健康人鼻咽部表面活性物质的测定

目的 探讨健康人鼻咽部表面活性物质的状况,并对磷脂成分进行研究.方法 采集健康人鼻咽部灌洗液,用高效液相色谱方法对表面活性物质的磷脂酰丝氨酸、磷脂酰乙胺醇、磷脂酰胆碱和鞘磷脂进行测定.结果 ①鼻咽部存在表面活性物质,磷脂4种成分均可测出;②磷脂成分的构成中,磷脂酰胆碱含量最多,为(53.94±17.10)%,是主要成分,其次是鞘磷脂和磷脂酰丝氨酸,分别是(22.18±24.08)%和(17.58±9.03)%,磷脂酰乙醇胺只占小部分,为(6.30±4.28)%.结论①鼻咽部存在表面活性物质;②鼻咽部表面活性物质的磷脂由磷脂酰丝氨酸、磷脂酰乙胺醇、磷脂酰胆碱和鞘磷脂组成,磷脂酰胆碱含量最多,对鼻咽部表面活性物质起决定作用.     

Nasopharyngeal neuroglial heterotopy - Choristoma: Case report and review of the literature

We describe the case of a nine-month-old patient with a nasopharyngeal choristoma. The case presented includes the retrospective review of the historical, radiological, surgical and histological assessment of this pathology as well as a literature review of this entity. This case was presented in an infant with difficulty feeding, nasal obstruction and failure to thrive, evaluated with flexible nasal endoscopy, CT and MRI. The lesion was then surgically removed without complications. Nasopharyngeal choristoma is a rare congenital non-malignant mass, which may present within a range of symptoms and severity according to its size, growth and location.     

Quality of weight loss during chemoradioherapy in patients with nasopharyngeal cancers

PurposeRadiation therapy with chemotherapy (CCR) is currently the gold standard treatment for nasopharyngeal carcinoma (NPC). Anatomical changes are mainly due to weight loss. Our prospective study aimed to evaluate the nutritional status and the quality of weight loss in our patients to adapt the subsequent nutritional management of patients during treatment for NPC.Patients and methodsA prospective, single-center study of 27 patients with non-metastatic NPC treated in our oncology radiotherapy department between August 2020 and March 2021. Data from interrogation, physical examination, and bioelectrical impedancemetry (weight [W], body mass index [BMI], fat index [GI], fat mass [FM], and fat-free mass (FFM]) were collected at the beginning, the mid, and the end of treatment.ResultsWeight loss from mid to end of treatment (median = −4 kg [−9.4; −0.9]) was greater than that from baseline to mid-treatment (median = −2.9 kg [−8.8; 1.8]) (P = 0.016). Weight loss during the entire treatment was −6.2 kg [−15.6; −2.5] (8.4%). The losses of FM were identical between the beginning-mid treatment and the mid-end treatment; they were respectively −1.4 kg [−8.5; 4.2] and −1.4 kg [−8.2; 7.8] (P = 0.4). FFM losses between the mid- and the end of treatment (−2.5 kg [−27.8; 0.5]) were greater than those between baseline and mid-treatment (−1.1 kg [−7.1; 4.7]) (P = 0.014). Median FFM loss during treatment was −3.6 kg [−28.1; 2.6]).ConclusionThe results of our study show that weight loss during CCR for NPC is complex and is not just about loss but about a disruption of body composition. Regular follow-ups by nutritionists are required to prevent denutrition during treatment.     

Clinical application of endoscopic soft palate augmentation in the treatment of velopharyngeal insufficiency

Velopharyngeal structure augmentation with the injection of autologous fat tissue into the nasal mucosa of the soft palate has been reported previously. However, as the injection points in the velopharyngeal space cannot be observed directly, these injections may be difficult to perform accurately. This report describes a new endoscope-assisted approach in which the materials for velopharyngeal structure augmentation are administered while observing the injection points directly, also enabling adjustment of the amount of material injected. A case series of five patients aged 8–16 years who underwent endoscopic soft palate augmentation under general anaesthesia is reported. Autologous fat tissue was injected into the nasal mucosa of the soft palate using a needle-type device of an endoscope, and the effects of the treatment were evaluated. The injections were performed successfully, and the velopharyngeal function was improved. This new technique of endoscopy-assisted augmentation was useful for the treatment of velopharyngeal insufficiency.     

