[Clinical analysis of nodular fasciitis in the head and neck].

Objective: To analyze the clinical features, diagnosis, treatment and prognosis of nodular fasciitis (NF) in the head and neck. Methods: Seven cases of primary NF in the head and neck admitted to Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from 1990 to 2022 were retrospectively analyzed, including 3 males and 4 females, aged from 2 to 67 years, and the location, course of disease, clinical manifestations, imaging findings, and treatment results of the disease were summarized. Results: Of the 7 patients, the primary sites were respectively nasal vestibule, paranasal sinus, nasal dorsum, sella turcica and clivus, neck, subglottis, and tonsil. Three cases presented with rapidly growing subcutaneous painless masses within 2 months, 1 case presented with hemoptysis, hoarseness and asthma for 28 days, 1 case presented with blood in the nasal discharge for 2 months, 1 case presented with headache for 1 month, and 1 case was found to have tonsillar neoplasms on physical examination for 3 days. CT was performed in 5 patients and the lesions showed soft tissue density shadows, and MRI was also performed in 2 of them, which showed T1 isointensity or T2 slightly long abnormal signal shadows. All patients underwent simple surgical resection of the mass. The patients were followed up for 13 months to 10 years, and none had recurrence. Conclusion: Primary NF in the head and neck is rare, with atypical clinical symptoms and imaging findings. Surgery is the mainstay of treatment for NF with good results.

[Transoral robotic surgery for treatment of lingual thyroglossal duct cyst].

Objective: To investigate the feasibility, safety and efficacy of transoral robotic surgery (TORS) in the treatment of lingual thyroglossal duct cyst (LTGDC). Methods: The clinical data of 10 patients with LTGDC treated with TORS in Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from May 2017 to November 2020 were analyzed retrospectively,including 6 males and 4 females, aged 5-44 years. The cysts were fully exposed, and resection usually started from the cephalic side of lesions. The range of resection was 3 to 5 mm away from the lesions, and partial hyoid bone was removed if necessary. Intra-operative robotic set-up time,operation time and estimated blood loss,and post-operative local bleeding, dyspnea and recovery time for oral intake were analyzed. SPSS 12.0 software was used for statistical analysis. Results: The cysts in all 10 patients were successfully resected by TORS with da Vinci Si surgical system. The mean robotic set-up and exposure time, operation time, estimated intraoperative blood loss and recovery time for oral intake were (15.5±7.1) min, (17.6±7.4) min, (8.9±6.4)ml and (2.3±2.2)days, respectively. No patient required tracheostomy intra-or post-operatively, and no symptoms of airway obstruction, postoperative bleeding, pharyngeal fistula, hoarseness and neurological impairment occurred after operation. The patients were followed up for 5 to 47 months, with median follow-up time of 17 months, and no recurrence was observed. Conclusion: TORS is safe and feasible for resection of LTGDC, with rapid recovery and low recurrence rate.

[In vitro evaluation of the antibacterial activity of nemonoxacin against Mycobacterium abscessus].

Objective: To evaluate the in vitro antibacterial activity of nemonoxacin against clinical isolates of Mycobacterium abscessus (M. abscessus). Methods: A total of 194 clinical strains of M. abscessus were collected from 2014 to 2017 in Shanghai Pulmonary Hospital. The minimum inhibitory concentrations (MICs) of nemonoxacin and other quinolones commonly used (moxifloxacin, levofloxacin and ciprofloxacin) against M. abscessus in clinic was determined by the micro-broth dilution method. Synergy between nemonoxacin and frequently used anti-M. abscessus drugs (clarithromycin, amikacin, imipenem, cefoxitin, tigecycline and linezolid) was assessed in vitro. Results: The MIC range of nemonoxacin to M. abscessus was 0.25-64.00 mg/L. The MIC50 and MIC90 were 4 and 16 mg/L, respectively. Most M. abscessus isolates demonstrated an MIC of ≤ 4 mg/L against nemonoxacin, with a percentage of 68.0% (132/194), which was significantly higher than that against moxifloxacin (51.0%, 99/194; χ2 = 11.651, P<0.01), ciprofloxacin (46.4%, 90/194; χ2 = 18.572, P<0.01) and levofloxacin (25.8%, 50/194; χ2 = 69.586, P<0.01), respectively. Nemonoxacin showed no antagonistic effect with commonly used anti-M. abscessus drugs, except imipenem. Conclusions: Nemonoxacin showed moderate in vitro antibacterial activity against M. abscessus, which was better than that of other fluoroquinolones commonly used in clinic at present. Therefore, nemonoxacin may be one of the options for combined treatment of M. abscessus infection.

[Safety and effectiveness of transoral robotic surgery for oropharyngeal cancer: a pilot study].

Objective: To evaluate the indication, safety and effectiveness of transoral robotic surgery (TORS) for oropharyngeal cancer based on our preliminary experience. Methods: Twelve patients, including six with tonsil cancer, five with tongue base cancer and one with posterior pharyngeal wall cancer, who underwent TORS with Da Vinci Si surgical system from March 2017 to October 2018 at Tongji Hospital of Huazhong University of Science Technology were respectively analyzed. And the surgical time, intraoperative blood loss, postoperative local bleeding, dyspnea, nerve function injury, oral intake time, whether or not to receive chemoradiotherapy were analyzed. Results: All tumors in the 12 patients were en bloc removed by TORS. Surgical time ranged from 25 to 80 min with an average of 34.2 min. The blood loss ranged from 10 ml to 50 ml with an average of 20.8 ml. The recovery time for oral intake ranged from 1 day to 30 days with an average of 8.4 days. No patient underwent tracheostomy after TORS. Also, no patient manifested with airway obstruction, bleeding or nerve injury symptoms after operation. All 12 patients reached pathologically negative surgical margins. The patients were followed up for 4 to 22 months, with a median of 12 months. All patients who combined with more advanced than T3 stage, or more advanced than N2 stage were recommended to oncologist, then, followed with radiotherapy or chemoradiotherapy if no relevant contradictions occurred. No local recurrence or distant metastasis case was found. Conclusion: With proper indications, the application of TORS in oropharyngeal cancer is a relatively safe, effective and minimal invasive therapy, which merits more clinical applications.

