Intraoperative Repair of Cerebrospinal Fluid Rhinorrhea in Skull Base Tumor Resection: A Retrospective Study of Acellular Dermal Matrix Versus Turbinate Flap.

BACKGROUND: The acellular dermal matrix (ADM) and turbinate flap (TF) have been widely used in the reconstruction of skull base defects. However, owing to the lack of reported data, the therapeutic effects have been controversial. The purpose of the present study was to compare the effect of the ADM and TF on cerebrospinal fluid (CSF) rhinorrhea after nasal endoscopic resection of a skull base tumor. METHODS: The data from 46 patients who had undergone nasal endoscopic resection of a skull base tumor and repair of CSF rhinorrhea were retrospectively analyzed. The patients were divided into ADM and TF groups according to the difference in repair materials used. We compared and analyzed the intraoperative information and postoperative outcomes. RESULTS: The operation time, blood loss, defect area, and need for blood transfusion were not significantly different between the ALT and TF groups. The postoperative length of hospital stay (14.33 ± 3.66 vs. 16.76 ± 5.51 days; P = 0.669) and the incidence of complications, including wound infection (1 vs. 0; P = 0.270), intracranial infection (1 vs. 1; P = 0.900), hemorrhage (2 vs. 3; P = 0.788), 15-day CSF leak (1 vs. 2; P = 0.658), and respiratory infection (2 vs. 1; P = 0.450) were comparable between the 2 groups. The 6-month (0 vs. 0; P = 1.000) and 12-month (0 vs. 0; P = 1.000) incidence of recurrence also showed no significant differences. CONCLUSION: The use of the ADM for patients with CSF rhinorrhea showed comparable results in terms of postoperative outcomes compared with the use of TF. ADM could serve as a safe and feasible alternative for endoscopic repair of CSF rhinorrhea after nasal endoscopic resection of skull base tumors.

Prognostic Value Of The Preoperative Neutrophil To Lymphocyte Ratio In Patients With Sinonasal Squamous Cell Carcinoma.

OBJECTIVE: This study explored the effectiveness of a new inflammatory prognostic system, using preoperative neutrophil to lymphocyte ratio (NLR) to predict the postoperative survival rate of patients with sinonasal squamous cell carcinoma (SSCC). METHODS: Patients diagnosed with SSCC who undergone surgically treated without neoadjuvant therapy were included in the study between May 2008 and October 2017. Preoperative NLR is defined as: preoperative neutrophil/postoperative lymphocyte ratio. The prognostic value was uncovered by univariate and multivariate Cox hazards analysis. RESULTS: A total of 147 patients were included in this study. Through the multivariate analysis, pathological T stage (hazard ratio [HR] 1.719, confidence interval [CI] 1.277-3.642, p<0.001), pathological N stage (HR 1.344, 95% CI 1.015-2.776, p<0.001), and preoperative NLR (HR 1.579, 95% CI 1.217-3.092, p=0.002) were independent risk factor for overall survival (OS). Pathological T stage (HR 1.835, 95% CI 1.141-3.132, <0.001), pathological N stage (HR 1.281, 95% CI 1.169-2.476, p<0.001), and preoperative NLR (HR 1.688, 95% CI 1.162-3.363, p p<0.001) were also independently associated with disease-free survival (DFS). Pathological T stage (HR p<0.001, 95% CI 1.537-3.021, p<0.001), pathological N stage (HR1.571, 95% CI 1.157-2.258, p<0.001), and preoperative NLR (HR 1.509, 95% CI 1.153-3.104, p=0.001) were independent risk factors for disease-specific survival (DSS). CONCLUSION: The preoperative NLR is considered to be a useful predictor of postoperative survival in SSCC patients.

Correction: May the change of platelet to lymphocyte ratio be a prognostic factor for T3-T4 laryngeal squamous cell carcinoma: A retrospective study.

[This corrects the article DOI: 10.1371/journal.pone.0210033.].

Effect of High-Intensity Focused Ultrasound Versus Plasma Radiofrequency Ablation on Recurrent Allergic Rhinitis.

BACKGROUND High-intensity focused ultrasound (HIFU) and plasma radiofrequency ablation (PRA) have been used to treat recurrent allergic rhinitis (AR); however, there is a lack of literature comparing the efficacy of these 2 methods. We assessed and compared the therapeutic effects of HIFU and PRA on recurrent AR. MATERIAL AND METHODS We enrolled 66 patients with recurrent AR at West China Hospital of Sichuan University. Visual analogue score (VAS), pain score, rhinoconjunctivitis quality of life questionnaire (RQLQ), and nasal endoscopy were performed to evaluate the therapeutic effect. RESULTS Nasal endoscopy showed that HIFU and PAR reduced the volume of the inferior turbinate, whereas HIFU reduced the amount of nasal secretions in patients. VAS scores showed that HIFU and PRA nasal congestion symptoms were significantly reduced (P<0.05). The preoperative VAS scores for nasal fluid and sneezing were significantly lower in patients receiving HIFU (P<0.05) than in those receiving PRA (P>0.05). HIFU-treated patients had significantly lower postoperative pain scores than those in the PRA group (P<0.05). RQLQ showed activity, sleep, and non-nasal or ocular symptoms, and both HIFU and PRA patients had significantly lower scores (P<0.05). Nasal symptom scores, actual problems, and mood in the HIFU group were significantly worse than those in the PRA group (P<0.05). However, neither treatment had a significant effect on ocular symptoms (P>0.05). CONCLUSIONS Compared with PRA, HIFU can significantly reduce the nasal symptoms of AR patients, improve the quality of life, and can be used as an adjuvant therapy with better therapeutic effect.

