Analysis of efficacy and prognosis of neoadjuvant chemotherapy and （or） surgery plus radiotherapy for hypopharyngeal squamous cell carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the risk factors that affect the prognosis of patients with hypopharyngeal squamous cell carcinoma（HPSCC） and to compare the efficacy of surgical resection followed by adjuvant radiotherapy（SR） with that of neoadjuvant therapy consisting of platinum-based chemotherapy and fluorouracil combined with either cetuximab or nimotuzumab, followed by SR. The study also aimed to evaluate the overall survival（OS） of patients, their postoperative eating function, tracheostomy decannulation rate, and tumor response to the two neoadjuvant chemotherapies. Methods:A retrospective analysis was performed on the medical records of HPSCC patients who received SR or neoadjuvant therapy followed by SR treatment at the Shanghai General Hospital from 2012 to 2019 and had not undergone any prior treatment. The prognostic factors were analyzed, and the survival analysis of patients who underwent SR treatment with two neoadjuvant chemotherapy regimens was performed. Results:A total of 108 patients were included in the study. The results of the univariate analysis showed that gender（P=0.850） had no significant correlation with the survival rate of HPSCC patients who underwent SR. However, age, smoking history, alcohol consumption history, platelet-to-lymphocyte ratio（PLR）, neutrophil-to-lymphocyte ratio（NLR）, T stage, N stage, neoadjuvant therapy with either cetuximab or nimotuzumab combined with platinum-based chemotherapy and fluorouracil, and histological grade were significantly associated with prognosis（P<0.05）. The multivariate analysis revealed that smoking history, histological grade, and neoadjuvant therapy with either cetuximab or nimotuzumab combined with platinum-based chemotherapy and fluorouracil were independent risk factors affecting the prognosis of HPSCC（P<0.05）. Patients who received neoadjuvant therapy had longer OS than those who underwent SR only（P<0.001）. There was no significant difference in tumor response to the two neoadjuvant therapies and in OS（P>0.05）, and there was no significant difference in the rate of oral feeding and tracheostomy decannulation among the three treatment groups（P>0.05）. Conclusion:Univariate analysis showed that age at tumor onset, smoking history, alcohol consumption history, NLR, PLR, T stage, N stage, whether receiving neoadjuvant chemotherapy, and pathological grade were associated with the prognosis of HPSCC patients receiving SR treatment. Multivariate analysis showed that smoking history, pathological grade, and neoadjuvant chemotherapy were independent risk factors affecting the prognosis. Neoadjuvant chemotherapy with cetuximab or nimotuzumab can prolong the OS of patients, providing a certain basis and reference for the treatment of HPSCC.

Efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS):a multicenter randomized controlled trial / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the therapeutic efficacy of Han-uvulopalatopharyngoplasty (HUPPP) combined with radiofrequency ablation of tongue base or HUPPP with traction of tongue base on moderate to severe patients with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: This is a multicenter randomized controlled trial. From March 2017 to July 2019, moderate to severe OSAHS patients from three clinical center in Shanghai who were intolerant to continuous positive airway pressure (CPAP) and with velopharyngeal and glossopharyngeal plane obstruction were enrolled in this study. According to the surgical type, they were 1∶1 randomized to HUPPP plus radiofrequency ablation of tongue base group (Ablation group) or HUPPP plus traction of tongue base group (Traction group). All patients completed over-night standard Polysomnography (PSG), upper-airway assessment (Friedman classification, Müller test, CT and cephalometric examination), preoperative routine examination, Epworth Sleepiness Scale (ESS) and Quebec sleep questionnaire (QSQ). Six to 12 months after operation, all the above-mentioned examinations were repeatedly performed. Changes of aforementioned variables before and after operation were assessed. Results: A total of 43 patients with moderate to severe OSAHS were enrolled in this study. One patient lost to follow-up, the remaining 21 were allocated to Ablation group and 21 were allocated to Traction group. The total therapeutic efficacy of all patients was 69.05% (61.90% in Ablation group and 76.19% in Traction group), but there was no statistical significance between the two groups (P= 0.317). The value of sleep scale score (ESS and QSQ), objective sleep variables (apnea-hypopnea index, oxygen saturation, percentage of time with blood oxygen less than 90% in total sleep time, oxygen desaturation index and micro-arousals) and upper airway cross-sectional area (palatopharyngeal and retrolingual area) of the two groups were improved (P<0.05), but the differences between the two groups were not statistically significant (P>0.05). Conclusion: For moderate to severe OSAHS who had glossopharyngeal plane obstruction, both HUPPP plus radiofrequency ablation of tongue base or HUPPP plus traction of tongue base are effective treatment for OSAHS, and the curative effect is similar. The choice of surgical type could be selected according to patient's or surgical conditions.

