OBJECTIVETo present the clinical characteristics and combination therapy of rhino-orbito-cerebral mucormycosis.

METHODSThe clinical data of 9 patients with rhino-orbito-cerebral mucormycosis treated between January 2008 and January 2013 were analyzed retrospectively. The clinical features, diagnosis, pathological characteristics, surgical technique and combination therapy were summarized. All the patients were treated with nasal endoscopic surgery and combined drug therapy.

RESULTSNine patients were under the state of systemic immunosuppression. Two patients died of intracranial infection. One patient with the symptom of headache was first alleviated after treatment, with visual acuity recovered partially, but this patient died 4 months later due to recurrence of mucormycosis and intracranial infection. Two patients with headache recovered after treatment, the visual acuity recovered to the hand movement, endoscopic examination of surgical cavity was clean and epithelialized, with no recurrence, still alive 5 years up to now. The symptom of headache in another 4 patients disappeared after treatment, visual acuity improved significantly, endoscopic surgical cavity was clean, follow-up with no recurrence, survived more than 2 years, and were still in the treatment of primary disease.

CONCLUSIONRhino-orbito-cerebral mucormycosis is a serious chance infectious disease under the state of systemic immunosuppression, the development is rapid and the mortality rate is high, early diagnosis and combined treatment with nasal endoscopic surgery is necessary.

Adult ; Female ; Humans ; Male ; Middle Aged ; Mucormycosis ; Nose Diseases ; microbiology ; Orbital Diseases ; microbiology ; Retrospective Studies

OBJECTIVETo explore the law of wide band tympanometry energy reflectance (WBTER) in Chinese infants of Han nationality with normal outer and middle ears, and to provide the normal values for the clinical application of WBTER.

METHODSNinety four infants (170 ears) of Han nationality with normal outer and middle ears evidenced by temporal bone CT, and 226 Hz and 1 000 Hz tympanometry at the ages between three and 48 months (median age: 14 months) were selected and divided into four groups: 3-6 months (32 ears), 7-12 months (53 ears), 13-24 months (46 ears) and 25-48 months (39 ears). WBTER was conducted on these infants, and the basic law of energy reflectance under different frequencies, as well as the influence of age on energy reflectance were analyzed using SPSS 15.0.

RESULTSThe normal value of energy reflectance was higher at low frequency, gradually decreased with the increase of frequency, reached the minimum near 4 000 Hz , followed by constantly increased till 8 000 Hz. In the scope of frequency below 1 000 Hz and above 6 350 Hz, the energy reflectance values of infants in the group of 3-6 months were significantly lower than those of infants in other age groups (P < 0.05). In comparison to the group below six months, the groups over six months generally had higher energy reflectance and lower fluctuation.

CONCLUSIONSThe pattern of energy reflectance across frequency range for Chinese infants and children was consistent with that of other races reported in foreign countries. The WBTER changes with the growing of age, which tends to be stable after the first six months of birth.

Acoustic Impedance Tests ; statistics & numerical data ; Asian Continental Ancestry Group ; Audiometry, Pure-Tone ; Child, Preschool ; Ear, External ; physiology ; Ear, Middle ; physiology ; Female ; Humans ; Infant ; Reference Values

OBJECTIVETo develop a mouse model for acute otitis media (AOM) via transbullar injection method and evaluate its feasibility and practicability.

METHODSThe middle ears (ME) of C57BL/6 mice were inoculated via transbullar injection method with 5 µl streptococcus pneumoniae (S.pn) 19F suspension (1×10(7) CFU/ml), and the control group was inoculated equivalent phosphate buffered solution (PBS). Behavior changes were observed daily following inoculation. The ME tissues for histological examination and the middle ear lavage fluid (MELF) for total cells quantification, S.pn load determination and cytokines measurement were collected at 12 h, day 1, 2, 3, 5, 7 after inoculation, respectively.

RESULTSWithin 24 hours after instillation, the density of S.pn and the level of acute inflammatory cytokines in ME cavity increased rapidly, some mucosal hyperplasia was evident and leukocytic infiltration (primarily neutrophils) began. The level of ME inflammatory response reached maximal at 2-3 days after inoculation, with extensive effusion, leukocytic infiltration and mucosal thickening. Meanwhile, the density of S.pn decreased gradually. Bacterial clearance was completed by day 5 with extensive resolution of ME inflammation, although mucosal hyperplasia did not resolute until day 7.

CONCLUSIONA mouse model for AOM is successfully established via transbullar injection method, laying foundation for future study of AOM.

