Objective To compare the severity of sensorineural hearing impairment resulted from radiotherapy (RT) and radiochemotberapy (CRT) in patients with nasopharyngeal carcinoma (NPC). Methods Between March 2002 and May 2007, 100 initially diagnosed NPC patients in Shandong Tumor Hospital and Qi Lu Hospital were randomized to RT group and CRT group. All patients underwent intensity modulated radiation therapy. In CRT group, concurrent and adjuvant CDDP were administered (CDDP 25 mg/m2/d for 3 days to 4 cycles). Pure tone auditory threshold examination was performed 1 week ,6 months, 1 year and 2 years after the completion of radiotherapy. Statistical analyses were performed using Mann-Whit-ney U test,chi-square test and Fisber's exact probability test. Results The high-frequency threshold was significantly increased in CRT group comparing with RT group at 1- and 2-year after the treatment. In RT group, the hearing threshold was impaired immediately after the treatment, partially recovered within the first year but impaired again after 2 years. In CRT group, hearing threshold was impaired at the same time and kept getting worse until 1 year after radiotherapy, which could not be recovered. Conclusions Patients with NPC treated with radiotherapy and concurrent/adjuvant chemotherapy have more severe sensorineural hearing impairment comparing with those with radiotherapy alone, especially to the high frequency sound in the speech range. Inner ear tissue tolerance should be redefined for patients receiving radiochemotherapy.

OBJECTIVE: Study for surgical approaches on anterior skull base tumors. METHOD: All 37 cases with anterior skull base tumors were surgically treated. Twenty-one cases were treated with anterior craniofacial approaches: Frontal subcranial combined with total maxillectomy in 8 cases or/with orbital exenteration in 5 cases, combined with lateral rhinotomy in 1 cases, combined with naso translocation with medial maxillectomy in 7 cases. Partial or total maxillary swing combined with naso pyramid translocation in 13 cases. Frontonasal, fronto-orbital and midface degloving in one case respectively. RESULT: Of the 27 malignant cases the 3 and 5-year survival rates were 81.9% (22/27) and 62.9% (17/27) respectively, and one tumor free case living well more than 9 years. There were no recurrence in 10 cases with benign tumor. CONCLUSIONS Various craniofacial approaches except lateral rhinotomy provide directly satisfactory tumor exposure and facilitate enbloc resection of the naso paranasal sinus tumor with intracranial extension. Partial or total maxillary swing combined with naso pyramid translocation is good for tumor involving the skull base without intracranial invasion. The fronto-nasal pyramid translocation is good for removal of the upper part of nasal tumor with intracranial extension on well developed frontal sinus. The fronto orbital approach is proper for removal of fronto-sphenoid tumor and midface degloving may be used in selected cases.
Adolescent ; Adult ; Aged ; Craniotomy ; methods ; Female ; Frontal Bone ; surgery ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Skull Base ; surgery ; Skull Base Neoplasms ; surgery ; Young Adult

OBJECTIVE: To study the diagnostic value of high-resolution computed tomography (HRCT) and multiplanar reconstruction (MPR) in assessment of semicircular canals disease. METHOD: Eighty-three patients were scanned with HRCT and the original data were processed with MPR. The semicircular canals full length was respectively observed in one image of MPR in the normal ears. The abnormal location of the canal were observed. RESULT: In one image the full length of the horizontal, superior and posterior semicircular canal can be respectively displayed in one image of MPR in normal ears. By this way ,1 superior semicircular canal dehiscence (SSCD)was found in precaution group, 1 superior and 2 horizontal semicircular canal blocked, 1 vestibular aqueduct (VA) joined into superior semicircular canal and 2 VAs joined into posterior semicircular canal and abnormity of the three semicircular canals were found in SNHL. CONCLUSION MPR canould display the three canals full length in one picture and have a high specificity in the diagnosis of the semicircular canal abnormity.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Hearing Loss, Conductive ; diagnostic imaging ; Humans ; Image Processing, Computer-Assisted ; Infant ; Male ; Middle Aged ; Semicircular Canals ; abnormalities ; diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To investigate the expressions of nuclear factor-kappa B ligand (RANKL), receptor activator of nuclear factor-kappa B(RANK)and osteoprotegerin (OPG) and the relation of RANKL with bone- erosion in human cholesteatoma tissue. METHOD: Thirty cholesteatoma and twenty normal auditory canal skin specimens were investigated. The expressions of RANKL, RANK and OPG were examined by immunohistochemistry. RESULT: The overexpressions of the cytokine RANKL and RANK were found in infiltrated lymphocytes in the cholesteatoma tissue comparing with normal external meatal skin( t = 7. 758,6. 482, P <0. 05); While, the expression of OPG was significantly higher in cholesteatoma tissue comparing with normal external meatal skin. the OPG/ RANKL was decreased in cholesteatoma tissue comparing with normal external meatal skin( t = 8. 183, P < 0. 05). CONCLUSION This study revealed that the expressions level of RANKL and RANK were markedly increased in the perimatrix of cholesteatoma, which is closely related to the bone- erosion induced by cholesteatoma.
Adolescent ; Adult ; Case-Control Studies ; Cholesteatoma, Middle Ear ; metabolism ; pathology ; Ear Ossicles ; pathology ; Female ; Humans ; Male ; Middle Aged ; Osteoprotegerin ; metabolism ; RANK Ligand ; metabolism ; Receptor Activator of Nuclear Factor-kappa B ; metabolism ; Young Adult

