Objective To summarize the surgical experiences of treating the frontal sinus cerebrospinal fluid rhinorrhea (FS-CSFR) via combined transfrontal and intranasal endoscopic approaches. Methods We retrospectively analyzed the clinical data of 17 patients with FS-CSFR,received surgery in our hospital from 1996 to 2009, with emphasis on postoperative complications,clinical outcomes and key technology involved in surgery via combined transfrontal and intranasal endoscopic approaches. Results Of the 17 patients, 9 were successfully repaired after 1 surgery via combined transfrontal and intranasal endoscopic approaches; the other 8 were initially treated by endoscopic intranasal approach alone, of which 5 (62.5%) were successful and 3 failed. And then, the 3 patients subsequently underwent the surgery via combined transfrontal and intranasal endoscopic approaches and succeeded. These 12 patients with FS-CSFR, performed surgeries via combined transfrontal and intranasal endoscopic approaches were successfully repaired with quick recovery, mild complications, and no significant facial scars. Follow up was performed for 6 to 10 y and no CSFR recurrence was noted. Conclusion Surgery via combined transfrontal and intranasal endoscopic approaches offers advantages not only in overcoming the difficulty and defects of intranasal endoscopy but also in providing a few traumas and an easy approach, which helps the recovery.

Objective To investigate the therapeutic efficacy of endoscopic optic nerve decompression (EOND) on patients with traumatic optic neuropathy (TON) and their related prognostic factors. Methods The clinical data of 103 eyes with TON,admitted to our hospital from January 1995 to February 2001 (n=53) and from March 2001 to December 2009 (n=50),were retrospectively analyzed; the clinical outcomes of these patients after being performed EOND were observed. Univariate analysis (Chi-square test) and logistic regression were performed to analyze the prognostic factors of TON underwent EOND therapy. Results The total effective rate of 103 eyes was 37.86％ (39/103); the effective rate of eyes with residual vision was 83.3％ (20/24),which was significantly higher than that of those without residual vision (24.05％,19/79,P＜0.05).Univariate analysis and multiple factor logistic regression,respectively,showed that 3 variables significantly increased the risk of the visual acuity:no residual vision, interval from injury to surgery for more than 3 d and ethmoid and/or sphenoid sinus hematocele after injury.Other factors such as age,disturbance of consciousness,optic canal fracture,performing of sheathotomy,hormone level and interval from injury to surgery for more than 7 d were not correlated with the efficacy (P＞0.05).Comparing fractures at different sites and with different severities,the efficacy of surgery was also different. The logistic regression equation is P (1)=1/ [1+e-(-2139+2.839X3+1.372X5+2.263X9)]. Conclusion The total therapeutic efficacy of EOND on patients with TON is not satisfactory, especially for those without light perception. The prognostic factors of TON were very complex and interactive; no light perception, interval from injury to surgery for more than 3 d,hemorrhage within the ethmoid and/or sphenoid sinus and lateral or multiple fracture of optic canal are factors affecting the prognosis of EOND for patients with TON. The indication for EOND must be individualized.

Objective To investigate the feasibility and reliability of the measurement of critical anatomic landmarks of endoscopic endonasal anatomy of pterygopalatine fossa and infratemporal fossa using multislice spiral computed tomography (MSCT), and to illustrate the spatial relationship of the surgical landmarks in pterygopalatine fossa and infratemporal fossa through an endoscopic endonasal view and radiological images. Methods Included in this study were eleven fixed cadaver heads (22 pterygopalatine fossa and infratemporal fossa), which were prepared from MSCT scans for establishing a spatial coordinates system to calculate the radiological anatomic data and attaining 3D reconstruction image, and also were anatomically dissected to get anatomic data. The anatomic data in two groups were compared, the endoscopic and radiological images of the same regions acquired during the endoscopic endonasal approaches observed.Results The distance ((-x) ± s) from nasal columella to sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, carotid canal, foramen lacerum in radiological group were:(68.83±3.00), (72.49±2.88), (75.26 ±3.14), (88.55±5.00), (95.19±4.31), (106.76±3.77), (88.16 ±2.87) mm and in anatomic group were: (68.90 ±3.04), (72.73 ±3.08), (75.44 ±3.07), (89.75 ±4.13), (96.22±3.37), (106.68 ±3.75), (88.47 ±2.64) mm. There was no statistical difference between two groups(t value were -0.856, -1.134, -0.920, - 1.923, - 1.903,2.820 and 1.209, respectively, all P > 0.05 ). Sphenopalatine foramen, pterygoid canal, foramen rotundum, foramen ovale, foramen spinosum, foramen lacerum, carotid canal were the corresponding anatomic structures in endoscope and radiology, which provided the surgeons with anatomic landmarks to identify the spatial relationship of the surgical structures in pterygopalatine fossa and infratemporal fossa.Conclusions MSCT measurements of anatomic landmarks are feasible and reliable, can be used in clinical individualized surgery. The corresponding anatomic structures of endoscopic and radiological landmarks provide useful reference to surgeons when operating in these areas through an endoscopic endonasal approach.

