The outcome of transnasal endoscopic total maxillectomy in the treatment of sinonasal adenoid cystic carcinoma / 临床耳鼻咽喉头颈外科杂志

Objective:To assess the prognosis of sinonasal adenoid cystic carcinoma with hard palatine invasion treated by transnasal endoscopic total maxillectomy. Methods:Clinical data of twenty-six patients with sinonasal adenoid cystic carcinoma invading hard palatine treated by transnasal endoscopic total maxillectomy between May 2014 and December 2020 was analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Cox regression was used to investigate the prognosis factors. Masticatory function after maxillectomy has also been assessed using the questionnaire of patients' satisfaction about masticatory function. Results:Margins in 8 patients（30%） were positive. The median time of follow-up was 38 months（6 to 85 months）. Twenty-five patients recurred. Four patients died of distant metastasis. The 5-year overall survival rate and relapse-free survival rate was 79.5% and 89.1%, respectively. Independent predictors of outcome on multivariate analysis were positive margin（P=0.018）, recurrence（P=0.006） and distant metastasis（P=0.04）. Conclusion:Transnasal endoscopic total maxillectomy could be performed for the treatment of the sinonasal adenoid cystic carcinoma with hard palatine invasion. Positive margin, local recurrence and distant metastasis were important predictors for patients' prognosis.

Establishment of Endoscopic Surgical Innovative System of Recurrent Nasopharyngeal Carcinoma / 肿瘤防治研究

Nasopharyngeal carcinoma (NPC) is a common malignant tumor in China. Radiotherapy is the first-line treatment. After appropriate radiotherapy, about 5%-15% patients experience recurrence. In view of the poor efficacy and high incidence of severe late toxicities associated with re-irradiation, salvage surgery by the transnasal endoscopic approach is recommended for recurrent NPC (rNPC). Compared with re-irradiation, endoscopic surgery can better prolong survival, improve the quality of life, and reduce complications and medical expenses of patients with rNPC. However, the complexity of the nasopharyngeal skull base enhances the difficulty and risk of surgery. Expanding the boundary of surgical resection remains a clinical challenge for otolaryngologists. In this regard, to help more advanced patients with rNPC, the surgical innovative system of NPC needs to be established by multi-disciplinary cooperation, involving skull base anatomy-based investigation, appropriate administration of the internal carotid artery (ICA), repair of skull base defect, and establishment of various types of endoscopic endonasal nasopharyngectomy.

Clinical analysis of sinonasal chondrosarcoma in 47 cases / 中华耳鼻咽喉头颈外科杂志

Objective@#To discuss the treatment, pathological subtypes and recurrence of sinonasal chondrosarcoma, and to identify the prognostic factors.@*Methods@#Between January 1994 and May 2018, 47 patients with sinonasal chondrosarcoma who were treated in Eye, Ear, Nose and Throat Hospital, Shanghai Medwal College, Fudan University were retrospectively reviewed, including 19 males and 28 females, aging from 7 months to 71 years old, with a median age of 38 years old. The clinical symptoms, location of tumor, surgical method, pathological subtype, recurrence and prognosis were collected and analyzed. Kaplan-Meier method was used to calculate the disease-specific survival rate, disease-free survival rate and draw survival curve. Log Rank was used to analyze the prognostic factors. Cox regression was used for multivariate analysis.@*Results@#Except for one patient who gave up treatment after tumor biopsy, other 46 patients underwent radical resection, including 31 cases of endoscopic resection and 15 cases of extranasal approach resection. Thirty-nine patients were diagnosed as conventional intramedullary chondrosarcoma with pathological grade Ⅰ of 24 cases and grade Ⅱ of 15 cases. Six cases were diagnosed as mesenchymal chondrosarcoma while 2 cases were diagnosed as myxoid chondrosarcoma. During an average follow-up period of 56.1 months (17-156 months), 23 patients had recurrence (54.8%, 23/42), among whom 9 patients had re-operations and 5 patients died. Thirty-seven patients survived, including 25 patients survived without tumors. In addition, 5 patients were lost to follow-up, including the patient who gave up treatment after tumor biopsy. Five-year overall survival rate and disease-free survival rate was 84.7% and 34.3%, respectively. Multivariate analysis showed that invasion of skull base was an independent risk factor affecting disease-free survival rate (95% confidence interval: 1.089-5.825, P=0.031).@*Conclusions@#Radical resection is the primary treatment for sinonasal chondrosarcoma. The most common pathological subtype is conventional intramedullary chondrosarcoma. Sinonasal chondrosarcoma has a high local recurrence rate. The long-term prognosis is well after complete excision of the lesion. The most important cause of death is uncontrollable local disease and invasion of adjacent key structures.

