Lacrimal gland Alterations and the Effect of artesunate on experimental induced diabetes rat models and related mechanisms.

Diabetic patients are at high risk of developing lacrimal gland dysfunction, and the antimalarial drug artesunate (ART) was recently used to induce experimental-induced diabetes mellitus. This study's objective is to investigate the lacrimal gland alteration and the effect of ART on experimentally induced diabetes rat models and its related mechanisms. Forty rats were divided into five groups (8 rats/group): healthy control group (HC), diabetic group (DM), 50 mg/kg ART intervention diabetic group [DM + ART (50 mg/kg)], 100 mg/kg ART intervention diabetic group [DM + ART (100 mg/kg)] and 6 U/kg Insulin intervention diabetic group (DM + INS). The morphology of the eyeball and lacrimal gland tissues was determined using hematoxylin and eosin staining. In addition, external lacrimal glands were harvested for electronic microscopic examination, NFκB1, and TNF-α protein expression evaluation by immunohistochemistry and mRNA expression analysis by RT-PCR. Histopathological and ultrastructural changes suggest ART intervention has an improved structural effect. Protein expression of NFκB1 in the DM + ART (100 mg/kg) group was decreased. TNF-α significantly decreased in the DM + ART (50 mg/kg) and insulin groups. We concluded that ART improves structural changes in a lacrimal gland in diabetic rats. The present study provides further evidence of the therapeutic effect of ART on the lacrimal gland of diabetic rats by decreasing the expression of NFκB1 and TNF-α.

A stomaplasty for total laryngectomy with a previous tracheostomy.

OBJECTIVE: Stomaplasties were widely used to prevent or revise stomal stenosis, however, a previous tracheostomy can limit the choice of some techniques. This study aims to deal with this condition through a novel and simple technique called "Collar stomaplasty". METHODS: This study involved 43 patients submitted for laryngectomy between 2017 and 2020. A tracheostomy 6-31 days prior to laryngectomy was performed in all cases. The collar stomaplasty, shaping the previous tracheostomy and surrounding skin, included 17 cases and the traditional X-shaped stomaplasty included 26 cases. Fisher's exact test was applied in an intergroup comparison of complications. RESULTS: One out of the collar stomaplasty group demonstrated perioperative stomal infection and avascular necrosis (5.9%). Another developed stomal stenosis (5.9%). In the X-shaped stomaplasty group, necrosis at the tip of the tracheal flap occurred in 14 cases (53.8%), and stomal stenosis occurred in 5 cases (19.2%). A statistically significance occurred in stomal necrosis (p<0.05) while no statistically difference is observed in stomal stenosis (p>0.05) between these two groups. CONCLUSIONS: The collar stomaplasty technique creates a laryngectomy tracheostoma by remodeling a previous tracheostomy. A wide and stable stoma, which facilitates stomal care, can be accomplished by this simple technique.

Mobility of the arytenoid cartilage in glottic carcinoma: a CT image study.

BACKGROUND: Laryngeal carcinomas cause vocal cord (VC) mobility problems. Other than evaluation through flexible laryngoscopy, rare reports concerning CT findings for the motion of the VC or arytenoid cartilage (AC) are found. AIMS/OBJECTIVES: To explore a novel evaluation of the mobility of the AC in glottic carcinoma. MATERIAL AND METHODS: In 39 patients with glottic carcinoma grouped upon lesion locations and AC mobilities, laryngeal CT scans were collected during inspiration and phonation. AC static position and motion data were compared between paired lesion and control sides. RESULTS: No significant difference showed in the group with glottic carcinoma invading the anterior 2/3 of VC. In the abnormal mobility group, significant AC position changes and weaker motion of most measurements were proved on the lesion side. Lesion invading the posterior 1/3 of VC also resulted in an adducted, medially rotated and forward-tilted AC, rotation of axial angle (RAA) was the only motion item that decreased significantly. CONCLUSIONS AND SIGNIFICANCE: In most glottic cancer cases, CT and laryngoscope had similar judgments for AC mobility. For lesions extending to the cartilaginous VC with laryngoscopically confirmed normal mobility, CT measurement of RAA showed the feasibility of being an indicator for the earliest motion problem.

