OBJECTIVE To explore the clinical features and surgical treatment methods of primary parapharyngeal space tumors.METHODS The clinical data of 38 patients with primary parapharyngeal space tumors who were treated in the Affiliated Hospital of Southwest Medical University from June 2005 to April 2023 were retrospectively analyzed,and their clinical manifestations,imaging data,surgical methods,postoperative complications,postoperative pathological types and prognosis were analyzed.RESULTS The clinical manifestations of 38 patients were mainly pharyngeal discomfort and pharyngeal distension.CT and MRI can determine the size,location,and relationship of the tumor to surrounding tissue.The surgical methods included transcervical approach in 17 cases,transoral approach in 15 cases,transcervical-transparotid approach in 4 cases,and transcervical-transmandibular approach in 2 cases.Postoperative pathology diagnosed 28 cases(73.7%)of benign tumors and 10 cases(26.3%)of malignant tumors.After the postoperative follow-up of 2 months-17 years,there was no recurrence of benign tumor patients,and patients with malignant tumors survived well after comprehensive treatment with surgery and radiotherapy and chemotherapy.CONCLUSION Most patients with primary parapharyngeal space tumors have no specific clinical symptoms,and the types of pathologies are diverse.Choosing the appropriate surgical approach to remove the tumor is key to treatment.Neurologic deficits are the most important postoperative complication.Patients with benign tumors have good long-term effects after surgery,and patients with malignant tumors have better efficacy in the combination of surgery and chemoradiotherapy.

OBJECTIVE To analyse the prognosis and laryngeal function retention of patients undergoing minimally invasive and open surgery after induction chemotherapy.METHODS The clinical data of 54 hypopharyngeal carcinoma patients who received induction chemotherapy and underwent laryngeal preservation surgery in Beijing Tongren Hospital from 2016 to 2022 were retrospectively analyzed.The laryngeal function recovery and survival rate were compared between the two groups.RESULTS Twenty-eight patients underwent transoral minimally invasive surgery and 26 patients underwent partial laryngectomy and/or partial laryngectomy via external cervical approach.The 3-year survival rates of the two groups were 63%and 59%,respectively,and the difference was not statistically significant(P＞0.05).The differences were statistically significant(P＜0.05).CONCLUSION In patients with downstaged hypopharyngeal carcinoma after induction chemotherapy,the survival rate of transoral minimally invasive surgery is similar to that of open surgery,and the laryngeal function recovery of transoral minimally invasive surgery is better.

OBJECTIVE To investigate the mechanism of disruptor of telomeric silencing 1-like(DOT1L)on epithelial mesenchymal transition(EMT)in laryngeal squamous cell carcinoma(LSCC)via Notch1 signal pathway.METHODS Fresh tumor tissues and adjacent normal tissues from 30 pathologically confirmed LSCC patients were selected.The positive expression rates of DOT1L and its catalytic product H3K79me3 were detected by immunohistochemistry staining,the relative mRNA expression levels of DOT1L and H3K79me3 were measured by qRT-PCR.The human LSCC cell line TU686 was selected and divided into blank control group,over-expression group,and low-expression group.After 48 hours of cultivation,cell proliferation rate was measured using MTT method,cell apoptosis rate was measured using flow cytometry,and the relative expression levels of Notch1,E-cadherin,N-cadherin,and Vimentin proteins were detected using Western blot.RESULTS 1.Compared with normal tissues adjacent to cancer,the positive expression rates[(41.5±8.9)%vs.(18.3±3.6)%,t=56.963,P＜0.001;(40.5±7.7)%vs.(10.2±2.3)%,t=96.635,P＜0.001]and mRNA expression levels[(0.69±0.13)vs.(0.13±0.09),t=102.302,P＜0.001;(0.42±0.19)vs.(0.09±0.03),t=85.659,P＜0.001]of DOT1L and H3K79me3 in tumor tissues were significantly increased.2.Compared with the blank control group,cell proliferation rate in the over-expression group was significantly higher(t=45.628,P＜0.001),while apoptosis rate was lower(t=40.125,P＜0.001),Notch1,N-cadherin,and Vimentin proteins expressions were increased,E-cadherin was decreased(t=22.524,30.263,45.629,27.859,P＜0.001).The cell proliferation rate in the low expression group was significantly decreased(t=33.427,P＜0.001),but apoptosis rate was increased(t=78.529,P＜0.001),levels of Notch1,N-cadherin,and Vimentin proteins were lower,E-cadherin was higher,too(t=19.864,23.524,28.957,33.426,P＜0.001).CONCLUSION DOT1L is highly expressed in LSCC,affecting the methylation level of histones,thereby regulating cell proliferation,apoptosis,and EMT behavior.DOT1L is expected to become a new site for tumor targeted intervention.

