Misdiagnosis of adenoid cystic carcinoma of oropharynx: a case report / 临床耳鼻咽喉头颈外科杂志

Adenoid cystic carcinoma usually occurs in the salivary glands of the head and neck. It is a malignant tumor with a high degree of malignancy, resistance to radiotherapy and chemotherapy and poor prognosis. The clinical course of adenoid cystic carcinoma is slow and easy to be misdiagnosed. The main diagnosis and treatment means are individualized and precise treatment under the multi-disciplinary consultation mode, that is, surgical treatment and radiotherapy and chemotherapy. Adenoid cystic carcinoma is prone to relapse and hematologic metastasis, and the traditional radiotherapy and chemotherapy based therapies have not achieved satisfactory efficacy in the past three decades. How to detect, diagnose and treat early is an urgent task faced by clinicians.

Application of 3D printing in the flipped classroom in practice teaching of otolaryngology-head and neck surgery / 中华医学教育探索杂志

Objective@#To investigate the application of 3D printing in the flipped classroom in the practice teaching of otolaryngology-head and neck surgery.@*Methods@#A total of 68 medical undergraduates of the Grade 2013 in Air Force Medical University were divided into experimental group and control group, with 34 undergraduates in each group. The undergraduates in the experimental group received the teaching method of 3D printing in the with flipped classroom, and those in the control group received traditional teaching. The teaching effect was evaluated by questionnaire and examinations of basic knowledge and clinical skills, Independent-samples t test was used for between-group comparison with SPSS 20.0.@*Results@#Compared with the control group, the experimental group had significantly higher scores in theoretical examinations (34.79±2.20 vs. 31.73±3.12, t=4.676, P=0.000) and clinical skill examination (50.06±2.98 vs. 45.82±4.68, t=4.449, P=0.000). The questionnaire survey showed that among the 34 undergraduates in the experimental group, 31(91.2%) thought that the new teaching method could increase their learning interest, 33(97.0%) believed it could improve learning efficiency, 25(73.5%) believed the models obtained by 3D printing had good quality, 32(94.1%) felt that it could improve clinical skills, 28 (82.4%) thought it could enhance the interaction between students and teachers, and 29(85.3%) thought it did not bring extra burden.@*Conclusion@#The teaching method of 3D printing combined with flipped classroom in the practice teaching of otolaryngology-head and neck surgery can improve students' learning interest, academic scores, and clinical skills, and therefore, it holds promise for application in teaching.

Application of 3D printing in the flipped classroom in practice teaching of otolaryngology-head and neck surgery / 中华医学教育探索杂志

Objective To investigate the application of 3D printing in the flipped classroom in the practice teaching of otolaryngology-head and neck surgery. Methods A total of 68 medical undergraduates of the Grade 2013 in Air Force Medical University were divided into experimental group and control group, with 34 undergraduates in each group. The undergraduates in the experimental group received the teaching method of 3D printing in the with flipped classroom , and those in the control group received traditional teaching. The teaching effect was evaluated by questionnaire and examinations of basic knowledge and clinical skills, Independent-samples t test was used for between-group comparison with SPSS 20.0. Results Compared with the control group , the experimental group had significantly higher scores in theoretical examinations (34.79 ±2.20 vs. 31.73 ±3.12, t=4.676, P=0.000) and clinical skill examination (50.06 ±2.98 vs. 45.82 ±4.68, t=4.449, P=0.000). The questionnaire survey showed that among the 34 undergraduates in the experimental group, 31(91.2％) thought that the new teaching method could increase their learning interest, 33 (97.0％) believed it could improve learning efficiency, 25 (73.5％) believed the models obtained by 3D printing had good quality, 32 (94.1％) felt that it could improve clinical skills, 28 (82.4％) thought it could enhance the interaction between students and teachers, and 29(85.3％) thought it did not bring extra burden. Conclusion The teaching method of 3D printing combined with flipped classroom in the practice teaching of otolaryngology-head and neck surgery can improve students' learning interest, academic scores, and clinical skills, and therefore, it holds promise for application in teaching.