Acute Disease ; Animals ; Cytokines ; Disease Models, Animal ; Ear, Middle ; Injections ; Mice ; Mice, Inbred C57BL ; Otitis Media ; Otitis Media with Effusion

OBJECTIVETo investigate the effect of RNA interference (RNAi) targeting NRP-1 gene on the growth and proliferation of nasopharyngeal carcinoma (NPC) CNE-2Z cells.

METHODSShort hairpin RNA (shRNA) plasmids targeting NRP-1 were designed and synthesized. These plasmids were respectively transfected into human NPC CNE-2Z cells and xenograft tumors in nude mice. The expressions of Fluorescein-labeled plasmids in NPC CNE-2Z cells and xenograft tumors were observed by fluorescence microscopy. Cell proliferation was detected by MTT assay. The inhibitory effects on target genes were evaluated with RT-PCR and Western blotting, respectively. The inhibitory effect of plasmids with the most effective sequence on xenograft tumors in nude mice was observed.

RESULTSCNE-2Z cell proliferation was significantly inhibited by NRP-1/shRNA silencing. RT-PCR showed NRP-1 mRNA expression was significantly decreased. Western blotting demonstrated the NRP-1/shRNA silencing can effectively inhibit the expression of target proteins in CNE-2Z cells. After six weeks, there were significant differences in the mean tumor volumes in nude mice between plasmid group and negative control group [(0.599±0.002) vs (1.141±0.013) cm(3), P<0.05] or blank control group [(0.599±0.002) vs (1.165±0.308) cm(3), P<0.05], and the inhibitory rate of tumor growth was 48.6%.

CONCLUSIONRNA interference targeting NRP-1 can remarkably inhibit the growth of CNE-2Z cells in vitro and in vivo.

Animals ; Apoptosis ; Carcinoma ; Cell Cycle ; Cell Line, Tumor ; Cell Proliferation ; Gene Targeting ; Humans ; Mice ; Mice, Nude ; Nasopharyngeal Neoplasms ; metabolism ; pathology ; Neuropilin-1 ; metabolism ; Plasmids ; RNA Interference ; RNA, Small Interfering ; Transfection

OBJECTIVETo investigate the infiltration and prognostic significance of tumor-infiltrating mast cells (TIMs) in nasopharyngeal carcinoma (NPC).

METHODSImmunohistochemistry for tryptase was performed on 154 NPC specimens. The median value of TIM density was used as a cutoff point to separate the patient cohort into two groups with either low or high TIM infiltration. The associations between TIM and clinicopathological factors were analyzed by Mann-Whitney U text. Survival curves were plotted according to the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Log-rank test and the Cox proportional hazard models, respectively. P<0.05 was considered statistically significant. All statistical analyses were conducted using SPSS 13.0.

RESULTSTIM was mainly in the stroma of NPC and detected in all specimens. The median value of TIM density (25.60/high power field) was used as a cutoff point to separate the patient cohort into two groups with either low or high TIM infiltration. The density of TIM was positively correlated with N stage (Z=-2.193, P<0.05) and clinical stage (Z=-2.551, P<0.05). The 3-year overall survival (OS) and progression-free survival (PFS) of patients were 64.4% and 55.7% in the high TIM density group; 78.3% and 77.0% in the low TIM density group. For survival evaluation, high density of TIM was associated with worse OS and PFS (P<0.05). Multivariate Cox regression model analysis showed TIM infiltration was an independent risk factor for both OS and PFS.

CONCLUSIONSThe density of TIM in NPC increased with tumor stage. High TIM infiltration was associated with poor overall survival and progression-free survival.

Carcinoma ; Disease-Free Survival ; Humans ; Immunohistochemistry ; Mast Cells ; Multivariate Analysis ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; Prognosis ; Proportional Hazards Models

OBJECTIVETo explore the expression of YKL-40, TLR4 and NF-κB in chronic rhinosinusitis (CRS) with or without nasal polyps (CRSwNP and CRSsNP), and to investigate their expressional correlation and the potential role in pathogenesis of CRS.

METHODSThe specimens were obtained from sinus mucosa and inferior turbinate mucosa of the patients with informed consent. The different expression of YKL-40, TLR4 and NF-κB among each group was detected by real time RT-PCR and immunohistochemistry (S-P method). SPSS 17.0 software was used to analyze the data.

