Transcranial Doppler ultrasound for assessment of dynamic cerebral autoregulation in patients with acute ischemic stroke / 国际脑血管病杂志

Transcranial Doppler (TCD) is a method for measuring cerebral artery blood flow velocity, which has the advantages of low cost, non-invasive, high temporal resolution. Dynamic cerebral autoregulation (dCA) is to study the instantaneous change of cerebral blood flow (CBF) at the moment of arterial blood pressure or intracranial pressure change, that is, the ability to recover CBF in the face of sudden change of perfusion pressure. After the onset of acute ischemic stroke (AIS), effective dCA can maintain the stability of cerebral hemodynamics and avoid excessive or insufficient perfusion at the injured site. Therefore, it is of great significance to evaluate dCA in patients with AIS. However, at present, there is no recognized optimal evaluation method for dCA. This article mainly summarizes the advantages of TCD in evaluating dCA compared with other methods and the application of TCD combined with transfer function analysis (TFA) in evaluating dCA in AIS.

PLOD2 expression and its prognosis in laryngeal cancer / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the relationship of the expression of PLOD2 protein in laryngeal carcinoma and the clinicopathological features of patients. METHODS The expression of PLOD2 in paraffin-embedded specimens of 114 patients with laryngeal carcinoma was detected by immunohistochemistry. The relationship between the expression of PLOD2 and clinicopathological features was analyzed by χ2 t est, s urvival a nalysis b y K aplan-Meier method, and multivariate analysis of Cox proportional hazard model. The fresh frozen specimens of 8 patients randomly selected from the patients were detected by realtime quantitative polymerase chain reaction and Western blotting for the expression of PLOD2 in tumor tissues and adjacent normal tissues. RESULTS PLOD2 protein was associated w ith c linical s tage a nd T s tage(P <0.05). The expression level of PLOD2 protein in laryngeal squamous cell carcinoma was higher than that in adjacent normal tissue(P <0.05). Kaplan-Meier survival analysis showed that low expression of PLOD2 was associated with patient survival rate(χ2=12.484, P <0.001). Multivariate Cox regression analysis showed that PLOD2 protein expression and M stage were independent risk factors for laryngeal cancer growth (P value, both <0.05). CONCLUSION The level of POLD2 protein expression was positively correlated with clinical stage and T stage. PLOD2 protein is an independent risk factor for the growth of laryngeal cancer. The higher the expression of PLOD2 protein, the lower the prognosis of patients. PLOD2 protein expression may play an important role in the growth and prognosis of laryngeal cancer, and may be a new molecular marker for judging the growth and prognosis of laryngeal cancer.

Clinical anatomic study on the segment and adjacent of tract of congenital pyriform sinus fistula / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the anatomic tract of congenital pyriform sinus fistula (CPSF).@*Methods@#A total of 90 patients with CPSF undergoing open surgery between August, 2007 and March, 2017 at the Department of Guangdong General Hospital were retrospectively analyzed.@*Results@#The tracts of all the fistulas actually walked far different from those of theoretical ones. A whole fistula may be divided into 4 segments according to adjacent anatomy of CPSF. The posterior inner segment to the thyroid cartilage was initial part of the fistula. It originated from the apex of pyriform sinus, then piercing out of the inferior constrictor of pharynx inferiorly near the inferior cornu of the thyroid cartilage (ICTC), and descended between the lateral branch of the superior laryngeal nerve and the recurrent laryngeal nerve. The ICTC segment was the second part of the fistula, firstly piercing out of the inferior constrictor of pharynx and/or cricothyroid muscle, and then entering into the upper pole of thyroid. The relationship between fistula and ICTC could be divided into three types: type A (medial inferior to ICTC) accounting for 42.2% (38/90); type B (penetrate ICTC) for 3.3% (3/90); and type C (lateral inferior to ICTC) for 54.5% (49/90). The internal segment in thyroid gland was the third part of fistula, walking into the thyroid gland and terminating at its upper pole (92.2%, 83/90) or deep cervical fascia near the upper pole of thyroid (7.8%, 7/90). The lateral inferior segment to thyroid gland was the last part of the fisula, most of which are iatrogenic pseudo fistula, and started from the lateral margin of thyroid gland.@*Conclusions@#CPSF has a complicated pathway. Recognition of the tract and adjacent anatomy of CPSF will facilitate the dissection and resection of CPSF in open surgery.

