[Feasibility and efficacy of pre-management of superior laryngeal artery in endoscopic surgery for hypopharyngeal cancer].

Objective: To explore the feasibility and efficacy for the dissection and ligation of the superior laryngeal artery in endoscopic surgery for hypopharyngeal cancer. Methods: Eight cadaveric heads were selected, and the laryngopharynxes were harvested. The positions of the superior laryngeal arteries entering the larynxes were dissected and observed under endoscopic vision, and their anatomical characteristics were summarized. Twenty-nine patients (all were male, aged 39-74 years old) with hypopharyngeal cancer who underwent transoral endoscopic surgery at the Department of Otorhinolaryngology Head and Neck Surgery of the Second Xiangya Hospital, Central South University from January 2018 to December 2019 were selected, and the patients were randomly divided into two groups by drawing lots, namely, the superior laryngeal artery was actively dissected and occluded during surgery in observation group (n=15) or not in control group (n=14). The differences in surgical time, bleeding volume, postoperative complications, and postoperative disease-free survival rate were compared between the two groups. Statistical analysis was conducted using SPSS 25.0 software. Results: The entry point of the superior laryngeal artery into the larynx was approximately at the level of the superior edge of the thyroid cartilage, and entered the larynx at the posterior one-third of the lateral wall of the pyriform fossa. The superior laryngeal artery might be determined through endoscopic exploration in all patients of observation group. The endoscopic surgery time [(40.00±7.56) minutes] and intraoperative bleeding volume [(24.00±8.28) ml] in the observation group were respectively less than those [(48.57±14.06) minutes and (42.86±15.41) ml] in the control group, and the differences were statistically significant (t=-2.064, P=0.049; t=-4.064, P=0.001). There was no case with postoperative bleeding in the observation group, but with one case of postoperative bleeding in the control group. Total disease free survival rate was 86.2% and there was no significant difference in disease free survival rates between the two groups during a follow-up period of at least 36 months (P=0.986). Conclusion: Dissection of the superior laryngeal artery during endoscopic surgery for hypopharyngeal cancer is feasible, and pre-management and occlusion of the superior laryngeal artery can effectively reduce intraoperative bleeding.

[Application of supraclavicular fasciocutaneous island flap for reconstruction after removal of tumors in parotid and auricle area].

Objective: To evaluate the efficacy of supraclavicular fasciocutaneous island flap (SIF) for repairing the defect of parotid or auricle regions after tumor resection. Methods: From February 2019 to June 2021, 12 patients (11 males and 1 female, aged 54-77 years old), of whom 4 with parotid adenoid cystic carcinoma and 8 with auricular basal cell carcinoma underwent reconstruction surgery for postoperative defects in the parotid gland area and auricular area with SIF in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University and their clinical data were retrospectively analyzed. Size of the SIF, time for harvesting SIF, neck lymph node dissection and postoperative complications were recorded. Results: The flap areas were (6-9) cm × (8-13) cm, and the harvesting time for SIF ranged from 40 to 80 min, averaging 51.7 min. The donor sites were directly closed. All patients underwent ipsilateral levels Ⅰ-Ⅲ neck dissection, with 4 cases undergoing additional level Ⅳ neck dissection and 2 cases undergoing level Ⅳ-Ⅴ neck dissection. Of the 12 SIF, 10 were completely survival and 2 had flap arterial crisis with partial flap necrosis, in addition, 1 had donor site wound dehiscence. With follow-up of 10-42 months, there were no tumor recurrences in 10 patients, 1 patient was lost to follow-up at 10 months postoperatively, and 1 patient experienced local tumor recurrence at 11 months after surgery and died 15 months later. Conclusion: SIF is an easily harvested flap with good skin features matching the skin in parotid and auricle regions and less damage to donor site, and this flap has no need for microvascular anastomosis technique. SIF is feasible and effective for repairing defects in parotid and auricle area.

[Feasibility and efficacy of preserving internal branch of superior laryngeal nerve in endoscopic surgery for hypopharyngeal squamous cancer: an observational study].