Expression and clinical pathological implications of carbonic anhydrase 9 and P glycoprotein in laryngeal squamous cell carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To identify the difference of CA IX and P-gp expression level between laryngeal squamous cell carcinoma (LSCC) and benign tissues, evaluate the relationship of these two proteins in LSCC, and their correlation with clinical and pathological features.@*METHOD@#Immunohistochemical detection of CA IX and P-gp were performed in 47 cases of LSCC and 20 cases of vocal cord polyps.@*RESULT@#Overexpression of CA IX and P-gp both in LSCC and in vocal cord polyp (P < 0.05) were confirmed, with a correlation between the two proteins in LSCC (r = 0.324, P < 0.05). The expression of CA IX was related to clinical staging and lymph node metastasis in LSCC (P < 0.05). While P-gp was related to clinical staging and histological grading in LSCC (P < 0.05).@*CONCLUSION@#The overexpression of CA IX and P-gp may play a role in LSCC progression.

The effect of MDR1 (P-gp) and ABCG2 on the drug resistance in Hep 2 cells / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the effect of MDR1 (P-gp) and ABCG2 on the drug resistance in Hep 2 cells.@*METHOD@#Flow cytometry was used to detect the variations of the antitumor drugs accumulation and discharging, and activity variations when MDR1 and ABCG2 inhibitors were used in Hep-2.@*RESULT@#The accumulation and discharging of mitoxantrone was significantly higher than the control group when ABCG2 inhibitor FTC was used in Hep-2 (P<0. 05). In contrast, P-gp did not appear similar case; To the mitoxantrone and cisplatin, there was no statistical correlation about activity of Hep-2 between P-gp or ABCG2 antagonist and the control; To the doxorubicin, combining FTC and P-gp, the activity of Hep-2 was higher than the control and difference was significant (P<. 05), In contrast, FTC and P-gp did not appear similar case when used alone; To the 5-FU, when PGP used, the activity of Hep-2 was higher than that in the control and difference was significant (P<0. 05), In con- trast, FTC and FTC+P-gp did not appear similar case; To the paclitaxel, when P-gp or FTC+P-gp used, the activity of Hep-2 was higher than that in the control and difference was significant(P<0. 05).@*CONCLUSION@#ABCG2 may lead to drug resistance mainly by changing the ability of cell in accumulating and discharging chemotherapy drugs. P-gp has other way. P-gp and ABCG2 play different roles in different drug resistance.

Academic features of tuina for children in western Hunan district / 中国针灸

Through the experiences in the clinical application of Liu Kai-yun's five-meridian theory of Tuina for children and consulting the relevant literatures, the following academic features of Tuina for children in western Hunan district are summarized in this paper: selecting the acupoints according to the pattern/syndrome differentiation and giving the treatment according to the meridian tropism theory; emphasizing the property of the body constitution and applying the reinforcing and reducing techniques; exquisitely combining the acupoints based on the five-meridian theory; coordinating the opening and closing techniques and regulating yin and yang. All of those provided the reference for the theoretic application of this Tuina school.

Deviation index of eye and mouth on peripheral facial paralysis / 中国针灸

Differences of some points, levels and angles of the healthy and affected sides of patients with peripheral facial paralysis were picked out according to photographs. Through analysis of the index between the healthy and affected side of the patients and the difference between healthy people and patients, it is approved that those special points, levels and angles, which are called as deviation index of eye and mouth, can evaluate peripheral facial paralysis objectively and judge the degree of deviation. Therefore, it provides references for the diagnosis of facial paralysis and its degree judgement.