The impact of predisposing, enabling, and need factors in utilization of health services among rural residents in Guangxi, China.

BACKGROUND: Healthcare in China has significantly improved, meanwhile many  socio-economic risk factors and health conditions factors affect accessibility and utilization of health services in rural areas. Inequity of health service in China needs to  be estimated and reduced. Andersen behavioral model is useful to assess the association of health service utilization with predisposing, enabling, and need factors. METHODS: A survey was conducted among 4634 residents of 897 households in 2012. Logistic regression analysis was performed to explore the association of predisposing (age, gender, marital status, ethnicity and family size), enabling (education level, travel time to the nearest health facility, medical expense per capita, and health insurance coverage), and need factors (chronic disease) with the utilization of health services (i.e. physician visit and hospitalization). RESULTS: We observed a significant association between need factor (chronic diseases) and health service unitization, after adjusting for all predisposing and enabling factors (physician visits: odds ratio (OR) = 5.87, 95 % confidence interval (CI) = 4.71-7.32; hospitalization: OR = 4.04, 95 % CI = 2.90-5.61, respectively). In addition, age, gender, marital status, family size and education level were significant predictors of health service utilization. The travel time to the nearest health facility was associated with the utilization of physician visits, and expenditure on healthcare was a hindering factor of hospitalization. CONCLUSIONS: The predisposing and enabling factors had a minor impact on health service utilization, while the need factor was a dominant predictor of health service utilization among rural residents in China.

Cross-platform data integration of paratubal electromyography and sonotubometry for eustachian tube: a pilot study.

CONCLUSION: The sensitive sonotubometry and MATLAB provide a new tool to study the eustachian tube (ET) function and contribute more to reliable data and precise analysis. The levator veli palatini muscle (mLVP) and the salpingopharyngeus muscle (mSP) may, respectively, be the most important and least important muscle for ET function. OBJECTIVES: The ET lumen dilation is a result of the contraction of the paratubal muscles, the tensor veli palatini muscle (mTVP), mLVP and mSP. To trace the dynamic ET muscle/lumen activities, the present study aimed to optimize sonotubometry and achieve cross-platform data integration of electromyography (EMG) and sonotubometry using MATLAB (matrix laboratory). METHOD: Seventeen healthy volunteers (34 ears) were chosen for the concurrent recordings of the paratubal EMG and sonotubogram under dry and water swallowing. RESULTS: The optimized sonotubometry based on computer sound card showed satisfied sensitivity. For both EMGs and sonotubogram, dry swallowing generated significantly greater amplitude and longer duration compared to water swallowing. Moreover, statistically significant differences (p < 0.05) were detected in the comparison of the amplitude, duration, and latency for the mTVP, mLVP, and mSP. The mSP activity was the weakest and even inactive in some cases, the mLVP presented the most powerful and long lasting activity during ET-opening.

[The study of acoustically evoked short latency negative responses in normal guinea pigs].

OBJECTIVE: To compare acoustically evoked short latency negative responses (ASNR) elicited from normal and profound hearing loss guinea pig ears and to confirm their vestibular nuclei origination. METHODS: Forty healthy guinea pigs were employed in the experiment, which were randomly divided into the control group (8 subjects, 16 ears), the masking group (16 subjects, 32 ears) and the deafened group (16 subjects, 32 ears). Air conductive white noise was chosen for masking. Masking dilemma was avoidable by an appropriate 15 dB gap between stimulus and masking sound. Both the masking group and the deafened group were further divided into ASNR group and non-ASNR group based on the presence of ASNR. Electrolytic lesion was conducted to the vestibular nuclei, followed by ABR/ASNR recording. The lesioned brainstem slices were microscopically verified. RESULTS: In the masking group, ASNR were present in 24 ears (75.0%, 24/32) and 12 ears (46.2%, 12/26) in deafened group, showing statistically higher presence rate for masking group (χ(2)=5.07, P=0.024). There were no significant differences for the ASNR threshold and latency between the masking ASNR group and the deafened ASNR group. For the two ASNR groups, electrolytic destruction to the vestibular nuclei subsequently eliminated the ASNR. Brainstem slice proved the accurate sites of electrolytic lesion. CONCLUSION: Moderate white noise masking prevents hearing system potential overlap without affecting vestibular system, therefore, ASNR is successfully elicited in normal guinea pigs. Both ASNRs from normal and deafened guinea pigs are of similar natures and origination from, the vestibular nuclei.