Objective: This study was performed to investigate the feasibility of preservation of internal branch of superior laryngeal nerve(ibSLN) during transoral endoscopic surgery for hypopharyngeal squamous cancer(HSCC) and the influence on patient's swallowing function after operation. Methods: From May 2020 to June 2021, the data of 29 HSCC patients who required for transoral endoscopic surgery in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University were prospectively included, and the included patients were divided into two groups randomly by lottery. According to whether ibSLN was actively dissected during operation, they were divided into ibSLN preservation group (n=15) and control group (n=14, without ibSLN preservation). Operation time, intraoperative hemorrhage, intraoperative neck dissection, postoperative radiotherapy, postoperative recurrence within 1 year, retention and swallowing function, the recovery of oral soft diet and the quality of life were compared between two groups. SPSS 25.0 software was used for statistical analysis. Results: The study included 29 eligible patients, including 25 males and 4 females.The age ranged from 42 to 67 (56.07±5.93) years. There were no significant differences(P>0.05) between 2 groups in the following data,including age(t=-0.56), gender(χ2=0.01), TNM stage(T stageχ2=0.29, N stage χ2=0.02), pathological diagnosis(χ2=0.03), preoperative swallowing function(χ2=0.00) and M. D. Anderson Dysphagia Inventory(MDADI) score(global t=0.55, emotional t=0.16, functional t=0.60, physical t=0.64), operation time(t=1.62) and intraoperative hemorrhage(t=-1.46), intraoperative neck dissection(χ2=0.01), postoperative radiotherapy(χ2=0.32), postoperative recurrence within 1 year(P>0.050). The swallowing function was evaluated by water swallowing test after operation. The swallowing function of ibSLN preservation group was better than control group, and the difference between two groups was statistically significant on the 1st (χ2=4.44, P=0.035), 5th (χ2=4.24, P=0.039) and 7th (χ2=4.55, P=0.033) day after operation. On the 14th day after operation, the MDADI scores of patients in the ibSLN preservation group were higher than those in the control group in global (t=2.45, P=0.021), functional (t=2.54, P=0.017) and physical (t=2.24, P=0.034) dimensions, except for emotional dimension (t=1.89, P=0.070). The median time of oral soft diet(U=23.00, P<0.001), normal oral diet(U=21.00, P<0.001) and the nasogastric tube removal time (U=18.50, P<0.001) in ibSLN preservation group was 2 days, 5 days and 6 days respectively, earlier than that in control group, which had statistically significant difference. Conclusion: Our results show that it is feasible to preserve the ibSLN during HSCC transoral endoscopic surgery, which can achieve rapid recovery of postoperative swallowing function.

[Narrow-band imaging for overcoming the microvascular pattern hidden under the plaque of the vocal fold leukoplakia].

Objective:To explore the application of narrowband imaging (NBI) in overcoming the microvascular pattern hidden under the plaque of vocal fold leukoplakia. Method:According to the morphology of intraepithelial papillary capillary loops (IPCL) around the plaque of vocal cord leukoplakia under NBI endoscopy,89 patients with microvascular morphology covered by plaque were divided into different groups. Subepithelial cordectomy was performed in 20 cases of benign group, subligamental cordectomy was performed in 45 cases of suspected malignant group, and transmuscular cordectomy was performed in 24 cases of malignant group, respectively. The lesions of vocal fold were biopsied with suspension micro-laryngoscope, and pathological examinations were also observed. Result:Pathological diagnoses showed that there were 10 cases of squamous epithelial hyperplasia, 8 cases of mild dysplasia, 21 cases of moderate dysplasia, 41 cases of severe dysplasia and carcinoma in situ, and 9 cases of invasive cancer, respectively. Spearman's analysis showed that there was a stronge positive correlation between the microvascular pattern of peripheral regions surrounding the plaque by NBI endoscopy and malignant degree of pathological classification(r=0.725, P<0.01). Conclusion:NBI endoscopy can overcome the "umbrella effect" of vocal cord leukoplakia. The microvascular morphology of the mucosa around the leukoplakia has a good correlation with final pathological diagnoses, and NBI endoscopy is helpful to determine the biopsy depth of the vocal cord leukoplakia.

