Extracapsular dissection versus partial superficial parotidectomy for the treatment of benign parotid tumours

The purpose of this study was to compare the complications of patients treated for a benign parotid tumour (BPT) by extracapsular dissection (ECD) vs. partial superficial parotidectomy (PSP). A comprehensive literature investigation was conducted by searching electronic databases. A systematic review and meta-analysis of comparative studies were performed to assess ECD and PSP for the treatment of BPTs with fixed-effects models. The outcomes analysed were transient or permanent facial nerve injury, Frey syndrome, recurrence rate, infection, and salivary fistula/sialocele. A total of 1641 patients from seven studies (1120 ECD-treated and 521 PSP-treated patients) were included in this meta-analysis. Transient facial nerve injury (odds ratio (OR) = 0.28, 95% confidence interval (CI): 0.11–0.71; p = 0.008) and Frey syndrome (OR = 0.12, 95% CI: 0.03–0.48; p = 0.003) were less prevalent in the ECD group. The rates of permanent facial nerve injury (OR = 0.77, 95% CI: 0.35–1.70; p = 0.520), recurrence rate (OR = 0.17, 95% CI: 0.02–1.75; p = 0.14), infection (OR = 0.70, 95% CI: 0.07–6.67; p = 0.76), and salivary fistula/sialocele (OR = 0.40, 95% CI: 0.06–2.66; p = 0.350) were similar in both groups. Although there was a trend that ECD showed a reduced risk for complications, the present results are not sufficient to conclude that ECD is more beneficial than PSP.     

腹腔镜胆囊切除术后右美托咪定滴鼻镇痛的效果观察

目的观察右美托咪定滴鼻用于腹腔镜胆囊切除术后镇痛的有效性和安全性。 方法选择2021年10月至2022年1月于邛崃市医疗中心医院收治并择期行全身麻醉下腹腔镜胆囊切除术的患者64例，其中男性17例，女性47例；年龄18~65岁，平均(44.03±10.97)岁；体重指数(BMI)<35kg/m²；美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组，试验组(D组，31例)于术毕清醒拔除喉罩后给予右美托咪定2 μg/kg滴鼻，对照组(C组，33例)于术毕清醒拔除喉罩后给予等容量0.9%等渗盐水滴鼻。记录两组患者一般情况及术中情况；记录术后2、8、12、24 h静息和运动时视觉模拟评分(visual analogue scale，VAS)；记录术后24 h内补救镇痛的例数以及初次补救镇痛的间隔时间；记录术后24 h内恶心、呕吐的发生例数及严重程度；记录24 h内最满意镇痛且最轻呕吐(satisfactory analgesia with minimal emesis，SAME)的达标比例；记录术后24 h内严重心动过缓、呼吸抑制、循环不稳、镇静过度等不良反应的发生情况。 结果与C组比较，D组2、8 h静息和运动VAS评分及12 h运动VAS评分明显降低(P<0.05)，两组术后补救镇痛的次数差异无统计学意义(P>0.05)，但D组初次补救镇痛的间隔时间明显延长(P<0.05)。与C组比较，D组术后恶心呕吐的发生率及严重程度明显降低(P<0.05)。D组SAME达标率明显高于C组(P<0.05)。两组患者术后均未出现严重心动过缓、呼吸抑制(SPO₂低于95%)、循环不稳(需要药物干预)、镇静过度等不良反应。 结论腹腔镜胆囊切除术后右美托咪定2 μg/kg滴鼻能在不辅助其他术后镇痛药的情况下，改善患者术后疼痛及恶心呕吐，延长初次补救镇痛的间隔时间，且无明显不良反应。     

Prediction of clinical response to omalizumab in moderate-to-severe asthma patients using the change in total serum IgE level

BackgroundOmalizumab (OMA) is an effective anti-immunoglobulin E (IgE) treatment for moderate-to-severe asthma. However, predicting an individual’s response is difficult. Monitoring change of total serum IgE may be useful for predicting the response to OMA. The purpose of this study was to determine if measuring the change in total IgE level could predict the response to OMA in patients with moderate-to-severe asthma.MethodsThis study included 25 patients (11 females and 14 males; mean age =46.1 years; mean pre-bronchodilator FEV1% =67.8%) with moderate-to-severe asthma. All patients were treated with OMA, and total IgE serum concentrations were measured at baseline before treatment (median baseline total serum IgE =210 IU/mL) and at 4 weeks after beginning treatment. Patients were divided into responders (i.e., excellent or good response) and non-responders (i.e., moderate or poor response) using the global treatment effectiveness (GETE) response method after 16 weeks of treatment. The characteristics of responders and non-responders were compared, and receiver operating characteristic (ROC) curve analysis was used to determine the ability of change in IgE level to predict treatment response.ResultsThere were 20 responders (80%) and 5 non-responders (20%), and responders demonstrated better improvements of asthma control test (ACT) and asthma control questionnaire (ACQ) scores, and reduction of oral corticosteroid use as compared with non-responders. Twenty-one patients had a total serum IgE 4-week-to-baseline ratio ≥2, and 20 of the patients responded to OMA. The area under the ROC curve (AUC) for baseline IgE level for predicting treatment response was 0.53 (95% CI: 0.18–0.88), and that of the week 4 IgE level was 0.69 (95% CI: 0.42–0.96). Using a cutoff value of 2, the 4-week: baseline IgE ratio achieved the highest AUC of 0.87 (95% CI: 0.64–1), with a sensitivity and specificity of 100% and 80%, respectively, for predicting treatment response.ConclusionsA total week 4 serum IgE level:baseline level ratio ≥2 can predict the response to OMA in patients with moderate-to-severe asthma after 16 weeks of treatment with high likelihood. Monitoring changes of total IgE level in asthma patients treated OMA may be useful for predicting clinical response.     

