声带任克水肿的临床特点及治疗原则

目的 探讨声带任克水肿(Reink's edema)的病因及发病机制,分析其临床特点及治疗原则.方法 对78例声带任克水肿患者的病因、流行病学特点、嗓音障碍特点进行分析,其中,29例患者进行戒烟及避免滥用嗓音并观察随访,49例患者接受嗓音外科手术,分析其疗效.结果 声带任克水肿的发生与长期大量吸烟有关,多发生在中、老年患者,男性高于女性(男女之比为7.7:1).嗓爵损害以声调下降最为明显,喉镜下表现为声带表面全长弥漫性水肿.29例非手术治疗的患者中,16例病变缩小,13例病变稳定.49例接受手术治疗的患者嗓音都有不同程度的改善,其中5例基本恢复正常(0级),34例仍有轻度障碍(1级),10例中度障碍(2级).术后所有患者嗓音客观声学参数值都较术前改善,其中以基频改变为明显.但大部分患者仍存在一定程度的嗓音障碍.结论 吸烟是导致声带任克水肿的重要原因,噪音外科手术后嗓音恢复程度有限,应根据病变范围、嗓音障碍程度及患者职业等因素综合考虑足否手术治疗.     

职业性噪声性聋与mtDNA缺失关系的探讨

目的 探讨线粒体DNA(mitochondrial DNA,mtDNA)缺失在噪声性聋发病中的可能作用.方法 在265名从事噪声作业的青年工人中,根据纯音听阈测试结果,分为语频听力损失组和语频听力正常组,其中自愿进入研究的语频听力损失组(A组)25人,双耳言语频率(500、1 000、2 000 Hz)听阈均值≥26 dB HL;在语频听力正常人群中随机抽取27人作为语频听力正常组(B组),两组分别抽取外周血,提取白细胞DNA,应用PCR方法检测mtDNA4977缺失情况.结果 A组mtDNA4977缺失检出率20%(5/25),B组mtDNA4977缺失检出率为0(0/27),A组mtDNA4977缺失检出率明显高于B组(P＜0.05).结论 mtDNA4977缺失可能在噪声性聋的发病中起重要作用,     

Intensity-modulated radiotherapy for cervical esophageal squamous cell carcinoma: clinical outcomes and patterns of failure

The objective of the study was to report clinical outcomes and patterns of failure for these patients with cervical esophageal squamous cell carcinoma (CESCC) treated with intensity-modulated radiotherapy (IMRT). A total of 64 patients with CESCC treated with definitive IMRT from May 2005 to March 2012 in our center were analyzed. Forty-two patients received radiotherapy alone and 22 patients received concurrent chemoradiotherapy. The location and extent of locoregional failures were transferred to the pretreatment planning computed tomography for dosimetry analysis. For all patients, the overall 2-year local failure-free survival, regional failure-free survival, distant failure-free survival, and overall survival rate was 74.5, 88.0, 66.6 and 42.5 %, respectively. Twenty-eight patients had developed treatment failure. Of the 28 patients, 14, 5, and 18 had developed local failure, regional failure, and distant metastasis, respectively. All of the 14 local failures were considered in-field failures. Of the five regional failures, three were considered in-field failures and two were marginal failures. The most frequently observed acute toxicity was mainly Grade 1 or 2. The incidence of acute Grade 3 mucositis (including pharyngitis), skin reaction, and leukopenia was 4.7, 12.5 and 10.9 %, respectively. IMRT provides satisfactory locoregional control for CESCC. Distant metastasis remains the predominate pattern of failure and the predominate pattern of locoregional failures is in-field failure.     

Frequency-specific hearing results after stapes surgery for Chinese population otosclerosis with different degrees of hearing loss

Abstract

Background: Frequency-specific hearing studies are important for predicting hearing results and the prognosis after stapes surgery, to prepare for the rehabilitation of frequency-specific hearing in patients with otosclerosis.

Objectives: To evaluate outcomes of stapes surgery of Chinese otosclerosis patients with different degrees of hearing loss.

Methods: We conducted a retrospective analysis of 213 otosclerosis patients who underwent stapes surgery in our hospital. Pre- and post-operative audiometric evaluation using conventional audiometry.

Results: The post-op ABG was less than 20?dB in 94.52% of all cases after surgery. There was no statistical significance of the post-op ABG among different groups at all frequencies except extremely severe group (p?<?.05). There was a significant improvement of both AC and BC thresholds in post-op period and the most significant improvement was found in severe group. There were no serious post-op complications and no re-operations during the follow-up period.

Conclusion: Stapes surgery is a suitable treatment option for otosclerosis with mild to extremely severe HL. The mild to moderate hearing loss groups had the most significant improvement of AC thresholds in the low frequency region, and the severe to extremely severe groups appeared in the high frequency region.     