[The role of autophagy in the invasion and metastasis of the squamous cell carcinoma of head and neck].

Objective:The aim of this study is to explore the effects of autophagy on the metastasis of the Squamous Cell Carcinoma of Head and Neck (SCCHN) via epithelial to mesenchymal transition (EMT) induced by TGF-ß1. Method:Establish the EMT model induced by TGF-ß1 in the SCCHN in time/concentration, and the expression of autophagy related protein microtubule associated protein 1 light chain3 (LC3) detected by western blot; Autophagy inhibitor chloroquine (CQ), depressing autophagy, the expression of E-cadherin, cytokeratin, Vimentin and LC3 were examined by Western blot. Wound healing and Transwell invasion assay indicate the effects to metastasis for SCCHN. Result:Autophagy was activated within TGF-ß1 induced EMT model in the SCCHN in time/concentration dependently. After autophagy was suppressed, the expression of E-cadherin and cytokeratin increased while vimentin and the capacity of metastasis was reduced compared with control group. Conclusion:TGF-ß1 induce EMT and Autophagy in the SCCHN. Autophagy could enhances metastasis in the SCCHN via EMT induced by TGF-ß1.

[Analysis of the lymphoepithelial carcinoma of the salivary gland: 12 cases report].

Objective:To improve recognization of clinical, imaging and pathological characteristics of lymphoepithelial carcinoma (LEC) of the salivary glands.Method:The clinical manifestations, imaging features, histological and immunohistochemical characteristics of LEC of the salivary glands (n = 12) between 2003 and 2013 were retrospectively reviewed.Result: Four cases of male and 8 cases of female were enrolled, and the average age of 53.25 years. Ten lesions were located in the parotid gland, and 2 cases were in the submandibular gland. Two cases were unilateral multiple tumors, 10 cases were unilateral solitary tumor, 4 cases were with cervical lymph node metastasis and 1 case was with peripheral facial paralysis. Ten patients had positive EB VCA IgA test. Homogeneous density and obvious enhancement were achieved in all lesions on CT scan. 8 cases were with irregular shapes, partially or ill-defined margin, and heterogeneous enhancement. Incomplete capsule was found in 4 cases, while no obvious capsule was found in 6 cases. HE staining showed that the infiltrative tumors were formed by the presence of sheets or nests of epithelial cells and interstitial lymphoid tissue. Immunohistochemistry staining revealed that the epithelial cells were reactive for pan CK, the lymphoid cells showed reactivity for both CD20 and CD3 markers. All cases underwent primary tumor and involved gland resection with ipsilateral neck dissection, and postoperative radiotherapy, and 2 cases combined with postoperative chemotherapy. The 3 year survival rate of patients was 75.0%(9/12), and 3 cases died of local recurrence or (and) distant metastasis within 1-2 years of definite diagnosis.Conclusion: LEC of salivary gland is associated with EB virus infection. Most cases present with unilateral solitary mass, and incidence of regional lymph node involvement is high. The imaging characteristics of tumor seem to be malignant on CT scan in most cases. Treatment includes multimodality therapy including surgical resection, neck dissection, and radiotherapy. Local recurrence and distant metastasis are the main causes of death.

[Transoral resection of partial fistula wall to treat incomplete second branchial fistula: a case report].

We describe a case of a 55-year-old man who presented with sore throat for two days, while neck swelling for one day, and was found to have a fistula in his left tonsil and an abscess in his left lateral pharyngeal wall with the lower bound to the upper border of the cricoid cartilage by ultrasonography and enhanced CT. The fistula from tonsillar fossa to hypopharynx was detected followed by left tonsillectomy, and then anterior wall of the fistula and mucosa covering it was resected. He was eventually diagnosed with incomplete second branchial fistula with infection, and was followed up for five years with no recurrence.

Investigation of serum vitamin D levels in Chinese infertile men.