[Digitalization study of sonotubometry device].

OBJECTIVES: Sonotubometry is wildly used in developed countries, offers a easy, versatile and objective way to assess the function of Eustachian tube. The objectives of this study are to develop a low-cost digitalized device. METHODS: The digitalized sonotubometry device was made of a personal computer with sound input and output accessories. The PC sound card, connected to a signal amplifier, exported probe band noise, while feedback sound was collected by a microphone. All 36 volunteers (72 ears) were involved in the sonotubometry test with JK-04A and CHN-08, in the conditions of dry-swallowing and wet-swallowing. The data were statistically analyzed using SPSS 13.0. RESULTS: The basic electroacoustic performance of the CHN-08 was acceptable. CHN-08 (7 kHz) detection and JK-04A consistency of kappa index was 0.472; CHN-08 (8 kHz) and JK-04A consistency of kappa index was 0.487; CHN-08 (7 kHz) and CHN-08 (8 kHz) consistency of kappa index was 0.688.Under the JK-04A, CHN-08 (7 kHz) and CHN-08 (8 kHz) three setups, Eustachian tube opening frequency was significantly lower for wet-swallowing than dry-swallowing, P < 0.05. CONCLUSIONS: A low-cost digitalized sonotubometry is successfully developed. Its electroacoustic performance proved acceptable by authority assessments. The detection rate of CHN-08 is in accordance with that of JK-04A moderately. The study revealed that Eustachian tube is opened more easily by dry-swallowing than by wet-swallowing.

[The nucleus origin of acoustically evoked short latency negative response in guinea pigs].

OBJECTIVE: This study established a model of acoustically evoked short latency negative response (ASNR) in guinea pigs. Stereotaxic coordinate guided electrolytic lesion was applied to animal brainstem nuclei, the vestibular nucleus and the cochlear nucleus, to define the neural origin of ASNR. METHODS: Twenty four guinea pigs with normal hearing were randomly divided into the control group (8 subjects, 16 ears) and the deafened group (16 subjects, 32 ears). Each animal experienced the auditory brainstem response (ABR) test. According to the presence of ASNR, the deafened group was further divided into ASNR group and non-ASNR group. Electrolytic lesion was conducted to the vestibular nucleus and cochlear nucleus respectively, followed by ABR test. The lesion structures were verified by brainstem slice and microscope. RESULTS: In deafened group, the ASNR was elicited in 10 ears (31.3%). The ASNR was eliminated due to the electrolytic destruction to the vestibular nucleus, but it remained unchanged after the same procedure to the cochlear nucleus. CONCLUSION: It is clear that the ASNR is originated from the vestibular nucleus, but not the cochlear nucleus.

[Inner ear morphological study of guinea pigs with acoustically evoked short latency negative response].