儿童与成人慢性分泌性中耳炎细菌学特点的分析

目的对比研究中耳炎差异球菌、肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、金黄色葡萄球菌、草绿色链球菌在慢性分泌性中耳炎(secretory otitis media,SOM)儿童及成人患者的中耳积液(middle ear fluid,MEF)及鼻咽部分泌物(nasopharynx,Nph)中的检出率。方法运用PCR技术，观察并比较6种细菌在慢性分泌物中耳炎儿童组与成人组患者的MEF及Nph中的阳性率。结果①本研究中SOM儿童组与成人组患者MEF的主要细菌分布相似。PCR检测阳性率分别为91.30%（63/69）和 88.25%（30/34），差异无统计学意义（χ2=0.244，P>0.05）；②儿童组及成人组患者的MEF中，常可检测出2种或2种以上的细菌，但儿童组较成人组更为常见，差异具有统计学意义（P<0.05）；③儿童组患者MEF中阳性率最高的细菌为肺炎链球菌及金黄色葡萄球菌，成人组患者MEF中阳性率最高的细菌为金黄色葡萄球菌；④儿童组患者的MEF中，肺炎链球菌的阳性率高于成人组，差异具有统计学意义（χ2=5.526，P<0.05），其余5种细菌差异无统计学意义（P>0.05）；⑤儿童组MEF与Nph细菌阳性率比较，NPh中草绿色链球菌、流感嗜血杆菌、卡他莫拉菌的阳性率均高于MEF（χ2=21.852，P<0.05；χ2=21.369，P<0.05；χ2=4.309，P<0.05），差异具有统计学意义（P<0.05）；而金黄色葡萄球菌、肺炎链球菌及耳炎差异球菌在MEF与Nph中阳性率相似，差异均无统计学意义（P>0.05）；⑥成人组MEF与Nph细菌检出率比较，除草绿色链球菌在Nph中阳性率高于MEF（χ2=15.281，P<0.05）外，其余5种细菌差异均无统计学意义（P>0.05）。结论SOM儿童患者较成人更易发生中耳腔多种细菌混合性感染。     

以耳部症状首发、合并鼻咽占位的肉芽肿性多血管炎1例并文献复习

目的 探讨1例临床少见的以耳部症状首发、合并鼻咽部占位的肉芽肿性多血管炎(GPA)的临床特征、实验室检查、病理表现及诊疗过程。 方法 回顾性分析患者的病例资料,总结病例特点并回顾国内外GPA相关文献。 结果 患者以中耳炎、迷路炎症状为首发表现,合并鼻咽部占位,病程中逐渐出现面瘫,三叉神经刺激症状加重。多次留取耳及鼻咽部活检示急慢性炎症细胞浸润。升级抗生素,同时为避免中耳炎侵犯岩骨及颅内行乳突开放术。中耳局部炎症改善后其耳痛、面瘫等仍不缓解,但激素治疗有效,遂进一步完善自免病相关检查并再次行鼻咽部活检,最终确诊为GPA,予激素及免疫抑制剂治疗得以控制症状。术后3个月暂无显著肺部及肾脏受累表现。 结论 临床上发现不典型的中耳炎或常规治疗反复不愈,且逐渐进展出现内耳、颅神经侵犯表现如眩晕发作、面神经麻痹等,同时激素治疗有效,且合并鼻咽部占位、鼻窦炎影像学表现,或累及其他器官如肺、肾脏时,均应考虑到GPA的可能。当反复留取病理活检未能取得特异性确诊依据时,动态监测抗中性粒细胞胞浆抗体、红细胞沉降率、尿潜血、胸部CT、血肌酐等也具有重要的提示意义。     

Cone beam computed tomography volumetric airway changes after orthognathic surgery: a systematic review

The aim of this systematic review was to provide a structured overview of three-dimensional airway volume changes in relation to various orthognathic surgeries. Clinical human studies performing pre- and postoperative three-dimensional airway volume assessments to investigate volumetric changes of the airway after orthognathic surgery were included. Pre-determined inclusion and exclusion criteria were applied in an extensive search of the PubMed, Embase, and Web of Science electronic databases. The cut-off date was set to January 1, 2022. Forty-one articles reporting retrospective and prospective case–control and case series studies were included. All studies were determined to be of medium quality (moderate risk of bias). The included studies were categorized by type of intervention. Pre- and postoperative volumes were extracted from the available data, and volume changes as a percentage of the preoperative levels were calculated. Isolated mandibular setback surgery generally decreased the airway volume. Isolated maxillary or mandibular advancement, bimaxillary advancement, and surgically assisted maxillary expansion generally increased the airway volume in the total airway and oropharynx, among which the effect of bimaxillary advancement surgery appeared most significant. High heterogeneity exists in the terminology and definitions of the airway and its segments. A more uniform methodology for airway volume measurement is needed to provide an insight into the impact on the airway of specific types of surgical intervention. In conclusion, airway volumes are affected after orthognathic surgery, which may be of clinical significance, especially in patients who are predisposed to obstructive sleep apnoea.