鼻内镜术后鱼腥草滴鼻液与糠酸莫米松鼻喷雾剂联合局部应用对鼻黏膜组织重塑的影响研究

目的　探讨鼻内镜术后鱼腥草滴鼻液与糠酸莫米松鼻喷雾剂联合局部应用对黏膜组织修复与重塑的影响。方法　将46例行鼻内镜手术的慢性鼻-鼻窦炎伴和不伴鼻息肉患者,通过随机数表随机分为3组,分别为鱼腥草滴鼻液+糠酸莫米松鼻喷联合治疗组（16例）、单用糠酸莫米松鼻喷雾剂组（15例）及单用鱼腥草滴鼻液组（15例）,在鼻内镜术后给予相应治疗,3个月后评估患者术后治疗有效率情况。采用免疫组化法评估鼻黏膜上皮细胞损伤分级,并分别计数鼻黏膜上皮细胞中转化生长因子β1（transforming growth factor-β1,TGF-β1）、成纤维细胞生长因子-2（fibroblast growth factor-2,FGF-2）、基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）阳性细胞数。结果　治疗3个月后,联合治疗组患者治疗后的病情完全控制率优于单药治疗组（P 均<0.05）,联合治疗组患者中无鼻黏膜损伤比例显著高于单药治疗组,且基底膜厚度较单药治疗组薄,TGF-β1阳性细胞数较单药治疗组少（P 均<0.05）。治疗后联合治疗组鼻黏膜上皮细胞中FGF-2阳性细胞数和MMP-9阳性细胞数较单药治疗组明显减少（P 均<0.05）。结论　鼻内镜术后鱼腥草滴鼻液与糠酸莫米松鼻喷雾剂联合局部应用,较局部单用以上两种药物有更好疗效,可促进黏膜上皮化,能明显减缓鼻黏膜重塑过程的发生与发展,促进鼻黏膜功能恢复,对鼻内镜术后鼻黏膜修复及预后具有积极意义。     

齐墩果酸通过抑制自噬调节变应性鼻炎中的Treg/Th17细胞失衡CSCD

目的探讨齐墩果酸对变应性鼻炎(AR)中调节性T细胞(regulatory T cells,Treg)/辅助性T细胞17(helper T cells 17,Th17)的调节作用及潜在机制。方法收集AR患者鼻黏膜组织及外周血单个核细胞(peripheral blood mononuclear cell,PBMC)。饲养BALB/c小鼠。PBMC用于建立AR细胞模型,BALB/c小鼠用于建立AR动物模型。对于AR细胞使用150μg/ml的齐墩果酸进行治疗。对于AR小鼠使用低剂量(L)-齐墩果酸(50 mg/kg)、高剂量(H)-齐墩果酸(200 mg/kg)、自噬抑制剂3-MA(10 mg/kg)、H-齐墩果酸+自噬激活剂雷帕霉素(Rapa,1 mg/kg)分别进行治疗。qRT-PCR测人鼻黏膜组织IL-17A和Foxp3的表达以及小鼠各组鼻黏膜组织中RORγt和Foxp3的表达。流式细胞术从PBMC中分选Th17和Treg细胞,并检测PBMC中白细胞介素17A(IL-17A)细胞和叉头样转录因子3(Foxp3)细胞的比例。Western blot法检测Th17和Treg细胞中自噬相关蛋白Beclin1、LC3-II、LC3-I、p62的表达。酶联免疫吸附试验检测各组小鼠鼻腔灌洗液中IL-17A和IL-10的表达。结果AR组患者鼻黏膜组织中IL-17A表达显著增加,但Foxp3的表达显著降低(P均<0.05)。齐墩果酸下调PBMC中IL-17A的表达,并上调Foxp3的表达。齐墩果酸抑制Th17细胞和Treg细胞中Beclin1、LC3-II以及LC3-I的表达(P均<0.05),促进p62的表达水平。齐墩果酸降低AR小鼠体内IL-17A和RORγt水平,并上调IL-10和Foxp3的水平(P均<0.05)。结论齐墩果酸通过抑制自噬信号改善AR中Th17/Treg细胞的平衡。     