OBJECTIVE: To establish a model of ototoxicity in guinea pigs with acoustically evoked short latency negative response (ASNR) and verify the responsible organ of ASNR based on microscopic characteristics of basal membranes, saccules, utricles and ampulla canalis semicircularis of the inner ear. METHODS: Total of 45 guinea pigs were employed in the experiment, which were randomly divided into the control group (15 subjects, 30 ears) and the deafened group (30 subjects, 60 ears). Each animal experienced auditory brainstem response (ABR). A quick treatment was employed for deafened group consisting of a subcutaneous injection of kanamycin at a dose of 400 mg/kg followed by jugular vein injection of ethacrynic acid at a dose of 40 mg/kg one hour later. The animals were performed ABR test from 7 to 10 days after the drug administration. The deafened group was further divided into ASNR group and non-ASNR group based on the presence of ASNR. All the guinea pigs were sacrificed after ABR tests. The Corti organ, macula sacculi, macula utriculi and crista ampullaris were observed by light microscope. RESULTS: In the deafened group (60 ears), 3 subjects died postoperatively, 27 subjects (54 ears) provided full data. ASNR was elicited in 19 ears (35.2%, 19/54), the thresholds of ASNR were from 110 to 125 dBSPL with average of (121.7 ± 4.5) dBSPL. ASNR latency ranges were 1.80 - 2.08 ms, the average latency of thresholds were (1.93 ± 0.07) ms. The stretched preparation results: overall hair-cell density of macula saccule, macula utriculi and crista ampullaris decreased in order of normal control group, ASNR group and non-ASNR group. There was no difference between the normal group and ASNR group for cell density of macula saccule. Apart from this, statistical differences were found among other groups. CONCLUSIONS: The present study evoked ASNR in an ototoxicity guinea pig model which was profound hearing loss with normal saccular function and normal saccular hair cell density. It suggested that ASNR originates from the saccule and have no relation with cochlear, utricle and semicircular canal according to morphological study.

[Origin of acoustically evoked short latency negative response in guinea pigs].

OBJECTIVE: To establish a model of acoustically evoked short latency negative response (ASNR) in guinea pigs, a model of profound hearing loss with normal saccular functions, and verify the correlation between ASNR and vestibular evoked myogenic potential (VEMP). METHODS: Thirty-two healthy guinea pigs were employed in the experiment, which were randomly divided into control group (16 subjects) and deafened group (16 subjects). Each animal experienced auditory and vestibular tests including auditory brainstem response (ABR), VEMP and caloric test. A quick treatment was employed for deafened group consisting of a subcutaneous injection of kanamycin at a dose of 400 mg/kg followed by a jugular vein injection of ethacrynic acid at a dose of 40 mg/kg one hour later. The animals were received ABR, VEMP and caloric test 7 - 10 days following the drug administration. The deafened group was further divided into ASNR group and non-ASNR group, based on the presence of ASNR. RESULTS: In deafened group, five subjects died postoperatively, 11 subjects (22 ears) provided full data, ASNR was elicited in eight ears (36.4%), the threshold was 120 - 130 dB SPL with mean of (124.4 ± 4.96) dB SPL. Its latency range was 1.75 - 2.60 ms with mean of (2.15 ± 0.27) ms. The mean latency of threshold was (2.34 ± 0.18) ms. All eight ASNR ears presented with VEMP. The VEMP threshold, positive and negative potential latencies proved no statistical difference (P > 0.05) between ASNR group and control group. Significant difference was detected between the VEMP presence of ASNR group and non-ASNR group (P = 0.002). There was no statistically significant correlation between VEMP and caloric test neither between ASNR and caloric test in deafened group. CONCLUSIONS: This study evoked ASNR in an ototoxicity guinea pig model which has profound hearing loss with normal saccular functions. The presence of ASNR correlated with VEMP, however, not correlated with caloric test, suggesting that ASNR and VEMP are both originated from the saccule.

[Analysis of the reason for the adhesion of vocal cord after CO2 laser laryngeal surgery].