A relevant research of connections between the genetic susceptibility of Parkinson's disease and three single nucleotide polymorphisms in transmembrane protein 175, methylcrotonoyl-coenzyme A carboxylase 1 and alpha-synuclein in northern Chinese Han population / 中华神经科杂志

Objective To investigate if there were connections between sporadic Parkinson's disease (PD) and three single nucleotide polymorphisms (SNPs) in transmembrane protein 175 (TMEM175 rs34311866), methylcrotonoyl-coenzyme A carboxylase 1 ( MCCC1 rs12637471 ) and alpha-synuclein (SNCA rs356182) in Northern Chinese Han population , and provide basic data for PD genetic research. Methods The research recruited 310 sporadic PD patients in northern Chinese Han population from the Department of Neurology, the First Hospital of China Medical University between 2008 and 2012, and 339 controls without nervous system manifestations from other departments of the First Hospital of China Medical University during the same period.We applied cleaved amplification polymorphism sequence-tagged sites polymerase chain reaction-restriction fragment length polymorphism method to detect the genotype distributions of the SNPs in the northern Chinese Han population , and calculated relevance with PD of the SNPs by chi-square test.Results According to the data, the allele A of SNCA rs356182 had positive effects on the onset of PD in northern Chinese Han population compared with controls (patient group A%＝20.97%(130/620), control group A% ＝29.20%(198/678), χ2＝11.632, P＝0.001); allele G of MCCC1 rs12637471 (χ2＝0.009, P＝0.926) and allele C of TMEM175 rs34311866 (χ2＝1.369, P＝0.242) showed no significant differences between PD and control groups.Conclusion SNCA rs356182 was related with PD, and TMEM175 rs34311866 (M311Y) as well as MCCC1 rs12637471 showed no correlation with PD in the northern Chinese Han population.

Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies.@*Methods@#Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases.@*Results@#Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web.@*Conclusions@#CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.

Value of modified Killian′s method in diagnosis of congenital pyriform sinus fistula / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the feasibility and significance of modified Killian(MK) method in the clinical diagnosis of congenital pyriform sinus fistula(CPSF) by electronic laryngoscopy.@*Methods@#The following examinations were performed for 30 suspected cases of CPSF, including the traditional electronic laryngoscopy, MK examination(modified Killian position+ head rotation+ the Valsalva maneuver), barium swallow X-ray(BSX) and CT , and a prospective comparison among them were done. Patients were divided into two groups according to their age: young age group(≤14 years old) and older age group (>14 years old). The results of MK examination from the patients were analyzed and the positive diagnostic rates (PDR) between groups were compared by using χ2 tests.@*Results@#Sinuses in 20 of 30 patients were depicted from pyriform sinus in BSX, and the PDR was 66.7%(20/30). The PRD of CT was 83.3%(25/30). The presence of air bubbles around the upper lobe of the thyroid gland or at the inferomedial edge of cricothyroid joints, morphological changes of thyroid grand as well as pseudo-fistula formation on lower neck were detected clearly on CT. Comparing to the traditional electronic laryngoscopy, the effect of exposing piriform fossa fistula by MK examination is significant(χ2=17.05, P<0.05), with the PDR of 13.3%(4/30) and 76.7%(23/30) respectively. Nevertheless, comparing to BSX and CT, there were no statistically significant differences in the effect to diagnose CPSF (χ2=0.31, χ2=0.10 respectively, P>0.05). The PDR of MK in older group is significantly higher than younger group(χ2=6.68, P<0.05).@*Conclusions@#MK examination can clearly reveal the hypopharyngeal anatomical structure and detect the sinus of CPSF .It could be a safe, feasible, convenient and economical method as an application in preoperative diagnosis and follow-up examination of clinical suspected CPSF.

Pectoralis major myocutaneous flap in the application of the head and neck surgery / 实用医学杂志

Objective To summarize experience in pectoralis major myocutaneous (PMMC) flap reconstruction for patients undergoing head and neck surgeries. Methods We conducted a retrospective study to analyse the clinical data of 20 patients who had PMMC flap reconstruction in a head and neck surgery from March 2011 to June 2016. All patients were male,with the average age of 54 years(ranging from 27 to 71 years). The PMMC flaps of all patients survived after the surgery. Only one patient developed pharyngocutaneous fistula ,and was recovered after treatment with incision dressing. Among follow?ups for 2 to 24 months,all patients got well recovered,the swallowing and communication functions normal communication and the appearance a satisfactory. good looking. Conclusion PMMC renders effective flathe flap reconstruction with broad clinical application value is an optimal choice for patients underwent head and neck surgery with muscle or skin defect,especially for those who had postoperative radiotherapy because of its rich blood supply and it has a lot of affluent tissues,fmore flexibility inle application and higher survival rate. So it is highly applicable,especially for grass?roots hospitals.

