservação da laringe

Abstract Introduction: Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. Objectives: To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. Methods: The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. Results: Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10-21 days). All patients achieved oral intake in a median time of 74 days (range, 15-180). Decannulation was achieved in all patients and the median time fordecannulation was 90 (range, 21-300 days). The mean followup duration was 38.3 months (range, 10-71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. Conclusion: Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.

Resumo Introdução: A parede posterior da faringe é o subsítio mais raro para carcinomas hipofaríngeos. Devido à sua raridade, há poucos estudos publicados na literatura especificamente sobre o carcinoma da parede posterior da faringe. Objetivo: Relatar nossos resultados funcionais em pacientes com carcinoma da parede posterior da hipofaringe após tratamento cirúrgico por ressecção via faringotomia lateral ou infra-hióidea, com preservação da laringe e reconstrução com retalho livre radial do antebraço. Método: O estudo incluiu 10 pacientes submetidos à cirurgia para carcinoma da parede posterior da hipofaringe por 6 anos. A morbidade pós-operatória associada foi investigada e os resultados funcionais foram analisados. Resultados: Nove pacientes apresentaram lesões T3 e um paciente apresentou lesão T2. Avia preferida para acessar a hipofaringe foi a faringotomia lateral em 5 pacientes e a faringotomia lateral combinada com a faringotomia infra-hióidea em 5 pacientes com extensão superior até a orofaringe. Os defeitos faríngeos foram reconstruídos com sucesso com retalhos livres radiais do antebraço. Quatro pacientes receberam apenas radioterapia adjuvante e 4 pacientes com doença cervical N2b e N2c receberam quimiorradioterapia adjuvante. A duração média da hospitalização foi de 15,6 dias (variação de 10 a 21 dias). Todos os pacientes retornaram à ingestão oral em um tempo médio de 74 dias (variação de 15 a 180). A decanulação foi possível para todos os pacientes e o tempo médio foi de 90 dias (variação de 21 a 300 dias). A duração média do seguimento foi de 38,3 meses (10 a 71 meses) e 8 pacientes sobreviveram. Um paciente foi a óbito devido a recorrência regional nos linfonodos retrofaríngeos e outro devido a metástase sistêmica. Conclusão: A cirurgia primária ainda é uma modalidade de tratamento muito eficaz para o carcinoma da parede posterior da hipofaringe e não compromete de forma permanente as funções de deglutição e da laringe se a reconstrução faríngea for feita com retalho livre.

Pharyngeal-cervical-brachial variant of Landry Guillain Barre syndromeafter dengueinfection:a case report

Dengue is a common mosquito-borne infection in India. We reported a rare Pharyngeal cervical brachial (PCB) variant of Landry Guillain Barre syndrome (LGBS) associated with the dengue virus infection. The pathogenesis seems to be molecular mimicry between gangliosides and microbial lipo-oligosaccharides. PCB usually presents with oropharyngeal or cervicobrachial weakness. Therefore, it must be recognised early and distinguished from conditions presenting with cephalocaudal progressing weakness, such as Myasthenia Gravis, Miller-Fisher syndrome, botulism, diphtheria, porphyria or brain stem stroke. The aim of the study was to add to the limited literature on the PCB variant of LGBS after dengue infection and shed some light on presentation and management options for this rare entity.