Perioperative nursing care to patients with maxillary defect repaired by 3D printing individualized titanium mesh / 现代临床护理

Objective To summarize the care points of nursing to patients with maxillary defect repaired by 3D printing individualized titanium mesh. Methods Nursing staff cooperated with doctors to control the disease of the whole body and prevent oral infection by performing psychological nursing, keeping the respiratory tract smooth after operation, preventing bleeding and infection of the wound, conducting oral, eye and pain care, preventing cerebrospinal fluid leakage, intracranial infection and venous blood thrombus of lower extremity and helping the patients with rehabilitation training. Results The hospitalization time of 5 patients was 11～20d with an average of (14.80 ± 3.31) d. 1 case had cerebrospinal fluid leakage during the operation and 1 had postoperative corneal edema. After treatment and nursing, all the patients were discharged from the hospital. Follow-up of 6 months showed no recurrence and good appearance in the maxillofacial region. Conclusion The nursing measures for the patients with to patients with maxillary defect repaired by 3D printing individualized titanium mesh include respiratory tract management, oral cavity, eye and pain nursing, prevention of bleeding and infection of wound, prevention of cerebrospinal fluid leakage, intracranial infection and venous thrombosis of lower extremities, which can promote the recovery of the patients soon.

Diagnosis and treatment of solitary pterygoid benign lesions / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical and pathological features of solitary pterygoid benign lesions, as well as the treatment and outcome of endoscopic surgery.@*METHOD@#We retrospectively analyzed clinical data of 4 patients with pterygoid benign lesions in our department. High resolution CT and enhanced MRI were performed before the operations, then endoscopic surgeries were carried out under the circumstance of general anesthesia. After a follow-up in 12 months to 48 months, nasal endoscopy and MRI examination were performed. Therefore we are able to understand the situation of operations and postoperative recurrences, and to inquire about the changes of symptoms and the relief of symptoms before and after surgery.@*RESULT@#From the Pathological diagnosis, it showed 2 cases of cystic lesions, 1 case of spindle cell lipoma, 1 case of inflammatory lesion. Postoperative follow up showed scar formation, smooth surface, no recurrence, and no new symptom. Nasal obstruction is relieved after the surgery, and no changes in the sympotoms of headache were observed.@*CONCLUSION@#The combination of high resolution CT with enhanced MRI isimportant for ascertaining the location, extent and nature of the pterygoid lesions. Endoscopic surgery is a minimally invasive, safe, and effective method for the treatment of solitary pterygoid benign lesions.

Long-term outcome of budesonide middle meatus treatment for chronic rhinosinusitis patients following endoscopic sinus surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the long term clinical effect of budesonide treatment in middle meatus for chronic rhinosinusitis(CRS) following endoscopic sinus surgery (ESS).@*METHOD@#A total number of 53 patients with CRS received ESS were divided into two groups according to budesonide treatment: budesonide-treated group with 21 cases (39.6%) and control group with 32 cases (60.4%). Gelatin sponges soaked with 1 ml budesonide suspension were put in middle meatus in budesonide-treated group, while only gelatin sponges were put in middle meatus in control group. Visual analogy score (VAS), sino-nasal outcome test-22 (SNOT-22) and Lund-Kennedy endoscopic scale were carried out before ESS and two years after ESS.@*RESULT@#In budesonide-treated group, there were a statistical difference before and after ESS in the VAS, SNOT-20 and Lund-Kennedy score (P<. 05). In control group, difference was also significant in VAS, SNOT-20 and Lund-Kennedy score before and after ESS (P < 0.05). The VAS gap of post-operative and pre-operative in two groups are significantly different (P<. 05). However, there was no significant difference in the SNOT-20 and Lund-Kennedy endoscopic scale gap before or after the operation between two groups.@*CONCLUSION@#It is safe, convenient and practicable to perform budesonide treatment in middle meatus following ESS, which can significantly ease the post-operative discomfort of nose.