Associations between serum thyroid-stimulating hormone levels and outcomes in patients with acute ischemic stroke / 国际脑血管病杂志

Objective To investigate the correlation between the serum thyroid-stimulating hormone levels and the outcomes in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke were enrolled prospectively.The general clinical data,vascular risk factors,and biochemical indexes including thyroid hormones were collected.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of baseline neurologic deficit.The modified Rankin Scale (mRS) was used to evaluate the neurological outcomes at day 90 after onset.The mRS 0-2 was defined as good outcome.Multivariate logistic regression analysis was used to identify the independent influencing factors of the poor outcomes in patients with acute ischemic stroke.Results A total of 140 patients with acute ischemic stroke were enrolled,including 95 men (67.86％) and 45 women (32.14％),aged 35-94 years old.Thirteen patients (9.29％)had subclinical hyperthyroidism and 17 (12.14％) had subclinical hypothyroidism.Ninety-eight patients (70.00％) had good outcome and 42 (30.00％) had poor outcome.The proportions of male (x2 =4.717,P =0.047) and small arterial occlusive stroke (x2 =5.564,P =0.018),as well as uric acid (t =2.602,P =0.010),FT3 (t =2.406,P=0.017),and TSH (t =2.302,P =0.023) in the good outcome group were significantly higher than those in the poor group (P =0.001);age (t =-3.489,P=0.001),fasting blood glucose (Z =-2.178,P =0.031),and baseline NIHSS score (t =-8.009,P ＜ 0.001) were significantly lower than those of poor outcome group.The proportion of patients with TSH in the first quartile (＜0.805 mU/L) in the good outcome group was significantly lower than that in the poor outcome group (17.35％ vs.42.86％;x2 =10.204,P =0.003,and that in the fourth quartile (＞ 2.476 mU/L) was significantly higher than the poor outcome group (30.61％ vs.11.90％;x2=5.488,P=0.002).Multivariate logistic regression analysis showed that after adjusting various confounding factors,the higher baseline NIHSS score was an independent risk factor for poor outcome at day 90 after onset (odds ratio,1.690,95％ confilence interval 1.317-2.168;P＜ 0.001),while the higher baseline TSH level was associated with good outcome (odds ratio,0.520,95％ confidence interval 0.408-0.867;P=0.007).Conclusions The higher serum TSH level was independently associated with good neurological outcome at day 90 after onset in patients with acute ischemic stroke.

Effect of acupuncture on macrophage polarization of white adipose tissue in obese mice induced by high-fat diet / 中国针灸

