Efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of OSAHS with soft palate oropharyngeal obstruction / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: Seventy-three patients(including 60 males and 13 females) with OSAHS admitted to the department of otorhinolaryngology of our hospital in recent two years were retrospectively analyzed. All the patients had velopharyngeal obstructionevaluated by electronic endoscopic Müller test and were divided into control group (34 cases) and observation group (39 cases). The patients in the control group were performed modified uvulopalatopharyngoplasty, while those in the observation group were performed relocation and expansion pharyngoplasty by suspension sutures.The scores of ESS, AHI and LSaO2 before and after treatment were collected and compared. Results: The total effective rate of the observation group was 94.87%, which was significantly higher than 79.41% of the control group. The AHI was lower and LSaO2 value was higher (χ2=-1. 896,-1. 968,P<0.05)in the observation group. The sleeping symptoms and quality of life of the two groups were significantly improved. The ESS score of the observation group was decreased more significantly than that of the control group after treatment, and the difference was statistically significant (χ2=-1.451,P<0.05). The incidence of foreign body sensation in pharynx of the observation group (89.74%) was higher than that of the control group (55.88%), and the postoperative bleeding and postoperative recurrence rate (0.00%, 2.56%) was lower than that of the control group (8.82%, 14.70%)with statistical significance (χ2=4.738,4.249,4.119,P<0.05).The incidence of transient nasopharyngeal reflux in both groups was low and statistically insignificant (χ2=0.629,P>0.05). Conclusions: Preoperative strict screening of indications plays an important role in the selection of palatopharyngeal surgery methods and curative effect. Relocation and expansion pharyngoplasty by suspension sutures can improve the clinical efficacy of OSAHS with better safety and less recurrence.

The development of techniques served to widen the lateral velopharyngeal space for treating OSAHS / 临床耳鼻咽喉头颈外科杂志

Since Fujita first described uvulopalatopharyngoplasty(UPPP)in 1981,UPPP and its modified procedures have been widely used to treat obstructive sleep apnea and hyponea syndrome(OSAHS).However,despite of its wide application,the success rates was uncertain,ranging from 20% to 80%,with patients of varing Friedman stages.It is well known that the principle of UPPP is to remove the redundant tissue of palate,elongated uvula and hypertrophic tonsils in order to widen the anteroposterior space at the level of palate.But recently,surgeons have found that not only the collapse of soft palate but also the collapse of lateral wall at the palate level can contribute to the obstruction of upper airway at the level of palate.As a result,many surgeries which can widen the lateral velopharyneal space have sprung up in these years.This review focuses on the development of techniques that emphasize the enlargement of lateral velopharyneal space in patients with OSAHS.

Femoral supracondylar osteotomy for the treatment of valgus knee osteoarthritis in young and middle-aged patients / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of open supracondylar osteotomy of the femoral condyle for the treatment of valgus knee osteoarthritis.</p><p><b>METHODS</b>From April 2008 to June 2015, 21 patients with valgus knee osteoarthritis underwent an open wedge femoral supracondylar osteotomy using the distal femur dissection plates combined with autologous iliac bone graft for the bone defect. There were 8 males (8 knees) and 13 females (15 knees), ranging in age from 30 to 54 years old, with a mean age of 41.2 years old. All the patients had valgus deformity and knee joint pain in the lateral compartment. The average tibiofemoral angle was (162.0±2.6)° which was measured on the image of preoperative lower extremity weight-bearing X-ray. Clinical outcomes were comprehensively assessed according to the bone healing time, postoperative complications, progress of knee osteoarthritis after operation, the Hospital for Special Surgery rating system (HSS), and tibiofemoral angle before and after operation.</p><p><b>RESULTS</b>All 21 patients were followed up, the valgus deformity of knee joint was corrected in all patients after operation. No obvious delayed union or nonunion were found, and no serious complications were found. The HSS knee score was improved from the preoperative 57.3±3.1 to the final follow-up time 88.6±2.7. Tibiofemoral angle was improved to the postoperative(176.0±1.4)°.</p><p><b>CONCLUSIONS</b>Open wedge femoral supracondylar osteotomy has a clear surgical approach, and it is easy to control the bone mass of osteotomy and can effectively correct the valgus deformity and improve the function of knee joint using this method. It is an effective method for the treatment of valgus knee osteoarthritis in young and middle-aged patients.</p>

Effects of breathing patterns on flow field in upper airway of an OSAHS patient during natural sleep / 医用生物力学