RESULTSmRNA level: The relative expression of YKL-40 in CRSwNP group (0.91±0.17) was higher than those in the control group (0.49±0.09), the difference was significant (t=2.12, P<0.05). The relative expression of TLR4 in CRSsNP group (0.88±0.19) and CRSwNP group (0.67±0.13) were lower than those in control group (1.48±0.14), the differences were significant (t value was -4.11, -2.48, all P<0.05). The relative expression of NF-κB in CRSsNP group (0.69±0.13) and CRSwNP group (0.72±0.14) were lower than those in control group (1.20±0.15), the differences were significant (t value was 2.33, 2.27, all P<0.05). Protein level: The expression of YKL-40 in CRSwNP group was stronger than that in CRSsNP group and control group (U value was 72.5 and 73, all P<0.01). The expression of TLR4 in CRSwNP group and CRSsNP group was weaker than that in control group (U value was 62 and 38, all P<0.01). There was a negative correlation between YKL-40 and TLR4 (rmRNA=-0.741, P<0.01; rprotein=-0.46, P<0.05) in CRSwNP group.

CONCLUSIONSThe expression of YKL-40 in pantients with CRSwNP is higher than those in healthy control and CRSsNP patients. There was a negative correlation between YKL-40 and TLR4. Both of them may be involved in the pathogenesis of CRSwNP.

Adipokines ; genetics ; metabolism ; Chitinase-3-Like Protein 1 ; Chronic Disease ; Humans ; Immunohistochemistry ; Lectins ; genetics ; metabolism ; NF-kappa B ; Nasal Mucosa ; Nasal Polyps ; RNA, Messenger ; Rhinitis ; metabolism ; Sinusitis ; metabolism ; Toll-Like Receptor 4 ; metabolism ; Turbinates

OBJECTIVETo investigate the factors associated with oral infections in patients with oral cancer undergoing radiotherapy.

METHODSClinical data of 241 patients with oral cancer undergoing radiotherapy between March 2012 and May 2014 in sichuan cancer hospital were reviewed. Univariate and multivariate analyses were performed to determine the factors related to oral infection occurring in the patients. SPSS 17.0 software was used to analyze the data.

RESULTSNinety-three (38.59%) of 241 cases had oral infection. Among the 93 cases, 49 (52.69%) cases presented with fungal infections, 44 (47.31%) cases with bacterial infection, and 38 (40.86%) cases with mixed infection. Oral infection occurred since the fifth week after radiotherapy in 55 (59.14%) patients. Multivariate Logistic regression analysis showed that the risk factors for oral infection after radiotherapy were the late stage of cancer, poor oral health habits, the coexistence of multiple treatments, city dwellers and surgical history (all P<0.05).

CONCLUSIONSOral infections commonly occur in the late period of radiotherapy. The late stage of cancer, poor oral health habits, the coexistence of multiple treatments, city dwellers and surgical history are key risk factors for oral infection in patients with oral cancer undergoing radiotherapy.

China ; epidemiology ; Humans ; Mouth Diseases ; epidemiology ; etiology ; Mouth Neoplasms ; complications ; radiotherapy ; Multivariate Analysis ; Risk Factors

OBJECTIVETo study the patterns of cervical lymph node metastasis of medullary thyroid carcinoma.

METHODSNinety-one patients with medullary thyroid carcinoma first treated between January 1999 and October 2014 were analyzed retrospectively. Of 91 patients, 39 cases presented with clinical negative node (cN0) and 52 cases with clinical positive node (cN+). Central compartment dissection was performed in all cases. Lateral neck dissection was performed in 52 cN+ cases (71 sides). All neck dissection specimens were obtained and analyzed for lymph node (LN) involvement with respect to neck levels. The distribution of LN with metastasis was studied in cN+ patients and the following factors were used to study the predictive value of central compartment LN metastasis: sex, age, family history, tumor size, bilateral tumor, multifocality of the tumor, extracapsular spread, and remote metastasis. Univariate analysis with the χ(2) test was used to analyze the statistical correlation between central compartment LN metastasis and other clinical factors. Multiple logistic regression analysis was used to identify the factors related to central compartment metastasis.

RESULTSNeck and bilateral neck metastasis rates were 73.6%, 19.8% respectively. Metastasis rates in central compartment and superior mediastinal region were 68.1% and 27.5% respectively. The central compartment metastasis rate was 33.3% in cN0 patients and 94.2% in cN+ patients. The superior mediastinal metastasis rate was 2.6% in cN0 patients and 46.2% in cN+ patients. Extracapsular spread was an independent predictive factor for central compartment metastasis (χ(2)=15.592, P=0.000, OR=12.876). The incidences of LN metastases at level II, III, IV, V were 62.9%,84.5%,83.1%,50.0% in cN+ patient, respectively. Multi-sites were involved. The possibility of lateral neck metastasis was higher when preoperative value of calcitonin was higher than 300 ng/L (66.7% vs 28.6%, χ(2)=5.771, P=0.016).