<p><b>OBJECTIVE</b>To observe the effect of acupuncture at acupoints and non-acupoints on macrophage polarization of white adipose tissue in obese mice induced by high-fat diet(HFD).</p><p><b>METHODS</b>Fifty male C57BL/6 mice were randomly divided into a control group (=10), and other mice were fed with HFD for 16 weeks to establish model. Thirty model mice, which were successfully established and continuously fed with HFD for 8 weeks, were randomized into a model group, a non-acupoint group and an acupuncture group (=10/group). The mice in the control group were continuously fed with common food for 8 weeks. From the second day after model established, the mice of the acupuncture group were treated with acupuncture at "Guanyuan" (CV 4), "Zusanli" (ST 36) and "Weiwanxiashu" (EX-B 3); the mice of the non-acupoint group were treated with acupuncture at two non-acupoints in tail, 15 min a time, once a day for 8 weeks. After model establishment and on the second day after the last acupuncture treatment, the body weight was recorded. The level of serum triglyceride (TG), total cholesterol (TC) in eye socket blood were measured. The morphological structure of epididymis white adipose tissue (eWAT) in mice was observed by hematoxylin and eosin (HE) staining. The mRNA expressions of interleukin-6 (IL-6), monocyte chemotactic protein 1 (MCP-1), tumor necrosis factor α (TNF-α), IL-10, inducible nitric oxide synthesis (iNOS), CD206 in eWAT of mice were determined with real-time quantitative PCR (RT-qPCR). The protein expressions of iNOS and CD206 in eWAT were determined with immunohistochemistry staining (IHC).</p><p><b>RESULTS</b>Compared with the control group, the body weight in the model, non-acupoint and acupuncture groups increased at the 16th and 24th weeks (all<0.05). Compared with the model group, the body weight of the acupuncture group at the 24th week decreased (<0.05). The serum TG and TC in the model group increased compared with those of the control group (both<0.05). The TC in the non-acupoint group decreased (<0.05), and the TG and TC in the acupuncture group decreased compared with those in the model group (both<0.05). Meanwhile, the mRNA expressions of MCP-1, TNF-α, IL-6 and iNOS in the model and non-acupoint groups increased compared with those in the control group (all<0.05), and the mRNA expressions of IL-10 and CD206 decreased (all<0.05). The mRNA expressions of MCP-1, TNF-α, IL-6 and iNOS in the acupuncture group were lower than those in the model group (all<0.05), and the mRNA expressions of IL-10 and CD206 were higher (both<0.05). HE staining showed alveolate adipose tissue in the control group with numbers of unilocular adipose cells, vacuolar polygon or circle. The adipose cells in the model group were larger and irregular with larger intercellular space. The adipose cells in the acupuncture group were minified with smaller intercellular space. Compared with those in the control group, the protein expressions of iNOS increased (both<0.05) and those of CD206 decreased (both<0.05) in the model and non-acupoint groups. Compared with those in the model group, the protein expression of iNOS decreased (<0.05) and that of CD206 increased (<0.05) in the acupuncture group.</p><p><b>CONCLUSION</b>Acupuncture can improve inflammation of obese mice through affecting macrophage polarization of white adipose tissue.</p>

Long term result of arytenoidectomy with CO₂ laser for dyspnoea in iatrogenic bilateral vocal fold paralysis patients / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the optimal time of tracheotomy/arytenoidectomy and the improvement of dyspnoea, dysphonia and dysphagia after arytenoidectomy with CO₂ laser in iatrogenic bilateral vocal folds paralysis patients. Method:Thirty patients [29 females, 56 (49-60) years, one male, 49 years] with bilateral vocal cords paralysis resulted from neck surgery were retrospectively analyzed by case archived information and following-up questionnaire. The data included patients' dysponea time, degree and duration from tracheotomy/arytenoidectomy to neck surgery. Twenty sixty patients required unilateral partial/total arytenoidectomy. The results of treatment were evaluated by questionnaire including dyspnoea, dysphonia and dysphagia. Result:All patients whose bilateral vocal paralysis were resulted from thyroid gland surgery. Dysponea occurred immediately after thyroidectomy surgery in 14 cases (46.7%), and 2 years later after thyroidectomy in 13 cases (43.3%), 8 years later in 3 cases (10.0%). There was one (3.3%) patient without tracheotomy. The duration of tracheotomy/arytenoidectomy to neck surgery was significantly correlated with duration of tracheotomy/arytenoidectomy to dyspnoea appearance (r=0.879, P<0.05), not correlated with duration of thyroid surgery to dyspnoea appearance. There is significantly negative correlation between degree of dyspnoea and duration of tracheotomy/arytenoidectomy to neck surgery (r=0.452, P<0.05). Twenty six patients appeared dyspnoea and underwent CO₂ laser arytenoidectomy after thyoidectomy 0.5-23 years. Five patients did unilateral total arytenoidectomy and 21 patients did unilateral partial arytenoidectomy. After 12-96 months following up, dyspnoea improved in 24 patients, no improved in 2 patients. Dysphonia improved and remained in 17 patients, being worse mildly in 8 patients and obviously in one patient. Dysphagia improved and remained in 24 patients, being worse in 2 patients. There was no difference between total and partial arytenoidectomy in dyspnoea, dysphonia and dysphagia. Conclusion:The morbidity of dyspnoea was correlated with time after neck surgery. It was rarely necessary to take tracheotomy immediately in bilateral vocal fords paralysis patients after neck surgery. The severer degree of dyspnoea led to shorter duration between neck surgery and tracheotomy/arytenoidectomy. There was obvious improvement after arytenoidectomy in dyspnoea, no significant change in dysphonia and dysphagia. The effect of total arytenoidectomy on bilateral vocal paralysis was similar to partial arytenoidectomy.