Application of high expansion degradable cotton in nasal bleeding model of dog.

BACKGROUND: The discomfort and complications have always been problems for nasal packing materials. This study provided a new nasal packing material called high expansion degradable cotton (HEDC). METHODS: Nasal endoscopic surgery was used to establish a dog model of nasal bleeding, and wound surfaces were filled with Merocel, Nasopore and HEDC, respectively. Intraoperative and postoperative bleeding of 24 h was calculated. We evaluate the absorbability score, adhesion score, infection sore and nasal mucosal epithelium in postoperative 3, 7, 14 and 28 days. HE staining and electron microscopy were used to evaluate the recovery of nasal mucosa. RESULTS: There was no significant difference in nasal bleeding between HEDC, Merocel and Nasopore. Nasal endoscopic examination revealed HEDC absorbability of score, adhesion score, infection score were significantly lower than Merocel and Nasopore. The epithelialization time of HEDC was significantly shorter than that of Merocel and Nasopore. HE staining showed that HEDC and Nasopore could significantly reduce scar hyperplasia on the wound surface. The results of electron microscopy suggested that HEDC could protect the edge cilia of the wound. CONCLUSION: HEDC could be used as new choice for hemostasis after nasal endoscopic surgery, which could reduce nasal epithelialization time, and protect wound edge cilia.

Risk factors for lower respiratory tract infection in children with tracheobronchial foreign body aspiration.

The aim of this study was to determine the risk factors for lower respiratory tract infection (LRTI) in children caused by tracheobronchial foreign body aspiration (TFBA).A total of 351 patients were retrospectively reviewed; all patients were diagnosed with TFBA at West China Hospital of Sichuan University from 2015 to 2017. Univariate analyses and multivariate analysis were used.Age (<2 years) (P < .001), type of foreign body (plant) (P < .001), shape of foreign body (nonsmooth) (P < .001), and residence time of foreign body (>7 days) (P = .001) were risk factors for LRTI on univariate analysis. Multivariate analysis showed age (<2 years) (hazard ratio [HR] = 4.457; 95% confidence interval [CI] = 2.031-6.884; P < .001), type of foreign body (plant) (HR = 2.686; 95% CI = 1.577-3.452; P < .001), shape of foreign body (nonsmooth) (HR = 1.649; 95% CI = 1.437-3.663; P < .008), and residence time of foreign body (>7 days) (HR = 1.751; 95% CI = 1.329-3.554; P = .004) were independent risk factors for LRTI. Furthermore, children with LRTI also had longer lengths of hospital stays and antibiotic use than did children without LRTI.Age, plant foreign body, nonsmooth foreign body, and long-term incarceration were all independent risk factors for LRTI in children. These results can help us to select more appropriate intervention times and stratified treatment for children with TFBA.

Acellular dermal matrix contributes to epithelialization in patients with chronic sinusitis.

BACKGROUND: Nasal endoscopic surgery is widely used for nasal diseases, including sinusitis and tumors. However, scar hyperplasia, nasal irritation, scab, and nasal obstruction delay nasal mucosal recovery, with prolonged cleaning exacerbating the patient's financial burden. Here, we presented a novel approach for the treatment of nasal mucosal defects, termed acellular dermal matrix. METHODS: A total of 31 patients with bilateral chronic sinusitis (maxillary sinusitis and ethmoid sinusitis) underwent nasal surgery and nasal mucosal repair in September-October 2016. We divided the nasal cavities of each patient into control and acellular dermal matrix groups, randomly selected one side for nasal mucosal repair by surgery. A suitable acellular dermal matrix size was selected according to the defect in each patient. After pruning, the acellular dermal matrix was placed on the wound surface and filled with gelatin sponge. All patients were followed up for 14 weeks to compare nasal mucosal epithelialization between the control and acellular dermal matrix groups. Results：No obvious complications and adverse reactions were observed after nasal surgery. Lund-Kennedy scores in the acellular dermal matrix group were significantly decreased compared with the control group at 8 (0 (0, 1) vs. 2 (2, 4); P<0.05) weeks. Epithelialization time of eight weeks in the acellular dermal matrix groups was significantly decreased than the control group of 14 weeks. CONCLUSION: Acellular dermal matrix provides a growth framework for the healthy mucosa on the wounded surface and reduces postoperative epithelialization time.