Feasibility of staged allogeneic larynx transplantation in dogs / 中国组织工程研究

BACKGROUND: The key to success in laryngeal transplantation is to control the infection. In practice, how to minimize the risk of infection should be considered first, so that the laryngeal allograft can survive after revascularization under the immunosuppressive state. Then the therapeutics methods should be focused on the functional recovery of respiratory, swallowing and phonation.OBJECTIVE: To explore the feasibility of staged allogeneic larynx transplant for dogs in order to decrease the infection rate.METHODS: Ten male conspecific Beagle dogs were assigned into five pairs of donor and receptor according to body mass and the size of larynx. The allogeneic larynx was embedded under the neck skin by allotransplantation. The dogs were treated with immunosuppressant daily to resist immnological rejection. The pharynx and trachea were contraposed after larynx survived to establishⅡstage laryngeal transplantation animal model.RESULTS AND CONCLUSION: InⅠstage of laryngeal transplantation, the laryngeal allograft survived well, blood supply was passable. Receptor dog 1 with vertical midline incision in the neck, receptor dogs 4 and 5 with transverse incisions in the neck grew well. No infection phenomena was found in receptor dogs 4 and 5. The lastⅡstage laryngeal transplantation was performed in the 4th week afterⅠstage laryngeal transplantation. Skin flap necrosis occurred in receptor dogs 2 and 3 with U-shape incisions. The donor larynx had different degree infection. Laryngeal allograft of receptor dog 2 died; laryngeal allograft of receptor dog 3 survived after treatment. The survival period of donor larynx in receptors was as long as 4 weeks. These findings indicate that the larynx infection is avoid or reduced by staged larynx transplantation with pre-embed laryngeal allograft after total laryngectomy. The receptor dog is tolerant; the donor larynx is easy to survive. The main histological change occurs in the epithelial mucosae which can be used as an inspect index of immunosuppressive agents. However, glandular organ secretion is a troublesome problem and immunodepressant must be continuously administrated for a long time.

Surgical treatment for severe stenosis of esophageal access / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the surgical management for the severe stenosis of peripheral esophageal access.@*METHOD@#Twenty-three patients who underwent severe stenosis of peripheral esophageal access from 2000 to 2009, were retrospectively reviewed. The surgical plan was selected by considering the stage of stenosis, dilatation, reconstruction of hypopharynx, oesophagus or larynx.@*RESULT@#Twenty-two patients resumed a normal oral diet and 21 cases succeeded in decannulation, no stenosis recurred after a 1-9 years follow-up.@*CONCLUSION@#The severe stenosis of peripheral esophageal access can get good results when the appropriate surgical plan were choice.

Treatment of allergic rhinitis with nasal mometasone furoate / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of nasal mometasone furoate on moderate to severe allergic rhinitis.</p><p><b>METHODS</b>Patients with moderate to severe allergic rhinitis were enrolled and received mometasone furoate nasal spray 200 microg once daily for four weeks. Four hundreds and sixty-three patients completed the study. We weekly interviewed the patients to evaluate the symptoms, and the affection of disease on night sleep and daily life. Mini Rhinoconjunctivitis Quality of Life Questionnaire (Mini-RQLQ) and Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ) were used to evaluate the quality of life.</p><p><b>RESULTS</b>The individual and total symptomatic scores of week 1, week 2 and week 4 decreased compared with baseline. The scores of Mini-RQLQ and NRQLQ of week 1, week 2 and week 4 decreased compared with baseline too. The scores of the next visit were significantly lower than those of the previous visit (P < 0.01).</p><p><b>CONCLUSIONS</b>A four-week administration of mometasone furoate nasal spray can effectively treat allergic rhinitis.</p>