OBJECTIVE: To observe the inner ear structure with volume rendering (VR) reconstruction and to evaluate the role of high-resolution computed tomography (HRCT) in congenital inner ear malformations. METHOD: HRCT scanning was performed in 10 patients (20 ears) without ear disease (control group) and 7 patients (11 ears) with inner ear malformations (IEM group) and the original data was processed with VR reconstruction. The inner ear osseous labyrinth structure in the images generated by these techniques was observed respectively in the normal ears and malformation ears. RESULT: The inner ear osseous labyrinth structure and the relationship was displayed clearly in VR imaging in the control group,meanwhile, characters and degree of malformed structure were also displayed clearly in the IEA group. Of seven patients (11 ears) with congenital inner ear malformations, the axial, MPR and VR images can display the site and degree in 9 ears. VR images were superior to the axial images in displaying the malformations in 2 ears with the small lateral semicircular canal malformations. The malformations included Mondini deformity (7 ears), vestibular and semicircular canal malformations (3 ears), vestibular aqueduct dilate (7 ears, of which 6 ears accompanied by other malformations) , the internal auditory canal malformation (2 ears, all accompanied by other malformations). CONCLUSION HRCT can display the normal structure of bone inner ear through high quality VR reconstructions. VR images can also display the site and degree of the malformations three-dimensionally and intuitively. HRCT is valuable in diagnosing the inner ear malformation.
Child ; Child, Preschool ; Ear, Inner ; abnormalities ; diagnostic imaging ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Tomography, X-Ray Computed ; methods

ObjectiveTo determine the risk factors associated with hypoglycemia in community patients with type 2 diabetes mellitus（T2DM）. MethodsA case-control study was performed among 914 patients with T2DM and no medical history of hypoglycemia were selected in the Diabetes Unit of Tongji University School of Medicine Affiliated Anting Community Health Center in 2018. A total of 196 patients with T2DM who had ≥1 hypoglycemia event in the past 12 months were presented as the case group， and 718 patients who did not have any hypoglycemia event during the same period were included as the control group. Medical history， medication， life style， and related factors were collected. Multivariate logistic regression analysis was used to determine the risk factors associated with hypoglycemia. ResultsHistory of coronary heart disease ［adjusted odds ratio（aOR）=2.077， 95% CI： 1.293-3.337］， renal disease （aOR=4.775， 95% CI： 1.537-14.830）， and previous insulin use （aOR =1.765， 95%CI： 1.147-2.716） significantly increased the risk of hypoglycemia， while angiotensin converting enzyme inhibitors（ACEI）（aOR =0.127， 95%CI： 0.044-0.366） and β-receptor blockers （aOR =0.271， 95%CI： 0.119-0.616） decreased the risk of hypoglycemia among diabetic patients. ConclusionIncidence of hypoglycemia in community patients with diabetes is high. History of coronary heart disease and kidney disease， and previous insulin use may increase the risk of hypoglycemia， which warrants further attention by community general practitioners.

Objective To analyze the epidemiological characteristics of syphilis in Jiading District of Shanghai from 2014 to 2018, and to provide a scientific basis for the development of future syphilis prevention and control work. Methods According to the date of onset, all syphilis cases in the infectious disease report information management system from 2014 to 2018, and their epidemic characteristics were analyzed using descriptive epidemiological methods. Results A total of 2 992 cases of syphilis were reported in Jiading District from 2014 to 2018, with an average annual incidence of 38.89/100 000. The overall incidence showed a downward trend year by year. Recessive syphilis was the main cause, and the incidence increased year by year. Fetal syphilis was relatively small and the incidence decreased year by year. The composition ratios of recessive syphilis, primary syphilis, secondary syphilis, and tertiary syphilis in different years were significantly different, and the differences were statistically significant (χ²=26.955, P<0.05). The peak time of syphilis was from March to June. The reported cases were mainly registered population, with a male to female ratio of 1.04:1. There were significant gender differences in the reported incidence of syphilis in each period in different years, and the gender difference between primary syphilis and secondary syphilis was statistically significant (χ²=17.793, P=0.001<0.05; χ²=12.701, P=0.013<0.05). There was no significant difference in gender between recessive syphilis, tertiary syphilis, and fetal syphilis (P>0.05). 20~39 years old had the highest incidence rate of syphilis. The areas with high incidence were mainly concentrated in the old urban area of Jiading Center and areas with high population density. The occupational distribution was mainly concentrated in young and middle-aged household workers and unemployed people, workers and elderly retirees. Conclusion In recent years, the syphilis epidemic in Jiading District of Shanghai has shown a downward trend. However, the situation of prevention and control was still severe. It is necessary to continue to improve the level of syphilis detection, and to detect and treat syphilis early. Meanwhile, it is important to strengthen publicity and education in key areas and key populations, and increase awareness of disease prevention to reduce the incidence of syphilis.