Comparative study on packing with or without Merocel after endoscopic sinus surgery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical effect of nasal packing with or without Merocel after endoscopic sinus surgery (ESS) in short and long term.</p><p><b>METHOD</b>A total of 112 patients with chronic rhinosinusitis who received endoscopic sinus surgery were randomly divided into two groups: packed group and non-packed group. In packed group, there were 37 cases, of which 10 cases were combined with allergic rhinitis and 11 cases received correction of nasal septum at the same time. In non-packed group, there were 75 cases, of which 15 cases were combined with allergic rhinitis and 26 cases received correction of nasal septum at the same time.Visual analogue score (VAS), Nasal bleeding and sinonasal outcome Test-22 (SNOT-22) were used to evaluate the clinical effect between two groups in short and long term respectively.</p><p><b>RESULT</b>The VAS of nasal obstruction, rhinodynia, dysphoria, epiphora, itching, sneeze, headache and facial pain in non-packed group were significantly lower than those in packed group (P < 0.05). Within 48 hours after ESS, the amounts of nasal bleeding were 0-45 ml (median 3 ml) in packing group and 0-18 ml (median 2 ml) in non-packing group. There were significant difference between two groups (Z = -3.54, P = 0.00). The difference value of postoperative and preoperative SNOT-22 of the packed group was 38.47 ± 20.25 and the non-packed is 41.03 ± 22.73 six months after ESS (t = 0.58, P = 0.56). Each group had one case of nasal adhesion. And as for middle turbinate dislodgement, there was one case in the packed group and two cases in the unpacked group. There was no case of nasal septum hematoma in the packed group, but two cases in the un-packed group. The results showed that there was no significant difference of clinical effect between the postoperative packing and unpacking groups.</p><p><b>CONCLUSIONS</b>It is safe and practicable to manage chronic rhinosinusitis without nasal packing after ESS, which in short term not only decrease discomfort, but also reduce nasal bleeding. Also, there is no significant difference of clinical effect between the postoperative packing and unpacking groups in long the term.</p>

Inhibition of Th2 reaction by thymic stromal lymphopoietin blockade in vitro / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the effect of thymic stromal lymphopoietin (TSLP) on transformation of dendritic cell (DC) and T cell in vitro.</p><p><b>METHODS</b>Mouse-derived immature dendritic cells and T lymphocytes were co-cultured in vitro, which were divided into 4 groups (TSLP stimulation group, TSLP stimulation and its receptor blocking group, ovalbumin stimulation group and ovalbumin stimulation and TSLP receptor blocking group). IL-4, IL-8 and IFN-β in cell culture supernatant were detected after 2 days by ELISA. SPSS 13.0 software was used to analyze the data.</p><p><b>RESULTS</b>IL-4 levels of TSLP receptor blocking groups [(48.84 ± 1.56) pg/ml, (52.53 ± 2.36) pg/ml]were significantly lower than those of corresponding TSLP stimulation group and ovalbumin stimulation group [(72.55 ± 7.76) pg/ml, (80.47 ± 21.93) pg/ml;t = 5.994, P < 0.05;t = 2.534, P < 0.05]. However, there were not significant differences of IL-8 and IFN-β expression between corresponding two groups of whether or not TSLP receptor blocking (all P > 0.05).</p><p><b>CONCLUSION</b>TSLP receptor blockade in vitro can inhibit T lymphocyte transformation to Th2, which may provide a new therapeutic strategy for clinical Th2 dominant diseases such as allergic rhinitis and asthma.</p>

Complications and treatment for button battery in the nose / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the injury of button battery to nose and discuss its management.@*METHOD@#Thirteen cases with button battery in nose were reviewed. After the removal of button battery, nasal cavity irrigations were carried out carefully by nasal endoscopy in all cases. Gelfoam full of erythromycin eye ointment was used to cover the injured mucous membrane.@*RESULT@#Among all the cases, 10 got full recovery without any complication. There are 2 cases of synechia nasal and 1 case of septum perforation.@*CONCLUSION@#Removal as soon as possible, careful cleaning and systemic drug are necessary. Nose bleed, septum perforation, adhesion and rhinostenosis should be noticed.