变应性鼻炎患者鼻分泌物中嗜酸粒细胞计数与鼻用糖皮质激素治疗反应的关系

目的 观察常年性持续性变应性鼻炎(allergic rhinitis,AR)患者不同炎症类型(嗜酸粒细胞炎症型与非嗜酸粒细胞炎症型)对鼻用糖皮质激素治疗的反应性.方法 选择近3个月内未接受糖皮质激素治疗的常年性持续性AR患者42例,根据鼻分泌物嗜酸粒细胞计数将患者分为嗜酸粒细胞组(A组,嗜酸粒细胞数≥0.03,23例)与非嗜酸粒细胞组(B组,嗜酸粒细胞数<0.03,19例)进行AR症状、体征评分和鼻分泌物细胞分类计数.采用酶联免疫荧光法测定鼻分泌物嗜酸粒细胞阳离子蛋白浓度.糖皮质激素治疗2、4、6个月时进行随访,并进行疗效评价.结果 A组鼻分泌物中嗜酸粒细胞数[中位数M(25分位数;75分位数),下同]、嗜酸粒细胞阳离子蛋白水平(x±s,下同)基线值分别为0.086[0.065;0.176]、(326±145)μg/L,B组分别为0.016[0.005;0.022]、(154±58)μg/L,两组比较差异有统计学意义(t值分别为4.40、3.33,P值均<0.01).鼻用糖皮质激素治疗2、6个月后,A组嗜酸粒细胞数,嗜酸粒细胞阳离子蛋白水平分别为0.038[0.006;0.070]、0.019[0.010;0.060]、(175±122)μg/L、(175±153)μg/L,与基线值比较差异均有统计学意义(F值分别为6.73、7.38,P值均<0.05);B组分别为0.014[0.004;0.032]、0.015[0.000;0.026]、(118±60)μg/L、(112±60)μg/L,与基线值比较,嗜酸粒细胞数差异无统计学意义(F=0.82,P>0.05),而嗜酸粒细胞阳离子蛋白水平差异有统计学意义(F=3.78,P<0.05).A组平均症状、体征评分与B组在基线及2,4、6个月时不同时间点比较差异均无统计学意义.鼻用糖皮质激素用量,两组各时间点比较差异均无统计学意义(P值均>0.05).结论 对于鼻分泌物嗜酸粒细胞数增高的AR患者,鼻用糖皮质激素能够抑制嗜酸粒细胞性炎症,改善AR患者的症状和体征.非嗜酸粒细胞数增高的AR患者对糖皮质激素治疗反应性差.     

CD8 +Treg细胞在慢性鼻窦炎中的表达及其与嗜酸粒细胞浸润的研究

目的:明确CD8 +调节性T细胞（Treg细胞）在慢性鼻窦炎（CRS）患者鼻黏膜组织和外周血中的表达情况,及其与鼻黏膜组织中嗜酸粒细胞（Eos）浸润的关系。 方法:对2017年3月至2018年10月于中山大学附属第三医院的33例慢性鼻窦炎伴鼻息肉（CRSwNP）、26例慢性鼻窦炎不伴鼻息肉（CRS...     

Toll样受体9配体CpG寡脱氧核苷酸鼻内预免疫对豚鼠鼻变态反应抑制作用的研究

目的 探讨Toll样受体9(toll like receptor 9,TLR9)配体CpG寡脱氧核苷酸(CpG oligodeoxynucleotides)鼻内预免疫对豚鼠变应性鼻炎(allergic rhinitis,AR)的抑制作用.方法 50只实验豚鼠采用随机数宁表法分为5组,每组10只,分别为:空白对照组(简称对照组)、AR模型组(AR组)、CpG组、CpG+卵清蛋白组(ovalbumin,OVA,CpG+OVA组)、CpG模拟序列+OVA组(CpG-M+OVA组).AR组及对照组给予生理盐水预免疫;CpG组给予5.2 μg CpG826;CpG+OVA组给予5.2μg CpG+4.8μg OVA;CpG-M+OVA组给予不具免疫活性的CpG1982加OVA滴鼻.4个实验组动物依次进行腹腔OVA和氢氧化铝凝胶基础致敏,2次鼻腔激发,对照组则给予生理盐水.观察鼻黏膜组织损伤情况及嗜酸粒细胞计数.酶联免疫吸附法(ELISA)检测血清及鼻黏膜组织匀浆中白细胞介素(IL)5及γ干扰素(interferon γ,IFN-γ)的水平.免疫荧光(immunofluorescence,IF)观察细胞间黏附分子(intercellular adhesion molecule,ICAM)1在鼻黏膜上皮组织的表达.采用SPSS 11.0软件对数据进行分析.结果 CpG组动物的喷嚏,抓鼻症状要轻于AR组(Z值分别为3.412、3.523,P值均<0.05),CpG+OVA组症状轻于CpG-M+OVA组(Z值分别为3.984、4.452,P值均<0.05).CpG组豚鼠鼻黏膜组织嗜酸粒细胞平均((x)±s,下同)计数为(20.0±9.6)个,低于模型组的(53.5±19.8)个,CpG+OVA组豚鼠鼻黏膜组织嗜酸粒细胞计数为(9.5±5.7)个,低于CpG-M+OVA组的(49.2±18.9)个,差异有统计学意义(q值分别为3.785、4.576,P值均<0.05).ELISA结果显爪CpG组血清及鼻黏膜组织匀浆中IL-5水平低于AR组(q值分别为3.890、4.019,P值均<0.05),而CpG+OVA组低于CpG-M+OVA组(q值分别为4.128、4.245,P值均<0.05),而各组IFN-γ的水平差异尢统计学意义(F值分别为2.078、2.102,P值均>0.05).免疫荧光结果赤示CpG组鼻黏膜组织ICAM-1的表达水平要低于AR组,CpG+OVA组低于CpG-M+OVA组(Z值分别为3.697、3.765,P值均<0.05).结论 CpG寡脱氧核苷酸鼻内预免疫是一种行之有效的抑制鼻变态反应发生的方法.     

