Objective To evaluate acoustic effects of laryngeal microsurgery on vocal polyp, vocal cyst and vocal leuko- plakia. Methods 300 cases in vocal fold diseases were measured acoustically pre - and post - microsurgery. Results After openation, jitter, shimmer and NNE decreased statistically in vocal polyp and vocal cyst patients, and did not improve in vocal leukoplakia patients. Whether or not the surgery was done, F0 of all patients did not change Conclusion Laryngeal microsurgery had definite effect on clearing benign focus. After surgery, vocal functioin improved in vocal polyp and cyst patients, and in vocal leukoplakia, there was no improvement in such a short time as one week.

The cerebral resuscitation is the most important aim in advanced cardiopulmonary cerebral resuscitation (CPCR). Cerebral function protection after cardiac arrest (CA) is important to improve survival rates including those after the discharge. Therapeutic mild hypothermia maybe the only method that can improve neurological function of patients following resuscitation after CA, which was recommended as one of treatment strategies for unconscious patients after successful resuscitation in 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Although there are many cooling methods of inducing hypothermia, each has some advantages or shortcomings. There were many controversies on the choice, which need further research. We make a summary and analysis about the mechanism of therapeutic mild hypothermia, the possible complications at different stages and the clinical application of mild hypothermia, such as the evaluation before therapeutic mild hypothermia and the choice of hypothermia protocol and cooling methods, to provide guidance for clinical mild hypothermia therapy.

Objective To evaluate the effectiveness and advantage of the TruviewTM EVO2(R) optical laryngoscope in comparison with the commonly used laryngoscope for the endotracheal intubation in patients in the emergency setting. Method Thirty-six patients in need for emergency endotracheal intubation in our hospital from February to May 2009 were randomly assigned to give intubation by using a TruviewTM EVO2(R) optical laryngoscope (T group) or a commonly used laryngoscope(R group). Cormack and Lehane laryngoscope grade (the degree of exposure of glottis by using laryngoscope), IDS (Intubation Difficulty Scale) score, the time taken for successful intubation, lowest SpO2 and the complication during intubation were essential factors for comparison between two groups. Results Our data showed that there was no difference in duration of the successful endotracheal intubation attempts between these two groups (respectively 22.73 ± 7.66 s and 19.91 ± 8.03 s, P ＞ 0. 05). However, the glottis exposure condition was significantly improved with TruviewTM EVO2(R) optical laryngoscope (P ＜ 0.01). The average IDS score for patients in T group was 0.33 ± 0.49, which is much lower than those in the R group (4.11± 0.90, P ＜ 0.01). In addition, the average SpO2 value measured in T group during the intubation operation was significantly higher than that in R group (98.87±0.74% and 91.45 ±4.86% respectively, P ＜0.01) and there was less complication observed in patients of T group. Conclusions Using TruviewTM EVO2(R) optical laryngoscope for emergency endotracheal intubation could help to expose the glottis in an ideal view, predominately lower the C/L grade and thus decrease the difficulty in intubation for clinicians. Its specially designed oxygen supplier allows the SpO2 to be maintained at a high level during the operation as well as reduce the incidence of complication. It is therefore extremely useful for emergency tracheal intubation, particularly a difficulty intubation situation.

Objective:To evaluate the efficacy of the resection of nasal inverted papilloma (NIP) under endoscope.Methods: A total of 100 patients with NIP from April 2008 to December 2013 in our hospital were randomly divided into endoscopic surgery group (endoscopic group) and conventional surgery group (conventional group), each with 50 cases. All patients were followed up for 2 years, whose recurrence, complications and satisfaction were observed. Results: The patients were followed up for 2 years, and the recurrence rate between the two groups was not statistically significant (x2=0.96,P>0.05). The traditional group had a higher incidence of complications than the endoscopic group, and the difference was statistically significant (x2=4.16,P<0.05). Endoscopic patients’ satisfaction was higher, and the difference was statistically significant (x2=5.02,P<0.05).Conclusion: The resection of (NIP) under endoscope can reduce the incidence of complication, improve patient satisfaction, and will not increase the recurrence rate, which is an effective means of treatment to the NIP.

