[Metabolomics of nasal lavage fluid in patients with allergic rhinitis treated by Xiaoqinglong Decoction].

This study used nasal lavage fluid for metabolomics to explore its feasibility, and applied it to the clinical metabolomics study of Xiaoqinglong Decoction in the treatment of allergic rhinitis(AR), aiming to investigate the molecular mechanism of Xiaoqing-long Decoction in the treatment of AR through differential changes in local nasal metabolism. AR patients were selected as the research subjects, and nasal lavage fluid was collected as the sample. Metabolomics analysis using liquid chromatography-mass spectrometry was performed on normal group, AR group, and Xiaoqinglong Decoction group. The differences in metabolic profiles among the groups were compared using principal component analysis and partial least squares discriminant analysis, and differential metabolites were identified and subjected to corresponding metabolic pathway analysis. The results showed that Xiaoqinglong Decoction significantly improved the symptoms of AR patients. The metabolomics analysis revealed 20 differential metabolites between AR group and Xiaoqinglong Decoction group. The core metabolite with a trending return in comparison to normal group was trimethyladipic acid. The metabolites were involved in multiple pathways, including ß-alanine metabolism, glutathione metabolism, and phenylalanine, tyrosine, and tryptophan biosynthesis. The feasibility of applying nasal lavage fluid in nasal metabolomics was preliminarily demonstrated. Differential metabolites and enriched pathways in the treatment of AR patients with Xiaoqinglong Decoction were identified, indicating that it may improve rhinitis symptoms through the regulation of various metabolites, including antioxidant effects and correction of Th1/Th2 imbalance.

Postoperative hypoparathyroidism after thyroid operation and exploration of permanent hypoparathyroidism evaluation.

Background: To investigate the risk factors for hypoparathyroidism, discuss the prevention of postoperative hypoparathyroidism, and explore permanent postoperative hypoparathyroidism evaluation (PPHE). Methods: A total of 2,903 patients with thyroid nodules were treated between October 2012 and August 2015. Serum calcium and intact parathyroid hormone (iPTH) levels were measured at 1 day, 1 month, and 6 months postoperatively. The incidence and management of hypoparathyroidism were analyzed. The PPHE was established based on the risk factors and clinical practice. Results: A total of 637 (21.94%) patients developed hypoparathyroidism, and 92.15% of them had malignant nodules. The incidence rates of transient and permanent hypoparathyroidism were 11.47% and 10.47%, respectively. The iPTH level was lower in patients with malignant nodules who underwent total thyroidectomy (TT) and central-compartment neck dissection (CND). These factors were independently associated with the recovery rate of parathyroid function. The formula for PPHE is as follows: {iPTH} + {sCa} + {surgical procedure} + {reoperation} + {pathologic type}. A scoring system was developed, and we scored low, middle, and high risk of permanent postoperative hypoparathyroidism as 4-6, 7-9, and 10-13, respectively. The differences in the recovery rates of parathyroid function in several risk groups were statistically significant (p < 0.001). Conclusion: Simultaneous TT and CND is a risk factor for hypoparathyroidism. The reoperation is not associated with hypoparathyroidism. Identification of parathyroid glands in situ and preservation of their vascular pedicles are key factors in managing hypoparathyroidism. PPHE can forecast the risk of permanent postoperative hypoparathyroidism well.

Diagnosis and Treatment Strategy of Nasogenic Olfactory Dysfunction.

Since the global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a symptom of the onset of SARS-CoV-2, olfactory dysfunction (OD), has attracted tremendous attention. OD is not only a negative factor for quality of life but also an independent hazard and early biomarker for various diseases, such as Parkinson's and Huntington's diseases. Therefore, early identification and treatment of OD in patients are critical. Many etiological factors are responsible for OD based on current opinions. Sniffin'Sticks are recommended to identify the initial position (central or peripheral) for OD when treating patients clinically. It is worth emphasizing that the olfactory region in nasal cavity is recognized as the primary and critical olfactory receptor. Many nasal diseases, such as those with traumatic, obstructive and inflammatory causes, can lead to OD. The key question is no refined diagnosis or treatment strategy for nasogenic OD currently. This study summarizes the differences in medical history, symptoms, auxiliary examination, treatment and prognosis of different types of nasogenic OD by analyzing the current studies. We propose using olfactory training after 4-6 weeks of initial treatment for nasogenic OD patients with no significant improvement in olfaction. We hope that our research can provide valuable clinical guidance by systematically summarizing the clinical characteristics of nasogenic OD.

Diagnostic and surgical challenges of progressive neck and upper back painless masses in Madelung's disease: A case report and review of literature.