Clinical analysis of 252 children with Epstein-Barr virus infection / 中国基层医药

Objective:To investigate the clinical manifestations of Epstein-Barr virus infection in children and the efficacy of interferon combined with ganciclovir.Methods:A total of 252 children with Epstein-Barr virus infection who received treatment in Liaocheng Maternal and Child Health Hospital from June 2018 to February 2020 were included in this study. They were randomly assigned to undergo treatment either with ganciclovir alone (control group, n = 126) or interferon combined with ganciclovir (experimental group, n = 126). General condition, clinical manifestation, clinical outcomes, and clinical efficacy were compared between the two groups. Results:The 252 children with Epstein-Barr virus infection were divided into four groups according to different age brackets: infancy (3.97%), early childhood (53.57%), preschool (28.97%), school age (13.49%). Children at the early childhood and preschool ages accounted for high proportions. Their clinical manifestations included fever, pharyngeal congestion, cervical lymph node swelling, and pharyngeal pain. Children with hepatosplenomegaly accounted for the highest proportion (44.12%) among those at the school age, and children with binocular edema accounted for the highest proportion (10.37%) among those at the early childhood age. The time to defervesce, eyelid edema, and lymph node regression in the experimental group were (3.55 ± 1.58) hours, (3.82 ± 1.17) hours, and (9.55 ± 1.60) hours respectively, which were significantly shorter than those in the control group [(4.40 ± 1.80) hours, (5.33 ± 1.58) hours, (10.44 ± 1.66) hours, t = 3.64, 2.47, 2.67, P < 0.001, P = 0.024, 0.009]. The total response rate was significantly higher in the experimental group than in the control group [96.03% (107/126) vs. 84.92% (121/126), χ2 = 9.03, P = 0.003]. Conclusion:Epstein-Barr virus infection has different clinical manifestations in children at different ages. Interferon combined with ganciclovir is more effective on Epstein-Barr virus infection than ganciclovir alone.

Acupuncture therapy combined with rhubarb applied to the umbilicus for constipation in patients with stage IV-V diabetic nephropathy / 中国基层医药

Objective:To investigate the efficacy of acupuncture therapy combined with rhubarb applied to the umbilicus in the treatment of constipation in patients with stage IV-V diabetic nephropathy.Methods:Ninety stage IV-V diabetic nephropathy patients with constipation, who received treatment in Wenzhou Hospital of Traditional Chinese Medicine from December 2019 to December 2020, were included in this study. They were randomly assigned to receive either routine treatment (control group, n = 45) or routine treatment plus acupuncture therapy combined with rhubarb applied to the umbilicus (study group, n = 45). Serum motilin, gastrin, and somatostatin levels and orocecal transit time pre- and post-treatment were compared between the two groups. The constipation severity was evaluated using the Constipation Severity Scale (CSS). Quality of life was evaluated using the Patient Assessment of Constipation Quality of Life Questionnaire. Clinical efficacy was compared between the two groups. Results:The somatostatin level and orocecal transit time post-treatment in the study group were (13.66 ± 4.24) ng/L and (80.58 ± 10.11) minutes, respectively, which were significantly lower than those in the control group [(19.31 ± 6.13) ng/L, (87.16 ± 12.04) minutes, t = 5.08, 2.80, both P < 0.05]. Serum motilin and gastrin levels post-treatment in the study group were (281.07 ± 41.16) ng/L and (181.07 ± 35.16) ng/L, respectively, which were significantly higher than those in the control group [(259.64 ± 39.83) ng/L, (162.65 ± 32.83) ng/L, t = 2.51, 2.56, both P < 0.05]. The scores of the Constipation Severity Scale and the Patient Assessment of Constipation Quality of Life Questionnaire post-treatment in the study group were (10.66 ± 3.14) points and (60.14 ± 13.64) points, respectively, which were significantly lower than those in the control group [ (15.31 ± 4.13) points, (71.61 ± 14.72) points, t = 6.01, 3.83, both P < 0.05). Total response rate was significantly higher in the study group than in the control group (97.78% vs. 80.00%, χ2 = 5.51, P < 0.05). Conclusion:Acupuncture therapy combined with rhubarb applied to the umbilicus can be used to treat constipation in patients with stage IV-V diabetic nephropathy. The combined therapy can adjust the secretion of gastrointestinal tract-related hormones, shorten orocecal transit time, improve clinical symptoms, and improve clinical efficacy and quality of life.

