Studies on efficacy of a bioabsorbable steroid-eluting sinus stent in the frontal sinus opening of chronic rhinosinusitis with nasal polyps / 中华耳鼻咽喉头颈外科杂志

Objective: To assess the efficacy of a bioabsorbable steroid-eluting sinus stent in improving surgical outcomes when placed in the frontal sinus ostium (FSO) following full endoscopic sinus surgery (ESS) in patients with whole group chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: Patients with whole group CRSwNP who had similar lesions on bilateral sinus between September 2019 and March 2020 in Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Changhai Hospital were chosen. Patients with CRSwNP who underwent extended ESS were randomly assigned to receive a steroid-eluting sinus stent in one FSO whereas the contralateral side received surgery alone. Endoscopic evaluations recorded at 30, 90 days postoperative were graded by an independent assessment panel to assess the need for interventions in the FSO. Semi-quantitative data with CT and endoscopic score were performed by rank sum test. The need for postoperative intervention and the patency rate of FSO were analyzed using the McNemar test. Results: Thirty-one patients with whole group CRSwNP met all eligible criteria, including 17 males and 14 females, with the age of (44.5±11.8) years(x¯±s). Stents were successfully placed in one FSO of all patients. At 30 days post-ESS, the assessment panel reported that steroid-eluting stents reduced the need for postoperative interventions by 41.0% (χ2=5.314,P=0.021), the need for oral steroid interventions by 40.0% (χ2=4.133,P=0.042) and the need for surgical interventions by 74.8% (χ2=4.292,P=0.038) compared to control sinuses with no stents. Clinical surgeons also reported greater diameter of FSO compared to control sinuses at 30 days post-ESS (74.2% vs 48.4%, χ2=4.351, P=0.037). These results at 90 days post-ESS were consistent with those at 30 days post-ESS. Conclusion: Bioabsorbable steroid-eluting sinus stents in the FSO can reduce polyp formation, adhesion, and the need for postoperative interventions in FSO of CRSwNP patients and improve the early postoperative outcomes.

Current Status of Antithrombotic Strategy for Elderly Patients With Atrial Fibrillation and Acute Coronary Syndrome After Stent Implantation in Beijing Area / 中国循环杂志

Objective: To investigate the current status of antithrombotic strategy for elderly patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) after stent implantation in Beijing area and to study the safety and efficacy of different therapeutic strategy. Methods: A total of 467 relevant patients were enrolled by re-travelling electronic medical records from 12 hospitals in Beijing area. The patients' mean age was (78.70±3.32) years and they were divided into 2 groups by antithrombotic therapy condition: Triple therapy group, n=17 (3.64％), Double therapy group, n=450 (96.36％). The incidence of major adverse cardiac and cerebral events (MACCE) including all-caused death, non-fatal myocardial infarction, stent thrombosis, target vessel revascularization (TVR), stoke and bleeding was compared between Triple therapy group and Double therapy group.Results: The medication in Double therapy group included aspirin+ticagrelor, aspirin+clopidogrel, clopidogrel+warfarin and cilostazol+clopidogrel; in Triple therapy group was aspirin+clopidogrel+warfarin. Patient with HAS-BLED score≥3 was defined as high risk of bleeding and they were all treated by double therapy; HAS-BLED<3 was defined as low risk of bleeding, only 5.03％ patients were treated by triple therapy. 3 patients in Triple therapy group and 33 in Double therapy group suffered from gastrointestinal bleeding, P=0.338; 6 patients in Triple therapy group and 128 in Double therapy group had MACCE, P=0.589; 3 and 80 patients died in Triple therapy group and Double therapy group, P=0.766. Conclusion: Triple therapy was rarely used in elderly AF and ACS patients after stent implantation, double therapy was the main strategy; the incidence of MACCE and mortality were similar between triple and double therapies; patients with triple therapy had the higher incidence of gastrointestinal bleeding.

Diagnosis of early ovarian cancer by combination use of tran svaginal color doppler sonography and HE4,CA125 detection / 上海预防医学

Objective To estimate the clinical value of diagnosing early ovarian cancer by using transvaginal color doppler sonography (TVCDS ) , combined with the levels of serum tumor markers HE 4 and CA125. Methods A total of 151 patients with adnexal masses admitted for elective surgery were selected .According to the postoperative pathologic results , they were divided into ovarian cancer group (group A, 48 cases) and ovarian benign lesions group (group B, 103 cases).All patients were examined by TVCDS and the determination of serum HE 4 and CA125 level before surgery . The results were compared with pathological diagnosis after surgery . Results Serum HE4 and CA125 levels of the patients in group A were higher than those in group B .TVCDS parameters S/D, PI and RI were significantly lower in group A than in group B .The accuracy , sensitivity , specificity , positive predictive value, negative predictive value of TVCDS and HE 4+CA125 in ovarian cancer diagnosis were 94 .70%, 93 .75%, 95 .15%, 90 .00%, 97 .03%, respectively .The values were higher than the value of the sepa -rate checks .Con clusion TVCDS combined determination of serum HE 4 and CA125 level is helpful to the improvement of clinical diagnosis in ovarian cancer .