Expression and clinical significance of hypoxia-inducible factor-1alpha and cyclooxygenase-2 in laryngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of hypoxia-inducible factor-1alpha (HIF-1alpha) and cyclooxygenase-2 (COX-2) in laryngeal squamous cell carcinoma (LSCC), while determine their relationship with clinicopathologic characteristics and prognosis.</p><p><b>METHODS</b>Tumor tissues were obtained from 60 patients who underwent resection of laryngeal carcinoma in Affiliated First People's Hospital of Shanghai Jiaotong University. Immunohistochemistry (Envision DAKO) was used to detect the expressions of HIF-1alpha and COX-2 in the tumor tissues. As control group, 15 cases of atypical hyperplasia, 10 cases of leukoplakia of vocal cord and 10 cases of polyp of vocal cord were studied. All patients were regularly followed up and the clinical data were collected systematically.</p><p><b>RESULTS</b>Positive staining rates of HIF-1alpha and COX-2 were 95.0% (57/60) and 98.3% (59/60), respectively in all 60 specimen of LSCC. The positive expressions in LSCC were significantly higher than those in atypical hyperplasia, leukoplakia and polyp of vocal cord ( Fisher's exact test, P < 0.01). The expression of HIF-1alpha was correlated with COX-2 in LSCC (r = 0.526, P < 0.01). High level expressions of HIF-1alpha and COX-2 were 35.0% (21/60) and 38.3% (23/60) respectively. High level expression of HIF-1alpha was significantly correlated with clinical stages (chi2 = 4.331, P < 0.05) and lymph nodes metastases (Fisher's exact test, P < 0.05). High level expression of COX-2 was significantly correlated with clinical stage (chi2 = 8.539, P < 0.01) and T stages (chi2 = 6.792, P < 0.01). With univariate analysis, high level expressions of HIF-1alpha and COX-2 were significantly associated with a worse overall survival (chi2 = 6.003, P < 0.05 and chi2 = 9.489, P < 0.01, respectively) and disease-free survival (chi2 = 5.010, P < 0.05 and chi2 = 6.102, P < 0.05, respectively). With multivariate analysis, recurrence and high level expression of COX-2 were two unfavorable prognostic factors (RR = 7.104, P = 0.003; RR = 5.714, P = 0.008).</p><p><b>CONCLUSIONS</b>The expressions of HIF-1alpha and COX-2 played an important role in the process of tumorigenesis and development of LSCC, The expression of HIF-1alpha was correlated with COX-2 in LSCC. COX-2 and recurrence were probably significant risk factors for prognosis of LSCC.</p>

The significance of anastomosing the recurrent laryngeal nerve in the thyroidectomy / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the advantage of exposure recurrent laryngeal nerve (RLN) in thyroid surgery and to detect the methods of avoiding nerve damage.@*METHOD@#Two hundred and thirty thyroidectomy cases were studied from June 2003 to May 2006 retrospectively. One hundred and nine cases were operated with total lobectomies, 59 cases with lobectomies and gorge gland, 44 cases with subtotal thyroidectomy, 18 cases with total thyroidectomy. RLN were exposed during operation and vocal cord were supervised before and after surgery by laryngoscope.@*RESULT@#Two hundred and ninety-two RLNs were exposed including 156 of right and 136 of left, and 134 nerves gone along the tracheoesophageal groove and 158 deviated it. One hundred and ninety-seven (67.5%) gone under the artery and 60 up (20.5%), 24 (8.2%) through two artery branches, and the nerve branch across the artery branch were 11(3.8%). One hundred and eighty-five (63.4%) RLNs had branches into laryngeal, 107 (36.6%) RLNs had no branches. Eight cases came with hoarseness postoperatively, seven cases recovered, one improved for the other vocal cord surpassed compensation after 6 months.@*CONCLUSION@#Anastomosing the recurrent laryngeal nerve in the thyroidectomy was available and could protect RLN.

Application of pectoralis major flap to reconstruction of massive defects after head and neck tumor excision / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To discuss the effectiveness and advantage of application of pectoralis major flap in the reconstruction of massive defects after head and neck tumor excision.@*METHOD@#Thirteen patients with head and neck carcinoma underwent tumor excision, and the massive defects were fixed by pectoralis major myocutaneous flap. Ten patients with recurrent laryngeal carcinoma and 2 with hypopharyngeal carcinoma and 1 with thyroid carcinoma were included.@*RESULT@#Eleven cases healed well, 1 case appearance fistula of parotid gland, 1 case was lost to follow-up.@*CONCLUSION@#Pectoralis major myocutaneous flap with adequate vascularization, enough tissue and ideal healing ability cab be used to reconstruct massive defects. And so it can play an important role in providing a better life expectancy and can radically cure or relieve the complaint.