浸润毕罗芬明胶海绵在功能性鼻内镜鼻窦手术后应用效果的临床观察

目的 探讨慢性鼻窦炎伴鼻息肉患者鼻内镜术后行浸润毕罗芬喷剂明胶海绵填塞应用的有效性及安全性。方法 112例筛窦病变为主行鼻内镜手术的慢性鼻窦炎伴鼻息肉患者随机分3个组,浸润糠酸莫米松明胶海绵术中填塞+生理海水术后术腔冲洗(A组);浸润糠酸莫米松明胶海绵术中填塞+毕罗芬喷剂术后术腔冲洗(B组);浸润毕罗芬喷剂明胶海绵术中填塞+毕罗芬喷剂术后术腔冲洗(C组)。手术前及术后第2、4、8、12周随访时分别采集症状的SNOT-22评分、Lund-Kennedy内镜评分及囊泡组织中血管内皮生长因子(vascular endothelial growth factor, VEGF)表达情况,比较3个组之间在手术前后主、客观评分的差异,评估其安全性。结果 共有93例患者完成实验规定的3个月的术后随访。主观评分术后较术前明显下降,但术后各随访节点3组评分比较差异无统计学意义;客观内镜评估于术后第2、4、8、12周比较差异均有统计学意义,且呈A>B=C的趋势;客观免疫组化结果VEGF表达含量逐渐减少,在随访12周时比较差异有统计学意义,显示A>B=C的趋势。结论 浸润糠酸莫米松明胶海绵术中填塞...     

白介素-2信号通路在鼻息肉发病中的作用

目的：研究白介素2（IL-2）信号通路相关因子及调节性T细胞在鼻息肉患者组织中的表达情况,探讨二者之间的关联及其在息肉发病中的可能作用机制。方法：集取鼻息肉及正常对照组共30例患者的息肉组织及鼻甲黏膜,采用ELISA法检测局部组织内IL-2及IL-2R,免疫印迹检测组织中的磷酸化STAT5,实时荧光定量PCR法检测Foxp3mRNA在局部组织的表达情况;采用流式细胞术检测局部组织内Treg细胞的比率;同时分析IL-2通路相关因子及Treg细胞的相关性。结果：鼻息肉患者局部组织中IL-2、IL-2R及pSTAT5的含量较正常对照组显著降低,差异有统计学意义（均P〈O．05）;同时,与正常对照组相比,鼻息肉患者的Foxp3mRNA及Treg细胞的比率显著下调,差异有统计学意义（均P〈O．05）;且鼻息肉局部组织内IL-2信号通路相关因子的表达与Treg细胞比率及Foxp3mRNA水平呈正相关（均P〈O．01）。结论：IL-2信号通路的活化状态在鼻息肉患者局部组织中发生了变化,且与Treg细胞的表达呈正相关,提示IL-2信号通路在鼻息肉的发病中起重要作用,鼻息肉中Treg细胞的下调可能是由IL-2信号通路的活化下调所引起的。     