Recently, the question of whether vitamin D exerts an effect on the pathogenic process of infertility has become the centre of attention. There are some controversial conclusions on this issue. Based on previous studies, we sought to explore the difference of serum 25-hydroxyvitamin D3 , 1,25-dihydroxyvitamin D3 levels between infertile patients and fertile men, and to find the influence on semen quality. The analysis of serum 25-hydroxyvitamin D3 level showed no significant difference between infertile patients and fertile men. However, the levels of serum 1,25-dihydroxyvitamin D3 in oligospermia (P < 0.05), asthenospermia (P < 0.01), oligoasthenospermia (P < 0.05) and azoospermia (P < 0.01) patients were significantly lower than those in fertile men. Moreover, serum 1,25-dihydroxyvitamin D3 level was positively correlated with progressive motility and total sperm number in infertile patients. In addition, a positive correlation between serum prolactin and 1,25-dihydroxyvitamin D3 was observed in fertile men. Our results indicated that lower vitamin D could be a risk factor for poor semen quality in infertile men. The 1,25-dihydroxyvitamin D3 , as the biologically active form of vitamin D, may be more significant.

Laparoscopic Nissen fundoplication is more effective in treating patients with GERD-related chronic cough than Stretta radiofrequency.

AIM: Chronic cough is the most common extra-esophageal manifestation of gastroesophageal reflux disease (GERD). This study aimed to retrospectively analyze outcomes in patients with GERD-related cough following laparoscopic Nissen fundoplication (LNF) and Stretta radiofrequency (RF) respectively. METHODS: Medical charts of 83 patients with GERD-related cough that underwent LNF or Stretta RF between 2007 and 2012 were retrieved. Symptom scores (heartburn, regurgitation and cough) and proton pump inhibitors (PPIs) usages were evaluated. RESULTS: A total of 83 patients with GERD-related cough underwent LNF (N.=35) and Stretta RF (N.=48), and were followed up 36.78 ± 16.12 months (range 13-55 months). During the follow-up, the post-treatment scores were statistically lower as compared with the pre-treatment scores in both groups, while the cough improvement after Stretta was significantly lower than that after LNF (P<0.001). Besides, 27 (77.1%) patients achieved complete PPI therapy independence after LNF, comparing with 27 (65.1%) after Stretta (P<0.05). No significant differences in post-treatment complications were observed except for the abdominal distention. CONCLUSION: Even though laparoscopic Nissen fundoplication and Stretta are capable of controlling GERD-related cough effectively and safely in selected patients, laparoscopic Nissen fundoplication could improve more in symptoms and PPI elimination.

Experimental study for the mechanism of gastroesophageal-reflux-associated asthma.

Epidemiologic studies have shown a strong association between gastroesophageal reflux (GER) and asthma, especially in children. Diagnosing GER can be difficult in some patients when GER presents solely with asthma. The aim of this study was to explore the relationship between GER and asthma with animal model. Sixty rats were randomly divided into six equal groups, GER group, GER-associated-asthma group, allergic asthma group, and their control groups. The cytokine levels and concentration of inflammatory cells in bronchoalveolar lavage (BAL) were determined. The BAL of the rats with allergic asthma contained higher concentration of Interleukin-5 (IL-5) and more eosinophils than those of rats with GER-associated-asthma. This demonstrates that assaying the concentrations of IL-5 and inflammatory cells in BAL may be an effective method of distinguishing GER-associated asthma from allergic asthma.

Experimental study on genistein prevention and treatment of transplant arteriosclerosis in aortic transplants of rat.

OBJECTIVE: Our objective was to study the effects of genistein, a soy isoflavone, on transplant arteriosclerosis, in addition to its immunosuppressive and antioxidant properties. MATERIALS AND METHODS: We performed male Brown-Norway to male Lewis aortic transplantation. The recipients were randomly assigned to 3 groups: no treatment controls, dimethyl sulfoxide (DMSO; 5 mL/kg) solvent controls, and experimental group that received genistein (20 mg/kg/d) by daily intraperitoneal injection. On postoperative day 60, the graft was harvested and blood obtained. The transplanted aorta was analyzed by histology and immunohistochemistry. The serum was analyzed by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Compared with the 2 controls, leukocyte recruitment to the graft was significantly inhibited by genistein, with a profound reduction in the number of CD69 macrophages infiltrating the adventitia of the transplanted aortas. Moreover, genistein significantly inhibited the expression of VEGF and IFN-gamma production (P < .01). CONCLUSION: These results suggested that the protein tyrosine kinase inhibitor genistein inhibited graft arteriosclerosis.