CONCLUSIONSCervical lymph node metastasis of medullary thyroid carcinoma is higher. Central compartment dissection is necessary in cN0 patients with extracapsular spread. Neck dissection from level II to level VII was necessary in cN+ patients. Preoperative value of calcitonin maybe can predict the lateral neck metastasis incidence.

Carcinoma ; Carcinoma, Neuroendocrine ; diagnosis ; pathology ; therapy ; Head and Neck Neoplasms ; diagnosis ; pathology ; therapy ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Mediastinal Neoplasms ; Neck ; Neck Dissection ; Retrospective Studies ; Thyroid Neoplasms ; diagnosis ; pathology ; therapy

OBJECTIVETo explore the feasibility and effect of CO2 laser surgery for early glottic carcinoma with anterior commissure involvement.

METHODSTwenty-seven patients with T1b glottic squamous cell carcinoma who underwent transoral CO2 laser surgery as the primary modality of treatment from January 2008 to August 2013 were reviewed. All patients were males and the age ranged from 46 to 81 years old. The patients did not receive any other treatments. Preoperative enhanced CT scan was performed to assess the status of the tumors and the lamina of thyroid cartilage. All the patients without the lamina of thyroid cartilage involved underwent transoral CO2 laser surgery.

RESULTSAmong 27 cases, aside from 1 patient converted to open operation due to inadequate exposure, 26 patients were successfully implemented operation. All the patients were followed-up for 12 to 60 months (median 26 months) and no recurrence. Granulation occurred four to six weeks after operation in all patients. Among them, granulation disappeared automatically three to six months in 22 patients and was resected with local anesthesia in other 4 patients, which the pathological results were inflammatory lesion. All patients did not undergo tracheotomy and nasogastric feeding, with an average stay of three days in hospital after surgery, and had different degree of vocal cord adhesion 6 months later.

CONCLUSIONSTransoral CO2 laser surgery is an ideal procedure for early glottic carcinoma with anterior commissure involvement. Better preoperative evaluation, endoscopic technique and satisfied exposure are keys to the success of operation.

Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; therapy ; Endoscopy ; Glottis ; Head and Neck Neoplasms ; therapy ; Humans ; Laryngeal Neoplasms ; therapy ; Laser Therapy ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Thyroid Cartilage ; Vocal Cords

OBJECTIVETo evaluate the predictive value of the position of the hyoid in surgical outcomes of velopharyngeal surgery for obstructive sleep apnea hypopnea syndrome (OSAHS).

METHODSThe polysomnography, CT, and anthropometry data were retrospectively reviewed from patients who underwent revised uvulopalatopharyngoplasty with uvula preservation (H-UPPP) simply or the combination of H-UPPP and transpalatal advance pharyngoplasty (TAP) for OSAHS from July 2008 to December 2011. OSAHS was diagnosed by polysomnography (PSG) in 128 patients who underwent H-UPPP or H-UPPP with TAP surgery for their sleep disorder. After surgical treatment, the patients were evaluated by PSG.

RESULTSThe 128 patients included were all male, the mean age of these patients was (39.6±8.5) years, ranged from 19 to 66 years. Seventy-seven patients were successfully treated and 51 did not respond to surgical treatment. The overall apnea hypopnea index (AHI) improved from (58.2±22.4) times/h preoperatively to (20.6±18.1) times/h postoperatively (t=14.9, P<0.001). The vertical distance from inferior margin of hyoid to the inferior mandibular margin (D-HM) was the only parameter that had a significant difference between responders [(14.6±7.7)mm] and non-responders [(19.4±8.0)mm] (t=3.452, P=0.001). D-HM, AHI and the lowest blood oxygen saturation were significant predictors of surgical outcomes (P<0.05). There was a significant correlation between the D-HM and the postoperative AHI (r=0.284, P=0.001). The D-HM of ≥23 mm could predict the postoperative AHI of >10 times/h a specificity of 95.2%.

CONCLUSIONThe D-HM is a negative predictor of surgical outcomes, patients with a D-HM of ≥23 mm are inappropriate candidates for velopharyngeal surgery.

Adult ; Anthropometry ; Humans ; Hyoid Bone ; Male ; Mandible ; Middle Aged ; Palate ; Pharynx ; Polysomnography ; Postoperative Period ; Retrospective Studies ; Sleep Apnea, Obstructive ; surgery ; Treatment Outcome ; Uvula