鼻息肉组织中IL-9和IL-17及Foxp3的表达及意义

目的：观察鼻息肉组织中IL-9、IL-17及Foxp3的表达,初步探讨Th9、Thl7／Treg细胞失衡在鼻息肉发病机制中的作用。方法：标本取自40例鼻息肉患者鼻息肉组织（鼻息肉组）和20例鼻中隔手术患者的正常中鼻甲黏膜（对照组）。采用免疫组织化学法检测鼻息肉标本和正常中鼻甲黏膜中IL-9、IL-17及Foxp3的表达水平。结果：鼻息肉组织中IL-9、IL-17阳性率分别为75．0％、80．0％,其表达明显高于对照组（阳性率分别为35．0％和50．0％）,而Foxp3表达（37．5％）明显低于对照组（80．0％）,均P％0．05。结论：IL-9和IL-17因子明显与鼻息肉的发病有关,推测鼻息肉组织中有明显Th9浸润,并存在Thl7／Treg失衡,二者可能在鼻息肉的发病机制中起重要作用。     

鼻息肉、鼻息肉病及对照鼻黏膜蛋白质双向电泳图谱的建立

目的　建立鼻息肉、鼻息肉病及对照鼻黏膜组织蛋白质双向凝胶电泳 (2 DE)图谱。方法　收集并- 80℃冻存鼻息肉、鼻息肉病及鼻黏膜组织样本各 3例 ,双向凝胶电泳分离样本总蛋白、银染凝胶显色 ,扫描图像 ,ImageMaster 2 DEElite4 .0 1软件分析。结果　鼻息肉、鼻息肉病和鼻黏膜组织同一样本三块凝胶平均蛋白质点数分别为 82 5± 78个 ,891± 6 7个和 936± 6 2个 ;平均匹配点数分别为 6 82± 96个 ,76 7± 83个和 82 1± 78个 ,其平均匹配百分率分别为 82 .7%、86 .1%和 87.7% ;位置重复性分析 ,IEF方向平均偏差为 1.13± 0 .16mm ,SDS PAGE方向平均偏差为 1.4 5± 0 .2 1mm。鼻息肉、鼻息病和鼻黏膜三种组织各 3例样品的平均蛋白质点数分别为 876± 95个 ,95 3± 84个和 10 16± 79个。三种组织的 2 DE平均凝胶图谱 :鼻息肉、鼻息肉病和鼻黏膜蛋白质点数分别为116 2个、12 74和 1336个 ,平均匹配点数为鼻息肉与鼻黏膜之间 75 7个 ;鼻息肉病与鼻黏膜之间为 82 5个 ;鼻息肉与鼻息肉病之间为 883个。结论　本实验建立了图像清晰、分辨率高和重复性好的鼻息肉、鼻息肉病及鼻黏膜组织的固相PH梯度 2 DE图谱 ,有助于进一步识别鉴定三者差异表达的蛋白质。     

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance

The expression of vascular endothelial growth factor (VEGF) and VEGF‐C in early laryngeal cancer: relationship with radioresistance Angiogenesis is essential for tumour growth and invasion. Vascular endothelial growth factor (VEGF) is a prime mediator of tumour angiogenesis. VEGF‐C is a closely related protein that effects lymphatic endothelial cells and may be important in the process of lymphatic metastasis. The purpose of this study was to evaluate the expression of these cytokines in patients with T1 and T2a glottic, squamous cell carcinoma, in comparison with normal epithelial control tissue, to ascertain any association with radioresistance. Twenty‐two tumours treated by radiotherapy (13 radiosensitive, nine radioresistant) and seven normal control tissues were studied. The minimum follow‐up was 2 years after radiotherapy. Expression of VEGF and VEGF‐C was evaluated by immunohistochemistry of formalin‐fixed, paraffin‐embedded biopsy specimens. Analysis was carried out using a quantitative computer image analyser. Both VEGF and VEGF‐C were detectable in tumour and normal control specimens. There was increased expression in tumour specimens of both VEGF (P = 0.03) and VEGF‐C (P < 0.001). In addition, the expression of VEGF‐C was associated with tumours of higher histological grade (P = 0.021). There was, however, no difference in VEGF and VEGF‐C expression between radioresistant and radiosensitive tumours. The expression of VEGF and VEGF‐C is increased in early laryngeal squamous cell carcinoma (SCC). However, measuring the expression of these proteins cannot predict radioresistance in this tumour group.     

Treatment of Maxillary Sinus Carcinoma: Clinical Results Using the Kitasato Modality

The conventional therapeutic regimen for maxillary sinus carcinoma consists of dissection of the maxilla, full-dose irradiation and extensive chemotherapy. However, the results obtained with this treatment are often poor. Even when patients recover, their quality of life is significantly reduced as a result of deformity of facial structures and swallowing and articulation dysfunctions. A retrospective analysis of 68 patients with maxillary sinus carcinoma treated with the Kitasato modality between 1975 and 1999 was conducted. All patients underwent pergingival maxillary sinus surgery combined with pre- and postoperative irradiation therapy with standardized total doses of 16 Gy; the postoperative irradiation was given in combination with regional intra-arterial infusion chemotherapy administered via the superficial temporal artery. All visible tumor lesions were removed where possible in order to preserve or facilitate cellular immunity after surgery. The cumulative 5-year survival rates were 85.7% for Stage II patients, 88.1% for Stage III, 76.6% for Stage IVA and 75.0% for Stage IVB.     