Comparison of Jefferson-fracture reduction plate and micro titanium plate in the transoral single-segment fixation of unstable atlas fractures / 中华创伤骨科杂志

Objective:To compare Jefferson-fracture reduction plate (JeRP) and micro titanium plate in the transoral single-segment fixation of unstable atlas fractures.Methods:From January 2008 to December 2020, 45 patients with unstable atlas fracture were treated by single-segment fixation through an oral approach with a JeRP or a micro titanium plate at Department of Orthopedic Surgery, General Hospital of Southern Theatre Command. They were 24 males and 21 females, aged from 15 to 67 years. By the Gehweiler classification, 11 atlas fractures were type Ⅰ and 34 type Ⅲ; by the American Spinal Injury Association (ASIA) classification, the spinal cord injury was grade D in 7 cases and grade E in 38 cases; by the Dickman classification, the atlas transverse ligament injury was type Ⅰ in 4 cases and type Ⅱ in 11 cases. Of the patients, 26 were treated by transoral single-segment fixation with a JeRP and 19 by transoral single-segment fixation with a micro titanium plate. The 2 groups were compared in terms of baseline data, operation time, blood loss, hospital stay, visual analog scale (VAS) for neck pain and atlas lateral mass displacement (LMD) before operation and at the last follow-up, and intraoperative and postoperative complications.Results:The 2 groups were comparable because there was no significant difference between them in the preoperative general data ( P>0.05). All patients were followed up for 12 to 55 months (mean, 21.8 months). Wound dehiscence or infection was observed in none of the patients after operation. About 12 months after operation, all fractures achieved bony union, neck pain basically disappeared, and neck movement had no obvious limitation. The hospital stay was (13.9±2.2) d for the JeRP group and (14.2±2.9) d for the micro titanium plate group, showing no significant difference between the 2 groups ( P>0.05). The operation time was (203.5±173.4) min and the blood loss (167.3±138.6) mL in the JeRP group, significantly more than those in the micro titanium plate group [(121.5±50.5) min and (98.4±57.2) mL] ( P<0.05). In the JeRP group, the preoperative LMD was (6.7±1.7) mm and the preoperative VAS score (6.8±1.0) points, significantly higher than the last follow-up values [(0.7±0.6) mm and (0.7±0.6) points] ( P<0.05). In the micro titanium plate group, the preoperative LMD was (6.6±1.5) mm and the preoperative VAS score (6.7±0.9) points, significantly higher than the last follow-up values [(0.9±0.6) mm and (0.8±0.7) points] ( P<0.05). However, there was no significant difference in the preoperative or the last follow-up comparison between the 2 groups ( P>0.05). Implant loosening was observed in one patient in the JeRP group while foreign body sensation in the throat was reported in one patient after operation in the micro titanium plate group. Conclusions:Both JeRP and micro titanium plate in the transoral single-segment fixation can lead to effective treatment of unstable atlas fractures. Compared with JeRP, the micro titanium plate can effectively shorten operation time and reduce blood loss due to its smaller size and lower incision.

Clinical characteristics in patients with persistent positive pharyngeal swab of omicron variant and analysis on nucleic acid testing of anal swabs / 中华危重病急救医学

Objective:To analyze the clinical characteristics in patients with persistent positive pharyngeal swab of 2019 novel coronavirus Omicron variant and results of nucleic acid testing of anal swabs to provide basis for prevention and control measures.Methods:This study included 93 patients whose pharyngeal swab nucleic acid test were persistent positive and admitted to the ward of Daping Hospital in the National Exhibition and Convention Center (Shanghai) Makeshift Hospital from May 1 to May 24, 2022. The gender, age, underlying diseases, vaccination status, clinical symptoms, interval between infection onset and anal sampling, length of hospital stay, the nucleic acid test result of pharyngeal swabs and anal swabs and the time turning negative were collected and analyzed.Results:The age of 93 patients ranged from 8 to 72 years old with a median of (46.0±16.0) years old. Among them, 30 cases (32.3%) were male and 63 cases (67.7%) were female. Sixty-five patients (69.9%) received 2-3 shots of vaccine, 2 patients (2.1%) received 1 shot, and 26 patients (28.0%) did not receive any vaccination. Twenty patients (21.5%) had underlying diseases, of which hypertension (13 cases, 14.0%) and type 2 diabetes mellitus (6 cases, 6.5%) were the most common. Twenty-four patients (25.8%) had asymptomatic infection and the rest (69 cases, 74.2%) had mild symptoms. Cough (50 cases, 53.8%) and sore throat (28 cases, 30.1%) were the most common clinical manifestations of the upper respiratory tract in these patients. Only 6 patients (6.5%) had gastrointestinal symptoms (including diarrhea in 5 patients and diarrhea with vomiting in 1 patient). Pharyngeal and anal swabs were collected simultaneously from all 93 patients at 8-16th days [(11.55±2.27) days] after 2019 novel coronavirus Omicron variant infection. The pharyngeal swabs were positive in 79 patients (85.0%) and the anal swabs were positive in 5 patients (5.4%). The time of pharyngeal swabs turning negative was (14.7±2.9) days, and that of anal swab turning positive was (14.2±1.9) days. The median length of hospital stay was (16.7±2.9) days.Conclusions:In patients with persistent positive nucleic acid of the 2019 novel coronavirus Omicron variant, there were more mild infection than asymptomatic. The upper respiratory tract symptoms such as cough and sore throat were the most. The likelihood of transmission of 2019 novel coronavirus Omicron variant through the digestive tract may be low. The correlation between gastrointestinal symptoms and 2019 novel coronavirus Omicron variant RNA in the digestive tract is uncertain.

