人格特征对男性喉鳞状细胞癌患者术后近期心理状况的影响

目的 探讨人格特征对喉鳞状细胞癌（LSCC）患者术后近期心理健康状况的影响。方法 纳入2017年1月—2019年12月在湖北省肿瘤医院行手术治疗的119例男性LSCC患者，术后5~7 d采用SCL-90、SAS、SDS自评量表评估术后心理状态，采用EPQ问卷测评患者的人格特征。多元线性逐步回归方法分析LSCC患者术后近期SAS和SDS评分的影响因素。结果 男性LSCC患者术后SCL-90、SAS、SDS得分显著高于中国常模（P≤0.05），EPQ中精神质（P）量表和神经质（N）量表得分高于中国常模（P<0.01）。男性LSCC患者术后躯体化、强迫、焦虑、抑郁、敌对、恐怖、偏执、精神病性因子得分均显著高于中国常模（P<0.05）。家庭收入、手术方式、术后近期是否行放化疗、P和N人格特征是术后SAS评分的影响因素（均P<0.01）；家庭收入、手术方式、术后近期是否行放化疗和N人格特征是术后SDS评分的影响因素（P<0.01）。结论 LSCC患者术后近期存在抑郁、焦虑等心理障碍；具有P和N人格特征；家庭收入、手术方式、术后近期是否行放化疗以及P和N人格特征是影响术后SAS及SDS评分的独立危险因素。     

丙泊酚复合瑞芬太尼喉罩全麻的效果分析与研究

目的 探讨丙泊酚复合瑞芬太尼喉罩全身麻醉(全麻)的效果。方法 62例腹腔镜、泌尿科、骨科、肛肠科、妇科等手术治疗的患者,随机分为实验组和对照组,每组31例。对照组采用常规气管插管静脉复合全麻,实验组给予靶控输注丙泊酚复合瑞芬太尼喉罩全麻。比较两组患者插入喉罩(插管)、插管1 min、插管3 min、拔出喉罩(拔管)1 min、拔管3 min时心率(HR)和平均动脉压(MAP)水平;不良反应发生情况、麻醉效果;全麻起效时间、维持全麻时间、术后苏醒时间。结果 实验组插管时、插管1 min、插管3 min、拔管1 min、拔管3 min的HR水平分别为(77.52±6.36)、(73.26±5.56)、(72.01±4.69)、(75.35±7.63)、(72.34±6.79)次/min,均低于对照组的(92.34±7.85)、(87.97±5.25)、(78.85±5.20)、(95.69±9.21)、(85.63±7.43)次/min,差异均具有统计学意义(P<0.05)。实验组插管时、插管1 min、插管3 min、拔管1 min、拔管3 min的MAP水平分别为(90.25±6.73)、(87.65±7.98)、(88.79±7.65)、(88.09±5.61)、(88.52±5.16)mm Hg(1 mm Hg=0.133 kPa),均低于对照组的(109.51±7.85)、(103.27±12.43)、(102.52±8.21)、(106.74±7.68)、(104.62±7.71)mm Hg,差异均具有统计学意义(P<0.05)。实验组不良反应发生率3.23%低于对照组的19.35%,差异具有统计学意义(P<0.05)。实验组麻醉总有效率96.77%均高于对照组的80.65%,差异均具有统计学意义(P<0.05)。实验组全麻起效、维持全麻、术后苏醒时间分别为(1.61±0.23)、(100.59±6.72)、(17.99±3.52)min,均短于对照组的(2.93±0.41)、(123.61±7.85)、(36.87±4.16)min,差异均具有统计学意义(P<0.05)。结论 针对腹腔镜等手术患者应用丙泊酚复合瑞芬太尼喉罩全麻对血液动力学影响小,不良反应发生率低,麻醉效果良好,降低对机体损伤,值得推广应用。     

Exploration and validation of the effects of robust co-expressed immune-related genes on immune infiltration patterns and prognosis in laryngeal cancer

ObjectivesLaryngeal cancer is a common malignant tumor that originates from the larynx, yet its molecular mechanisms have not been thoroughly explored. The purpose of this study was to identify and evaluate immune-related genes in laryngeal cancer through gene co-expression networks, which may serve as biomarkers for its immunotherapy.MethodsWe applied ESTIMATE to evaluate the immune-infiltration landscape of tumor microenvironment. The co-expression networks were constructed by weighted gene co expression network analysis (WGCNA) and compared with the existing human immune related genes (IRGs) to determine the co-expressed IRGs. GSVA combined with CIBERSORT and ssGSEA illustrated the correlation of hub genes and immune infiltration patterns. TIDE algorithm and Subclass mapping evaluated the function of hub genes in predicting immune function and immunotherapeutic sensitivity. The pRRophetic was employed in the sensitivity prediction of chemotherapeutic drugs.ResultsA total of 23 co-expressed IRGs were identified and showed robust expression characteristics. These genes were significantly related to immune infiltration patterns, immune function and sensitivity prediction of immunotherapy and chemotherapeutic drugs for laryngeal cancer patients. Genetic alteration in somatic mutation level and related pathways were also revealed.ConclusionThe 23 co-expressed IRGs may act as immunotherapeutic biomarkers and potential therapeutic targets for laryngeal cancer with certain expression robustness. The molecular mechanisms deserve further investigation, which will guide clinical treatment in the future.     

