Open surgery with a lateral neck approach in cases of foreign body impaction that penetrating the neck through the esophagus: a single-center experience.

BACKGROUND: Because the cases are quite scarce, we aimed to review cases of foreign body impaction penetrating the neck through the esophagus to analyze the characteristics of these cases. The open surgery skills of the surgeon, the treatment procedure and the surgeons' experience in the rare diseases were analyzed. METHODS: We collected and analyzed all cases from 2015-2020 in our hospital. Surgical skills and procedures for fasting and anti-infection treatment were reviewed retrospectively. Follow-up was telephone communication. RESULTS: Our series included 15 cases. Tenderness in the pre-cervical site was a physical sign for screening. Thirteen cases underwent a lateral neck open surgery with the incision including the left side of neck and only two cases were incised from the right side of the neck. Pus was found 3 days after the impaction in one case, the shortest time observed in our series. The esophageal laceration was only sutured primarily in 5 cases (33.33%) among all fifteen cases. After sufficient drainage (average more than 9 days), antibiotic treatment and fasting (normally 2-3 weeks), patients gradually began to switch to solid foods from fluids after complete blood counts and confirmations from esophageal radiography result. No severe complications occurred, and all the patients have no swallowing dis-function and recovered well. CONCLUSION: Surgery should be performed as soon as possible after impaction. Lateral neck approach surgery and the therapeutic procedure described in this article are safe and effective treatments.

A comparison of patients with neck abscesses caused by esophageal foreign body impaction vs. inflammatory disease: a retrospective study.

OBJECTIVES: During clinical practice, we have detected a few cases of neck abscesses in patients diagnosed with esophageal foreign body impaction (EFB) but without the primary inflammatory disease. However, we do not know if neck abscesses caused by an inflammatory source are more like to be associated with a more severe progression or poorer prognosis. In this study, we aimed to identify differences between these two groups of patients by comparing progression and prognosis. MATERIALS AND METHODS: We retrospectively reviewed all patients who underwent neck abscess incisions between January 2011 and March 2022 and divided these patients into two groups: an EFB group and an inflammation group. Data were described by percentages, means, and standard deviations (SDs). Fisher's precision probability test was used to compare differences between the EFB and inflammation groups. Categorical variables were analyzed by Pearson's Chi-squared test. In addition, three factors including hospital days, intensive care unit (ICU) stay, and drainage-tube removal time were used for multivariate analysis to identify independent correlations separately. RESULTS: We enrolled a total of 33 patients with neck abscesses who received surgical incisions; the EFB group included 14 (42%) cases, while the inflammatory group included 19 (58%) cases. No significant differences were identified between the two groups in terms of surgery type (with or without mediastinotomy) and postoperative management (negative pressure drainage or postoperative irrigation). There were no significant differences between the two groups in terms of hospital stay, the timing of drainage-tube removal, the risk of ICU admission, and the probability of receiving intubation and tracheotomy. The incidence rate of esophageal perforation differed significantly between the two groups (p < 0.001). However, there were no significant differences in terms of other preoperative or postoperative comorbidities. The multivariate analysis revealed that the application of mediastinotomy (HR = 0.216 [0.049, 0.963]; p = 0.044) was correlated with a longer stay in the hospital. The time from symptoms to surgery was associated with a longer drainage tube removal time (HR = 0.392 [0.159, 0.967]; P = 0.042) and longer ICU stay (OR = 79.754[1.513, 4203.182]; P = 0.03). CONCLUSION: Patients with neck abscesses associated with EFB and inflammation received the same therapeutic management, and there were no significant differences between these two groups in terms of prognosis. Furthermore, esophageal perforation was found to be irrelevant to the aggravation of neck abscesses, and there was no need for additional surgery to repair a perforated esophagus in patients with neck abscesses. LEVEL OF EVIDENCE: Retrospective cohort (2b).

The racial disparity of nasopharyngeal carcinoma based on the database analysis.

OBJECTIVE: To investigate whether the racial/ethnical disparity of nasopharyngeal carcinoma exists among the four major ethical groups in the United States named Asians, Caucasians, African Americans and Hispanics between the years of 1973 to 2013 using the Surveillance, Epidemiology, and End Result (SEER) database. METHODS: The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database from 1973 to 2013 was utilized in this study to calculate survival trends for the four main ethical groups in the United States. The cases of nasopharyngeal carcinoma were extracted based on the SEER code cs0204schema. Death due to the diagnosed nasopharyngeal cancer was considered to be the event of interest, and death due to other causes was treated as the censoring events. Kaplan-Meier model was adopted to estimate survival outcomes; the Cox proportional hazards model was employed to do the hazard ratios (HR) estimation. RESULTS: A total of 8068 eligible patients of nasopharyngeal carcinoma were identified. The cohort was composed of 40.69% Caucasians, 11.34% African Americans, 40.16% Asians and 7.81% Hispanics. According to the multivariate Cox regression analysis, Asians had a better survival prognosis against Caucasians (HR: 0.74, 95% CI: 0.65-0.84, P < 0.001). African Americans showed marginal worse survival prognosis compared with Caucasians (HR: 1.26, 95% CI: 1.07-1.49, P < 0.005). There was no significant difference between Hispanics and Caucasians (HR: 1.13, 95% CI: 0.92-1.39, P = 0.261). CONCLUSION: Asians showed a disease specific survival advantage over Caucasians, African Americans and Hispanics, which was independent of sex, age at diagnosis, grade, TNM staging and treatment strategy.

