Objective:To evaluate the clinical effect of laryngofissure without tracheotomy.Method:One hundred and sixteen cases of laryngofissure without tracheotomy in our department were analyzed retrospectively.Result:Of 116 cases, 101 cases had the laryngeal carcinoma; 9 cases had laryngeal stenosis; 6 cases had benign tumor of larynx. All the incisions were healed by first intention; and postoperative duration of hospital stay were 7 to 20 days. Three cases recurred in 101 cases of laryngeal carcinoma (2.97%), and underwent reoperation,the 5 year survival rate was 100%. One case recurred in 9 cases of laryngeal stenosis, and underwent reoperarion of laryngoplasty with T-tube implanted. No recurrence in 6 cases of benign tumor of larynx.Conclusion:Laryngofissure without tracheotomy have the advantage of less trauma , fast rehabilitation and no destroying the normal respiratory functions. It is completely feasible so long as surgeons grasp the adaption of operation strictly and select suitable cases.

ObjectiveTo compare the clinical and the pathological diagnosis of elderly with dementia, assess the related factors affecting the diagnosis.MethodsThe 42 autopsied elderly patients with dementia were assessed with the National Institute for Neurological Disorders and Stroke (NINDS) criteria and the ischemic scales of Hachinski, Rosen, Loeb and Gandolfo for the clinical diagnosis of dementia. Specificity was calculated using the neuropathologic diagnosis as a gold standard.ResultsThe patients were differentiated with pathology verified Alzheimer's disease (AD), vascular dementia (VaD), and “mixed” (AD plus VaD) dementia, Parkinson's disease dementia (PDD). Comparing clinical criteria and neuropathology, the consistent rate was 80.0% for AD, 52.4% for VaD, 18.2% for AD+VaD and 0.0% for PDD. The consistent rate between 3 scores and the pathological diagnosis was about 40%～70%. There were no significant differences between the average age of onset and the survival time, and the ischemic scales of Hachinski, Rosen, Loeb and Gandolfo among the 4 types of dementia. There was no significant difference in the specificity of the NINDS criteria among the 4 types of dementia.ConclusionDementia associated with cerebrovascular disease and Parkinson's disease is the main factor affecting the diagnosis of elderly with dementia. There is no significant difference for the diagnosis of dementia among the ischemic scales of Hachinski, Rosen, Loeb and Gandolfo.

OBJECTIVE: To investigate diagnosis method and treatment experience of jugulare glomus tumor (JGT) and carotid body tumor (CBT). METHOD: Retrospective analysis. Clinical materials from 4 patients at one genealogy with JGT and CBT were collected. The clinical features, radiological characteristics, surgical methods and prognosis were assessed. The proband suffered from left JGT and left CBT, her younger sister had right CBT as well as her younger female cousin had bilateral CBT and right JGT, her older male cousin had bilateral CBT and left JGT. These JGT and CBT in four patients were resected under general anesthesia after preoperative ultrasound, CT or CT angiography (CTA), MRI, and digital subtraction angiography (DSA) examination as well as preoperative vascular embolization. RESULT: The surgery was uneventful in four cases, and there was no hemiplegia or deaths. All patients were followed up for 2 years to 29 months without recurrence. Six months after operation, the hoarseness also disappeared in the older male cousins but did not improve significantly in younger female cousin. The younger female cousin get right peripheral facial paralysis 1 year after surgery and her temporal bone CT indicated a right JGT. CONCLUSION It is very important to assess JGT and CBT by Ultrasound, CT, CTA, MRI and DSA. Surgical resection is the first optional treatment for JGT and CBT. Blood loss can be reduced by preop erative vascular embolization. Serious complications could be avoid by operating under microscope, which can supply a clear surgical field and make the surgeon to protect the large blood vessels and nerve.
Adult ; Carotid Body Tumor ; diagnosis ; surgery ; Female ; Follow-Up Studies ; Glomus Jugulare Tumor ; diagnosis ; surgery ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

Objective To analyze epidemiological characteristics of mitochondrial DNA12SrRNA A1555G mutation in Chinese populations with non-syndromic sensorineural hearing loss by the literature review and find the main actual deficiencies in course of epidemiological study.Methods From Cbmdisc and PUBMED database pulled out were all published epidemiological literatures about Chinese mtDNA12SrRNA A1555G mutation from 1996 to 2008.Reviewed were the primary data of these studies including the number of samples,demographic characteristics of the samples,mutation frequencies,interrelations between the mutation and aminoglycoside exposure and so on.Results 21 papers out of 25 were induded in this study.The patients had non-syndromic sensorineural hearing loss from 14 regions of China.A total of 3 473 were found including 230 patients with A1555G mutation and the average mutation frequency was 6.62%.The samples in each regions ranged from 72 to 802 and the reported mutation frequencies were from 0.67%-14.6%.The statistical discrepancy was significant among mutation frequencies in different regions by χ~2 test(P=0.0000).The number of patients with aminoglycoside antibiotics exposure was 739 including 100 with A1555G mutation in all literatures.The proportions in different regions were from 2.70% to 33.33% with the average of 13.53%.The average proportion was significantly higher than the mutation frequency in patients with non-syndromic sensorineural hearing loss.Conclusion Some deficiencies in epidemiological research Omutation in China included age,ethnic,and geographic bias,insufficiency of samples,inadequate randomization and so on.Researchers should focus with more efforts on the epidemiological characteristics of A1555G mutation in Chinese people.