OBJECTIVE: To investigate the reason for the adhesion of vocal cord after CO2 Laser laryngeal surgery. METHOD: One hundred and nineteen patients who were untaken CO2 Laser laryngeal microsurgery. RESULT: Among 119 cases, 9 cases of bilateral vocal cord paralysis, 42 cases of vocal cord polyps and 3 cases of precancerous laryngeal lesions did not show vocal cord adhesion after CO2 Laser laryngeal microsurgery. Contrarily, one of 5 cases with laryngeal stenosis, 5 of 41 cases with laryngeal papilloma and 6 of 19 cases with laryngeal carcinoma shew the adhesion of vocal cord after CO2 Laser laryngeal microsurgery. CONCLUSION: Through selecting the appropriate patient and surgery spot, processing correctly during and after surgery, using the suitable dosage of laser and reducing the heat radiation, the adhesion of vocal cord can be avoided after CO2 Laser laryngeal surgery.

[Treatment of laryngeal granuloma].

OBJECTIVE: To study treatment method of laryngeal nonspecific granuloma. METHOD: Twenty-five patients with histopathologically identified laryngeal nonspecific granuloma were retrospective reviewed from 1998-2005. All patients were surgically treated by laser laryngomicrosurgery under general anesthesia, postoperative non-operative therapies included anti-gastroesophageal reflux medication, topical inhalant steroid (Beclometasone, Fluticasone) and voice therapy. Two patients were treated with 12 Gy of low-dose radiotherapy after surgery. RESULT: Laryngeal nonspecific granuloma have remarkable tendency of recurrence despite of surgery and non-surgical managements. Recurrence of laryngeal nonspecific granuloma occurs between 2-3 months postoperatively and requires repeated operation for 3 5 times. For intubation granuloma, 6 out of 8 were healed. Six out of eight contact granulomas were healed. Six of gastroesophageal reflux granulomas were healed. Glottic carcinoma was demonstrated in one case after 2 sessions of combined managements. Two patients were completely healed by low-dose radiotherapy of 12 Gy. CONCLUSION: Laryngeal nonspecific granuloma have an obvious tendency of recurrence, however, surgery is an important therapy. Combined non-surgical therapies (anti-gastroesophageal reflux medication, topical inhalant steroid and voice therapy) are necessary. In case which routine ways fail to control recurrence, low-dose radiotherapy is recommended because of its safety and satisfied effect.

[Clinical study of juvenile nasopharyngeal angiofibroma].

OBJECTIVE: To present our experiences of diagnosis and treatment for juvenile nasopharyngeal angiofibroma (JNA) and to evaluate the factors influencing intra-operative bleeding and tumor recurrence. METHOD: Forty-five patients suffered form JNA experienced surgical management and/or radiotherapy between January 1980 and December 2001 were studied retrospectively. All the patients were males. The age ranged from 13 to 24 years with mean of 16.3 years. Three operative approaches were selected according to tumor stage: the traditional and modified transpalatal, lateral rhinotomy and craniofacial combined approach. Six cases received postoperative radiotherapy and 1 case received radiotherapy without surgery. RESULT: The tumors were completely resected in 36 cases and recurred in 9 cases (20%) during a follow-up period of 6-84 months. Six of the 9 recurrent tumors were completely resected and the rest 3 were incompletely resected combined with postoperative radiotherapy. No recurrence was found in a follow-up period of 1-3 years. The tumor stage influences intraoperative bleeding and the incidence of recurrence. No statistically significance difference was found when comparing preoperative embolization of the vessels and ligature of the external carotid artery patients with non-embolized and control group (P = 0.554). CONCLUSION: (1) With the approaches of operation selected according to tumor stage, most of the tumors can be removed by the traditional/modified transpalatal and lateral rhinotomy approaches; (2) Preoperative ligature of the external carotid artery and embolization of the vessels feeding the tumor can not reduce intraoperative bleeding. The inconsistency of tumor staging in test and control groups may lead to this result; (3) The tumors stage influences the intraoperative bleeding and the incidence of recurrence; (4) Radiotherapy is an effective adjuvant treatment for the patients with advanced stage or recurrent tumors.

[Relationship between secretory otitis media and language disorder in children: analysis of 1108 cases].