Objective To study the effects of different pressure boundary conditions and breathing patterns on the airflow of upper airway and related physiological status of the obstructive sleep apnea hypopnea syndrome (OSAHS) patient at sleep stage with eupnea and apnea, respectively. Methods The CT scan data of an OSAHS patient during natural sleep in supine position were acquired and used to reconstruct a three-dimensional finite element model of upper airway. Meanwhile the pressure changes in laryngeal cavity of the OSAHS patient were clinically measured and then used as the boundary conditions, and four typical breathing patterns (nasal inhaling and nasal exhaling, nasal inhaling and oral exhaling, oral inhaling and nasal exhaling, oral inhaling and oral exhaling) were considered for computational fluid simulation. Results The airflow of the OSAHS patient during sleep was an unstable, whorled and bidirectional flow, which was significantly affected by pressure boundary conditions and breathing patterns. Compared with nasal breathing, the maximum velocity of airflow by mouth breathing was increased, resulting in an increase of pressure drop in oral cavity, with was about 30% in inspiration and 100% in expiration. Conclusions It is significant to use CT data of an OSAHS patient during natural sleep for model reconstruction and the clinically measured pressure in laryngeal cavity as boundary conditions for finite element simulations, and the results will contribute to understand the characteristics of flow field in upper airway of the OSAHS patient during real natural sleep.

Progress of biomechanical research on obstructive sleep apnea hypopnea syndrome / 医用生物力学

Obstructive sleep apnea hypopnea syndrome (OSAHS) is a kind of disease characterized by repetitive pharyngeal collapse during sleep, and its pathogenesis involves multiple aspects. In this paper, from the aspect of biomechanics, various factors that might induce sleep apnea were studied based on anatomic and physiological characteristics of human upper respiratory system, and biomechanical models of OSAHS reported in recent years as well as potential mechanical pathogenesis of OSAHS were then analyzed. Finally, the prospects of future researches on OSAHS biomechanics were discussed. Establishing the biomechanical model of upper airways is an effective method not only important for studying pathogenesis of OSAHS, but also helpful for preoperative assessment and postoperative predictions for OSAHS treatment in clinic.

The non-replicating recombinant vaccinia virus expressing six genes of HIV-1 can be passaged stably in CEF / 病毒学报

To investigate the genetic stability (including the vector of vaccinia virus and six foreign genes: gp160, gag, pol, rev, tat and nef) of the HIV-1 non-replicating recombinant vaccinia virus (rNTV-C). rNTV-C was serially passaged to passage 25 (P25) in primary chicken embryo fibroblast (CEF). P9, P12, P15 and P25 were selected to study the genetic stability in four aspects, including the genetic stability of viral vector, the genetic stability of six foreign genes, the expressing stability of foreign genes and the genetic loss of foreign genes. The results showed that the viral vector was non-replicated vaccinia virus of Tiantan strain and was passaged stably; foreign gene sequences matched with designed sequences, the insert sites were right, and the nucleotide mutation rate was less than one over ten thousands within different passages of rNTV-C; the target proteins could be expressed effectively, and the expression level was stable within different passages of rNTV-C; the genetic loss of gag and nef was less than 5% within different passages of rNTV-C. The above results provided important data for the vaccine production.

Expression and immunity of multi-HIV B'/C subype genes in replicating DNA vaccines / 病毒学报

To understand the effect of various gene structures of HIV B'/C subtype on the gene expression and immunity in DNA vaccine, replicating DNA vector pSCK2 was used to construct seven DNA vaccines carrying one or more of HIV B'/C subtype genes: gagpol, gp160 and rtn (rev, tat and nef fusion gene). Immunofluorescence staining indicated that Gag, Gp160, Rev, Tat and Nef could be expressed from the seven DNA vaccines. Stronger expression was observed with the gene in single-gene expression plasmid or with the gene located at upper-IRES in double- or multi-gene expression plasmid. ELISA test showed that Gag induced higher antibody response, but the antibody titers stimulated by Gp160, Pol, or RTN were very low. Both Gag single-gene expression plasmid and Gag-RTN double-gene expression plasmid separately inoculating induced stronger antibody response against Gag than Gag-Gp160 double-gene expression plasmid and Gagpol-Gp160-RTN multi-gene expression plasmid or combined inoculation of Gag and Gp160 single-gene expression plasmids did. ELISPOT detection showed that all the seven DNA vaccines could stimulate cellular immune response against Gag, Pol, Gp160, Tat, and Nef, respectively. Gagpol or Gp160 single-gene expression plasmid separately inoculating stimulated the strongest cellular immune response. Tat and Nef expressed in all the plasmids induced similar immune response. These results indicated that HIV B'/C subtype genes gagpol, gp160 and rtn could be efficiently expressed in the replicating DNA vaccine vector, single-gene expression plasmid had the higher gene expression level and induced stronger immune response; combined immunization of Gagpol and Gp160 had dramatically lower immunity than Gagpol or Gp160 separated immunization did. Immunity of RTN had no difference between combined and separated immunizations. Therefore, in case of immunization with DNA vaccines containing different HIV genes, it is necessary to optimize the combined immunization procedure, especially for the combination of Gag and Gp160-containing vaccines.