OBJECTIVE To investigate the effect and mechanism of action of KRT8 small interfering RNA(si-KRT8)in exosomes derived from patient serum with hypopharyngeal carcinoma on chemosensitivity to 5-fluorouracil(5-FU)in human pharyngeal squamous cell carcinoma FaDu cell line.METHODS The cancerous tissues of hypopharyngeal cancer patients and The serum,cancerous tissues and paracancerous tissues of drug-resistant patients after treatment were collected.A 5-FU-resistant cell line of FaDu(FaDu/R)was constructed for subsequent experiments.Exosomes were isolated from patient serum by ultrafast gradient centrifugation,identified using transmission electron microscopy and Western blot(WB)techniques.si-KRT8 was encapsulated into exosomes(Exosome@si-KRT8)using electroporation technology and subsequently used to treat cells.Real-time fluorescence quantitative PCR(RT-qPCR)and WB were used to detect the expression levels of KRT8 in different tissues,exosomes after electroporation of si-KRT8,and FaDu cells,respectively.Cell counting kit-8(CCK-8),terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay,migration invasion technique and WB were used to detect the effects of Exosome@si-KRT8 on viability,apoptosis,and epithelial-mesenchymal transition of FaDu/R cells.RESULTS The expression level of KRT8 in drug-resistant tissues of hypopharyngeal carcinoma and FaDu/R cells was elevated compared with that in paraneoplastic tissues,cancer tissues and normal FaDu cells(t=15.79,P＜0.01).Isolated patient serum exosomes showed a double membrane structure and expressed both CD63 and TSG101 proteins,and KRT8 expression in exosomes was decreased after electro-transfection with si-KRT8(t=6.70,P＜0.01).Exosome@si-KRT8 inhibited KRT8 protein expression levels in FaDu/R cells(t=123.50,P＜0.01).Compared with the 5-FU group and the 5-FU+Exosome group,Exosome@si-KRT8 was able to inhibit the viability of FaDu/R cells(t=17.07,P＜0.01),promote the level of apoptosis in FaDu/R cells,and inhibit the expression of drug-resistance-associated proteins in FaDu/R cells(P-gp:t=103.20,MDR1:t=238.60,P＜0.01),and Exosome@si-KRT8 was able to suppress the expression of metastasis of FaDu/R cells(t=42.30,t=122.00,P＜0.01)and promoted the expression of E-cadherin while inhibiting the expression level of N-cadherin(t=130.80,t=83.90,P＜0.01).CONCLUSION Serum-derived exosome encapsulation of si-KRT8 enhances chemosensitivity of hypopharyngeal carcinoma cells and its mechanism of action may be related to inhibition of epithelial-mesenchymal transition.

