[Application of three-staged paramedian forehead flap in reconstruction and repair of full-thickness nasal defect].

Objective: To evaluate the application of three-staged paramendian forehead flap technique in reconstruction of severe full-thickness nasal defect. Methods: Clinical data of 7 cases with nasal reconstruction by three-staged forehead flap technique in the First Affiliated Hospital of Xinjiang Medical University and HongKong University Shenzhen Hospital between June 2016 and October 2019 was retrospectively reviewed. All were males aged from 10 to 71 years. There were 4 cases of basal cell carcinoma of the external nose, 2 cases of traumatic nasal defects and 1 case of large rhinophyma. All the operations were performed with the paramedian forehead flap in three stages. In stage Ⅰ, full layered forehead flap was transposed to the nasal detect. Lining flaps were reconstructed with folded forehead skin (n=4), turn-over flap plus septal chondro mucosal pivotal flap (n=2), or bipedicled vestibular skin and nasal mucosa advancement flap (n=1). According to the reconstruction mode of the lining flaps, whether to implant cartilage to reconstruct the external nasal stent at stage Ⅰ was determined. At stage Ⅱ, the folded flaps were partly or completely separated from the covering flaps along the free edges of nasal alar. All the excess soft tissue including subcutaneous fat and frontalis muscle were excised, cartilage grafts were placed or sculpted to make an ideal nasal contour. The covering flaps were then returned on the recontoured, three-dimensional recipient bed. At stage Ⅲ, the pedicles were divided. Descriptive statistical method was used to analyze the data. Results: In all cases, restoration of the nasal contour was remarkably good, no flap necrosis occurred. All patients were followed up for 6 months to 2 years, and the appearance and function of the nose recovered well. All patients were satisfied with their final aesthetic results. Conclusions: Three-staged paramedian forehead flap technique ensures maximal blood supply for the lining flap and the inserted cartilage graft, and restores an ideal three-dimensional nasal contour for reconstruction of large full thickness nasal defects.

Integrin-linked kinase is overexpressed in laryngeal squamous cell carcinoma and correlates with tumor proliferation, migration and invasion.

OBJECTIVE: To investigate the role of integrin-linked kinase (ILK) in invasion and metastasis of the laryngeal squamous cell carcinomas (LSCC) and to evaluate the effects of antisense oligonucleotide sequence (ASONs) targeting the ILK gene on the proliferation, epithelial-mesenchymal transition (EMT), migration and invasion of LSCC. PATIENTS AND METHODS: 116 patients who had previously undergone complete resection of the tumor for LSCC were studied retrospectively. The ILK expression level in tumor tissues and adjacent normal tissues were determined by immunohistochemistry. The changes of ILK expression from each group were assessed and correlated to the clinical parameters of the patients. Secondly, ILK antisense oligonucleotide (ILK-ASONS) was used to silence the ILK gene of LSCC cell from Hep-2 cell line. The expression of ILK, epithelial marker E-cadherin and mesenchymal marker Vimentin were evaluated by Western blotting. The proliferation of cells after transfection was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT). The apoptosis was detected by flow cytometry. The migration and invasion activity of Hep-2 cells was detected by Matrigel invasion and cell migration assays. RESULTS: The expression of the ILK protein was significantly associated with tumor differentiation (p=0.046), lymph node metastasis (p=0.020) and pTNM stage (p=0.019). ILK ASONS-transfected cells showed a significant decrease in cell proliferation, cell migration and invasive activity compared to mock-transfected cells. ILK ASONS-transfected cells increased the expression of E-cadherin, whereas the expression of ILK and Vimentin decreased, compared with mock-transfected cells. CONCLUSIONS: The expression of ILK was significantly correlated with differentiation and metastasis of the laryngeal carcinomas. The inhibition of the ILK gene could downregulate the proliferation, migration and invasion of Hep-2 cells. These findings suggest that the ILK gene could be a potential target for the treatment of laryngeal cancer.

[Relationship between upper airway volume and polysomnography parameters of patients with obstructive sleep apnea hypopnea syndrome].