Surgery for primary trigeminal maxillary neuralgia under transnasal endoscope / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility of endoscopic surgery for primary trigeminal neuralgia, and to evaluate its advantages and disadvantages.</p><p><b>METHODS</b>Fifteen patients diagnosed as primary trigeminal neuralgia were included in this study. All of them had maxillary neuralgia, concurrently with 8 ophthalmic neuralgia and 2 mandibular neuralgia. The median course of disease was 4 years. The surgeries were performed by transnasal endoscope, through sphenopalatine foramen, into the pterygopalatine fossa, to find rotundum foramen, and then coagulated and cut the maxillary nerve. Post-operative evaluation was done based on Brisman R' s way. The post-operative improvement of symptom was compared with preoperative symptom, and the complications of this operation were observed.</p><p><b>RESULTS</b>The follow-up time was 6 months to 16 months, with the median time of 13 months. Thirteen patients were cured, 2 patients had effective outcome. Seven months after operation, 1 patient appeared supraorbital neuralgia. After the radiofrequency operation, the pain was improved. All of the patients had no serious complications and no subjective discomfort of nose and eyes.</p><p><b>CONCLUSIONS</b>The surgery for primary maxillary neuralgia under transnasal endoscope had a direct way to rotundum foramen, with clear operative vision. It is a minimally invasive surgery, it can minimize the serious complications. The primary curative effect is confirmed.</p>

Transnasal endoscopic repair of frontal cerebrospinal fluid rhinorrhea / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the surgical approaches, methods and techniques of repair of cerebrospinal fluid (CSF) rhinorrhea via frontal sinus under transnasal endoscopy.</p><p><b>METHODS</b>Cerebrospinal fluid rhinorrhea, located at the posterior wall of the frontal sinus (n = 9) and posterior lateral wall of the frontal recess (n = 4) had been repaired surgically. A transnasal endoscopic approach was chosen in 12 patients and combined approach was used in 1 patient during the first procedure. Three patients needed the second surgery. Among them, one patient needed to repair CSF rhinorrhea, 1 patient needed to treat intracranial abscess of frontal lobe via combined approach and another one was treated because of the complication of frontal cyst.</p><p><b>RESULTS</b>Twelve patients were successfully repaired in the first surgery. Only 1 patient needed second surgery. Two patients occurred complications. One was intracranial infection after surgery, external drainage and packing in the frontal sinus was used. Another was obstructive cyst in frontal sinus, transnasal endoscopic frontal sinusotomy was performed.</p><p><b>CONCLUSIONS</b>CSF rhinorrhea which located at the posterior wall of the frontal sinus can be successfully repaired via transnasal endoscopic approach if the leak was visible under endoscopy. The size of the frontal ostium and leak vantage should be considered to prevent the drainage of the frontal sinus which would result in obstructive cyst in frontal sinus, frontal sinusitis and intracranial infection. Combined approach was suggested to the patients that leakage could not be seen in frontal sinus or frontal ostium was difficult to enlarge.</p>

Development and application of a safe SARS-CoV neutralization assay based on lentiviral vectors pseudotyped with SARS-CoV spike protein / 病毒学报

The severe acute respiratory syndrome-associated coronavirus (SARS-CoV) spike protein (S) is a major target for neutralizing antibody. To develop and apply a safe neutralization assay for SARS-CoV, lentiviral SARS-CoV S pseudotypes had been constructed based on a three plasmid system, which contained pVRC8304 (harboring codon optimized full-length SARS-CoV S protein), pCMV delta 8. 2 (HIV-1 gag/pol construct) and pHR'CMV EGFP (the green fluorescent protein reporter construct). The pseudo-typed lentiviral particles were used to develop an in vitro microneutralization assay that was both sensitive and specific for SARS-CoV neutralizing antibody. We used this assay to determine the titers of the neutralizing antibodies (Nabs) in serum samples from mice immunized with various rVVs expressing different S fragments of SARS-CoV. The serum antibodies derived from S and various segments of S1 region neutralized SARS-CoV in vitro. No cross-neutralization occurred with the goat antiserum prepared with inactivated HCoV-OC43 or HCoV-229E. Neutralization titers measured by this assay were highly parallel with those measured by the assay using live SARS-CoV. Because the pseudotype assay does not require handling live SARS virus, it is a useful tool to determine serum neutralizing titers during natural infection and the preclinical evaluation of candidate vaccines.