The building of multiple drug resistant human laryngeal cancer cell line and its characteristics / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To build the multiple drug resistant human laryngeal cancer cell line and investigate its characteristics.@*METHOD@#Human laryngeal cancer cells were exposed in stepwise escalating concentration of Taxol until the resistant cell line was developed. The IC50 and the resistance folds of multidrug resistance were detected by an ATP assay. The differences of cell cycle distribution, apoptosis, and Rhodamine accumulation between Hep-2 and Hep-2T cells were studied through flow cytometry. The MDR1 and MRP1 gene were detected through realtime quantitative RT-PCR, and the corresponding protein was detected through western-blotting.@*RESULT@#A multidrug resistance cell line-Hep-2T induced by Taxol was effectively developed, whose drug resistance was 104 times that of Hep-2 cells. Doxorubicin, Gemcitabine, 5-Fu, Cisplatin all increased the drug resistance by 46.78, 1.95, 2.50, 1.05 folds. The cell cycle distribution altered. The apoptosis of Hep-2 cells was quite greater than that of Hep-2T cells (45.32% vs 4.26%, P < 0.01, flow cytometry), (54.47 +/- 48.95 vs 9.84 +/- 12.53 P < 0.01, hoechst staining) after Hep-2 and Hep-2T exposed to Taxol at IC50 to Hep-2. The copy ratio of MDR1/GAPDH mRNA of Hep-2T was 64.2 +/- 36.7 times that of Hep-2 (P < 0.05), while MRP1/GAPDH of Hep-2T was only 1.20 +/- 0.09 folds more than that of Hep-2 (P < 0.05). The proteins of MDR1/P-gp were greatly over expressed in Hep-2T cells compared with Hep-2 cells (P < 0.01) whose was in the same trend (P < 0.05), while the elevated expression of MRP1 was lower than that of MDR1/P-gp.@*CONCLUSION@#When considering the possible methods to reverse MDR of SCCHN, more emphasis should be laid on MDR1/P-gp, and when combining this with chemotherapy the non-P-gp substrate chemotherapeutic agents should be considered. At the same time, more attention should be paid to the changes of cell cycle distribution during the drug selection.

The application of diethylstilbestrol injection in perforation of nasal septum / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the repairing effect of ] diethylstilbestrol injection in mucosa injury of nasal septum.@*METHOD@#11 cases with perforation of nasal septum were made about 1-2 mm new wound surface around perforation, the cotton piece infiltrated by diethylstilbestrol injection was closed directly to the surface of perforation when the diameter of perforations not more than 8mm, xenoma and auto ethmoid bone were used before using cotton piece infiltrated by diethylstilbestrol injection when the diameter of perforations more than 8mm.@*RESULT@#Eleven cases of perforation were cured, the symptoms disappear gradually. There is no reperforation during follow-up six months. There is no adverse effect.@*CONCLUSION@#The application of ] diethylstilbestrol injection was easy in operation and observation. The price of ] diethylstilbestrol injection was inexpensive,and it is no adverse effect. Curative effect is significant. It is a good method to be used to repair perforation of nasal septum.

Research of the expression of PTEN in squamous cell carcinoma of larynx by the tissue chip technology / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the expression of PTEN in squamous cell carcinoma of larynx and its relationship with factors like pathologic fractionation, clinical TNM stage, and prognosis by the tissue chip technology.@*METHOD@#We studied the expression of PTEN gene and its mRNA on a series of 146 cases of primary laryngeal carcinoma patients, 40 cases of precancerous lesion and 26 cases of vocal fold polyp by tissue chip by, immunohistochemistry and in situ hybridization method. The observed data observed and some relevant clinical dada were statistically analyzed.@*RESULT@#The expression of PTEN in vocal fold polyp was negative, and its positive expression in precancerous lesion and laryngeal carcinoma were 40% and 43.15% respectively by immunohistochemistry, and were 72.50 and 59.59% respectively in situ hybridization. The difference between the expression of PTEN in laryngeal carcinoma and its pathological fraction and prognosis was statistically significant, but was not significant between that and location, clinical stage and LN metastasis. The mRNA expression of PTEN was higher than that of the protein expression in precancerous lesion and cancer tissue.@*CONCLUSION@#The tissue microarray technique required shorter time and less expense, and showed higher consistency in our essays. And the present study suggests PTEN was a prognosis factor of the Laryngeal carcinoma.