Objective:To study the relationship among upper airway volume of naso-pharyngeal, yelo-pharyngeal,glosso-pharyngeal, hypo-pharyngeal area which measured by spiral computed tomography three-dimensional reconstruction technique, apnea hypopnea indexes, and the lowest oxygen saturation in patients with OSAHS.Method:①fifty-one patients with OSAHS were received polysomnography, and then were divided into groups by the AHI,LSaO2 values. ②To measure upper airway volume at normal breath and Müller maneuver state using spiral computed tomography three-dimensional reconstruction technique of CT measurement, and to calculate volume change rate and observe the upper airway compliance. ③To analyses the relationship between upper airway volume and AHI,LSaO2 values.Result:The smallest upper airway volume of OSAHS was at the velo-pharyngeal level; the volume of velo-pharyngeal level were negatively correlated with AHI during normal respiration and Müller's maneuver state and were positively correlated with LSaO2; the volume of hypo-pharyngeal were negatively correlated with AHI during normal respiration; the volume of glosso-pharyngeal were positively correlated with LSaO2 during Müller's maneuver state.Conclusion:①The volume of velo-pharyngeal level with OSAHS patients can reflect the severity of AHI,LSaO2. ②The measurement of upper airway volume using spiral computed tomography three-dimensional reconstruction technique is good method to evaluate the upper airway compliance of OSAHS patients.

[Application of functional parotidectomy via retroauricular hairline incision in the excising superficial parotid tumor].

Objective: To evaluate the usefulness of retroauricular hairline incision (RAHI) in partial superficial parotidectomy (PSP) by comparison with modified Blair incision (MBI). Methods: A retrospective analysis of 64 medical records for patients with benign parotid tumors who underwent partial superficial parotidectomy was undertaken (28 were in MBI group, 36 in RAHI group). Size and location of tumors, operative time, occurrence of facial nerve paralysis and Frey's syndrome, and cosmetic outcomes were compared between RAHI and MBI groups. Results: Compared with MBI group, RAHI group showed better cosmetic results for benign parotid tumors in mean satisfaction score(P<0.001). There were no significant differences in size and location of tumors, operative time, incidence of transient or permanent facial nerve paralysis and Frey's syndrome between two groups (P>0.05). Conclusions: Partial superficial parotidectomy can be performed safely via RAHI in most cases of benign parotid tumors. Compared with MBI, RAHI for benign parotid tumorscan improve the cosmetic outcome, without increasing the operative time or operative morbidity.

[Functional modified periauricular incision in parotidectomya].

Objective:The purpose of this study was to present the usefulness of modified periauricular incision in parotid surgical procedures. Method:Sixteen consecutive partial superfacial parotidectomies were performed using modified periauricular incision. Clinical evaluation of cosmetic satisfaction, incidence of complications such as Frey's syndrome, facial nerve palsy, earlobe numbness and salivary fistula were observed. Result:The parotid tumors were removed in all cases with need for any further skin procedures, as the incisions produced a good aesthetic result. The average scale of cosmetic satisfaction are 9.2. Temporary paralysis of the facial nerve were found in two patients, and six patients felt numbness around earlobe after operation. Hey all recovered in 1 to 3 months after surgery. All patient healed without salivary fistula and Frey's syndrome. No recurrence was happened during follow-up in 6 to 30 months (median follow-up period was 22 months). Conclusion:The results of the present study indicate that modified periauricular incision have a high-quality and highly aesthetic option for surgical procedures concerning benign conditions of the parotid gland.

Continuous positive airway pressure-associated cutaneous amoebiasis in an immunosuppressed patient.

Organisms of the genus Acanthamoeba are environmentally ubiquitous and colonizers of the oral mucosa in humans. While largely asymptomatic in healthy persons, Acanthamoeba infection can cause disseminated disease with poor prognosis in immunosuppressed populations. Here we report a unique case of cutaneous amoebiasis associated with continuous positive airway pressure use in an immunosuppressed patient.

Interventions for mycosis fungoides: critical commentary on a Cochrane Systematic Review.