Construction of professional curriculum website for otolaryngology-head and neck surgery based on CMS and its application / 中华医学教育探索杂志

Construction of excellent professional curriculum website is the most important part of medical teaching quality and teaching innovation.Requirements,designing procedure,construction and evaluation process as well as the future development for construction of professional curriculum website of otolaryngology-head and neck surgery were proposed by applying content management system (CMS),which based on the technology of dynamic web page and database and by combining with characteristics of the discipline to resolve problems occurred in construction of tradition statical network station.High-quality professional curriculum website is expected to improve teaching quality.

Diagnosis and treatment of unilateral allergic fungal sinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate the clinical and pathological manifestation, prognosis of unilateral allergic fungal sinusitis (AFS), and to analyze the characters and treatment paradigm of unilateral AFS.@*METHOD@#Clinical and pathological information of 10 cases of unilateral AFS were analyzed. Nasal endoscopy, skin prick test, and visual analogue score (VAS) of severity of illness were taken before surgery. Mucosa membrane and inspissated secretion obtained during endoscopic surgery were stained with hematoxylin-eosin and silver hexosamine. Regular clean of sinus and intranasal steroid spray were taken after surgery.@*RESULT@#Endoscopy showed that 5 cases had pale mucous membranes in the ipsilateral nasal cavity. Skin prick test was positive in all patients. Nasal CT scan demonstrated unilateral lesion in all 10 patients. In the involved sinus, all 10 patients had brown or yellow brown viscous secretion, which demonstrated eosinophilic amorphous mass with accumulation of eosinophils, Charcot-Leyden crystallization and fungal hyphae under microscope. The number of eosinophils in lamina propria of sinus mucosa membrane was 72 +/- 11/hpf. After follow-up for 16 to 26 months(mean 22 months), 9 cases were cured and 1 improved. The pre-operative VAS was 8.5 +/- 1.2, and the post-operative VAS was 1.1 +/- 1.0 (P < 0.01).@*CONCLUSION@#The systemic and local allergic reaction may co-exist in unilateral AFS, in which local hypersensitivity may be the dominant reaction. Endoscopic sinus surgery and intranasal steroid spray are effective in the treatment of unilateral AFS.

The cellular immune response produced in BALB/c mice immunized with HPV6b L1/Ct MOMP multi-epitope chimeric DNA / 中华微生物学和免疫学杂志

Objective To study on the specific cellular immune response produced in BALB/c mice immunized with human papillomavirus (HPV) type 6b capsid protein L1 and Chlamydia trachomatis (Ct) major outer membrane protein(MOMP) multi-epitope chimeric DNA (HPV6b L1/Ct MOMP multiepitope) , and the enhancement of the specific cellular immune response to Ct MOMP multi-epitope by HPV6b L1. Methods The Ct MOMP multi-epitope gene was connected to the C terminal of HPV6b L1,the gene of HPV6b L1 had been optimized according to the codon usage of eukaryotic system, and then the HPV6b L1/Ct MOMP multi-epitope chimeric gene was cloned to pcDNA3.1 ( + ) vector. After identification by restriction enzyme digestion and DNA sequencing, the recombinant plasmid was transfected into COS-7 cells, Indirect Immunofluorescence (IIF) was used to confirm the expression of proteins. Then, BALB/c mice were randomly assigned to receive (intramuscular injection) either pcDNA3.1 ( + )/HPV6b L1/Ct MOMP or pcDNA3.1 ( + )/Ct MOMP or pcDNA3.1 ( + ) or PBS ( n = 12, 150 μg/time), and the same immunization schedule was repeated third times at 2 week intervals. The level of cytokine( IFN-γ, IL-4, IL-10) -producing CD3+ T cells in spleen, the cytotoxicity of Ct MOMP-specific and HPV6b L1-specific cytotoxic T lymphocyte (CTL) in spleen were detected by intracellular cytokine staining-fluorescence activated cell sorter (ICS-FACS) and LDH release assays, respectively. Results After immunization, when the efCTL (44.56%±4.02%, 35.35% ±2.89% ) and HPV6b L1 specific cytotoxicity of CTL (27.08% ±2.04%, 21.68% ±4.06% ) in pcDNA3.1 ( + )/HPV6b L1/Ct MOMP multi-epitope chimeric DNA immunized mice, were significantly higher than that in pcDNA3.1 ( + )/Ct MOMP multi-epitope DNA (35.50%±2.68%, 30.24% ±1.75%; 12.27% ±3.36%, 9.32% ±3.07%) and other control groups(F=72.87, F=114.55, P＜0.05; F=30.04, F=10.47, P＜0.05), and Ct MOMP multi-epitope specific cytotoxicity of CTL in pcDNA3.1 ( + )/Ct MOMP multi-epitope DNA immunized mice were significantly higher than that in control groups( F = 58.85, F = 120.21; P<0.05). The level of intracellular cytokine IFN-γ in pcDNA3.1 ( + )/HPV6b L1/Ct MOMP multi-epitope DNA immunized mice(4.34% ±0.06%)was higher significantly than that in pcDNA3.1 ( + )/Ct MOMP multi-epitope DNA immunized mice(3.14% ± 0.18%, P<0.05 ) and other control groups ( F = 473.83, P<0.05 ), while, the levels of IL-4 ( F =0.97, P ＞ 0.05 ) and IL-10 ( F = 2.25, P ＞ 0.05 ) had no significant difference between groups. Conclusion Both Ct MOMP and HPV6b L1 protein specific cellular immune response could be induced in BALB/c mice immunized with HPV6b L1/Ct MOMP multi-epitope chimeric plasmid, and the HPV6b L1 gene optimized by eukaryotic codon could significantly enhance the cellular immune response induced by Ct MOMP multi-epitope gene in BALB/c mice.