Objective To analyze the incidence and epidemic characteristics of Class A and B infectious diseases in Jiading District of Shanghai from 2014 to 2019，understand the prevention and control effects of infectious diseases in recent years，and provide a reference for the formulation of future prevention and control strategies and measures for infectious diseases． Methods According to the " China Disease Prevention and Control Information System"，statistical analysis was conducted on the data of Class A and B infectious diseases in Jiading District of Shanghai from 2014 to 2019． Results A total of 11 862 cases of Class A and B infectious diseases were reported in Jiading District of Shanghai from 2014 to 2019，with an average annual incidence rate of 127.34/100000． The overall reported incidence rate showed a downward trend (χ²=36.354，P =0.000<0.05) ．The top five infectious diseases with an average annual incidence were syphilis，gonorrhea，tuberculosis，scarlet fever，and hepatitis B．The incidence rate in the central area of Jiading District was high over the years，and the incidence rate in the north and south was low．The incidence of males was higher than that of females，and the difference was statistically significant (χ²=818.269，P=0.000<0.05) ．The high incidence age was 5- years old， followed by 20- years old. The top three occupations in terms of morbidity were workers, housework, unemployed，and retired．In terms of onset time，December and May-June were the two peak periods; February was the trough．Conclusion Class A and B infectious diseases in Jiading District of Shanghai showed a downward trend from 2014to 2019． Blood-borne and sexually transmitted infections and respiratory infectious diseases are still infectious diseases that need to be focused on prevention and control，mainly syphilis，gonorrhea and tuberculosis. Targeted prevention measures should be formulated in conjunction with peak onset times and key populations to further reduce the incidence of Class A and B infectious diseases．

OBJECTIVETo analyze the audiologic results of cochlear implantation in bilateral severe to profound sensorineural hearing loss following head trauma.

METHODSA retrospective study of our cochlear implantation cases in bilateral severe to profound sensorineural hearing loss following head trauma (with or without temporal bone fractures). Four patients in second hospital of Shandong university were analyzed in this study.

RESULTSAll the patients received unilateral cochlear implantation and gained open-set speech perception ranging from 92% to 100%. The aided hearing threshold ranged from 30 dBHL to 35 dBHL. None of them experienced a decrease in the hearing performance in the follow-up (1-2 years).

CONCLUSIONWith sufficient preoperative assessment, cochlear implantation is an effective management for hearing rehabilitation in bilateral severe to profound sensorineural hearing loss following head trauma.

China ; Cochlear Implantation ; Craniocerebral Trauma ; Hearing ; Hearing Loss, Bilateral ; Hearing Loss, Sensorineural ; surgery ; Hearing Tests ; Humans ; Retrospective Studies ; Speech Perception

Objective: To observe the position of the electrode in the cochlea following cochlear implantation by cone beam computed tomography (CBCT). Methods: Twenty-five children who received cochlear implantation and CBCT examinations in the Department of Otorhinolaryngology Head and Neck Surgery from the Second Hospital of Shandong University between January 2016 and December 2017 were selected. There were 15 males (17 ears) and 10 females (10 ears). The age ranged from 0.5 to 7.0 years old, with a median age of 1.6 years. 23 patients with unilateral implantation and two patients with bilateral implantation. The implants were all Med-El standard 12-electrode contact arrays. The CBCT was used to determine the position of the electrode in the cochlea, the distance between the electrode contacts and modiolus, and intracochlear insertion length of the electrode arrays. SPSS Statistics, version 22.0 was used for data processing and statistical analysis. Results: CBCT images could clearly demonstrate the structure of round window, oval window, modiolus, osseous cochlear duct, osseous spiral lamina, and electrodes. The electrode arrays of all the children were fully implanted into the cochlea. 26 of the electrode arrays were located in the scala tympani and one of them was inserted into the scala vestibular. The mean intracochlear insertion length of the electrode arrays was 30.23 (95%CI, 30.04-30.71) mm. The distance between the electrode contacts and modiolus gradually increased at the 1-4th electrode contacts and reached the maximum at the 4th electrode contacts with an average of 1.10 mm (95%CI, 1.02 to 1.18 mm), and then gradually decreased from the 5th electrode contacts. Conclusions CBCT can clearly show cochlear fine structures and therefore accurately assess the electrode position following cochlear implantation.