Chest imaging comparison between non-tuberculous and tuberculosis mycobacteria in sputum acid fast bacilli smear-positive patients.

OBJECTIVE: The aim of this study was to distinguish and compare the chest imaging features of non-tuberculous mycobacteria lung disease (NTM-LD) and pulmonary tuberculosis (PTB) in patients with sputum acid fast bacillus (AFB)-smear positive since an earlier differential diagnosis between these two is very important in clinical practice. PATIENTS AND METHODS: A total of 4167 previously untreated cases with AFB smear-positive sputum were collected from January 2011 to January 2014, in Shanghai Pulmonary Hospital, Tongji University, China. Among them, 124 cases were identified with NTM-LD after specimen culture and strain identification. A cohort of 210 patients with PTB was randomly selected from the remaining 4043 cases with PTB as comparator. The clinical and chest computed tomography (CT) imaging data were compared. RESULTS: The most prevalent pathogens in patients with NTM-LD were Mycobacterium abscessus (42%, 52/124) and Mycobacterium intracellulare (34%, 42/124). Univariate analysis showed patients with NTM-LD more frequently had bronchiectasis (85.5% vs. 45.7%, p < 0.001), thin-walled cavity (D ≥ 3 cm) (16.9% vs. 7.6%, p = 0.011) compared to PTB patients. Additionally, the location of lesion also differed and the right middle lobe (23.9% vs. 16.3%, p < 0.001) and left lingual segment bronchiectasis (19.9% vs. 8.2%, p < 0.001) were more prominent in NTM-LD. Multivariate analysis showed, bronchiectasis (OR = 8.521, 95% CI: 4.209-17.250, p < 0.001) and thin-walled cavity (D ≥ 3 cm) (OR = 3.561, 95% CI: 1.394-9.097, p = 0.008) were also the independent predictors for the diagnosis of NTM-LD. CONCLUSIONS: Bronchiectasis in the right middle lobe or left lingual segment and thin-walled cavity with a diameter of more than 3 cm are the frequently the chest CT features in patients with NTM-LD, which might be helpful for an early diagnosis in patients with AFB-smear positive.

Detection of aminoglycoside resistance related genes in multidrug-resistant Acinetobacter baumannii isolated from a single institute of Shanghai, China.

AIM: Aminoglycoside resistance is common in Acinetobacter baumannii. We investigated aminoglycoside resistance genes in clinical multidrug-resistant Acinetobacter baumannii strains isolated from the Chinese population. METHODS: One-hundred-and-seven strains of multidrug-resistant Acinetobacter baumannii were isolated from Ruijin Hospital in Shanghai, China. The minimum inhibitory concentrations (MICs) of amikacin, kanamycin, tobramycin, gentamicin, netilmicin and neomycin for these strains were determined with agar dilution method. 16S rRNA methylase genes and eight aminoglycoside modifying enzyme genes were tested via polymerase chain reaction. RESULTS: We found MICs of amikacin, kanamycin, tobramycin, gentamicin, netilmicin and neomycin in these strains with doses of ≥64 µg/mL, ≥64 µg/mL, ≥128 µg/mL, ≥128 µg/mL, ≥32 µg/mL and ≥8 µg/mL, respectively. Most of those strains showed a high-level resistance to aminoglycosides. ArmA was found in 90% (97/107) of the strains. Six modifying enzyme genes, including aac(6')-Ib, aac(6')-II, aac(3)-II, aac(3)-I, aph(3')-I and ant(3")-I were found with a positive rate of 47%, 50%, 28%, 31%, 93% and 96%, respectively. CONCLUSION: Multidrug-resistant Acinetobacter baumannii is highly resistant to aminoglycosides. Resistant genes could coexist in one strain, therefore, strict implementation of infection control measures is essential to avoid the rapid spread or outbreaks of these multidrug-resistant Acinetobacter baumannii in healthcare-associated facilities.

[Study on the association between HPV16/18 and expression of p53 protein in laryngeal papillomas].

OBJECTIVE: To understand the relationship between the expression of p53 protein and HPV16/18 infection in laryngeal papillomas. METHOD: Using PCR and immunohistochemistry techniques examined the paraffin embedded tissues of 35 cases of laryngeal papillomas. RESULT: Showed that HPV16/18-DNA were found in 24 cases of laryngeal papillomas (68.8%); overexpression of p53 protein were detected in 19 cases (54.3%); both of HPV16/18-DNA and overexpression of p53 protein were demonstrated in 12 cases of laryngeal papillomas (34.3%). CONCLUSION: This study suggests that HPV16/18 infection and p53 gene mutation are associated with pathogenesis of laryngeal papillomas. The relation between HPV infection and p53 mutation in tissues of laryngeal papillomas remains to be clarified.