Typing and homology of drug resistance genes of carbapenem-resistant Enterobacteriaceae / 实用医学杂志

Objective To investigate the genotype and its homology of carbapenem-resistant Enterobacter (CRE)isolated from hospitalized patients and to provide theoretical basis for clinical treatment. Methods Drug sensitivity of bacteria to antibiotics widely used in clinic was detected with a VITEK-2 COMPACT fully automated microbiological system. Resistance genes including blaKPC,blaNDM-1,blaIMI-1,blaGES,blaSME and blaSHV were detected by polymerase chain reaction(PCR)assay. Results Thirty carbapenem-resistance strains were col-lected,including e.cloacac(17 strains),e. Aerogenes(10 strains),e. Sakazakii(2strains)and e. Cancerogenus (1strain). Positive genes included blaSHV(20.0%),blaNDM-1(16.7%),blaKPC(6.7%),blaGES(3.3%), blaIMI-1 (0) and blaSME (0). Five strains which harbored blaNDM-1 were isolated into 3types. Conclusions The most prevalence resistance genes among the strains are blaSHV ,followed by blaNDM-1 and other resistance genes at difference levels. There is potentially clonal spread of the resistance genes in the same room or in the whole hospital.

Typing and homology of drug resistance genes of carbapenem-resistant Enterobacteriaceae / 实用医学杂志

Objective To investigate the genotype and its homology of carbapenem-resistant Enterobacter (CRE)isolated from hospitalized patients and to provide theoretical basis for clinical treatment. Methods Drug sensitivity of bacteria to antibiotics widely used in clinic was detected with a VITEK-2 COMPACT fully automated microbiological system. Resistance genes including blaKPC,blaNDM-1,blaIMI-1,blaGES,blaSME and blaSHV were detected by polymerase chain reaction(PCR)assay. Results Thirty carbapenem-resistance strains were col-lected,including e.cloacac(17 strains),e. Aerogenes(10 strains),e. Sakazakii(2strains)and e. Cancerogenus (1strain). Positive genes included blaSHV(20.0%),blaNDM-1(16.7%),blaKPC(6.7%),blaGES(3.3%), blaIMI-1 (0) and blaSME (0). Five strains which harbored blaNDM-1 were isolated into 3types. Conclusions The most prevalence resistance genes among the strains are blaSHV ,followed by blaNDM-1 and other resistance genes at difference levels. There is potentially clonal spread of the resistance genes in the same room or in the whole hospital.

Endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 71 patients and analysis of the prognostic factors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of endoscopic nasopharyngectomy in the management of recurrent nasopharyngeal cancers (NPC) and to identify the prognostic factors.</p><p><b>METHODS</b>Between January 2006 and March 2014, 71 patients who received endoscopic nasopharyngectomy for recurrent NPC were retrospectively reviewed. The sex and the age of the patients, T stage, and tumor necrosis were recorded. Correlation between clinicopathological features and survival time was analyzed. Kaplan-Meier analysis was used to calculate the disease overall survival, disease-specific survival, and disease-free survival rates. Cox multivariate regression analysis and ROC curve analysis were used to determine the predictive value of the parameters.</p><p><b>RESULTS</b>The median age of 71 patients with recurrent nasopharyngeal carcinoma was 51.0 years old. Male to female ratio was 2.9:1 (male: 53, female: 18). The lesions were staged as follows (AJCC, 2010, seventh edition): rT1, 27; rT2, 10; rT3, 19 and rT4, 15. All patients underwent successful endoscopic nasopharyngectomy. No patient was transferred to open approach. The mean operative time was 155 minutes. The average blood loss was 450 ml. Three patients needed intraoperative blood transfusion. No serious postoperative complications occurred. Postoperative follow-up time was 5-96 months. During follow-up, 48 cases survived, including that 7 patients survived with disease, 1 patient had pulmonary metastases, and 1 case had cervical lymph node metastasis. Two-year overall survival and disease-free survival rates were 74.0% and 60.5%, respectively. Five-year overall survival and disease-free survival rates were 39.0% and 31.9%, respectively. Multivariate analysis showed that tumor necrosis was an independent prognostic factor for survival in recurrent nasopharyngeal carcinoma patients (P=0.001).</p><p><b>CONCLUSION</b>Endoscopic nasopharyngectomy is a safe and effective procedure for the treatment of recurrent nasopharyngeal carcinoma.</p>

Clinical study of the combination therapy with intranasal antihistamine and nasal corticosteroids in the treatment of nasal obstruction of persistent non-allergic rhinitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To determine if greater efficacy could be achieved with the intranasal antihistamine azelastine and the intranasal corticosteroid fluticasone propionate used concurrently in the treatment of nasal obstruction of persistent non-allergic rhinitis.@*METHOD@#A total of 162 persistent non-allergic rhinitis cases with moderate to severe nasal obstruction were randomized to treatment with the following: the combination therapy or nasal corticosteroids monotherapy. Efficacy was assessed by change from baseline in nasal obstruction score at week 2 and week 6 visits. The perceptions of global treatment satisfaction(convenience, side effects, cost and effectiveness) in both groups were analyzed.@*RESULT@#In both groups, the nasal obstruction score assessment descended significantly at week 2 and week 6 visits versus at baseline (all P < 0.01). At week 2 and week 6 visits, the nasal obstruction score in the combination therapy groups were significantly improved than that in nasal corticosteroids monotherapy groups (all P < 0.01). The perceptions of global treatment satisfaction in the combination therapy groups were significantly better (P < 0.05).@*CONCLUSION@#Azelastine nasal spray and intranasal corticosteroid in combination may provide a substantial therapeutic benefit for patients with persistent non-allergic rhinitis, especially nasal obstruction. The combination therapy was well tolerated and safety.

The expression and relationship of CXCR4 and microvessel density in laryngeal squamous cell carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the expression of chemokine receptor 4 (CXCR4) in laryngeal squamous carcinoma and its correlation with clinicopathology character and the building of microvessel density (MVD). To evaluate its role in the carcinogenesis and progression in laryngeal squamous carcinoma.@*METHOD@#The expression of CXCR4 in fresh laryngeal squamous carcinoma tissues and adjacent normal tissues from 42 patients were examined by RT-PCR, immunohistochemical staining and Image-pro-plus software. The numbers of regeneration blood vessels in the laryngeal squamous carcinoma was counted by antibody against factor V associated antigen and immunohistochemical analysis.@*RESULT@#The positive expression rate of CXCR4 in tumor samples was significantly higher than that in normal ones (P 0.05), while it were higher in tumors of grade III, IV than in grade I, II of pathology classification (P < 0. 01). The expression of CXCR4 were significantly higher in tumors with cervical lymph node metastasis than that in tumor without cervical lymph node metastasis (P < 0.01). The expression of CXCR4 protein and CXCR4 mRNA were at the same level. The expression level of CXCR4 in the laryngeal squamous carcinoma tissue was positively correlated with vascularization.@*CONCLUSION@#The higher expression of CXCR4 may play a key role in the invasion and metastasis of laryngeal squamous carcinoma, and were correlated with micro-vascularization.