悬雍垂腭咽成形术联合鼻部手术治疗OSAHS疗效分析

目的：探讨悬雍垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)联合鼻部手术治疗阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome, OSAHS)的临床疗效。方法：所有患者术前均行多导睡眠呼吸监测（polysomonography,PSG）确诊,在行UPPP手术同期行鼻中隔偏曲粘膜下切除术18例,双侧下鼻甲粘膜下部分切除术20例,腺样体切除术2例。其中5例重度患者术前先在局麻下行气管切开,然后在全麻下行UPPP和鼻部手术,其中2例患者选择了气管切开后6～7d再行UPPP和鼻部手术。术后随访1～2年。结果：患者均有不同程度的症状减轻,其中症状基本消失者5例,明显减轻者14例,症状缓解者6例。无术后并发症发生,术后6～13d（平均8.3d）拔除了气管套管。结论：UPPP联合鼻中隔偏曲矫正、下鼻甲部分切除术治疗OSAHS可取得良好的手术疗效,对于重度OSAHS患者,行前置性气管切开术,能够有效预防手术并发症的发生。     

调节性T细胞与IgE、IL-4、IL-5在变应性鼻炎小鼠和鼻用激素抗炎中的实验研究

目的探讨CD4+CD25+FOXP3+调节性T细胞(regulatory T cells,Tregs)与IgE、IL-4、IL-5在变应性鼻炎(allergic rhinitis,AR)小鼠及鼻用激素抗炎中的表达及作用。方法 5～6周龄雌性Balb/c小鼠30只,随机分为正常组、AR组和鼻用激素组。正常组无干预;AR组采用卵清蛋白(ovalbumin,OVA)全身致敏并雾化和滴鼻激发;鼻用激素组在成功致敏后,每次激发完30 min后雾化吸入丙酸氟替卡松10 min。小鼠于末次激发24 h后处死,鼻黏膜行苏木素-伊红染色;流式检测气管旁引流淋巴结和脾脏中CD4+CD25+FOXP3+Tregs表达;ELISA检测血清中OVA-特异性IgE及鼻腔灌洗液中IL-4、IL-5含量。结果与正常组小鼠相比,AR组小鼠鼻黏膜出现大量的嗜酸性粒细胞(EOS),CD4+CD25+FOXP3+Tregs表达在气管旁引流淋巴结中上调,脾脏中无差别;IgE、IL-4、IL-5含量明显升高,而鼻用激素组小鼠CD4+CD25+FOXP3+Tregs在气管旁引流淋巴结和脾脏中表达继续明显上调;EOS数目与IgE、IL-4、IL-5含量均被明显抑制。结论 CD4+CD25+FOXP3+Tregs不仅在AR中,而且在鼻用激素对AR的干预中都发挥着重要的免疫调节作用,同时IgE、IL-4、IL-5介导变应性炎症反应,在AR的发生发展中发挥重要作用。     

影像导航技术在鼻腔鼻窦内翻性乳头状瘤手术中的应用

目的探讨影像导航技术在鼻腔鼻窦内翻性乳头状瘤（NIP）手术中的应用价值。方法将68例行手术治疗NIP患者按时间顺序分为前、后两组,前组应用鼻内镜手术或鼻内镜手术＋传统术式（2001年5月～2004年12月）34例,后组以前组术式为基础加用影像导航技术（2005年1月～2007年6月）34例,对两组术后复发率进行比较。结果应用影像导航技术的后组术后复发率低于前组,差异有统计学意义（P〈0．05）。结论影像导航技术在鼻腔鼻窦内翻性乳头状瘤手术中能进行三维重建,具有定位准确、影像立体,不受组织移位和解剖复杂影响的优点,可降低术后的复发率。     

Na+,K+-ATPase and Ca2+-ATPase activities in the cochlear lateral wall following surgical induction of hydrops

Na+,K+-ATPase and Ca2+-ATPase activities have not been studied quantitatively in the cochlea affected by endolymphatic hydrops. The present study was designed to measure quantitatively the Na+,K+-ATPase and Ca2+-ATPase activities in the cochlear lateral wall and the threshold of auditory brainstem response (ABR) for guinea pigs in the early stages (=2 months) of experimentally induced endolymphatic hydrops. A significant negative association was demonstrated between Ca2+-ATPase activity and the change in ABR threshold for hydropic cochleae (P=0.014), but not for control cochleae (P=0.123), although no such significant association was revealed between Na+,K+-ATPase activity and any change in ABR threshold for both hydropic cochleae (P=0.751) and control cochleae (P=0.352). A significant increase in Ca2+-ATPase activity in the cochlear lateral wall was observed for the hydropic ear, in which normal ABR thresholds were maintained, as compared to the control ear. On the contrary, a mild decrease in Ca2+-ATPase activity in the cochlear lateral wall was observed for the hydropic ear, in which ABR thresholds increased significantly. The present findings suggest that alterations of Ca2+-ATPase activity in the cochlear lateral wall may implicate disturbed calcium-homeostasis in the inner ear, resulting in hearing dysfunction in the early stages of experimentally induced endolymphatic hydrops.     