On the relation of PAG neurons to laryngeal and respiratory muscles during vocalization in the monkey

Despite evidence from previous unit recording, microstimulation, lesioning and anatomical studies, the functions of the midbrain periaqueductal gray (PAG) remain unclear. We attempted to clarify the function of the PAG by recording activity of PAG units along with laryngeal and respiratory electromyograms (EMG) during vocalization in awake monkeys. PAG units were classified with respect to vocalization on the basis of their discharge patterns as 'early burst', 'late burst', 'tonic-increase' and 'tonic-off', with the vast majority being of the early- and late-burst type. Early-burst cells were correlated most frequently with inspiratory muscles of the respiratory system and laryngeal abductor muscles. Late-burst cells were most clearly correlated with laryngeal adductor and expiratory respiratory muscles. Data from spike-triggered averaging and parametric correlations indicate that most cells are related to single muscles, but a significant number were related to functionally related groups of two or more muscles. The results suggest that the PAG determines qualitative aspects of vocalization by the multisynaptic action its cells have on laryngeal and respiratory motoneurons.     

部分喉切除术患者的营养护理

目的:探讨部分喉切除术患者营养支持的护理。方法:对2 5例部分喉切除术患者,从术前的营养支持、术后管饲的护理以及吞咽功能训练三方面进行指导。结果:2 5例部分喉切除术患者营养状况得到明显改善,无发生营养相关的并发症。结论:提示部分喉切除术患者的营养护理能提高机体免疫力,确保患者顺利度过手术康复期。     

一种新型的声门外通气设备——喉导管

喉导管是一种新型的声门外通气设备.在气道的建立和维持上和喉罩相比有相似的优缺点.喉导管和喉罩总的插管成功率相近,一次插管成功率喉导管要远远高于喉罩.喉导管的气道封闭性更好.喉导管可用于四肢、泌尿、妇科和躯干体表手术以及困难气道的插管.在喉部空间狭小患者和颈髓损伤患者气道的建立上比喉罩更有优势,亦可用于心肺复苏时紧急气道的建立.     

肿瘤转移抑制基因KAI1在喉鳞状细胞癌中表达的研究

目的　探讨肿瘤转移抑制基因KAI1在喉鳞状细胞癌 (简称鳞癌 )中的表达及其与之发生、发展的关系。方法　采用原位杂交方法检测 84例原发性喉鳞癌 (primarylaryngealsquamouscellcarcinoma ,PLSCC)、2 7例喉癌前病变不典型增生 (laryngealprecancerouslesion ,LPL)、10例声带息肉(vocalcordpolyp ,VCP)和 10例正常喉黏膜 (normallaryngealtissues ,NLT)石蜡标本组织细胞中KAI1mRNA的表达。结果　NLT、VCP、LPL和PLSCC 4种组织中KAI1阳性表达的积分吸光度值 ( x±s)分别为 (136 2 0 6 8± 36 6 75 5 )、(1336 74 5± 4 2 85 8 5 )、(90 36 8 8± 2 5 70 1 9)和 (6 7880 6± 2 8189 5 ) ,其中NLT组和VCP组之间差异无显著性 (t=0 14 2 ,P >0 0 5 ) ,NLT组和LPL组之间差异有显著性 (t =4 2 81,P <0 0 1) ;PLSCC组中KAI1表达普遍下调 ,且病理分化G1 2组阳性表达水平高于G3组 ;T1 2病变组高于T3 4组 ;颈淋巴结NO组高于N1及N1以上组 ;临床Ⅰ Ⅱ期组高于临床Ⅲ Ⅳ期组 (P值均 <0 0 1)。KAI1表达与患者性别无关 (P >0 0 5 )。结论　KAI1低表达在喉鳞癌的发生、发展中可能起着重要作用 ,可望作为喉鳞癌早期诊断、评估肿瘤细胞侵袭转移潜能及患者病程发展阶段的指标之一。     

A clinical comparison of the Laryngeal Tube™ and the Laryngeal Mask™ in spontaneously breathing anesthetized patients

Abstract: Background: The laryngeal mask airway (LMA) can be used in general anaesthesia without neuromuscular block. The laryngeal tube (LT) is a new airway device with similar airway features as LMA. LT is provided with a distal cuff to prevent regurgitation. In this study we compared the LMA and LT concerning patient and user aspects. Methods: Sixty patients with ASA (American Society of Anestesiologists) score 1–2 scheduled for minor surgery were randomized to be ventilated either through LMA or LT. After insertion, the number of insertion attempts, and “positioning” and “airway-assessment” was evaluated. The patients reported on “sore throat” after 30 and 60 minutes and the day after anaesthesia. Results: Gender and mean age were equal in both groups. The first insertion attempt was successful in 25 of 28 patients randomised to LMA and in 23 of 27 patients randomised to LT. LMA was evaluated to be easier in “positioning” whereas no difference in “sore throat” was reported. Conclusion: We found no difference between the LMA and the LT in terms user and patient friendliness and safety.