OBJECTIVE To investigate the prognostic value of serum creatinine-cystatin C ratio(CCR)for nasopharyngeal carcinoma(NPC).METHODS NPC patients who underwent consultation at the Army 72nd Group Military Hospital from January 2007 to December 2015 were retrospectively analyzed and divided into high-expression and low-expression groups according to whether the CCR was＜0.81(median),and the predictive variables of the high-expression and low-expression groups were compared.Kaplan-Meier survival analysis and Cox regression were used to analyze the effect of CCR on overall survival(OS),and clinical prediction models and column line diagrams were constructed and evaluated based on relevant predictive factors.RESULTS A total of 516 NPC patients were included.The percentage of elderly patients in the high-expression group(22.5%)was significantly lower than that in the low-expression group(32.6%),and the percentage of highly-differentiated patients(22.5%)was significantly higher(14.7%),and the percentage of patients with TNM stage Ⅰ and Ⅱ(40.7%)was significantly higher than that in the low-expression group(29.8%),and the differences of the above indexes were all statistically significant(P Kaplan-Meier survival analysis suggested that low-expression CCR was significantly associated with poorer OS,and multifactorial Cox regression analysis showed that age,CCR,pathologic grade,time from diagnosis to treatment,and TNM stage were significantly associated with OS(P＜0.05).The clinical prediction model constructed on the basis of the above predictive factors had higher AUC values than the traditional TNM staging model,and its column line graph predicted OS with good agreement with the actual.CONCLUSION CCR can be considered as a potentially useful prognostic factor for NPC patients.

OBJECTIVE To analyze the results of subjective visual vertical(SVV)and subjective visual horizontal(SVH)in female patients with benign paroxysmal positional vertigo(BPPV).METHODS Retrospectively,310 peri-menopausal females(40-60 years old)who met the diagnostic criteria of BPPV,were included as the peri-menopausal group.110 female BPPV patients aged＜40 years and 332 female BPPV patients aged＞60 years were included as the youth and senior group.To analyze the SVV/SVH characteristics of female BPPV patients in different age groups.RESULTS 1.The total SVV/SVH abnormality rate in female BPPV patients was 42.29%;2.There was no difference in SVV/SVH abnormality rate between peri-menopausal and youth group in the different affected BPPV types(all P＞0.05);3.In senior group,the SVV/SVH abnormality rate showed horizontal semicircular canal cupulolithiasis BPPV(58.62%)＞horizontal semicircular canal canalolithiasis BPPV(48.65%)＞posterior semicircular canal BPPV(36.68%)in different affected BPPV types,with statistically significant differences(P＜0.05);4.There was no difference in the total SVV/SVH abnormality rate among BPPV patients when compared among the three groups(41.94%,46.36%,41.27%,P＞0.05).CONCLUSION The SVV/SVH abnormality rate in female BPPV patients is around 40%,and varies with age in different affected BPPV types.

OBJECTIVE To explore the clinical characteristic manifestation of Rosai-Dorfman disease(RDD)involving the nasal cavity and paranasal sinuses.METHODS The clinical data of 16 patients with RDD involving the nasal cavity and paranasal sinuses who received treatment in Department of Rhinology of Beijing Tongren Hospital Affiliated to Capital Medical University from December 2016 to December 2023,were retrospective analyzed.RESULTS The male to female ratio was 1:3,with an average age of 47.4 years and an average disease duration of 22.34 months.There were 14,3,5,6 and 1 patients who complained of nasal congestion,dry nose,decreased sense of smell,head and face pain,and bulging/diplopia,respectively.There were 9 patients who had external nasal swelling.There were 14 RDD patients who were involved at least the nasal septum,12 patients who were simply affected in the nasal cavity,and 3 cases who involved the paranasal sinuses.There was 1 case belonged to a mixed type of RDD.There were 8 of 10 cases who were misdiagnosed or missed due to intraoperative rapid freezing.Endoscopic examination showed bilateral bulging in 9 patients'nasal septum,and nodular or granular new growth on 7 patients'nasal floor and inferior turbinate surface.Sinus CT found 9 patients'the nasal septum area showed a circular uniform soft tissue shadow or symmetrical soft tissue thickening shadow,5 patients'nasal floor and inferior turbinate showed obvious soft tissue thickening shadow.CONCLUSION RDD involving the nasal cavity and paranasal sinuses has certain typical features in external nasal manifestations,endoscopic and imaging examinations.Comprehensive judgment can help improve the feasibility of clinical diagnosis of RDD.