Spontaneous cervical haematoma resulting from intrathoracic pathology

Spontaneous cervical haematomas are rare occurrences for which a wide variety of aetiologies have been reported. Although the pathogenesis of this condition can be quite diverse, all known cases have emanated from a cervical source. The authors report the first case of a spontaneous cervical haematoma arising from an intrathoracic source. A case review and Medline search from 1962-2003 was carried out. No prior experience with intrathoracic sources for cervical haematomas has previously been reported. Transcervical haematoma evacuation confirmed the intrathoracic origin and a median sternotomy was required to gain control of this haemorrhage. Thoracic sources should be considered in the differential diagnosis of a spontaneous cervical haematoma. Preparations for a combined procedure with a thoracic surgeon can be predicted pre-operatively based on imaging studies.     

鼻部手术联合其他平面手术治疗OSAHS疗效分析

目的探讨鼻部手术联合其他平面手术（如腭咽平面、舌咽平面手术）治疗阻塞性睡眠呼吸暂停低通气综合征（obstructive sleep apnea-hypopnea syndrome,OSAHS）的效果。方法32例患者术前均行多导睡眠呼吸监测（poly-somonography,PSG）确诊,所行鼻部手术包括单纯鼻中隔偏曲黏膜下切除术18例、鼻中隔偏曲黏膜下切除术加单侧下鼻甲黏膜下部分切除术10例、鼻中隔偏曲黏膜下切除术加双侧下鼻甲黏膜下部分切除术2例、鼻中隔偏曲黏膜下切除术加单侧鼻息肉切除加筛窦开放术2例。术中同期联合悬雍垂腭咽成形术（uvulopalatopharyngoplasty,UPPP）26例;UPPP手术、舌根部分切除、舌骨悬吊4例;舌根部分切除、舌骨悬吊2例。32例中2例重度患者行气管切开全麻下行UPPP和鼻部手术、舌根部分切除术,2例因为气管插管和拔除气管套管困难,在手术结束后行气管切开,余28例均在气管插管全麻下进行手术,术后进ICU监护12-24 h,随访1年。结果治愈10例,好转12例,减轻9例,无效1例,所有患者无手术并发症发生。结论鼻部手术联合其他平面手术治疗OSAHS可取得良好效果。对于重度OSAHS或气管插管困难者,术前行气管切开术或手术结束即行气管切开,能有效预防手术并发症的发生。     

Genetic polymorphisms of alcohol and aldehyde dehydrogenases, and drinking, smoking and diet in Japanese men with oral and pharyngeal squamous cell carcinoma

The genetic polymorphisms of aldehyde dehydrogenase-2 (ALDH2), alcohol dehydrogenase-1B (ADH1B, previously called ADH2), and ADH1C (previously called ADH3) affect the metabolism of alcohol. The inactive ALDH2 encoded by ALDH2*1/*2 and the less-active ADH1B encoded by ADH1B*1/*1 increase the risk of esophageal squamous cell carcinoma in East Asian drinkers. This case-control study involved 96 Japanese men with oral and pharyngeal squamous cell carcinoma (hypopharyngeal cancer in 43 patients and oral/oropharyngeal cancer in 53) and 642 cancer-free Japanese men. The risk of the cancers overall and of hypopharyngeal cancer was increased 3.61- and 10.08-fold, respectively, by ALDH2*1/*2 among moderate-to-heavy drinkers (9+ units/week; one unit = 22 g of ethanol), but the risk of oral/oropharyngeal cancer was not significantly affected by the ALDH2 genotype. The results obtained with a simple alcohol flushing questionnaire were essentially comparable with those obtained by ALDH2 genotyping. Among moderate-to-heavy drinkers, men with the less-active ADH1B*1/*1 had a significantly higher risk of the cancers overall, of hypopharyngeal cancer, and of oral/oropharyngeal cancer (OR = 5.56, 7.21 and 4.24, respectively). In view of the linkage disequilibrium between ADH1B and ADH1C, the ADH1C genotype does not significantly affect cancer risk. The significant independent risk factors for oral and pharyngeal cancer overall among moderate-to-heavy drinkers were inactive ALDH2*1/*2, less-active ADH1B*1/*1, frequent drinking of strong alcohol beverages straight, smoking, and lower intake of green-yellow vegetables. Educating these risks for cancer of the upper aerodigestive tract could be a useful new strategic approach to the prevention of these cancers in Japanese.     