TRIM24 siRNA induced cell apoptosis and reduced cell viability in human nasopharyngeal carcinoma cells.

Nasopharyngeal carcinoma (NPC) is a common cancer occurring primarily in East Asia and Africa. The high rate of recurrence and metastasis of NPC continuously endangers the health of patients. The present study aimed to identify the underlying mechanisms involved in the progression of NPC and provide experimental basis to develop a novel and efficient agent against NPC. The present study measured the expression level of tripartite motif containing 24 (TRIM24) in tumor tissues from NPC patients using reverse transcription quantitative polymerase chain reaction. Subsequently, Cell Counting kit­8 and flow cytometry were used to detect the cell proliferation and apoptosis of NPC cell lines HONE1 and CNE1 cells where the TRIM24 gene was knocked­down with small interfering RNA (siRNA). Further, caspase kits and western blot analysis were used to detect the expression of apoptosis and angiogenesis­associated proteins. The present study detected a higher expression level of TRIM24 in tumor tissues and NPC cell lines and lower cell viability and higher apoptotic rate were observed when TRIM24 was silenced. Meanwhile, upregulated caspase­3 and caspase­9 indicated induced cell apoptosis in HONE1 and CNE1 cells following the treatment with TRIM24 siRNA. Additionally, the downregulated expression level of vascular endothelial growth factor (VEGF) and VEGF receptor 2 suggested inhibited angiogenesis of NPC cells. Additionally, the reduced levels of janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3) indicated a blocked JAK2/STAT3 signaling pathway. However, there was no direct evidence that inactivation of the JAK2/STAT3 signaling pathway was involved in regulation of siTRIM24, these results suggested that TRIM24 has an important role in the growth of NPC. Additionally, silenced TRIM24 may lead to inhibited cell proliferation and induced cell apoptosis in NPC cells. The limitation of this study was that HONE1, CNE1 and CNE2 cells may have been contaminated with other cells. Further experiments with validated NPC cells may be needed.

Performance-intensity functions of Mandarin word recognition tests in noise: test dialect and listener language effects.

PURPOSE: This study established the performance-intensity function for Beijing and Taiwan Mandarin bisyllabic word recognition tests in noise in native speakers of Wu Chinese. Effects of the test dialect and listeners' first language on psychometric variables (i.e., slope and 50%-correct threshold) were analyzed. METHOD: Thirty-two normal-hearing Wu-speaking adults who used Mandarin since early childhood were compared to 16 native Mandarin-speaking adults. Both Beijing and Taiwan bisyllabic word recognition tests were presented at 8 signal-to-noise ratios (SNRs) in 4-dB steps (-12 dB to +16 dB). At each SNR, a half list (25 words) was presented in speech-spectrum noise to listeners' right ear. The order of the test, SNR, and half list was randomized across listeners. Listeners responded orally and in writing. RESULTS: Overall, the Wu-speaking listeners performed comparably to the Mandarin-speaking listeners on both tests. Compared to the Taiwan test, the Beijing test yielded a significantly lower threshold for both the Mandarin- and Wu-speaking listeners, as well as a significantly steeper slope for the Wu-speaking listeners. CONCLUSION: Both Mandarin tests can be used to evaluate Wu-speaking listeners. Of the 2, the Taiwan Mandarin test results in more comparable functions across listener groups. Differences in the performance-intensity function between listener groups and between tests indicate a first language and dialectal effect, respectively.

Myelination of the postnatal mouse cochlear nerve at the peripheral-central nervous system transitional zone.

In the nerve roots of vertebrates, the peripheral nervous system (PNS) and central nervous system (CNS) interface at the PNS-CNS transitional zone (PCTZ), which consists of cell boundaries with various myelin components. We have recently shown that the mouse cochlear nerve presents an exceptionally long segment of the CNS tissue extending into the PNS using light microscopy. However, it is unclear how oligodendrocytes and Schwann cells contribute to the formation of myelin components of the PCTZ. It is undetermined how myelination is initiated along the cochlear nerve, and when it adopts a mature pattern. In this study, immunofluorescence using antibodies specific to oligodendrocyte marker myelin oligodendrocyte glycoprotein (MOG) and Schwann cell marker myelin protein zero (MPZ) were used to detail the expression of myelin components along the postnatal mouse cochlear nerve. We found that the expression of MPZ was initially observed in the soma of bipolar spiral ganglion neurons at postnatal day 0 (P0) and progressed to the central and peripheral processes after P8-P10. Myelination of the CNS tissue was initiated in close proximity to the PCTZ from P7 to P8 and then extended centrally. Myelination of the PCTZ reached a mature style at P14, when the interface of the expression of MOG and MPZ was clearly identified along the cochlear nerve. This knowledge of PCTZ formation of the cochlear nerve will be essential to future myelination research, and it will also gain clinical interest because of its relevance to the degeneration and regeneration of the auditory pathway in hearing impairment.