[Clinical control status and quality of life in patients with chronic rhinosinusitis and asthma after endoscopic surgery].

Objective:The aim of this study is to investigate the clinical control status and quality of life of patients with chronic sinusitis and asthma after endoscopic surgery. Method:A prospective study of 36 patients with chronic rhinosinusitis and asthma who had endoscopic surgery. All patients underwent standardized drug therapy before operation. After evaluation by the respiratory and anesthesiologists, they were admitted to the hospital for endoscopic surgery. The patients were closely monitored during the operation, and the patients were observed and recorded. Self-control was performed to compare the observational indexes of the patients for half a year and one year after surgery. Result:①The Asthma Control Scale （ACT） score showed that the proportion of complete control of asthma increased from 8.33% before surgery to 30.56% in the first half of the year and 27.78% in 1 year, which was significantly improved （P<0.05）. ②Asthma Quality of Life Questionnaire（AQLQ） showedthatthe indicators of postoperative quality except the response to the stimulus, limited activity, asthma symptoms, psychological status and concern for their own health are all have statistically significant （P<0.05）. ③In the first half of the year, there were 47.22%, in 1 year, 41.67% of the patients had improved asthma medication. There was no difference between the two groups （P>0.05）. ④The exhaled nitric oxide index was decreased in the first half of the year and in the first year after operation. ⑤There was no significant change in lung function indexes before and after operation （P>0.05）. Conclusion:In patients with chronic sinusitis and asthma, under the comprehensive treatment of endoscopic surgery, improving the quality of life of patients can also improve the control of asthma symptoms and medication, control the development of asthma, and have a positive effect on clinical efficacy.

[The application of preoperative pulmonary function and FeNO test in patients with chronic rhinosinusitis].

Objective: To explore the application of lung function and exhaled nitric oxide in the evaluation of patients with chronic rhinosinusitis(CRS) with or without polyps who denied bronchial asthma history and planned to undergo endoscopic sinus surgery. Method: Two hundred and thirty-two patients with CRS during April 2016 to April 2018 in our hospital were recruited in this study. All patients accepted lung function and exhaled nitric oxide test before surgery to evaluate whether accompanied with asthma, improvements after standardized drug therapy in patients with asthma. SpO2, Ppeak and PETCO2 were monitored and recorded during surgery. Postoperative symptoms of wheezing, shortness of breath, chest tightness and cough were also observed and recorded. Result: ① Of the 232 patients, 18 patients were diagnosed as bronchial asthma, with a positive rate of 7.8%. 17 cases had positive results in bronchodilation test, 1 case was negative whose PEF improvement rate was 40.4%; The mean FeNO of the 18 patients was 46 ppb, of which 16 patients whose FeNO was over 25 ppb; The mean FeNO of 40 cases with normal pulmonary function was over 25ppb, of which 4 cases' FeNO were over 50 ppb;② 232 patients' intraopertive anesthesia monitor showed that SpO2 were greater than 95%, Ppeak were less than 35 cmH2O, PETCO2 were greater than 35 mmHg; ③ Mild dyspnea occurred in a patients diagnosed as asthma the next morning after surgery. The auscultation was scattered in the wheezing sound, and the symptoms were relieved in 10 minutes after inhalation of salmeterol. Conclusion: Routine screening for lung function and FeNO and standardized perioperative treatment in patients with CRS before nasal endoscopy is useful.

[The relationship between viral infection and nasal polyps:A Meta-analysis].

Objective:The relationship between viral infection and the occurrence of nasal polyps was explored to help us understand the etiology and pathogenesis of nasal polyps, and to provide scientific basis for the prevention and treatment of nasal polyps through a Meta-analysis. Method:By searching Pubmed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, and VIP Database, time starts from database building until January 1, 2018, a comprehensive case-control study on the relationship between human papillomavirus, Epstein-Barr virus (EBV), respiratory virus infection and nasal polyps published at home and abroad has been conducted. At the same time, relevant literature references have been included and the full texts have been obtained. Stata 12.0 analysis software was used to perform statistical processing on each original data.Odds ratios (OR) and their 95% confidence interval (CI) were adopted to assess the strength of association. Result:21 articles with 24 studies were included on the relationship between HPV, EBV, respiratory viral infection and nasal polyps. The Meta-analysis results showed that the OR of HPV infection and nasal polyps was 6.74, 95%CI was 2.50－18.20, P<0.001, the OR of EBV and nasal polyps was 5.15, 95%CI was 1.66－16.02, P=0.005, the OR of respiratory viruses and nasal polyps was 1.68, 95%CI was 0.93－3.03, P=0.087.There was no significant publication bias in all of the comparisons. Conclusion:HPV and EBV infection were closely associated with the nasal polyps. Respiratory viral infection was not associated with the nasal polyps. Viral infection may be one of the etiologies of nasal polyps. It plays an important role in the pathogenesis of nasal polyps. The prevention and treatment of the virus infection should be targeted at early intervention.

[Multiple-factor analysis of serum allergen distribution of patients with allergic rhinitis and level of main allergen IgE in Shenyang area].