Livin基因在喉癌组织中mRNA表达及其意义

目的探讨Livin mRNA在喉癌中的表达及意义。方法采用RT-PCR(逆转录-聚合酶链反应)方法检测41例喉癌及癌旁组织、12例声带息肉新鲜标本中Livin mRNA的表达。结果在喉癌组织标本中可检测到Livin mRNA的高表达,而在癌旁组织及声带息肉中呈低量表达,有显著性差异(P<0.01)。结论 Livin基因的表达水平上调与喉癌的发生密切相关,可能在喉癌的发生、发展中起重要作用。     

鼻内镜术后中药鼻腔雾化吸入辅佐治疗慢性鼻-鼻窦炎的主客观评估

目的 评价慢性鼻-鼻窦炎(chronic rhinosinusitis, CRS)患者在鼻内镜术(endoscopic sinus surgery, ESS)后用中药进行鼻腔超声雾化吸入辅佐治疗的疗效。方法 63例CRS患者随机分为治疗组(33例)和对照组(30例),ESS术后第3天行鼻腔超声雾化吸入。治疗组雾化用药为鼻窦炎口服液,每天早晚各1次,每次8mL,连续5d,后改为每周1次,连续3个月。对照组使用生理盐水鼻腔雾化吸入,方法相同。雾化前(术后第2天)、雾化5d和3个月后分别采用视觉模拟量表、Lund Kennedy评分系统、Lund Mackay评分法进行相关评估。结果 通过对主观症状、鼻内镜及鼻窦CT扫描进行检查评估,治疗组与对照组在雾化前后及组间比较差异均有统计学意义。结论 CRS患者ESS术后中药雾化吸入能明显提高手术疗效。     

Distributive characteristics of projection from vestibular nuclei to nucleus raphe magnus in rats

BACKGROUND: Morphological studies have confirmed that vestibular nuclei accepts serotoninergic projections from nucleus raphe magnus, nucleus raphes pallidus, etc. But it is still unclear whether there is bi-directional association between vestibular nuclei and nucleus raphe magnus. OBJECTIVE: To observe the characteristics of projective fibers from vestibular nuclei to nucleus raphe magnus using tetramethyl rhodamine (TMR) in rats, so as to provide more sufficient morphological evidence of neural association from vestibular nuclei. DESIGN: An observational experiment. SETTING: Department of Anatomy (K.K. Leung Brain Research Center), the Fourth Military Medical University of Chinese PLA. MATERIALS: Eighteen male SD rats of clean degree, weighing 250-280 g, were provided by the Experimental Animal Center of the Fourth Military Medical University of Chinese PLA. METHODS: The experiments were carried out in the laboratory of Department of Anatomy (K.K. Leung Brain Research Center), the Fourth Military Medical University of Chinese PLA from September 2006 to January 2007. All the rats were anesthetized with intraperitoneal injection of pentobarbital sodium, then according to the coordinates on the rat brain atlas, 0.1 μL TMR (100 g/L) was injected into nucleus raphes magnus via the tip of glass microtubule by means of microinjection. Seven days later, the rats were anesthetized, then perfused and fixed to remove brain, and then frozen coronal brain sections were prepared. The retrogradely labeled neurons in the injected and projected sites were observed under fluorescence microscope. Light filters with evoked wave length of 540-553 nm and emission wave length ≥ 1 580 nm were selected to observe the orange TMR-labeled neurons. All the sections were observed and counted under the fluorescence microscope. MAIN OUTCOME MEASURES: Characteristics and number of retrogradely labeled neurons at different sites of nuclei. RESULTS: Totally 18 SD rats were enrolled, 9 of them were excluded due to the deviation of injected site, and the other 9 were involved in the final analysis of results. The concentrated region of TMR injection was mainly restricted to nucleus raphes magnus, and diffused to the surrounding area to different extents. There were obvious differences in the distributions of the labeled neurons among the subdivisions in vestibular nuclei, as well as the distributions of the labeled neurons at different sites in the same subdivision. The majority of the labeled neurons distributed in the rostral levels of medial vestibular nucleus and the lateral vestibular nucleus, while fewer labeled neurons were observed in superior vestibular nucleus. CONCLUSION: ① There might be bi-directional association between vestibular nucli and nucleus raphe magnus, suggesting that nucleus raphe magnus played a role in the transmission and processing of vestibular information. ② The projection from nucleus raphe magnus to vestibular nucleus has certain distributive characteristics in the region.