OBJECTIVE To determine the prevalence of frontal recess cells variations in patients with frontal sinus associated headache according to the International Frontal Sinus Anatomy Classification(IFAC).METHODS A retrospective study was conducted on the CT scans of sinuses in patients with frontal sinus associated headache.We reviewed 46 patients with frontal sinus-related headache who had clinical symptoms and were relieved after nasal endoscopic surgery.The development of frontal recess cells in the frontal recess drainage area was analyzed,and the variation of middle meatus and sinus involvement were analyzed in the same time.The Anatomical variations and imaging characteristics of frontal recess cells development in patients with frontal sinus associated headache were analyzed.RESULTS A total of 92 sinus CT profiles were analyzed in 46 patients.The most common cells were agger nasi cell(ANC)(100%,92/92),followed by supra bulla cell(SBC)(78.3%,72/92),supra agger cell(SAC)(67.4%,62/92),supra bulla frontal cell(SBFC)(27.2%,25/92),supra agger frontal cell(SAFC)(20.7%,19/92),frontal septal cell(FSC)(8.7%,8/92)and supraorbital ethmoid cell(SOEC)(0%,0/92).In the conventional frontal sinus drainage area,SAFC(P=0.0108),SAC(P=0.0104)and SAFC(P=0.0088)in the IFAC classification were significantly associated with the occurrence of frontal sinus associated headache.At the same time,the middle concha bullosa also showed a significant correlation with the occurrence of frontal sinus associated headache in the lower segment of the frontal recess drainage channel(P=0.0390).CONCLUSION In the frontal recess drainage channel,the abnormal development of SAC,SAFC,SBFC and the middle concha bullosa are significantly correlated with frontal sinus associated headache.

OBJECTIVE To investigate the application of endoscopic Draf Ⅱ-Ⅲ frontal sinus surgery in the treatment of recurrent frontal sinus infection and fistula formation after craniocerebral trauma.METHODS There were 8 cases of recurrent frontal sinus infection after craniocerebral trauma,the main manifestations were headache,recurrent frontal infection,discharge of pus,fistula formation.The average onset time was 43.25 months.The patients underwent DRAF Ⅱ-Ⅲ frontal sinus surgery under nasal endoscopy,including Draf Ⅱa 2,Draf Ⅱb 5,and Draf Ⅲ1,respectively.During the operation,the frontal sinus ostium was expanded.It was found that bone wax blocked the frontal sinus ostium in the frontal sinus.The bone wax was removed,and the frontal sinus drainage was smooth.No facial incision was made in all patients.RESULTS There were 8 patients with frontal infection who were cured after surgery.No cerebrospinal fluid rhinorrhea or intracranial infection occurred during or after operation.After discharge,the outpatient follow-up review was conducted in 1,3,6,and 12 months.It was found that the frontal sinus remained unobstructed.The frontal sinus did not become infected again,and the fistula gradually healed.CONCLUSION Draf Ⅱ-Ⅲ frontal sinus surgery under nasal endoscopy is an effective way to treat recurrent frontal sinus infection and fistula formation after craniocerebral trauma.

OBJECTIVE To investigate effects of children with allergic rhinitis on physical and mental condition of their family caregivers.METHODS The family caregivers of 149 children with allergic rhinitis were enrolled,and fatigue,anxiety and depression scales were investigated and risk factors were analyzed through questionnaires.RESULTS The symptoms of fatigue,anxiety and depression in family caregivers were more frequent in family caregivers whose children had more severe symptoms of allergic rhinitis(r=0.426,P=0.000;r=0.479,P=0.000;r=0.358,P=0.000).Family caregivers with children aged＜3 years or with other allergic diseases combined had higher levels of fatigue(P=0.000,P=0.000),anxiety(P=0.000,P=0.000)and depression(P=0.003,P=0.001),while the family caregivers of children with perennial/persistent symptoms had higher levels of depression(P=0.021).The degree of fatigue,anxiety and depression in females was significantly higher than that in males(P=0.032,P=0.018,P=0.021).CONCLUSION Children with allergic rhinitis in children had significant impact on the fatigue,anxiety and depression of their family caregivers.The symptoms of fatigue,anxiety and depression were related to age of children,characteristics of disease,whether they were combined with other allergic diseases,and gender and education level of the family caregivers.