Endoscopic surgery for nasopharyngeal angiofibroma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and the surgical techniques of transnasal endoscopic procedure for juvenile nasopharyngeal angiofibroma (JNA).</p><p><b>METHODS</b>Twenty-one nasopharyngeal angiofibroma patients were treated using transnasal endoscopic approach. They were divided into group A (without intracranial extension) and group B (minimal intracranial extension) according to the staging of Sessions. The patients were treated mostly with endoscopic surgery. In two midfacial operations cases, endoscopy was also used. The staging, average blood loss during surgery, tumor residual, and (or) recurrent tumor were evaluated.</p><p><b>RESULTS</b>Group A (19 cases) had an average blood loss of 1000 ml. Nineteen patients had no residual or recurrent tumor over a follow-up of 8-24 months. Group B (2 cases) had an average blood loss of 1500 ml. One of the patients had minimal residual tumor around the cavernous sinus, but showed no progression over a follow-up of 2 years. Another patient had no residual or recurrent tumor over a follow-up of 8 months.</p><p><b>CONCLUSIONS</b>The data suggests that transnasal endoscopic surgical techniques can be used to treat JNA which either limited to nasal and nasopharyngeal cavities or and the tumor with sphenoid and ethmoid invasions and even minimal intracranial extension.</p>

The role of cycline dependent kinase 4 in the malignant transformation induced by silica / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the role of cycline dependent kinase 4 (CDK4) in the malignant transformation of human fetal lung diploid fibroblast cell (2BS) induced by silica.</p><p><b>METHODS</b>Recombination vectors with antisense pXJ41-CDK4 were constructed, and then were transfected into the malignant transformed cells induced by silica. In situ hybridization and immunohistochemistry were used to analyze the expression of CDK4. Cell growth curve, doubling time, cell cycle distribution and the growth capacities on soft agar were analyzed before and after antisense CDK4 RNA was transferred into malignant transformed cells induced by silica.</p><p><b>RESULTS</b>During the malignant transformation of 2BS cells induced by silica, CDK4 gene was overexpressed. Antisense pXJ41-CDK4 transduction suppressed CDK4 gene expression in the antisense pXJ41-CDK4 transfected cells. Antisense CDK4 RNA led to cell cycle arrest, resulting in lengthened G1 phase (the percentages of cells in the G1 phase increased from 45.1% to 58.0%), and eventually attenuated the proliferation of malignant transformed cells induced by silica. At the 8th day, the suppression rates decreased by 77.43%. The doubling time prolonged from 21.0 h to 42.7 h. The growth capacities on soft agar of cells transfected by antisense pXJ41-CDK4 were decreased.</p><p><b>CONCLUSION</b>CDK4 might play an important role in maintaining the transformed phenotype of the cancer cells.</p>

Role of telomerase in chrysotile induced malignant transformation of normal human embryonic lung fibroblasts / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the role of telomerase in asbestos dust induced malignant transformation of human embryonic lung fibroblasts in vitro.</p><p><b>METHODS</b>Human telomerase catalytic subunit (hTERT) was transferred into human embryonic lung fibroblasts (HELF). Chrysotile dust at concentration of 2.5 microg/cm(2) was added to HELF transduced with and without hTERT (HELF-T+), respectively, and their transduced foci were separated. Biological characteristics of the cells, telomerase activity, length of telomere and cell growth curve were observed. Colony forming test was performed on soft agar to evaluate the nature of transformation.</p><p><b>RESULTS</b>The hTERT gene was transferred into HELF steadily, and HELF-T+ was established. Malignant transformation occurred in both HELF and HELF-T+ by asbestos stimulation. Asbestos dusts could induce higher rate of transformations in HELF-T+ [(2.08 +/- 1.08)/utensil] than in HELF [(1.08 +/- 0.10)/utensil], P < 0.05. Telomerase activity in both transformed malignant cells and HELF-T+ was higher, as well as the longer length of telomere in them.</p><p><b>CONCLUSION</b>Rate of malignant transformation in cells with more activity of telomerase and longer length of the telomere was higher after stimulation with asbestos, indicating telomerase could play an important role in asbestos induced human cells malignant transformation.</p>