Diagnosis and treatment of primary duodenal carcinoma / 中华普通外科杂志

Objective To evaluate the diagnosis, treatment and prognosis of primary duodenal carcinoma. Methods The clinical data of 41 cases with primary duodenal carcinoma admired during 2000-2007 were analyzed retrospectively. Results Clinical manifestation was not specific, including abdominal pain, abdominal distention, jaundice, bowel obstruction or bleeding. The correct diagnosis rate of endoscopy, duodenography, ultrasound and CT was 86%, 90%, 20% and 33% respectively. 23 cases underwent pancreaticoduodenectomy, 6 cases received segmental duodenectomy, 9 cases received bypass operation and 3 cases underwent biopsy. Overall postoperative 5-year survival rate was 18%. Univariate analysis revealed that the operation types, tumor histology, depth of tumor invatian, lymphatic invasion correlated with prognosis. Multivariate analysis showed that only the operative types, depth of tumor invasion and lymphatic invasion were independent prognostic factors. Conclusions Duodenography and endoscopy are major methods for diagnosis of primary duodenal carcinoma. Pancreaticoduodenectomy is the choice of therapy for primary duodenal carcinoma.

Prediction of the B cell epitopes for the major outer membrane protein of Chlamydia trachomatis / 生物医学工程学杂志

To predict the B cell epitopes for major outer membrane protein (MOMP) of Chlamydia trachomatis (CT), the secondary structure of CT MOMP was predicted by the methods of GOR based on the sequence of amino acids of E serotype CT MOMP. By combining the comprehensive analysis of transmembrane domain, hydrophilicity profile, surface probability, antigenic index and average flexibility, the B cell predominant epitopes of CT MOMP were further predicted. The N-terminal No. 73-81, 217-225, 377-386, 261-270 and 161-175 were the predominant B cell epitopes. Prediction of the B cell epitopes for the CT MOMP by the multi-parameters is helpful for the identification of B cell epitopes.

