OBJECTIVE: To study the spontaneous rehabilitation and phonation quality of vocal cords after different types of CO2 laser microsurgery. METHOD: Surgical procedures based on Remacle system Type I, Type II, Type III, Type IV and Type V a respectively. Three hundred and fifteen cases with hoarseness based on strobe laryngoscopy results were prospectively assigned to different group according to vocal lesions apperence,vocal vibration and imaging of larynx CT/MRI. Each group holded 63 cases. The investigation included the vocal cords morphological features,the patients' subjective feelings and objective results of vocal cords. RESULT: There are no severe complications for all patients in perioperative period. Vocal scar found in Type I ,1 case; Type II, 9 cases ;Type III, 47 cases; Type IV, 61 cases and Type Va 63 cases respectively after surgery. The difference of Vocal scar formation after surgery between surgical procedures are statistical significance (χ2 = 222.24, P < 0.05). Hoarseness improved after the surgery in 59 cases of Type I , 51 cases of Type II, 43 cases of Type III, 21 cases of Type IV and 17 cases of Type Va. There are statistically significance (χ2 = 89.46, P < 0.05) between different surgical procedures. The parameters of strobe laryngoscope: there are statistical significance on jitter between procedures (F 44.51, P < 0.05), but without difference within Type I and Type II (P > 0.05). This happened in shimmer parameter and the maximum phonation time (MPT) as jitter. There are no statistical significance between Type IV and Type Va on MPT (P > 0.05). CONCLUSION Morphological and functional rehabilitation of vocal cord will be affected obviously when the body layer is injured. The depth and range of the CO2 laser microsurgery are the key factors affecting the vocal rehabilitation.
Cicatrix ; Hoarseness ; therapy ; Humans ; Laryngoscopes ; Laryngoscopy ; Laser Therapy ; Lasers, Gas ; Microsurgery ; Phonation ; Vocal Cords ; physiology ; surgery

Objective To investigate the influencing factors of ankylosing spondylitis(AS)patients’life quality and medical coping styles.Method Two hundred patients visiting at the outpatient department of our hospital took part in the assessment on AS life quality and medical coping styles to look into the living quality of AS patients and its medical coping methods and influencing factors.Results The total score on life quality was(66.82±5.57),among whose dimensions the psychological function was scored the lowest by(10.65±4.05). Pearson correlation analysis showed that the scores on confrontation of coping styles were positively related with the dimension of social function in life quality(r=0.18,r=0.13,P<0.05),the scores on the avoidance of coping style were positively related to the dimension of physiological function in the life quality(r=0.12,r=0.14,P<0.05),the scores on yielding in coping styles was negatively correlated to physiological function of the life quality(r=-0.20,P<0.05).Regression analysis results showed that the AS patients’life quality was impacted by the course of the disease,coping styles and modes for paying medical expenses(P<0.05).Conclusions The AS patients’life quality is low and it is related to their coping style,the course of the disease and modes for paying medical expenses.Medical personnel should implement targeted interventions to guide patients into taking correct medical coping styles according to the specific condition of patients,in order to improve their quality of life.

OBJECTIVE: To investigate the efficacy of submucosal resection by CO2 laser in the treatment of recurrent laryngeal papilloma and the effect on prognosis. METHOD: A total of 11 patients diagnosed as recurrent laryngeal papilloma were included in this review. Papilloma was marked before operation and checked under fibro-laryngoscope. Papilloma was resected completely including the submucosal tissure with CO2 laser or microequipment. In widespread papilloma, false membrane in raw surface were cleared 7-10 days after operation. Surgical specimens (including membrane) were detected by routine pathology, HPV typing and immunohistochemical pathologic examination. The patients were checked once a month in the first 3 months after operation, and then once for every 3 months. Once the hoarseness and other symptoms aggravated or the disease was recurrent, the patients were treated immediately. RESULT: HPV viral DNA was found in 10/11 cases, with HPV11 (7/11 cases) and HPV6 (3/11 cases). Cases with regards to follow-up, from 6 months to 1 year, 3 cases were followed up 1 year after operation, without recurrence. Five patients including 2 children were followed up 6 to 12 months after operation, without recurrence. Two children underwent 2 or 3 operations, were followed-up more than 6 months withouting recurrence. CONCLUSION Papilloma submucosal resection could decrease postoperative recurrence and is worth to be further investigated.
Child ; DNA, Viral ; blood ; Human papillomavirus 11 ; isolation & purification ; Human papillomavirus 6 ; isolation & purification ; Humans ; Laryngeal Neoplasms ; diagnosis ; surgery ; Laryngoscopes ; Lasers, Gas ; Neoplasm Recurrence, Local ; Papilloma ; diagnosis ; surgery ; virology ; Papillomavirus Infections ; diagnosis ; surgery ; Postoperative Period ; Prognosis ; Respiratory Tract Infections ; diagnosis ; surgery