提高垃圾焚烧厂发电效率的最新应用技术

介绍了提高垃圾焚烧厂热效率的最新工艺技术,阐述了组合式高效垃圾发电工艺(WTE-GT)和再热循环工艺及案例,指出了对我国垃圾焚烧行业发展的借鉴意义。     

新生儿听力筛查联合聋病易感基因检测的临床应用价值分析

目的:探讨进行新生儿筛查工作上,做听力筛查、聋病易感基因的联合检测临床应用价值.方法:纳入600例新生儿,在其出生后2～3天做瞬态诱发耳声发射(TEOAE)初筛,对经过初筛未通过的新生儿在出生后42天进行耳声发射(OAE)联合自动判断听性脑干反应(ABR)复筛,采集新生儿出生后的脐带血液,开展对聋病易感基因检测,在检测上具体筛查如下的基因:GJB2基因、GJB3基因、SLC26A4基因、线粒体DNA12S rRNA基因,综合听力筛查、聋病易感基因检测结果综合对检测情况的分析汇总,且做随访观察.结果:600例新生儿听力筛查中,初筛未通过44例,出生后42天复筛14例未通过,持续3个月的随访发现其中存在7例听力出现缺失的病例;聋病易感基因检测出95例携带遗传耳聋基因突变,其中GJB2基因突变59例,GJB3基因突变3例,SLC26A4基因突变29例,线粒体DNA12S rRNA基因突变4例;听力筛查联合聋病易感基因检测结果显示:听力筛查未通过并且聋病易感基因检测异常7例,听力筛查未通过而聋病易感基因检测正常37例,聋病易感基因检测异常但是听力筛查通过88例.结论:新生儿听力检查工作中,听力筛查同聋病易感基因联合检查能发现高危听力障碍群体,保证新生儿的健康成长.     

Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media

Objectives: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM).

Materials and methods: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n?=?72) received MeroGel as the MEPA, Group 2 (n?=?64) cartilage, and Group 3 (n?=?69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4?kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient.

Results: Mean pre- and post-operative ABG was 30.9?dB and 17.6?dB in Group 1, 31.4?dB and 21.9?dB in Group 2, and 32.2?dB and 19.1?dB in Group 3. The ABG closure was 13.3?±?7.5 in Group 1, 9.5?±?5.9 in Group 2, and 13.1?±?9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p?p?Conclusions: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.     

<Emphasis Type="Italic">Staphylococcus aureus</Emphasis> from patients with chronic rhinosinusitis show minimal genetic association between polyp and non-polyp phenotypes

Background

Staphylococcus aureus has a high prevalence in chronic rhinosinusitis (CRS) patients and is suggested to play a more etiopathogenic role in CRS patients with nasal polyps (CRSwNP), a severe form of the CRS spectrum with poorer surgical outcomes. We performed a microbial genome-wide association study (mGWAS) to investigate whether S. aureus isolates from CRS patients have particular genetic markers associated with CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP).

Methods

Whole genome sequencing was performed on S. aureus isolates collected from 28 CRSsNP and 30 CRSwNP patients. A mGWAS approach was employed using large-scale comparative genomics to identify genetic variation within our dataset.

Results

Considerable genetic variation was observed, with >?90,000 single nucleotide polymorphisms (SNPs) sites identified. There was little correlation with CRS subtype based on SNPs and Insertion/Delection (Indels). One indel was found to significantly correlate with CRSwNP and occurred in the promoter region of a bacitracin transport system ATP-binding protein. Additionally, two variants of the highly variable superantigen-like (SSL) proteins were found to significantly correlate with each CRS phenotype. No significant association with other virulence or antibiotic resistance genes were observed, consistent with previous studies.

Conclusion

To our knowledge this study is the first to use mGWAS to investigate the contribution of microbial genetic variation to CRS presentations. Utilising the most comprehensive genome-wide analysis methods available, our results suggest that CRS phenotype may be influenced by genetic factors other than specific virulence mechanisms within the S. aureus genome.

     

Blastic plasmacytoid dendritic cell neoplasm: update on therapy especially novel agents

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematopoietic malignancy mainly affecting elderly patients. Most patients present with asymptomatic skin lesions as the first symptom and has a high frequency of bone marrow involvement. BPDCN is typically characterized by CD4+ and CD 56+ co-expression without common lymphoid or myeloid lineage markers. There is no consensus on the optimal therapeutic strategy for BPDCN. It is highly responsive to chemotherapy but the median event-free survival is very short. Allogeneic stem cell transplantation may improve the prognosis of BPDCN but the rate of relapse is still high. There are no specific targeted agents approved for patients with BPDCN, but advances in the understanding of the pathobiology of BPDCN and the results of early clinical studies have revealed novel targets and potentially effective agents. Novel targeted therapies may improve outcomes for patients with BPDCN in the future.