BACKGROUND: The authors performed a systematic review of randomized controlled trials (RCTs) on interventions for any stage of typical mycosis fungoides (MF). They searched electronic databases including the Cochrane Central Register of Controlled Trials, Medline, Embase, and the Latin American and Caribbean Health Science Information database, and included reports from conference proceedings and unpublished data without language restrictions. The authors also searched trial registries affiliated with the U.S.A., Australia, the World Health Organization and the European Organisation of Research and Treatment of Cancer for studies on 'mycosis fungoides' or 'cutaneous T-cell lymphoma'. These searches were supplemented by correspondence with the groups or individuals who conducted the RCTs. METHODS: The authors included RCTs with participants who were 18 years of age or older, that had staging information, and in which > 90% of patients had biopsy-proven typical CD4+ MF. Data on treatment and outcome of participants, including information on stage of MF, therapy, quality of life, remission or improvement, duration of remission, survival, adverse effects and toxicity were obtained from included studies. Primary outcomes were adverse effects and quality of life. Secondary outcomes were clearance of at least 90% of surface area involvement, improvement of at least 50% of surface area involvement, survival rate, relapse rate and disease-free interval. The authors also recorded potentially significant participant-related prognostic factors, such as age and sex, and tumour-related prognostic factors, such as histological subtype and systemic involvement. FINDINGS: From 407 unique references, 14 RCTs were included with a total of 675 patients. These trials included skin-directed therapies [topical peldesine, topical imiquimod, topical hypericin, intralesional interferon (IFN)-α, psoralen ultraviolet A (PUVA) therapy, electron-beam therapy (EBT) and local radiation], systemic therapies [extracorporeal photopheresis (ECP), denileukin diftitox, bexarotene] and combination therapies (injected transfer factor with concomitant topical nitrogen mustard use). Only one meta-analysis of two studies comparing PUVA with IFN-α vs. PUVA alone could be performed, and no significant differences between the two therapies were found. Two studies on intralesional IFN-α vs. placebo were included in the review and provided opposing results, but were not examined by meta-analysis due to differences in their study design. The remainder of the Cochrane analysis reviewed outcomes of individual RCTs. There were statistically significant differences in improvement or clearance for five therapeutic regimens. One trial of topical hypericin vs. placebo found a relative benefit of hypericin, risk ratio (RR) for improvement 7·00, 95% confidence interval (CI) 1·01-48·54, P ≤ 0·028. A trial comparing ECP with PUVA demonstrated significantly better improvement in the PUVA group (RR 0·07, 95% CI 0·00-1·00, P ≤ 0·002). An RCT examining 'conservative', stepwise escalation from topical nitrogen mustard to 'combination therapy' with EBT and cyclophosphamide, doxorubicin, etoposide and vincristine chemotherapy found that combination therapy was superior in clearance (RR 2·18, 95% CI 1·10-4·33, P ≤ 0·03) and improvement (RR 1·40, 95% CI 1·12-1·74, P ≤ 0·003). However, there were no statistically significant differences in survival rates at a median follow-up of 75 months. A comparison of subcutaneously injected IFN-α and acitretin vs. subcutaneously injected IFN-α and PUVA found increased clearance with IFN-α and PUVA (RR 0·54, 95% CI 0·35-0·84, P ≤ 0·005). There were also significant reductions in grade III, severe adverse events on the World Health Organization scale; events requiring discontinuation; and neurological disorders in the IFN-α plus PUVA group. Finally, a trial comparing active vs. inactivated transfer factor found significant differences between the groups, favouring inactivated transfer factor (Fisher's exact test, P ≤ 0·03, RR 0·09, 95% CI 0-0·61). The original study authors speculated that their results reflected a better initial prognosis for the group receiving inactivated transfer factor. None of the interventions assessed showed significant long-term benefit. Despite significantly superior clearance rates in four trials, participants in those studies had high relapse rates. INTERPRETATION: This review of RCTs for MF interventions led to more questions than answers due to a dearth of adequately powered RCTs. Only one meta-analysis could be performed. The remaining review was based on single trials, many of which assessed infrequently used treatments or regimens and are not reflective of current clinical practices. Only two of the 14 RCTs assessed patient health-related quality-of-life outcomes.

Prospective study of sensorineural hearing loss following radiotherapy for nasopharyngeal carcinoma.

OBJECTIVES: To investigate the severity and incidence of sensorineural hearing loss in patients with nasopharyngeal carcinoma treated with radiotherapy. METHODS: Forty-two patients with nasopharyngeal carcinoma were treated with conventional radiotherapy. Audiological testing was performed to compare patients' hearing before and at varying stages after radiotherapy. RESULTS: At one month post-radiation, a significant hearing threshold increase was seen only for high frequencies. At 12, 24 and 60 months post-radiation, significant threshold increases were observed at speech frequencies (4.0 and 8.0 kHz), compared with pre-radiation data. The mean values of wave I, III and V latencies and of the I-V interpeak latency intervals were not significantly altered at one month post-radiation, but were significantly prolonged at 12, 24 and 60 months post-radiation, compared with pre-radiation data. CONCLUSION: In patients with nasopharyngeal carcinoma treated with radiotherapy, the severity and incidence of radiation-induced sensorineural hearing loss increased with time, especially at high frequencies. This hearing impairment may be due to changes in the cochlea and/or the retrocochlear auditory pathway.