BACKGROUND: Madelung's disease (MD) is a chronic alcoholism-associated metabolic syndrome characterized by symmetrical subcutaneous deposition of adipose tissue in the head, neck, shoulders, back, trunk, and nerve roots of the upper and lower limbs. It is relatively rare in Asian individuals and is prone to misdiagnosis. Herein, we report a case of a patient with MD who had undergone surgical management at our hospital, and we discuss the pathogenesis, diagnosis, and treatment of MD. CASE SUMMARY: We report a case of MD in a 65-year-old man of Han descent. The patient had multiple, painless progressive masses for more than five years in the neck and more than 30 years in the upper back. Because of neck mobility limitations and progressive cosmetic deformities caused by the masses, he was admitted to our hospital. He drank approximately 500 mL of liquor per day and smoked heavily for more than 30 years. Contrast-enhanced computed tomography of the neck and chest documented abundant unencapsulated, subcutaneous fatty deposits. We prepared a staged operation plan. The patient was diagnosed with MD; he was advised to abstain from alcohol and was followed up regularly. After a 3-month follow-up, no recurrence of fat accumulation was found in the surgical areas. CONCLUSION: This report presents a case of surgical treatment for MD to improve clinicians' understanding of the disease.

Fluorescence identification of parathyroid glands by aminolevulinic acid hydrochloride in rats.

OBJECTIVE: In this study, we investigate the feasibility of the use of aminolevulinic acid hydrochloride (5-ALA)-induced fluorescence in the detection of parathyroid glands in rats. BACKGROUND DATA: The intraoperative identification of parathyroid glands is difficult, which is one of the main reasons for postoperative hypoparathyroidism. MATERIALS AND METHODS: An animal experiment was designed. Ten Sprague-Dawley (S-D) adult rats were injected intraperitoneally with a 300 mg/kg dosage of 5-ALA. Anesthesia and surgical dissection were performed to expose the thyroid gland 1 h later. Blue light with a wavelength of 405±3 nm was used to light the trachea bilaterally in order to detect parathyroid fluorescence by direct vision. Histology of the fluorescent tissue was performed to confirm parathyroid identification. RESULTS: Parathyroid gland fluorescence was visualized in all 10 S-D rats. The red fluorescence of the parathyroid glands was located on the posterolateral thyroid glands and could be seen with the naked eye. Histology of the fluorescent tissue confirmed the identification of parathyroid glands under light microscopy. CONCLUSIONS: 5-ALA induced fluorescence of parathyroid glands can clearly differentiate them from the surrounding tissue by direct vision alone. This method could be used intraoperatively and has potential clinical value.

[Clinical analysis of myoepithelial carcinoma of head and neck].

OBJECTIVE: To evaluate clinical feature, diagnosis, treatment and prognosis of myoepithelial carcinoma (MC) in the head and neck. METHODS: Clinical data of 11 patients which were confirmed by pathology and immunohistochemistry in Cancer Center, Sun Yat-sen University from Jan. 1992 to Dec. 2006, were reviewed. There were 5 cases in parotid gland, 1 in hard palate, 1 in maxillary sinus, 1 in pharyngeal recess, 1 in bucca cavioris, 1 in scalp, and 1 in gingiva. Male female ratio is 4 to 7. The median age at diagnosis was 37 years (range: 14 - 60 years). RESULTS: All cases were operated, 4 underwent surgery alone, 2 underwent surgery plus adjuvant radiotherapy, 2 received surgery plus adjuvant chemotherapy, 3 underwent surgery plus adjuvant chemoradiation. After operation, 8 cases occurred local recurrence and 4 cases occurred distance and lymph nodes metastasis. There was spindle cell type in 5 cases, clear cell type, plasmacytoid cell type in 2 cases, epithelioid cell type, mixed type in 1 case. The median follow-up time was 40 months. AS to the last follow-up time, 8 patients died. CONCLUSIONS: The characteristics of the tumor were rapidly enlarging, invading the surrounding regions, high rates of lymph node metastasis, high rates of distance metastasis. It was easily recurrence if the surgical excision was not radically for MC, and the prognosis was poorly. MC was a sort of malignant tumor. Radical operation must be advocated initially. Chemotherapy and radiotherapy may be effective after operation.

Expression and clinical significance of SPARC in clinical stage II tongue squamous cell carcinoma.

BACKGROUND AND OBJECTIVE: Secreted protein acidic and rich in cysteine (SPARC) is expressed widely in malignant tumors. It is related to prognosis and biological behaviors of tumors. This study was to detect the expression of SPARC in stage II tongue squamous cell carcinoma and analyze its relationship with prognosis. METHODS: Tongue carcinoma samples (T2N0M0) were obtained from 55 patients treated in Sun Yat-sen University Cancer Center from January 1999 to December 2003. Twenty-five squamous epithelium samples with tongue inflammation nearby were taken as control. Immunohistochemistry was used to detect the expression of SPARC. Its relationships with survival, occult lymph node metastasis and recurrence were analyzed. RESULTS: The positive rate of SPARC was 49.1% in tongue cancer tissues and 0 in normal tissues (p < 0.001). The accumulative 5-year survival rate was significantly lower in SPARC-positive patients than in SPARC-negative patients (30.0% vs. 85.3%, p = 0.005). The positive rate of SPARC was significantly higher in tissues with occult lymph node metastasis than in those without metastasis (86.7% vs. 35.0%, p = 0.001), and higher in tissues with recurrence than in those without recurrence (100% vs. 31.5%, p < 0.001). The expression of SPARC was positively correlated to occult lymph node metastasis (r = 0.46, p < 0.001) and recurrence (r < 0.595, p < 0.001). CONCLUSION: SPARC is highly expressed in stage II tongue squamous cell carcinoma, and positively correlated to survival, occult lymph node metastasis and recurrence.