OBJECTIVE: To discuss the relationship between secretory otitis media (SOM) and language disorder in children. METHOD: In 1108 language disorder cases, auditory brainstem responses (ABR) and acoustic immittance were measured respectively. According to the ABR threshold, all the children were divided into four groups: the normal group, the mild hearing loss group, the middle hearing loss group and the severe hearing loss group. RESULT: Of all the ears examined, 59.5% had hearing loss, while 12.64% had SOM. In the children of language disorder, the distribute of the "B" type tympanograph from much to little was:the mild hearing loss group, the middle hearing loss group, the severe hearing loss group and the normal group ( P < 0.01). The average hearing threshold of a part children with SOM decreased after therapy ( P < 0.01). The children with the severe hearing loss had no evident changes after therapy. CONCLUSION: Hearing disorder is the main cause of language disorder in children. While SOM recovers in children with mild or middle hearing loss, the language in part of them could be improved. However, the language in those who with severe hearing loss probably remains the primary level.

[Preservation of laryngeal and glossal function in surgical treatment of oropharyngeal glossal epiglottic carcinoma].

OBJECTIVE: To study the feasibility, surgical techniques and results of surgical treatment of oropharyngeal glossal epiglottic carcinoma with laryngeal and glossal functions preserved. METHODS: A retrospective review of 21 (17 males, 4 females, age range 44 to 72 years) cases with carcinoma extending from the oropharynx, glossa to the epiglottis treated during 1990 to 2000 was conducted. The clinical stage was T2N0 in 4, T2N1 in 5 and T3N1 in 12 according to 1992 UICC. All the cases were undergone partial resection of the glossal base-epiglottis and suproglottic horizontal partial laryngectomy. Seventeen cases received selective neck dissections and all the patients received postoperative radiotherapy (50-60 Gy). RESULTS: The 3-year and 5-year survival rates in this series were 73.3% and 57.1%, respectively. Decannulation and complete preservation of laryngeal and glossal functions were achieved in 20 cases (95.7%), while partial preservation (speaking and deglutition) in one case (4.2%). CONCLUSION: Preservation of the laryngeal and glossal functions in surgical treatment of oropharyngeal glossal epiglottic carcinoma is feasible. Subhyoid approach was proved to be the best way for tumor resection in such an extent.

[Clinical and pathological study of chordoma in the skull base].

OBJECTIVE: To study the clinical and pathological characteristics of chordoma in the skull base. METHOD: The clinical manifestation, radiological finding and pathological characteristics in 20 patients with skull base chordoma were reviewed. Among them, 7 were immunohistochemical stained for keratin, epithelial membrane antigen, vimentin, glial fibrillary acidic protein and desmen, 2 were studied by electron microscope. 19 patients received surgical resection(5 cases were assisted by nasal endoscope). Eleven patients received radiation therapy. All 19 patients were followed-up for 3-5 years after treatment. RESULTS: (1) Clinical type were divided into four types in this group according to symptoms, sign, imaging features, operation finding, the original places and the expansive direction of the tumor. Seller type 5 cases, clival type 9 cases, occipito-temproral type 2 cases and extent type 4 cases. One case with multiple cranial never palsies died due to the pressure on brain stem by the neoplasm, was autopsied prove lungs metastasis. 5 years survival rates were 65% and 35% respectively. (2) Vacuolated physaliferous cell is the pathology characteristic of chordoma. (3) Positive rate of epithelial marker antigens are higher than other mesenchymal neoplasms. Distended rough endoplasmic reticulum and filament were found within the cytoplasm under transmission electron microscope. CONCLUSION: Chordoma is a kind of low malignancy which express epithelial and mesenchymal characteristics. Vacuolated physaliferous cell is the characteristic Pathologic appearance. Immunohistiochemical stain is helpful in differential diagnosis. Complete excision is still technically impossible. Chordoma maintain high recurrence rate after surgery, with metastasis. Combined modality therapy include surgical operation and radiation could prolonged survival period.