Efficacy of early treatment on 52 patients with preneoplastic hepatitis B virus-associated hepatocellular carcinoma by compound Phyllanthus Urinaria L / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the change in the number of antibodies of preneoplastic hepatocellular carcinoma (HCC) using early treatment by Compound Phyllanthus Urinaria L. (CPUL) on patients with preneoplastic hepatitis B virus (HBV)-associated HCC.</p><p><b>METHODS</b>A total of 102 cirrhosis patients with regenerative or dysplastic nodules whose sera were tested positive for at least one of these six proteins (five up-regulated genes URG4, URG7, URG11, URG12 and URG19, and one down-regulated gene DRG2) were assigned randomly to two groups using continual random codes by SPSS software. Fifty-two patients were in the treatment group and 50 patients were in the control group. CPUL was used in the treatment group for 3 years, while the control group did not receive any treatment. The changes in HBV-DNA level, number of antibodies, and hepatocarcinogenesis occurred were observed. Patients who did not develop HCC were followed up for another 2 years.</p><p><b>RESULTS</b>HBV-DNA levels decreased ⩾2log in 22.2% (10/45) of patients in the treatment group in contrast to only 5.0% (2/40) of patients in the control group (P=0.0228). The number of antibodies that were tested positive in the treatment group (1.08±1.01) was significantly lower compared with the control group (2.11±1.12) after 24 months of drug treatment (P<0.01). Both the positive rates of anti-URG11 (33/52) and anti-URG19 (31/52) were over 60% at baseline in the two groups, and were decreased to 48.1% (25/52) and 46.2% (24/52) respectively at 36 months of drug treatment, while the rates increased to 68.0% (34/50) and 66.0% (33/50) respectively (P=0.0417, P=0.0436) in the control group. The positive rate of anti-DRG2 was increased to 55.8% (29/52) at 36 months of drug treatment, while in the control group was decreased to 36.0% (18/50, P=0.0452). Among the 102 patients who developed HCC, 2 were in the treatment group and 9 were in the control group, meaning that a significant difference between the two groups (P=0.0212). In 11 patients who developed HCC, anti-URG11 and anti-URG19 were always positive, while anti-DRG2 was negative. Patients newly developing HCC were 6 (20.0%) in the control group, and only one (2.5%) in the treatment group (P=0.0441) during 2-year follow-up after the end of the treatment.</p><p><b>CONCLUSIONS</b>Anti-URG11, anti-URG19 and anti-DRG2 could be used as early markers in the prediction of the therapeutic efficacy of CPUL in treating preneoplastic HCC. CPUL is useful in preventing or delaying the development of HBV-associated cirrhosis to HCC.</p>

Efficacy of ursodeoxycholic acid combined with Tongdan Decoction () on immunological indices and histopathological changes in primary biliary cirrhosis patients / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the efficacy of ursodeoxycholic acid (UDCA) combined with Tongdan: Decoction () on immunological indices and histopathological changes in patients with primary biliary cirrhosis (PBC) of IIor III histological stage.</p><p><b>METHODS</b>Sixty PBC patients were assigned randomly and equally: to the control group treated with UDCA alone and the treatment group treated with UDCA combined with Tongdan Decoction. The immunological indices and histopathological changes were detected before and after 24-week treatment, and the follow-up lasted for 1-3 years.</p><p><b>RESULTS</b>After 24-week treatment, CD4(+)CD28(-) in the peripheral blood was lowered and CD4(+)CD25(+) was increased in both groups, and better effect was shown in the treatment group (P<0.01). The levels of IgM, IgG, and IgA decreased markedly after 96-week treatment in the treatment group (P< 0.05, P< 0.01), while in the control group, only the latter two showed significant decrease after 148 week (all P<0.05). At the end of the 3-year follow-up, the medians of histopathological <inflammation grading and fibrosis staging declined to a lower rank, and the effect on inflammation was superior in the treatment group to the control group shown by non-parameters Wilcoxon paired symbols test ( Z=2.761,P=0.006).</p><p><b>CONCLUSION</b>Combined therapy of Tongdan Decoction and UDCA showed a better therapeutic effect: than UDCA monotherapy on PBC, especially in improving immunological indices and histopathological hepatic changes.</p>