To study the effect of unilateral vocal cord paralysis on vocal vibration, EGG parameters of 46 patients were analysed. EGG of most patients were abnormal, CQ decreasing while CI, CQP and CIP increasing. The incidence of normal EGG in patients whose vocal cord located in the middle was higher than that in the para - middle. Inversely, the incidence of abnormal EGG - CQ of the former was lower than that of the latter. EGG of the group in the intermediate was abnormal. The position of paralyzed vocal cord had no effect on CI,CQP and CIP. EGG reflects the characteristics of per vibratory cycle, and is a potential technique to study the irregular vocal vibration.

Objective To study the effects of Electroglottography(EGG) on screening vocal fold disorders.Methods 134 cases of glottal carcinoma and 167 benign vocal diseases and 62 healthy volunteers were measured. EGG waveform and variables were analyzed to investigate the sensitivity and specificity of EGG measurement.Results Compared with healthy people, the majority of EGG waveform and variables of vocal fold disorders were abnormal. The differences were significant statistically either between healthy people and vocal fold disorders or between benign vocal diseases and malignancy. In benign vocal diseases, the differences of EGG waveform and variables among vocal polyp and cyst and leukoplakia were insignificant statistically, and nor were the differences among various clinical T stages in glottal carcinoma.Conclusion EGG measurement is sensitive to screen vocal fold disorders, and is specific to distinguish benign and malignant diseases, but it couldn not be used to identify the types or clinical stage of the diseases.

Objective Two different transthoracic impedances were made with an adjustable impedance instrument to compare the success rate of defibrillation,heart and skin damage in a porcine model.Methods A total of sixteen pigs were randomly (random number) divided into two groups:low impedance group (about 50 Ω,n =8) and high impedance group (about 100 Ω,n =8).Defibrillation (recommended 150 J) was first attempted at 15 s after induction of ventricular fibrillation (VF).If spontaneous circulation was not recovered,2-minute chest compression and subsequent defibrillation attempts (maximum 200 J) were attempted.Model animal kept stabilization for 30 min after return of spontaneous circulation before induction of the next episode of VF,which was induced five episodes in each pig.Results In the low impedance group,VF was induced 39 times,39 of 43 attempted defibrillations were successful.In the high impedance group,VF was induced 40 times,40 of 70 attempted defibrillations were successful.The current and success rate of the first defibrillation were (34.9 ±3.2) A and 94.9％ respectively in the low impedance group,while those of the high impedance group were (19.1 ±2.1) A and 50％ respectively (both P ＜ 0.05).There were no significant differences in skin damage between two groups,but myocardial injury was lighter in the high impedance group.Conclusions Success rate of the first defibrillation with recommend 150 J obviously decreases with the increase of transthoracic impedance.The main factor of myocardial injury is current instead of the numbers of defibrillation.

Objective To determine the incidence and effect of unrecognized cardiac injury in critically ill patients and evaluate the significance of elevations of serum troponin Ⅰ and APACHE Ⅱscore in patients with critically illness.Methods We measured the level of serum troponin Ⅰ and evaluated relationship between elevations of serum troponin Ⅰ and APACHE Ⅱ score,myocardial injury,mechanical ventilation,intensive care unit stay by means of retrospective chart review and analysis of clinical data.Results Thirty-four(21.4%)of the 159 patients had evidence of myocardial injury based on elevated levels of cardiac troponin Ⅰ,only 9(26.5%)of these 34 patients were diagnosed as having acute myocardial infaction by the intensive care unit staff.Mortality in patients with myocardial injury that was unrecogniazed(41.2%)or recognized(44.4%)was higher than in those without myocardial injury(16.0%)(P

Objective To investigate the characterristics of distally based sural flap for the leg reconstruction.Methods Twenty-one patients with soft tissue defects in the instep,heel,ankle and distall one third anterior tibial region were analyzed.Results All flaps survived and healed with the affected area.Conclusion Distally based sural flap was reliable flap without sacrifice of major arteries.It can be used reliably for instep,heel,ankle and distal one third anterior tibial region.