Tongue Base Reduction with Temperature-controlled Radiofrequency Volumetric Tissue Reduction for Treatment of Obstructive Sleep Apnea Syndrome

In recent years a considerable effort has been made to establish the use of different surgical techniques for the treatment of obstructive sleep apnea syndrome (OSAS). Nevertheless, treatment of hypopharyngeal obstruction due to tongue base hypertrophy remains in many ways an unsolved problem. The aim of this study was to evaluate the safety and efficacy of tongue base reduction with temperature-controlled radiofrequency volumetric tissue reduction in the treatment of OSAS. Twenty patients with OSAS and tongue base hypertrophy were treated with radiofrequency tissue ablation. An intensified treatment protocol was used, delivering 2,800 J per treatment session under local anesthesia. Two nights of polysomnography testing were performed before and after treatment. Daytime sleepiness, snoring and postoperative morbidity were assessed using questionnaires. Mean respiratory disturbance index (RDI) was reduced from 32.1 to 24.9/h after a mean of 3.4 treatment sessions. Six patients (33%) were cured after the procedure (reduction in RDI of &#83 50% and a postoperative RDI of <15/h) and ten (55%) showed an improvement of >20% in their RDI. Daytime sleepiness and snoring improved significantly. Peri- and postoperative morbidity was low; one severe complication occurred (tongue base abscess). We were able to achieve similar cure and responder rates to those reported in a recently published pilot study but with a reduced number of treatment sessions. We believe that this technique may improve patient acceptance and have beneficial cost implications.     

Cervical Reflex Induced by Click Stimuli in Cats

We studied click-evoked potentials in the anterior horn of the spinal cord in 17 cats. A concentric needle electrode was inserted into the anterior horn of the spinal cord at levels C3-C6. Potentials evoked with 105 dB SPL clicks were recorded with a peak latency of 4.89-5.10 ms only at the C3 level. These responses were observed 45-60 dB SPL above the auditory brainstem response (ABR) threshold, and no potentials were evoked by stimulation of the contralateral ear. Average was performed 100 times with changes in stimulation frequency of 1-20 Hz. The amplitude of the potentials decreased with increasing stimulus frequency, but there were no changes in ABRs. The responses disappeared after destruction of the medial vestibulospinal tract at the obex level, but ABRs were still recorded. The spinal nucleus of the accessory nerves was located in the anterior horn of the spinal cord at levels C1-C6, and the sternocleidomastoid muscle motoneurons were found at levels C1-C3. The click-evoked potentials recorded in this study reflect responses of the spinal nucleus of accessory nerves through the vestibulospinal tract to click stimulation. The responses have the same characteristics as vestibular-evoked myogenic potentials that can be recorded using surface electrodes over the sternocleidomastoid muscles of humans.     

Lack of significant estrogen and progesterone receptor expression in nasal telangiectasias in hereditary hemorrhagic telangiectasia: an immunohistochemical analysis

Obstructive sleep apnea syndrome (OSAS) is characterized by snoring and apnea during sleep leading to decreased oxygen saturation and disturbed sleep, excessive daytime sleepiness and neuropsychological disturbances. This study investigates cognitive neuropsychological abilities in a group of 53 OSAS patients before and after treatment with uvulopalatopharyngoplasty. General intellectual ability, verbal learning and memory as well as executive functioning were measured at baseline and 6 months postoperatively. After surgery there were significant improvements in verbal learning and memory (mean change - 39, SD 57.3, p <0.001), recall (mean change - 24.3, SD 39.3, p <0.001) and executive functioning (as assessed by percentage of errors on the Wisconsin Card Sorting Test; mean change-9.1, SD 15.7, p <0.001). These improvements were in accordance with improvements in the degree of sleep apnea, the oxygen desaturation index (mean change -9.7, SD 15.9, p <0.001) and arterial minimum oxygen saturation (mean change 4.5%, SD 10.2%, p <0.01). Surgical treatment seems to improve verbal learning, memory and recall and executive functions in parallel with better oxygenation in OSAS.     

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.