Objective To summarize and analyze the pathogenesis ,methods of hearing reconstruction and curative effect of mixed hearing loss .Methods Patients with mixed hearing loss who underwent hearing reconstruc-tion from Jan 2009 to Dec 2011 in the ENT department of PLA General hospital were reviewed retrospectively .Af-ter the operation ,air conduction (AC) ,bone conduction (BC) ,air-bone gap (ABG) at main frequencies and audi-ometry changes were analyzed .Results Among 32 cases ,15 cases were chronic otitis media ,13 cases otosclerosis , 2 cases Van der Hoeve ,and 2 cases congenital middle ear malformations .There were 26 cases with significantly im-proved hearing after surgery ,and the effective rate was 81 .25% .AC showed great improvement at 0 .25~4 kHz (P<0 .05) while there was no change at 8 kHz (P>0 .05) .BC showed improvements at 1 and 2 kHz and improved significantly only at 2 kHz .After operation ,pure tone audiometry at AC and BC separately improved 24 .94 ± 8 .15 dB and 5 .90 ± 7 .96 dB;ABG narrowed down to 19 .04 ± 11 .06 dB .Conclusion Mixed hearing losses are mostly seen in chronic otitis media and tympanosclerosis .After auditory rehabilitation ,patients can experience improved hearing .

OBJECTIVE To investigate the contribution of the GJB6 gene [encoding connexin 30 (C?30)] mutations in Chinese population with sporadic non-syndromic hearing impairment. METHODS PCR reactions were performed with two pair of primers for the coding sequence of GJB6 gene and for the deletion of GJB6. PCR products bidirectional sequencing was subsequently applied in 214 patients with hearing loss and 86 normal controls. RESULTS A novel heterozygous mutation-233(C→A) was found, which results in amino acid change, A78D. This mutation wasn't detected in the control subjects. The altered valine residue lies within the second conserved transmembrane domain. The large deletion△(GJB6/ D13S1830)] of GJB6 was not found in this group. CONCLUSION The large deletion of GJB6 was not found in the Chinese deafness population. A novel heterozygous mutation of GJB6 was found. These results indicated GJB6 mutations are not a major cause of hearing loss in the Chinese population.

Objective Rheumatoid arthritis (RA) is a systemic autoimmune disease, which mainly involves joints across the body, resulting in joint stiffness and loss of daily activity. Recent evidence suggests that numerous self-reacting T cells, including Th1 and Th17, infiltrate the synovium in RA patients, accompanied by functionally-compromised Treg. Iguratimod, a new small molecule with anti-inflammatory and immunomodulatory effects, has shown curative effects in animal models of arthritis. In this study, we aimed to test the clinical effects of Iguratimodˊs on RA patients and its role in immunoregulation. Methods We examined the clinical effects of iguratimod on RA patients in a random controlled clinical trials and analyzed its effects on Th1, Th17 and Treg as well as their associated cytokines and transcription factors by flow cytometry and real-time polymerase chain reaction (PCR). Then t-test, chi-square test and rank sum test were used to conduct statistical analysis. Results Our results revealed that iguratimod therapy provided significantly greater clinical benefit [ACR20, ACR50, ACR70 reached 50%, 20%, 15% respectively in iguratimod treatment group, Z=-2.216,P=0.027] than placebo group with the reduction of Th1 and Th17 but increment of Treg after iguratimod treatment [Th1: week 0 (26.5 ±8.0)%, week 24 (14.2 ±7.3)%, P<0.01; Th17:week 0 (1.7±0.7)%, week 24 (1.3±0.4)%, P<0.05;Treg:week 0 (6.8±1.6)%, week 24 (8.9±2.9)%, P<0.05], which was statistically significant. Conclusion Our results provide theoretical and clinical based evidence for the impact of iguratimod on immunomodulation of RA.