ObjectiveTo examine whether Shenfu injection (SFI) reduces post-resuscitation myocardial dysfunction in a pig model by modulating expression imbalance of transcription factors of regulatory T cell, namely GATA-3 and T-bet.Methods Thirty pigs were randomly divided into sham group (n = 6) and cardiopulmonary resuscitation (CPR) group (n = 24) according to the random number table method, and the pigs in the CPR group were randomly subdivided into normal saline (NS) group, epinephrine (EP) group, and SFI group (n = 8 per group). After 8minutes of untreated ventricular fibrillation (VF) followed by 2 minutes of CPR, animals in three groups respectively received central venous injection of either 20 mL SFI (1.0 mL/kg, SFI group), EP (0.02 mg/kg, EP group) or NS (NS group). Blood samples were obtained before VF and 0.5, 2, 6 hours after restoration of spontaneous circulation (ROSC), and the parameters of hemodynamics and oxygen metabolism were determined. Surviving pigs were sacrificed at 24 hours after ROSC, the pathological changes in myocardium were observed, the levels of interleukin-4 (IL-4), tumor necrosis factor-α (TNF-α) andγ-interferon (IFN-γ) were measured by enzyme linked immunosorbent assay (ELISA), and expressions of protein and mRNA of GATA-3 and T-bet were determined by Western Blot and quantitative real-time polymerase chain reaction (RT-qPCR), respectively.Results Six pigs of three resuscitation groups were successfully resuscitated. The CPR time, number of defibrillation, defibrillation energy, and ROSC time were significantly decreased in the EP and SFI groups compared with those in the NS group. Compared with the sham group, the parameters of left ventricular systolic function and oxygen metabolism were significantly decreased, myofibril organelles were extensively damaged, and progressive and severe deterioration of the myocardium was found, and mitochondrial structure was not recognizable in the NS group; the level of IL-4 in myocardium were markedly decreased, while that of TNF-α, IFN-γand IFN-γ/ IL-4 [reflecting helper T cell 1/2 (Th1/Th2)] were significantly increased. Protein and mRNA expressions of GATA-3 were markedly reduced in the myocardium of pigs in the NS group compared with that of the sham group at 24 hours after ROSC, while T-bet was significantly increased. Compared with the NS group, animals treated with SFI had minimal myocardial intracellular damage, with decreased heart rate (HR, bpm: 90.33±3.79 vs. 106.83±5.36) and increased mean arterial pressure (MAP), cardiac output (CO), oxygen delivery (DO2), and oxygen consumption (VO2) at 6 hours after ROSC [MAP (mmHg, 1 mmHg = 0.133 kPa): 107.67±1.96 vs. 86.83±1.85, CO (L/min): 2.47±0.08 vs. 2.09±0.04, DO2 (mL/min): 364.31±4.21 vs. 272.33±3.29, VO2 (mL/min): 95.00±2.22 vs. 82.50±2.28, allP<0.05]. Compared with the NS groups at 24 hours after ROSC, level of IL-4 was markedly increased in myocardial cells (ng/L: 33.80±3.06 vs. 16.15±1.34,P< 0.05), while the levels of TNF-α, IFN-γ and IFN-γ/IL-4 were lowered significantly [TNF-α (ng/L): 18.16±0.71 vs. 29.64±1.89, IFN-γ (ng/L): 373.75±18.36 vs. 512.86±27.86, IFN-γ/IL-4: 16.15±1.34 vs. 33.80±3.06, allP< 0.05], and myocardial T-bet protein and mRNA expressions were reduced [T-bet protein (gray value): 0.41±0.07 vs. 0.59±0.11, T-bet mRNA (2-ΔΔCt): 4.37±0.21 vs. 7.57±0.55, bothP< 0.05], furthermore, myocardial GATA-3 protein and mRNA expressions were significantly up-regulated in SFI group [GATA-3 protein (gray value): 0.25±0.07 vs. 0.16±0.07, GATA-3 mRNA (2-ΔΔCt): 0.63±0.07 vs. 0.34±0.05, bothP< 0.05]. The parameters in SFI group were significantly improved compared with those of the EP group.ConclusionsMyocardial immune dysfunction is induced by Th1/Th2 imbalance following myocardial injury subsequent to CPR in pigs. SFI can attenuate myocardial injury and regulate myocardial immune disorders, protect post-resuscitation myocardial injury by modulating expression imbalance of transcription factors GATA-3 and T-bet.