Submicrostructure and typing of female genital condylomata.

Thirty biopsies from female genital condylomata were examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) to study structural characteristics and typing of condylomata. It was found that cytoplasmic clearing was marked in acuminate condylomata, diffuse interstitial and epithelial proliferation in nodular condylomata (flat condylomata), and invagination of the lesions into the interstitial tissue or glandular ducts in endophytic condylomata. In nodular condylomata, SEM also showed some structural features similar to those of intra-epithelial neoplasia. Microridges on the surface of squamous cells had villiform of granular changes. On the surface of a percentage of squamous or columnar cells, there were holes with a diameter of about 3 to 5 microns. A number of giant cells were seen among other cells. The cervical squamatization zone contained groups of special cells covered with dense microvilli. TEM of nodular condylomata revealed some pictures resembling active proliferation of tumor cells, such as enlarged or irregular nuclei (large N/C ratio), evaginated or invaginated nuclear membranes, condensed chromatin attached to the inner part of the nuclear membrane, transparent nucleoplasm, and frequent nucleosomes and karyokinesis. Virus particles with the morphological characteristics of HPV (naked hexagon-like particles with an average diameter of 45-50 nm) were seen in some nuclei with markedly condensed chromatin. It is suggested that HPV-induced genital condylomata, especially nodular one (flat condylomata), entail a potential progression to malignancy.

Chromosome observations of acute promyelocytic leukemia treated with all-trans retinoic acid.

Chromosome changes were observed in 8 patients with acute promyelocytic leukemia during the all-trans retinoic acid-induced differentiation course. Karyotype of patient bone marrow specimens after short-term incubation were analyzed using Giemsa-R banding. Analyses showed all 8 patients had the abnormal translocation between chromosomes 15 and 17, but when those patients were treated with all-trans retinoic acid and were in remission, the characteristic t(15;17) chromosomal abnormality disappeared. However, this aberration of chromosomes detected in 3 patients persisted during the early period of RA induction, although the patients could still achieve complete remission. However, it was found that the percentage of abnormal karyotypes declined during this early period. This phenomenon may be an important indicator for clinical remission. When one case relapsed, the t(15;17) reappeared. Thus the chromosome t(15;17) was not only useful in diagnosis, but also helpful in observing prognosis in acute promyelocytic leukemia.

Amylin increases cyclic AMP formation in L6 myocytes through calcitonin gene-related peptide receptors.

The cellular function of amylin is investigated in L6 myocytes, a rat skeletal muscle cell line. Both rat amylin and human amylin-amide acutely cause a dose-dependent increase in cyclic AMP formation in L6 myocytes. 100 nM amylin stimulates intracellular cyclic AMP concentrations 12-fold, whereas human amylin-amide at this concentration causes only a 2-fold increase. Up to 10 mM human amylin has no effect on cyclic AMP levels. Rat calcitonin gene-related peptide (CGRP) is more potent than amylin, causing a 60-fold increase over basal at 1 nM, with an EC50 value of 0.2 nM. The CGRP receptor antagonist, human CGRP8-37 (hCGRP8-37), completely blocks the stimulatory effect of both rat amylin and human amylin-amide on cyclic AMP production. [125I]CGRP binds specifically to a membrane fraction prepared from L6 [125I]CGRP with a Ki of 0.9 nM, while rat amylin also displaces [125I]CGRP with a Ki of 91 nM. Specific binding of [125I]CGRP to plasma membranes of rat liver and brain is also displaced by rat amylin with Ki values of 35 nM and 37 nM, respectively. In contrast, specific binding of [125I]amylin to numerous cells and tissues, under similar conditions, can not be demonstrated. These results suggest that the cellular effects and physiological actions of amylin may be mediated through receptors for CGRP.