Modified frontolateral partial larnygectomy without tracheostomy for early laryngeal cancer of the true vocal cord / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of modified frontolateral partial laryngectomy without tracheostomy in the treatment for early laryngeal cancer or severe atypical hyperplasia of the true vocal cord.</p><p><b>METHODS</b>A retrospective analysis of 41 patients treated in the past 6 years with modified frontolateral partial laryngectomy without tracheostomy was carried out. There were 39 early laryngeal cancers of the lateral vocal cord with 34 in T1a stage and 5 in T2, and the remain 2 patients had severe atypical hyperplasia of the lateral vocal cord. An ipsilateral false vocal cord flap was used in 39 patients and cervical skin flap in 2 to reconstruct the defect after resection of the true vocal cord. In order to get a large laryngeal cavity, a reverted sternohyoid fascia was used to cover the front area, which made the new laryngeal lumen become ladder-shaped.</p><p><b>RESULTS</b>The incisions of all 41 patients healed up by first intention. The only postoperative complication was subcutaneous emphysema, which developed postoperatively in 9 patients, but subsided prior to discharge. The estimated 1-, 3- and 5-year survival rates were all 100%. No patients died during the postoperative period.</p><p><b>CONCLUSION</b>Modified frontolateral partial laryngectomy without tracheostomy is effective with a high rate of success in eradicating early or selected invasive glottic squamous cell carcinoma or severe atypical hyperplasia of the true vocal cord.</p>

Mandibular swing procedure for surgical resection of advanced oropharyngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore a better approach to resect the advanced oropharyngeal carcinoma.</p><p><b>METHODS</b>From 1995 to 2005, 17 patients underwent mandibular swing procedure for excision of advanced oropharyngeal carcinoma including: 13 tonsillar cancers, 2 soft palate carcinomas and 2 lingual root cancers. Surgical procedure was selected according to the lesion. All tumors were resected through the mandibular swing approach or its combined approaches. Immediate reconstruction of the surgical defect was done using tongue flap, pectoralis major myocutaneous flap, sternohyoid myofascial flap, temporalis myofascial flap and forehead flap, respectively. After surgical resection of the tumors, all patients received postoperative radiotherapy.</p><p><b>RESULTS</b>All patients' advanced oropharyngeal carcinoma were successfully resected as planned through the mandibular swing procedure or its combined procedures without severe complications. Functions of deglutition, respiration and speech were well restored. The 3- and 5-year survival rate was 54. 5% and 40%, respectively.</p><p><b>CONCLUSION</b>The mandibular swing procedure and its combined approach is safe and effective in the surgical resection of the advanced oropharyngeal carcinoma, which can provide a good exposure for the oropharynx, supraglottic region, hypopharynx, the parapharyngeal space and the base of the skull.</p>