The application of CT-DCG and 3D reconstruction in Patients with Asymptomatic Lacrimal flow and nasal structural abnomalities / 第二军医大学学报

Objective To explore the value of computed tomographic DacryocystographyCT-DCGand computed tomographic three-dimensional3Dreconstruction with lacrimal passages in asymptomatic lacrimal flow patients with nasal structural abnomalities. Method: In 2006-2010, 18 nasal structural abnomalities cases with asymptomatic lacrimal flow and nasal obstruction were enrolled, the lacrimal flow caused by ocular region was obviated. Of all the 18 hypertrophic inferior turbinate cases, there were 12 cases accompanied with nasal septum deviation. The radiofrequency ablation of inferior turbinate and nasal septum deviation surgery under nasaI endoscope were takenThe CT-DCG and 3D reconstruction examines were observed preoperative and postoperative. All the patients were followed-up for 12 months. Result: 18 nasal structural abnomalities were corrected. The nasal obstruction were recoveried and improved in 1477.8%and 422.2% cases respectively. The symptom of epiphora had disappeared and improved in 1372.2% and 5 cases27.8%. Partial obstruction of the internal ostium was found preoperative and resolved postoperative with CT-DCG and 3D reconstruction. Conclusion: CT-DCG and 3D reconstruction can evaluate the asymptomatic alterationsof the normal lacrimal outflow in cases with nasal structural abnomalities, suggesting that they have great value in clinical applications.

Combination of genioglossus advancement by non-trephine technic with uvulopalatopharyngoplasty for treatment of obstructive sleep apnea-hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and reliability of genioglossus advancement and hyoid suspension with non-trephine technic (GAHM) and uvulopalatopharyngoplasty (UPPP) for surgical obstructive sleep apnea-hypopnea syndrome treatment.</p><p><b>METHODS</b>Twenty-six patients (4 female and 22 male) were classified as moderate and severe cases in terms of apnea hypopnea index (AHI) and Friedman classification in the present study. All cases patients underwent genioglossus advancement and hyoid suspension with non-trephine technic Uvulopalatopharyngoplasty UPPP. Pre- and postoperative polysomnography and Epworth sleepiness scale were performed to assess the therapeutic outcomes.</p><p><b>RESULTS</b>The whole operation time ranged from 120-180 minutes. The average amount of bleeding in genioglossus advancement was about 50-100 ml. There were no severe complications during and after the operation. All the cases were followed up to one year. After surgery, AHI was decreased in both group cases, (42.9 +/- 6.6 vs 16.2 +/- 5.7) in the severe group, and 21.3 +/- 4.4 vs 11.3 +/- 5.2 (x(-) +/- s) in the moderate group. With success defined as AHI decreased by more than 50 per cent after surgery, the total success rate in moderate and severe group was 83.3% and 91.7%, respectively (P < 0.01). Furthermore, the success rate of the moderate group was higher than those of the severe group (P < 0.01).</p><p><b>CONCLUSION</b>GAHM combined with UPPP may be beneficial for the moderate and severe OSAHS patients with oropharyngeal and hypopharyngeal obstruction.</p>

Endonasal anatomy of lacrimal sac and its clinical significance in dacryocystorhinostomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the intranasal surface localization of the lacrimal sac in endoscopic dacryocystorhinostomy.</p><p><b>METHODS</b>Fifteen adult cadavers (30 sides) were studied, the data of projection position of the lacrimal sac on the lateral wall of nasal cavity were measured.</p><p><b>RESULTS</b>In 2/3 cadavers, the lacrimal sac is located above the axilla of the middle turbinate, and 1/3 lies below it. A majority of the lacrimal sac (2/3) are located below the entry point of the common lacrimal canaliculus, about 1/3 lies above it. Inner canthal ligament projects on the middle of the lacrimal sac, almost equal to the level of common lacrimal canaliculus. Thirty-two cases (thirty-nine sides) of chronic dacryocystitis were followed-up > 6 months after operation. Thirty-five sides were cured, 2 sides improved and 2 sides ineffective. The cure rate was 89.8%, improve rate 5.1% and ineffective rate 5.1%, respectively, and the total effective rate was 94.9%.</p><p><b>CONCLUSIONS</b>The central position of dacryocystorhinostomy should be 0.2 cm above the front of the axilla of the middle turbinate, to make an curved mucous membrane incision 0.8 cm above and 0. 4 cm below the front of the axilla of the middle turbinate and bone ostium about 1.2 cm x 1.0 cm. It is the best position in endoscopic dacryocystorhinostomy. Locating the inner canthal ligament with a bayonet type forceps to find the projection of lacrimal sac is also a simple and easy method.</p>