Research progress on treatment of IgA nephropathy with Traditional Chinese Medicine therapeutic systems / 国际中医中药杂志

The clinical treatment of IgA nephropathy in Traditional Chinese Medicine (TCM) can be treated from theories of Sanjiao, pharynx and kidney, collateral disease and Shaoyang. The Sanjiao theory declaims to clear away damp heat through the whole process of treatment, the upper Jiao lightening the Qi, the middle Jiao clearing away damp heat, and the lower Jiao collecting astringency, strengthening the kidney and cooling blood. The theory of pharynx and kidney focuses on clearing away heat, detoxifying and making benefit of the pharynx, supplemented by tonifying the kidney and strengthening the spleen. In the treatment of collateral diseases, it is considered that the disease is caused by the external invasion of disease pathogens or the damage of the vein caused by the influence of evil Qi. The treatment should be combined with strengthening the right and eliminating evil, and paying attention to promote blood circulation and remove blood stasis. The disease is caused by pooring Qi mechanism of Sanjiao and evil invading Shaoyang. The above TCM systems showed different treatment, but they all improve symptoms, reduce urinary protein quantification, improve quality of life with less adverse events.

Scalp-nape acupuncture as adjuvant therapy for pharyngeal dysphagia of stroke at recovery stage: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the therapeutic effect of scalp-nape acupuncture for pharyngeal dysphagia of stroke at recovery stage on the basis of neuromuscular electrical stimulation (NMES) and rehabilitation training.@*METHODS@#A total of 42 patients with pharyngeal dysphagia of stroke at recovery stage were randomized into an observation group and a control group, 21 cases in each group. Conventional medical symptomatic treatment was given in both groups. NMES and rehabilitation training were adopted in the control group, 30 min for each one. On the basis of the treatment in the control group, scalp-nape acupuncture was given in the observation group, scalp acupuncture was applied at lower 2/5 of anterior and posterior oblique lines of parietal and temporal, nape acupuncture was applied at Fengchi (GB 20), Yiming (EX-HN 14), Gongxue (Extra), Zhiqiang (Extra), Tunyan (Extra), etc. The treatment was given once a day, 5 days a week for 3 weeks in both groups. Before and after treatment, the videofluoroscopic dysphagia scale (VDS) score, the Kubota water swallowing test grade, the functional oral intake scale (FOIS) grade and the swallowing quality of life (SWAL-QOL) score were observed in both groups.@*RESULTS@#After treatment, the VDS scores were decreased and the SWAL-QOL scores were increased compared before treatment (P<0.05), the Kubota water swallowing test grade and FOIS grade were improved compared before treatment (P<0.05) in both groups. The changes of VDS score and SWAL-QOL score, Kubota water swallowing test grade and FOIS grade in the observation group were superior to those in the control group (P<0.05).@*CONCLUSION@#Based on NMES and rehabilitation training, scalp-nape acupuncture can enhance the therapeutic effect on pharyngeal dysphagia of stroke at recovery stage, and improve the patients' swallowing function and quality of life.