Observation of neural electrophysiology and morphology in traumatic optic neuropathy in cat model / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To establish the animal model of traumatic optic neuropathy similar to clinical feature by injuring the optic nerve of the pipeline through the ethmoid and sphenoid sinus. The electrophysiology and morphology were observed.</p><p><b>METHODS</b>The optic nerve in 2 cats was anatomically observed. Thirty healthy adult cats were divided into 1 h, 1 d, 3 d, 1 w, 2 w, 4 w injury groups. The right eye was selected as the experiment eye, and the left as the control. The optic canals were damaged by the injury instrument. The changes of optic nerve were observed using light and electron microscope. The pattern reversal visual evoked potential (PR-VEP) was used to determine the succeed model and pupil was monitored. PR-VEP and neural tissue morphology were examined at intervals of 1 h, 1 d, 3 d, 1 w, 2 w, 4 w after trauma.</p><p><b>RESULTS</b>Eight cats had Marcus-Gunn's pupil, and 22 cats did not have after injury. Neural tissue was physaliphorous degeneration in light microscope. The neural fibers swelled gradually and fibers physaliphorous degeneration in the first day after damage. At the seventh day, the bubble enlarged to be a big flat. After two weeks, the big flat bubble came out to be a bigger bubble. Under the electronic microscope, axons were physaliphorous degeneration, crack emerged between axon membrane and myelin sheath and myelin sheath were loose in the first day. At the third day, axon swelled, physaliphorous degeneration rose and myelin sheath were loose obviously. At the seventh day, axon and myelin sheath appeared loop in half cycle and bubble-like broke up. A lot of pieces came out and axon became physaliphorous and uniform. Microtubule and microfilament disappeared. After two weeks, myelin sheath became onion-like. On fourth week, myelin sheaths enlarged and squeezed to center. Axoplasm disappeared and neural tissues collapsed.</p><p><b>CONCLUSIONS</b>This animal model was similar to clinical optic nerve decompression through ethmoid and sphenoid sinus. The change of PR-VEP and neuromorphology were distinct before and after trauma. The pathological changes of optic nerve catching vibrated injury are mainly degeneration, so earlier decompression of optic nerve may improve the visual function.</p>

Relationship of CPAP pressure titration methods and CPAP compliance / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the relationship between the methods of CPAP pressure titration (under whole night PSG or by auto-set) and CPAP compliance. METHODS Forty-five patients with serious OSAHS who had been diagnosed in our sleep lab between 2001 and 2004 and were willing to try CPAP treatment were enrolled. They were divided into A and B group according to their wills: pressure titration under whole night PSG in lab (group A) or by auto-set in their families (group B). After pressure titration, patients and their families were educated for the knowledge of CPAP treatment in OSAHS patients. Questionnaires about QOL before CPAP treatment and half year later were carried out on the phone. The decreased score was used to evaluate the effect of CPAP treatment. The hours of per day using machine were used to evaluate the compliance of CPAP. RESULTS Group A and group B got the similar decreased score (14 VS 14.3) , compliance (4.91h VS 4.97h) and adherence (85.7 % VS 88 %) . CONCLUSION OSAHS patients under go pressure titration either in lab with PSG or in their home with auto-set have the same effect and same compliance of CPAP treatment. That means the simple auto-titration can substitute the traditional titration under whole night in lab.

Intraorbital surgery by transnasal endoscopic ethmoidal-lamina papyracea approach / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the feasibility of transnasal endoscopic surgery to treatment of intraorbital space occupying by ethmoidal-lamina papy-racea approach. METHODS The clinical data of 10 cases who underwent intraorbital surgery via transnasal endoscopic ethmoidal-lamina papyracea approach from June 2003 and Aug. 2006 were retrospectively studied. The patients included foreign body 1 case, cavernous hemangioma 2 case, lipoma 2 cases, inflammatory pseudotumor 2cases and hematoma 3cases. All intraorbital space occupying were operated by transnasal endoscopic ethmoidal-lamina papyracea approach but for one cavernous hemangioma which was dealt with through extra orbitectomy. The inflammatory pseudotumors were prescribed with glucocorticoid after operation.RESULTS Foreign body was removed successfully. One case of cavernous haemangioma was removed completely by transnasal endoscopic surgery and the other by extroorbital operation. All symptoms of proptosis and diplopia disappeared. One vision was enhanced from hand moving to 0.3 and another from light to hand moving. However, there was one hematoma which had been hindered about 14 days after damaged lost eyesight after operation. All cases were cured but one pseudotumor which recurred and was operated again. All cases were followed up 3 to 24 months. CONCLUSION Intraorbital surgery via transnasal endoscopic ethmoidal-lamina papyracea approach was available and feasible for the advantages of clear operation field, direct vision operation, less damage, rapid recovery and avoiding of facial scar, and intranasal endoscopic surgery can treat the rhino-orbital related diseases and nasal diseases at the same time.