Objective:To discuss multiple-factor analysis of serum allergen distribution of patients with allergic rhinitis and level of main allergen IgE in Shenyang area, and to provide a scientific basis for the prevention of allergic rhinitis in this area.Method:Serum IgE was detected in 749 cases［501 cases of male (66.8%), and 248 cases of female (33.2%)］, with allergic rhinitis.The age range was from 3 to 65 years old, and they were divided into 5 groups based on age. A questionnaire survey was conducted to analyze the distribution of serum allergens and to carry out a multiple-factor analysis of level of the main allergen IgE in patients.Result:The primary allergen was house dust mite/dust mite in each age group, and the differences in the positive rate of elm, mold, cat/dog fur scurf, cockroach and ragweed among different groups were statistically significant（P<0.01 or P<0.05）.The ingested allergen sequencing for all age groups: the distribution of 7-14 years old group and 15-35 years old group were consistent with that of the whole, among the under 6 years old group, mango and pineapple was ranked 1st,beef and mutton was ranked 2nd,the occurrence rate of shrimp and crab rose to the 3rd place, among the 36-60 years old group, mango, pineapple and milk was ranked 1st, egg was ranked 2nd, and beef and mutton ranked 3rd, the differences in positive rate of mango and pineapple, beef and mutton, crab and nut among all groups were statistically significant(P<0.01 or P<0.05).The IgE level of cockroach was impacted by the allergic history, home cultivation of flowers and plants and animal domestication. The IgE level of mold was impacted by sex, allergy history, home rearing of pet and furniture updates. The IgE level of wormwood was impacted by allergy history and asthma history. The IgE level of peanut was impacted by age and allergy history. The IgE level of egg was impacted by history of food and drink allergy, home cultivation of flowers and plants and home rearing of pet. The IgE level of crab was impacted by the allergy history and home rearing of pet.Conclusion: The primary inhaled allergen in all groups is house dust mite/dust mite, and the ingested allergen varies in each group, which has provided a reference basis for prevention of ingested allergy.The varying influence factors for IgE level of primary allergens could be used to prevent the patients from contacting the allergen,and each risk factor has become a focus of prevention and control for patients, offering a major help to the prevention and treatment of allergic rhinitis.

[A study on P16 and HPV16 in sinonasal squamous cell carcinoma].

Objective:The aim of this study is to evaluate the relationship between the expression of P16 and infection of HPV16 in sinonasal squamous cell carcinoma and its clinical and pathological features, futher prognosis was also investigated. Method:Fifty-five cases of sinonasal squamous cell carcinoma were collected,twenty cases of nasal in-verted papilloma and twenty cases of nasal polyp were chose as control. The expression of P16 and infection of HPV16 were detected by immunohistochemistry in both experimental group and control group. Result:The positive rate of P16 and HPV16 in sinonasal squamous cell carcinoma and nasal in-verted papilloma were significantly higher than it in nasal polyp (P<0.05 or P<0.01). The expression of P16 was correlated with tumor differentiation and clinical TNM stages (P<0.05), but was not associated with age, sex, smoking and the primary tumor site (P>0.05). HPV16 infection has no statistical relationship with analysis factors (P>0.05). There was a positive correlation between P16 expression an HPV16 infection in the cases of sinonasal squamous cell carcinoma (r=0.483, P<0.01). Survival curves showed that the expression of P16 and infection of HPV16 were positively associated with prognosis of sinonasal squamous cell carcinoma, Log Rank test showed a significant difference (P<0.05). Conclusion:The abnormal expression of P16 and HPV16 infection play an important role in the development of sinonasal squamous cell carcinoma. The two may had a synergistic effect. P16/HPV16 positive cases had better prognosis.

[The study of facial neurapraxia].

OBJECTIVE: To study the clinical characteristics and mechanism of facial neurapraxia. METHOD: Patients were tested with nerve excitability method and judged the degree of facial paralysis. Animal mode of neurapraxia was made and threshold of evoked electromyographic potential was tested. The fibers of facial nerve were observed under transmission electromicroscope. RESULT: Average restoration time of evoked electromyographic potential was 52.5 min. The lamellar separation of myelin sheath of facial nerve was found under electromicroscope. Patients with facial neurapraxia was judged as denervation negative and residual function of facial muscles was above 65%. CONCLUSION: Facial neurapraxia is mild reversible facial paralysis and relevant to the lamellar separation.

[Reconstruction of hypopharyngeal cavity with neck reverse rectangular thinned skin flap].

OBJECTIVE: To study the postoperative convalescence of swallow after reconstruction of hypopharyngeal defect with the neck reverse rectangular thinned skin flap. METHOD: A thinned reverse skin flap was designed in the middle line of a platysma skin flap, and was used in hypopharyngeal reconstruction for 20 patients with squamous cell carcinoma of the hypopharynx. RESULT: No skin flap complications occurred in all patients. Fistulas in 5 cases healed spontaneously in 7 days to 10 days without further surgery. One case with lower anastomotic site stenosis was performed by subsequent successful surgery. The survival rate was 50% and 33.3% respectively after 3 years and 5 years follow up. CONCLUSION: This flap was effectively applied for reconstruction of hypopharyngeal defect for hypopharyngeal cancer, which was easy to master by surgeons, and was a high successful procedure of choice.