甲状腺腺叶切除术精细化操作技术临床结果初步报告

目的 回顾总结集程序化、精细化操作与质控为一体的甲状腺腺叶切除术外科模式在甲状腺全切除术中临床应用结果.方法 2013年5月至2014年8月应用该外科模式实施甲状腺全切除72例,按程序化的设计和步骤进行精细化操作完成手术,对手术切口、手术时间、术中出血量、术中重要结构保护、切口愈合、术后并发症、患者满意度情况进行总结.结果 颈部第二皮纹切口更符合患者立位的社会属性;一侧腺叶手术时间30 ～ 50 min;出血约2～5 ml;无喉上神经损伤,出现暂时性喉返神经麻痹4侧,术后3～4周均自行恢复;暂时性甲状旁腺功能减退10例,术后4～6周自行恢复;切口均一期愈合;手术切口非常满意66例,满意4例,可接受2例.结论 集程序化、精细化操作与质控为一体的甲状腺腺叶切除外科模式对甲状腺手术的实施是一种良好的外科模式,对标准化流程的建立、质控和临床教学均有积极的推动作用.     

Quantitative analysis by reversed-phase high-performance liquid chromatography and retinal neuroprotection after topical administration of moxonidine

AIM: To determine moxonidine in aqueous humor and iris-ciliary body by reversed-phase high performance liquid chromatography (RP-HPLC), and to evaluate the retinal neuroprotective effect after topical administration with moxonidine in a high intraocular pressure (IOP) model. METHODS: The eyes of albino rabbits were administered topically and ipsilaterally with 0.2% moxonidine. A RP-HPLC method was employed for the identification and quantification of moxonidine between 2 and 480min, which presented in the aqueous humor and iris-ciliary body. Flash electroretinography (F-ERG) amplitude and superoxide dismutase (SOD) level were measured between day 1 and day 15 after topical administration with moxonidine in a rabbit model of high IOP. Histological and ultrastructural observation underwent to analyze the changes of retinal morphology, the inner retinal layers (IRL) thickness, and retinal ganglion cell (RGC) counting. RESULTS: Moxonidine was detectable between 2 and 480min after administration, and the peak concentration developed both in the two tissues at 30min, 0.51 μg/mL in aqueous humor and 1.03 μg/g in iris-ciliary body. In comparison to control, F-ERG b-wave amplitude in moxonidine eyes were significantly differences between day 3 and day 15 (P<0.01) in the high IOP model; SOD levels were significantly higher at all time-points (P<0.01) with a maximum level of 20.29 U/mgprot at day 15; and RGCs were significantly higher (P<0.05). CONCLUSION: Moxonidine is a viable neuroprotective agent with application to high IOP model. All layers of retina, including RGC layer, retinal nerve fiber layer and INL, are more preserved after moxonidine administration. SOD plays a neuroprotective role in ocular hypertension-mediated RGC death.     

Decoupling location specificity from perceptual learning of orientation discrimination

Perceptual learning of orientation discrimination is reported to be precisely specific to the trained retinal location. This specificity is often taken as evidence for localizing the site of orientation learning to retinotopic cortical areas V1/V2. However, the extant physiological evidence for training improved orientation turning in V1/V2 neurons is controversial and weak. Here we demonstrate substantial transfer of orientation learning across retinal locations, either from the fovea to the periphery or amongst peripheral locations. Most importantly, we found that a brief pretest at a peripheral location before foveal training enabled complete transfer of learning, so that additional practice at that peripheral location resulted in no further improvement. These results indicate that location specificity in orientation learning depends on the particular training procedures, and is not necessarily a genuine property of orientation learning. We suggest that non-retinotopic high brain areas may be responsible for orientation learning, consistent with the extant neurophysiological data.     

激素抵抗型婴幼儿Kasabach-Merritt综合征治疗中雷帕霉素的临床应用价值探讨

目的 初步评估临床上应用雷帕霉素治疗激素抵抗型婴幼儿Kasabach-Merritt综合征的临床疗效及安全性.方法 2015年2月至2016年4月共收集8例在我科接受治疗的Kasabach-Merritt综合征患儿,其中男5例,女3例,病灶位于颌面部3例、颈部1例、四肢2例,胸腹壁2例,8例患儿均表现为激素抵抗,对激素抵抗型Kasabach-Merritt综合征采用mTOR抑制剂雷帕霉素治疗.雷帕霉素服用方法为每次0.8 mg/m2,2次/d,间隔12h,血药浓度维持10～15 ng/ml.定期监测血常规、凝血功能、肝肾功能、血脂及雷帕霉素血药浓度等指标.根据血药浓度、血小板变化、凝血功能、瘤体缩小情况及副作用可适当调整用药计划.结果 8例患儿经雷帕霉素治疗后血小板均恢复正常,瘤体萎缩,并逐步撤离了激素,有效率达到100％.雷帕霉素平均起效时间(6.8±2.7)d,平均血小板稳定时间(19.1±8.5)d,目前雷帕霉素总的用药时间为4～10个月,平均(6.0±2.2)个月,开始雷帕霉素单药治疗时间为2～8个月,平均(4.5±1.9)个月.8例患儿仍在服药进行中,均无血小板下降和病灶复发.药物使用中不良反应主要为口腔黏膜炎及口腔溃疡(2例,GradeⅡ)、呕吐(1例,Grade工)、腹泻(2例,Grade Ⅰ/GradeⅡ)、发热(2例,GradeⅡ)、皮疹(1例,Grade Ⅰ)、疼痛(1例,Grade Ⅰ)、短暂性转氨酶及血脂异常(1例,Grade Ⅰ/GradeⅡ),予对症治疗后好转,无严重不良事件,无病例退出.结论 mTOR抑制剂雷帕霉素治疗激素抵抗型Kasabach-Merritt综合征具有一定的疗效及安全性,值得临床进一步推广应用.