Comparative imaging studies of congenital pyriform sinus fistula / 中华放射学杂志

Objective To investigate the image features of congenital pyriform sinus fistula (CPSF). Methods We retrospectively analyzed the clinical features and preoperative images of 80 patients with confirmed diagnosis of CPSF by surgical and pathological outcome in Guangdong general hospital from January 2007 to December 2014. At least one of the following imaging examinations were performed for all the patients, including Barium swallow X-ray (BSX), CT and MRI. Among them, 63 patients were examined with BSX, while 42 patients underwent plain and enhanced CT scans, wherein 40 of them were exanimated shortly after BSX. Thirty-two patients underwent plain and enhanced MRI scans. Patients were divided into two groups according to their age, young age group (≤14 years old) and older age group (>14 years old). Furthermore, they were also grouped based on inflammatory or quiescent stage clinically. The images of BSX, CT, and MRI from the patients were analyzed and the positive diagnostic rates (PDR) between groups were compared by using χ2 tests. Results For the patients examined with BSX, sinuses in 35 of 63 were depicted from pyriform and fistulas in 9 of 63 were depicted from the pyriform. The overall PDR of BSX was 74.6%(47/63),wherein 46.2%(12/26)in young age group , 94.6%(35/37)in older age group, 52.9%(9/17) in inflammatory stage group ,and 82.6%(38/46)in quiescent stage group. The inter-group differences were statistically significant (χ2 were 18.911 and 5.766,both P0.05).Conclusions BSX could be a screening method for suspected cases of CPSF in quiescent stage. However, the PDR could be affected by many factors (age and inflammation). CT and MRI could provide valuable information for diagnosis. An examination combined BSX and CT is preferred to improve the positive detective rate of CPSF.

Subclinical thyroid diseases and the risks or outcomes of ischemic stroke / 国际脑血管病杂志

Subclinical thyroid dysfunction including subclinical hypothyroidism and subclinical hyperthyroidism, subclinical hypothyroidism is more common in the general population. Subclinical thyroid dysfunction may increase the incidence of risk factors of stroke, like hypertension, diabetes melitus, dyslipidemia, atherosclerosis, atrial fibrilation, homocysteinemia and so on. Subclinical thyroid dysfunction may be associated w ith the outcomes in patients after acute ischemic stroke.

Stimuli phrases of adductor spasmodic dysphonia phonatory break in mandarin Chinese / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the characteristics of adductor spasmodic dysphonia phonatory break in mandarin Chinese and select the stimuli phrases.@*METHOD@#Thirty-eight patients with adductor spasmodic dysphonia were involved in this study. Standard phrase " fù mŭ xīn" and a speech corpus in mandarin Chinese with 229 syllables covering all vowel and constant of mandarin Chinese were selected. Every patient read the phrases above twice in normal speed and comfortable voice. Two auditory perpetual speech pathologists marked phonatory break syllables respectively. The frequency of phonatory break syllables and their located phrases were calculated, rated and described. The phrases including the most phonatory break syllables were selected as stimuli phrases, the phonatory break frequency of which was also higher than that of standard phrase "fù mŭ xīn".@*RESULT@#Phonatory break happened in the reading of all patients. The average number of phonatory break syllables was 14 (3-33). Phonatroy break occurred when saying 177 (77.3%) syllables in the speech corpus. The syllables "guŏ, rén, zāng, diàn, chē, gè, guăn, a, bā, ne, de" broke in 23.1%-41.0% patients. These syllables belonged to the phrases "pĭng guŏ, huŏ chē, shì de, nĭ shì gè hăo rén, wŏ mén shì yŏu zŏng shì bă qĭn shì nong dé hĕn zāng, wŏ mén nà biān yŏu wăng qiú yùn dong chăng, cān gŭan, jiŭ bā hé yī gè miàn bāo dìan, tā shì duō me kāng kăi a,wŏ yīng gāi zài xìn lĭ xiĕ yī xiē shén mē ne?". Thirty-seven patients (97.3%) had phonatory break in above mentioned words. Ratios of these words phonatory break also were more than "fù mŭ xīn".@*CONCLUSION@#Adductor spasmodic dysphonic patients exhibited different degrees of phonatory break in mandarine Chinese. The phrases" shì de, pĭng guŏ, huŏ chē, nĭ shì gè hăo rén, wŏ mén nà biān yŏu wăng qiú yùn dong chăng, cān gŭan, jiŭ bā hé yī gè miàn bāo dìan, tā shì duō me kāng kăi a" were recommended as stimuli phrases for adductor spasmodic dysphonia evaluation.