Objective To summarize the clinical experience of treatment of frontal sinus diseases via combined transfrontal and intmnasal endoscopic approaches, and to explore its indications. Methods A retrospective study of 24 patients was conducted. All patients were underwent combined transfrontal and intranasal double approaches because of different kinds of frontal sinus diseases, including 16 cases with frontal sinus cerebrospinal fluid rhinorrhea caused by traumatic comminuted fractures located in posterior wall of frontal sinus, 5 cases with osteoma, 3 cases with inverted papilloma (cancer was confirmed in one case). Results All sixteen cases with frontal sinus cerebrospinal fluid rhinorrhea were cured after the first attempt. All cases with osteoma and inverted papilloma (including the patient with canceration) were resected completely after the first attempt. Postoperative follow-up lasted from 3 to 132 months in frontal sinus cerebrospinal fluid rhinorrhea, 8 -38 months in osteoma, 7 -42 months in inverted papilloma and canceration, the median follow-up period was 36 months. No recurrence was found. Operations were successful in all the patients and frontal sinus outflow tracts were unobstructed. No intraoperative or post-operative complications occurred and no disfigurement was found. Condnsions The potential indications frontal sinus with their lateral boundaries or operative site beyond the plane of the lamina papyracea.

This study was aimed at analyzing the clinical and laboratory characteristics of patients with Listeria monocyto-genes bacteremia,to provide evidence for its diagnosis and treatment.A retrospective analysis was conducted on the clinical data for patients with L.monocytogenes bacteremia at Tangdu Hospital between September 2012 and April 2022.The data included age,sex,underlying diseases,treatments,and prognosis.Changes in indicators such as white blood cell(WBC)count,mono-cyte percentage,neutrophil percentage,monocyte/neutrophil ratio(M/N),C-reactive protein(CRP),and procalcitonin before and after treatment were statistically analyzed.Among the 32 patients with L.monocytogenes bacteremia,the average age was 31.9 years,and three patients were older than 65 years.The incidence rate was highest in summer(11 patients,34.4％),fol-lowed by spring(9 patients,28.1％).A total of 24 patients(75.0％)had underlying diseases.After accurate diagnosis,the treatment plans of 29 patients were adjusted to target antibacterial therapy consisting primarily of penicillins(17 patients,53.1％)and carbapenems(12 patients,37.5％).After treatment,the levels of neutrophils,lymphocytes,and CRP were signifi-cantly lower than those before treatment(P＜0.05).A total of 29 patients(90.6％)improved and were discharged,one patient died,and two patients had poor prognosis.The primary risk factors for L.monocytogenes infection were autoimmune diseases,tumors,and pregnancy.Penicillin was the first choice effective empirical treatment for listeriosis.A clear diagnosis of the pathogen and appropriate choice of antibiotics were particularly important for the treatment of L.monocytogenes infection.

OBJECTIVETo investigate the clinical type, diagnosis and prognosis of endoscopic surgery of choanal polyp (CP).

METHODSThirty four cases of CP treated between January 1998 to December 2005 were retrospectively reviewed. Pathogenesis, original sites, clinical manifestation, its relationship with paranasal sinuses, methods and effects of endoscopic surgery on CP were analysed.

RESULTS(1) In this study, 18 cases originated from the cyst or polyp in sinus (among them, 17 from maxillary sinus, 1 from posterior ethmoid sinus). (2) Five cases from nasal fontanelles or sphenoethmoidal recess, mucosa of sphenoidal ostium, accompanied with homolateral empyema or mucosal edema of maxillary sinus or sphenoid sinus. (3) Eleven cases from middle turbinate, uncinate process, olfactory cleft, nasal septum and anterior wall mucosa of ethmoidal sinus with normal adjacent sinus. (4) All cases were treated by complete excision of the CP and open sinus procedures of the affected ones with intranasal endoscopic approach. No recurrence was observed during the follow-up.

CONCLUSIONS(1) We propose to divide the CP into three clinical types: intrasinus, sinus obstruction and simple ones. We also suggest to abide by the operation principal based on clinical types and to select rational methods and extent of operation. (2) Definite diagnosis and clinical type can be obtained by endoscopic examination and CT scan of sinus before operation. (3) Endoscopic surgery is precise and mini-invasive in treatment of CP and complete removal of CP root can effectively reduces the recurrence.

Adolescent ; Adult ; Aged ; Child ; Endoscopy ; Female ; Humans ; Male ; Maxillary Sinus ; Middle Aged ; Nasal Polyps ; diagnosis ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods ; Retrospective Studies ; Young Adult

Adult ; Female ; Humans ; Male ; Middle Aged ; Parotid Neoplasms ; diagnosis ; pathology ; surgery ; Retrospective Studies