May the change of platelet to lymphocyte ratio be a prognostic factor for T3-T4 laryngeal squamous cell carcinoma: A retrospective study.

BACKGROUND: Many blood markers have been shown to predict the recurrence and survival of various malignancies, but the effects of surgery on the body's inflammatory levels may cause changes in these inflammatory markers. Therefore, in this study, we assessed the relationship between changes in platelet to lymphocyte ratio (PLR) and survival and recurrence in patients with T3-T4 laryngeal squamous cell carcinoma (LSCC). METHODS: Data of patients with T3-T4 HSCC were reviewed. Continuous variables were expressed as mean ± SD and were compared using t test or Mann-Whitney U test. The covariate distributions were compared by Chi-square test. Survival curve was estimated by Kaplan-Meier analysis, and Log-Rank test were performed to estimate the survival curve and significance of the difference in survival distribution between groups, respectively. The prognostic value was uncovered by univariate and multivariate Cox hazards analysis. RESULTS: The 413 consecutive patients with LSCC were reviewed. Of these, 362 patients who met the criteria were selected, multi-factor analysis found that pathological T classification(hazard ratio [HR] = 1.878; 95% confidence interval [CI] = 1.342-3.023; P<0.001), pathological N classification (HR = 1.212; 95% CI = 0.867-2.125; P< 0.001) and change of PLR (HR = 2.158; 95% CI = 1.332-2.889; P = 0.004) associated with postoperative recurrence of T3-T4 LSCC. In addition, the pathological T classification (HR = 1.901; 95% CI = 1.255-2.999; P<0.001), pathological N classification (HR = 1.244; 95% CI = 0.810-2.212; P<0.001) and change of PLR (HR = 2.011; 95% CI = 1.354-2.753; P = 0.001) associated with postoperative survival in patients with T3-T4 LSCC. CONCLUSIONS: Results demonstrate that change in PLR may serve as a useful prognostic predictor for patients with T3-T4 LSCC.

Primary clear cell carcinoma of nasal cavity: a case report and review of literature.

Primary Clear Cell Carcinoma (CCC) of nasal cavity is rare and is often misdiagnosed as a malignant or benign lesion frequently. We reported a case of primary clear cell carcinoma of nasal cavity, with the complaint of epiphora in right eye, nasal obstruction and bleeding. CCC often confused with the metastatic renal clear cell carcinoma (RCC) of the nasal cavity, pathology and immunohistochemistry are the gold standards of Clear Cell Carcinoma could help us to make a definite diagnosis. Surgery, radiotherapy and chemotherapy are the main treatment methods.

Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: a meta-analysis.

The association between neutrophil-to-lymphocyte ratio (NLR) and differentiated thyroid cancer (DTC) is undecided. To rectify this question, we conducted a systematic meta-analysis based on 7 prospective cohort studies published between 2013 and 2015, comprising 7349 patients. Six of these cohorts included pretreatment (baseline) NLR data for patients with thyroid nodules. The meta-analysis of these 6 cohorts showed that the NLR of patients with DTC (4617 cases) was statistically similar to patients with benign nodules only (1666 cases), with a mean difference (MD) of 0.19 (95% CI: -0.09 to 0.46; I2 = 93%; P < 0.001). No significant difference in NLR was found between patients with DTC and patients with benign nodules. Two studies addressed an association between NLR and papillary thyroid carcinoma in patients stratified by age <45 and ≥45 years (496 and 891 cases, respectively); the pooled MD was 0.09 (95% CI: -0.37 to 0.55; I2 = 92.2%, P < 0.001). An elevated NLR seems not a reliable indicator of progressing DTC in patients with goiters, and there was no difference in NLR between patients aged <45 years and those aged ≥45 years. Well-designed and large-scale investigations are warranted to understand the value of NLR in the prognosis of DTC.

[The expression of interleukin-17 in blood and nasal tissue of patients with allergic rhinltis and nasal polyps].

OBJECTIVE: To study the expression of IL-17 in blood and nasal tissue of allergic rhinitis and nasal polyps, and to investigate the possible mechanism of IL-17 in the progress of allergic rhinitis and nasal polyps. METHODS: There were 41 patients enrolled, including the patients with allergic rhinitis, nasal polyps and deviated nasal septum. The blood and nasal mucosa tissue or nasal polyps were collected in all the patients. The expression of IL-17 was measured by the methods of ELISA and immunohistochemisty, and the number of eosinophils and IL-17 positive cells was measured. RESULTS: The IL-17 expression of nasal polyps was significantly elevated in the blood and nasal tissue, which was obviously correlated with the number of eosinophils infiltrated in nasal tissue. However, for the patients with allergic rhinitis, there was only apparent expression of IL-17 in nasal mucosa. CONCLUSION: IL-17 plays an important role in the development of nasal polyps, but for allergic rhinitis, it needs further study as an potential important aspect of the pathogenesis.