The clinical application of modified rhytidectomy incision in superficial parotid tumor surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the modified rhytidectomy incision in superficial parotidectomy.@*METHOD@#Thirty-five patients with superficial parotid tumor were included in this study. A modified rhytidectomy incision often used in facial plastic surgery was used for superficial parotidectomy and subtotal superficial parotidectomy with preservation of facial nerve and great auricular nerve. The follow-up study included the exposed region, the cosmetic effect of this approach and the rate of complication.@*RESULT@#All patients healed without salivary fistula, and were satisfied with this modified approach. Temporary paralysis of the marginal mandibular branch of facial nerve were found in five patients, and six patients felt insensible around earlobe after operation. They all recovered in 1 to 3 months after surgery, no recurrence was happened during follow-up in 36 to 60 months (median follow-up period was 48 months).@*CONCLUSION@#The modified rhytidectomy incision provided good exposure, had less complication and better cosmetic outcome.

Endoscope-assisted superficial parotidectomy via retroauricular hairline approach: anatomical study / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To provide anantomical basis for the endoscope-assisted partial superficial parotidectomy via retroauricular hairline approach (EASPRHA) and assess its feasibility and safety.@*METHOD@#The surgical anatomy of retroauricular hairline region and parotid gland region were observed in 15 fresh human cadavers (30 halves). The EASPRHA was performed on 5 human cadavers (10 halves). After the procedure, the related vascular and neural structures were evaluated.@*RESULT@#The retroauricular hairline region extends between superficial musculoaponeurotic system and superficial cervical fascia. On the superficial surface of the upper sternocleidomastoid lie the lesser occipital nerve, the great auricular nerve and the external jugular vein. The bifurcation of great auricular nerve is(22.85 ± 2.01) mm from the bottom of earlobe. The parotid gland region extends between parotidomassteric fascia and parotid gland parenchyma. The facial nerve emerging from the stylomastoid foramen runs across the superficial surface of base of styloid process, passes through the interspace between cartilage of external acoustic meatus and posterior belly of digastric muscle, and enters the parotid gland. The bifurcation of facial nerve trunk is (19.10 ± 3.10)mm from the mastoidale and (39.49 ± 5.78) mm from the mandibular angle. Above the posterior belly of digastric muscle, the posterior auricular artery arises from the posterior wall of the external carotid artery with its main stem running over the superficial surface of facial nerve trunk. In all endoscope-assisted operations, the partial superficial parotidectomy was successful without the need for an additional incision. No major neurovascular damage wasobserved.@*CONCLUSION@#A thorough knowledge of the surgical anatomy of retroauricular hairline region and parotid gland region is an essential requirement in performing the safe and feasible EASPRHA.

Preliminary experiences of endoscopic CO₂ laser cauterization for treatment of congenital pyriform sinus fistula / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of endoscopic CO₂ laser cauterization (ECLC) as a definitive treatment of congenital pyriform sinus fistula (CPSF).</p><p><b>METHODS</b>Eleven patients with CPSF underwent ECLC between January 2011 to March 2013 at Guangdong General Hospital. Of the 11 patients aging from 20 to 672 months (median: 60 months), there were 4 males and 7 females; 10 lesions located in the left necks and 1 located in the right; 6 untreated previously and 5 recurrent; 10 sinus (with internal opening) and 1 fistula. The presentations included reduplicative neck swelling, pain, or a fistulous opening with purulent discharge at the anterior neck region. Preoperative examinations included barium esophagogram, CT, MRI and so on. Six patients had at least received one time incision and drainage procedure previously. All patients had been treated with antibiotics in acute infection period. After inflammation subsided, the openings of pyriform sinus fistula were confirmed by esophagoscopy and then ECLC on internal opening was routinely performed.Esophagoscopy was carried out again by 3 months later in every patient, the same technique would be performed immediately if the internal opening was not completely closed.</p><p><b>RESULTS</b>The existence of an orifice in the pyriform fossa was identified by esophagoscopy in 11 patients. In 9 patients, the treatment was successful and the internal opening completely closed after the first ECLC. However, the other 2 patients received the second cauterization 3 months later because of the incomplete close of the internal opening. The average number of treatments was 1.2 times. No complications such as dysphagia, hoarseness occurred with the endoscopic procedure. Both the patients and their families were satisfied with the cervical appearance. All the patients had an uneventful recovery and remained no symptom from 11 to 35 months (median: 24 months).</p><p><b>CONCLUSION</b>The endoscopic CO₂ laser cauterization is safe, effective, repeatable and minimally invasive, which can be suggested as first-line treatment for congenital pyriform sinus fistula.</p>