OBJECTIVE: To explore CT findings and pathologic basis of crazy paving pattern caused by pulmonary alveolar proteinosis. METHODS: Twenty-four patients who were diagnosed pathologically as pulmonary alveolar proteinosis by transbronchial lung biopsy and bronchoalveolar lavage fluid from June 2006 to May 2012 were included in this retrospective study. All patients underwent a 64-slice CT of the lungs. RESULTS: CT findings: crazy paving pattern was observed on CT imaging of all 24 patients. In 23 patients, crazy paving pattern displayed strip-shaped opacities with smooth edges, and there was a clear boundary between the pathological and normal lung tissues. The reticular opacities were connected with peripheral blood vessels and the branches were formed, and their diameters decreased slightly. Microscopically, hemangiectasis were seen in 17 patients. CONCLUSION Crazy paving pattern caused by pulmonary alveolar proteinosis displayed clear edges, and smooth reticular opacities, most of which were due to hemangiectasis of interlobular, interacinar and interalveolar septa. These findings of CT are helpful for the specific diagnosis of pulmonary alveolar proteinosis.
Biopsy ; Humans ; Lung ; pathology ; Pulmonary Alveolar Proteinosis ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed

Objective:To summarize the experience of respiratory management in 20 cases of fetuses diagnosed with prenatal malformations undergoing ex utero intrapartum treatment (EXIT) surgery.Methods:From 2016 to 2018, 20 cases of fetuses undergoing EXIT surgery were admitted to our hospital, including five cases of maxillofacial lymphangioma, four cases of cervical teratoma, three cases of lung cystadenoma, five cases of pleural effusion, and three cases of isolated lung.The fetal anesthesia was through maternal anesthesia.After the fetal head was delivered, the placental circulation was maintained.All cases were established with artificial laryngoscopy by visual laryngoscopy and tracheal intubation.The blood oxygen saturation and heart rate of the fetuses were recorded before and after intubation.After successful intubation, the umbilical cord was broken and the fetal arterial blood gas was drawn.Immediately, the neonatal surgery was performed in the delivery room, with 3 to 5 cmH 2O(1 cmH 2O=0.098 kPa) PEEP for respiratory support, and blood gas analysis during the operation were collected.After surgery, newborns were transferred to NICU. Results:(1) The 20 cases of fetal anesthesia under placenta maintenance, maternal 1.5 MAC sevoflurane inhalation anesthesia with remifentanil pumping, fetal oxygen saturation can be maintained at (51.5±4.7)%, fetal heart rate (155.3± 11.34) times/min; (2) The completion time of tracheal intubation of 20 fetuses was (24.20±3.43)s, the time of glottal exposure was (3.20 ±1.12)s, and the success rate of one intubation was 90% (18/20), of which two cases were exposed to glottis difficult, successful after two tracheal intubation; (3) The use of 3 to 5 cmH 2O PEEP to support the high-frequency positive pressure ventilation mode can provide good oxygenation[SpO 2 (92.10±3.34)%] during the neonatal surgery, the length of hospital stay of the fetus was (15.0±3.2) d, and ventilator duration time was (3.0±1.2) d. Postoperative complications included four cases of pneumonia and two cases of atelectasis. Conclusion:(1) Avoiding excessive deep anesthesia of mother, maintain the placental circulation effectively, providing good oxygenation before artificial airway establishment and providing effective anesthesia for the fetus are important in EXIT; (2) The visual laryngoscope shortens the intubation time, and the glottis is well exposed, which can increase the oxygenation index of the newborn after the umbilical cord is broken; (3) The high-frequency ventilation mode supported by PEEP can provide good oxygenation for newborns during surgery.

OBJECTIVE: To analyze the prevalence of an A-to-G mutation at nucleotide 1555 of the mitochondrial genome in patients with nonsyndromic hearing impairment (NSHI) of northwest region of China. METHOD: A standardized program of epidemiological design, administrative support, sample collection and mutation screening for mtDNA 12SrRNA A1555G were used performed to study the general condition and the molecular etiology of patients with severe to profound hearing loss from 5 provinces of northwest region of China. RESULT: Five-hundred-seventy-three cases with severe profound hearing loss from 5 provinces were collected and 31 cases were found to carry mtDNA 12SrRNA A1555G mutation. CONCLUSION Among the patients with severe to profound hearing loss from 5 provinces of northwest region, there was a high proportion of hereditary hearing impairment caused by mtDNA 12SrRNA A1555G mutation. Screening and testing for this mutation are effective methods to prevent ototoxicity in A1555G carriers and their maternal family members.
Adolescent ; Adult ; Child ; Child, Preschool ; China ; epidemiology ; DNA Mutational Analysis ; DNA, Mitochondrial ; genetics ; Female ; Hearing Loss ; epidemiology ; genetics ; Humans ; Male ; RNA, Ribosomal ; genetics ; Young Adult