Clinical study on operative effect of surgical treatment for hilar cholangiocarcinoma / 中华肝胆外科杂志

Objective To investigate the clinical effect of surgical treatment for hilar cholangio-carcinoma. Methods The clinical data of 89 patients with hilar cholangiocarcinoma surgically treated in our hospital were retrospectively analyzed. They were divided into 3 groups: radical resection(group A,n=23),palliative resection (group B,n=44) and external drainage operation (group C,n=22). Complications,operative mortality,survival rate and posttreatment quality of lire were compara-tively analyzed among the 3 groups. Results The rate of complications was significantly higher in group A than in group C (P<0.05). There was no marked difference in operative mortality between group A and group B (P>0.05). The 1-,2-and 3-year survival rates and scoring of quality of life were remarkably higher in group A than in other 2 groups (P<0. 001 and 0. 05). Conclusion Radical re-section of hilar cholangiocarcinoma can improve the long-term survival and significantly enhance quality of life of the patients after operation. For patients receiving unradical resection, palliative surgical man-agement can improve the long-term survival and enhance quality of life.

Clinical characteristic and treatment of maxillofacial trauma in the elderly / 中华老年医学杂志

Objective To analyze the clinical characteristic and provide therapeutic techniques of maxillofacial trauma in the elderly. Methods Geriatric maxillaofacial trauma patients admitted to our hospital from January 1992 to December 2002 was retrospectively reviewed. Data were collected according to etiology, location, comorbidities, associated injuries, therapeutic methods and the outcome. The patients were compared with a control group consisting of 200 young and adult patients admitted at the same period. Results For the 126 geriatric trauma patients, the major causes were traffic accidents(61.1%) and violence assault(25.4%). A large proportion of facial injuries occurred on the lower part of the face. 69.1% of the patients presented with preexisting diseases. Most of the fractures were not treated(35.7%). The length of hospitalization and ICU stay were relatively longer when compared with the control group(P

Expression of Nuclear Factor-Kappa B p65 in Gastric Carcinoma and Its Relationship with Vascular Endothelial Growth Factor / 中国普外基础与临床杂志

Objective To study the expression of nuclear factor-?Bp65 (NF-?Bp65) in gastric carcinoma and its relationship with vascular endothelial growth factor (VEGF). Methods The expression of NF-?Bp65 and VEGF in 56 gastric carcinomas was detected with immunohistochemistry and compared with benign tissues. Results The positive rates of NF-?Bp65 and VEGF in 56 gastric carcinomas were 62.5% and 76.8% respectively,and which were higher than those of gastric mucosal atypical hyperplasia (33.3% and 44.4%) and the normal gastric mucosa(0 and 8.3%) (P0.05). There was positive correlation between NF-?Bp65 and VEGF expression (r=0.36,P

The expression of NF-?Bp65 and bcl-x_ L gene in pancreatic carcinoma and their significance / 中国现代普通外科进展

Objective:To study the expression of NF-?Bp65 and bcl-x L gene in pancreatic carcinoma and their clinical significance.Methods:The expressions of NF-?Bp65 and bcl-x L protein in 52 pancreatic carcinoma were studied by immunohistochemistry,and their relationship to clinical pathology were analyzed.Results:The positive rates of NF-?Bp65 protein and bcl-x L protein in pancreatic carcinoma were 63.5% and 73.1% respectively,and which were higher than those of normal pancreatic tissues.The expression of NF-?Bp65 was related to tumor diameter,TNM stage and lymph node metastasis,and had no relation with the extent of differentiation and type of pathology.There was positive correlation between NF-? Bp65 and bcl-x L expression.Conclusion:NF-? Bp65 may be an important oncoprotein,and may have positive regulation on bcl-x L,then promote tumorgenesis.

Comparison of injury severity scores in evaluation of maxillofacial trauma / 解放军医学杂志

Objective To design a more reasonable method by comparing three existing injury severity scores for evaluating maxillofacial injury severity according to its features by retrospective analysis. Methods Nine hundred and eighty-four cases with maxillofacial trauma (≤30 days before hospitalization) selected from 1 159 cases were stratified by the number of fractures and the sites of trauma. The injury severity was evaluated with ISS, RFISS and MISS respectively. The results of ISS/RFISS/MISS were compared and analyzed with SPSS software. Results MISS could accurately differentiate single from multiple facial injuries. It was more meaningful for evaluating different sites of facial injury compared with ISS and RFISS. Conclusion MISS can be used to evaluate maxillofacial injury objectively and accurately.