Objective To explore the quality of life (QOL) outcome in patients with allergic rhinitis (AR). Methods A prospective trial was conducted to survey the QOL status of 101 AR patients, in contrast to that of 121 healthy individuals and 97 chronic pharyngitis (CP) patients by generic questionnaire medical outcomes study short-form 36-items health survey (SF-36), and to survey the most troublesome problems of AR patients by disease-specific questionnaire rhinoconjunctivitis quality of life questionnaire (RQLQ). The correlation between SF-36 and RQLQ had also been analyzed. All the results were analyzed statistically. Results By the assessment of SF-36, the scores of 3 domains ( x ± s, the same as follow, the scores were 78. 02 ± 18. 37, 56. 13 ± 17. 49, 78. 81 ± 16. 47, respectively) of AR patients were less than those (84.00 ± 18.36, 74.69±14.13, 83.78±14.31) of healthy individuals (P<0.05), and the scores of 7 domains (the scores were: 91.78 ± 11.78,79.16 ± 30. 23, 78.02 ± 18.37, 56.13 ± 17.49, 78. 81 ± 16. 47, 67. 66 ± 39. 57, 68. 78 ± 13. 65, respectively) of AR patients were similar with those (94.12±6.88, 80.67 ±32.38, 73.57 ±17.96, 59.73 ±16.58, 80.41 ±17.01, 63.58 ±39.99, 66.43 ±13.71) of CP patients (P>0.05). By the assessment of RQLQ, in AR patients, both the nasal symptoms and the practical problems got the highest scores (the scores were 2. 70 ± 1. 29, 2. 53 ± 1. 37 respectively). According to the assessment of the correlation between SF-36 and RQLQ, the correlation was weak (r = - 0. 199～ - 0. 526,P < 0.05). Conclusions The QOL of AR patients decreased compared with that of healthy individuals, but similar with that of CP patients. The most troublesome problems in AR patients were nasal symptoms and the practical problems. Both SF-36 and RQLQ were suitable for assessing the health status of AR patients. SF-36 and RQLQ each covered a different part of the QOL of AR patients, and the combination of the two questionnaires could improve the QOL measurement

Objective:To investigate distribution and drug resistance of pathogens of bloodstream infection in patients with hematological malignancies,in order to provide reference for clinical infection control and treatment.Methods:The clinical information of blood culture patients in the hematology department of our hospital from January 2016 to December 2021 was reviewed.They were divided into transplantation group and non-transplantation group according to whether they had undergone hematopoietic stem cell transplantation.The types of pathogens and their drug resistance were analyzed.Results:Two hundred and ninety-nine positive strains of pathogenic bacteria were detected.In the transplantation group,Gram-negative bacteria accounted for 68.5％(50/73),Gram-positive bacteria accounted for 6.8％(5/73),and fungi accounted for 24.7％(18/73).The resistance rate of Escherichia coli to the third-generation cephalosporins was 77.8％,and 11.5％to carbapenems.The resistance rate of Klebsiella pneumoniae to the third-generation cephalosporins was 50.0％,and 56.2％to carbapenems.In the non-transplantation group,Gram-negative bacteria accounted for 64.1％(145/226),Gram-positive bacteria accounted for 31.0％(70/226),and fungi accounted for 4.9％(11/226).Gram-positive bacteria were mainly Enterococcus faecium(6.6％,15/226)and Coagulase-negative Staphylococci(6.2％,14/226).The fungi were all Candida tropicalis.The resistance rate of Escherichia coli to the third-generation cephalosporins was 63.8％,and 10.3％to carbapenems.The resistance rate of Klebsiella pneumoniae to the third-generation cephalosporins was 46.3％,and 26.8％to carbapenems.Conclusion:The types of pathogenic bacteria in bloodstream infection in patients with hematological malignancies are varied.Gram-negative bacteria is the main pathogenic bacteria.The resistance of pathogenic bacteria to antibiotics is severe.Antibiotics should be used scientifically and reasonably according to the detection and resistance of pathogenic bacteria.

Objective To investigate the mechanism underlying gasdermin E(GSDME)-mediated pyroptosis in radiation-induced intestinal injury and to find out whether gasdermin(GSDM)family members regulate pyroptosis through similar signaling pathways.Methods Human normal colon epithelial cells(NCM460)and human colon cancer cells(HT-29)were exposed to radiation of different doses and durations before pyroptosis indicators were evaluated by observing pyroptotic bubbles,cell survival,and the cleavage of pyroptosis execution proteins.HT-29 cells overexpressing GSDME were subjected to radiation,followed by enrichment analysis of pyroptosis-related differentially expressed genes using RNA-seq.Results Radiation induced substantial pyroptosis in NCM460 cells.Overexpression of GSDME in HT-29 cells resulted in substantial radiation-induced pyroptosis.The pyroptosis state of human intestinal cells was simulated in the HT-29 model cell line.Overexpressions of GSDME-N and GSDMD-N resulted in the expression of more than 50％ of the differentially expressed genes in the pyroptosis state.Sequencing analysis showed that the genes in the pyroptosis state were mainly overrepresented in immune response,inflammatory response,and Rapl signaling pathway.Conclusion GSDME activation can mediate radiation-induced pyroptosis by producing GSDME-N fragments.GSDM family members participate in pyroptosis in a similar mode of regulation.Furthermore,radiation-induced activation of GSDME/D may regulate pyroptosis through immune response,inflammatory response,and Rap1 signaling pathway.