Meta-analysis on the risk factors for stomal recurrence after total laryngectomy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the risk factors of stomal recurrence in patients after total laryngectomy.@*METHOD@#A thorough literature search was performed among Wanfang database, Chinese Scientific Journals Database of VIP and pubmed database. Meta analysis was performed on a total of 2725 patients in 2 Chinese papers and 6 English papers which met the inclusion criteria. Data was analyzed by RevMan 5.0 software.@*RESULT@#Subglottic and transglottic location (tumor location), the extent of the tumor of the primary site (T4), preoperative tracheotomy were important risk factors of recurrence after total laryngectomy.@*CONCLUSION@#Subglottic and transglottic location (tumor location), the extent of the tumor of the primary site (T4), preoperative tracheotomy were related to stomal recurrence after total laryngectomy.

The surgical treatment effect on upper airway in treating refractory hypertension accompanied with OSAHS / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical treatment effect of refractory hypertension accompanied with OSAHS by surgery on upper airway.@*METHOD@#Thirty-two patients were enrolled in our research. PSG and blood pressure were examined on preoperation and 6th month, 1 year, 2 year of postoperation.@*RESULT@#The AHI and the time of SaO2 < 90% were lower significantly, and LSaO2 was improved (P < 0.01). The blood pressures of 32 patients were decreased.@*CONCLUSION@#The operation on upper airway could improve the hypertension of patient with OSAHS effectively.

The configuration of soft palate muscular phenotype in obstructive sleep apnea hypopnea syndrome / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the mRNA expression of muscle phenotype and collagen of soft palate and pathology in obstructive sleep apnea hypopnea syndrome (OSAHS).@*METHOD@#We used the Real-time PCR to test the mRNA expression of soft palate muscle myosin heavy chain (MyHC) phenotype and collagen in 12 OSAHS patients and 8 control patients. We also distinguished the muscle isoforms I , II with ATPase staining, then counted the numbers of isoforms muscle fiber.@*RESULT@#The mRNA expression of OSAHS group was more than control group in II A MyHC phenotype (P<0.01). The number of OSAHS group muscle fibre I isoform was less than control group with pH4. 3 ATPase staining (P<0.05).@*CONCLUSION@#Compare to control group, the enhancement happened in the mRNA expression of II A MyHC phenotype which can increase the velocity and power but de crease the enduring quality of muscle in OSAHS, and the reduce be in the I MyHC isoform of muscle fiber that can cause muscle velocity become slower and persistency become longer in OSAHS patients.

Selective neck dissection for treating recurrent branchial anomalies / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the role of selective neck dissection in the treatment of recurrent branchial anomalies.@*METHOD@#The clinical data of 18 patients with recurrent branchial anomalies were retrospectively analyzed. In accordance with the embryologic and anatomic features of branchial anomalies, different types of selective neck dissection were applied. With dissection and protection of important vessels, nerves and other structures, enbloc resection principles were applied to extirpate branchial lesions, scarrings and inflammatory granuloma during the operation.@*RESULT@#Of all 18 patients, 16 cases were healed with primary healing, 2 cases with local incision infection were healed after dressing changes. A temporary facial nerve paralysis occurred in 1 case with recurrent first branchial cleft fistula postoperatively, and completely recovered 2 months after operation. A postoperative temporary vocal cord paralysis occurred in 1 case with recurrent fourth branchial cleft fistula, and totally recuperated 1 month after operation. No recurrences were found in all 18 cases with a follow-up period of 12-78 months (average 35 months).@*CONCLUSION@#Selective neck dissection is a safe and effective surgical procedure for the radical treatment of recurrent branchial anomalies.