Objective To evaluate the effect of dexmedetomidine on acute kidney injury (AKI) and the relationship between the mechanism and expression of high mobility group protein B1 (HMGBl) mRNA in renal tissues of septic rats.Methods Fort-eight healthy adult male Sprague-Dawley rats,aged 8-12 weeks,weighing 240-270 g,were divided into 3 groups (n =16 each) using a random number table method:control group (C group),sepsis group (S group) and dexmedetomidine group (D group).AKI was induced by cecal ligation and puncture.The concentrations of serum cystatin C (Cys C) were measured by immunoturbidimetry at 24 and 48 h after operation.The rats were sacrificed after blood sampling,and kidney tissues were removed for determination of the expression of HMGB1 mRNA (by fluorescent quantitative real-time polymerase chain reaction) and for examination of the pathological changes.The damage to the renal tubules was scored.Results Compared with group C,the renal tubular damage score and serum Cys C concentrations were significantly increased,and the expression of HMGB1 mRNA was up-regulated in S and D groups (P＜0.05).Compared with group S,the renal tubular damage score and serum Cys C concentrations were significandy decreased,the expression of HMGB1 mRNA was down-regulated (P＜0.05),and the pathological changes of renal tissues were significantly attenuated in group D.Conclusion Dexmedetomidine can attenuate AKI in septic rats and the mechanism may be related to inhibiting the expression of HMGB1 mRNA in renal tissues.

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

Objective To investigate the effects of phonosurgery combined with botulinumtoxinof type A in-jection in adults with vocal nodules .Methods A total of 76 adults with diagnosis of vocal nodules were studied in this experiment .They were divided into two group according to the different treatments :the surgery group (n=40) ,and the group with the combined botulinum toxin of type A injection (n=36) .Preoperative and postoperative examinations consisted of electronic laryngoscope ,stroboscopic laryngoscope ,voice assessments of subjective and objective evaluations using GRBAS classification and voice disorder index (VHI) .The evaluation parameters were the longest phonation time (MPT) ,jitter and shimmer and dysphonia severity index (DSI) .The results from the two groups were compared .Results There were 5 cases cured ,28 cases improved and 7 cases of now effects in the surgery group .The effective rate was 82 .5％ .There were 30 cases cured and 6 cases improved in the combined in-jection group with the effective rate of 100％ .There were 22 cases with good glottis closure and 18 cases with incom-plete closure in the surgery group postoperatively ;in the combined injection group ,30 cases glottis closed well and 6 cases still closed incompletely .The differences of postoperative VHI ,MPT ,jitter ,shimmer and DSI in addition to G were significant different between the two groups .Conclusion Phonosurgery combined with botulinum toxin of type A injection is an effective way for the treatment of vocal fold nodules in adults .

Objective The present study aimed to establish a bone mineral density (BMD) reference database in China and to investigate the prevalence of osteoporosis in Chinese adults aged 50 years and older using dual energy X-ray absorptiometry (DXA). Method A total of 75321 examineers over 25 years old who underwent health checkups in 7 health check centers between 2008 and 2018 were included. All centers used a GE Lunar-DXA system to measure BMD of the lumbar spine (L1-L4), femoral neck, and total femur. The same European Spine Phantom (ESP) was used for scanning 10 times at every center, a regression equation was generated, and BMD data were cross-calibrated in each center. Peak BMD and standard deviation (SD) were identified according to 5-year age groups, and T scores were calculated based on the peak BMD and SD. Osteoporosis was defined according to the World Health Organization criteria. The prevalence of osteoporosis was standardized based on 2010 national census data for the Chinese population. Result The mean BMD values decreased with age, were highest in North China, followed by Northeast China, East China, and Southwest China, respectively, and increased with body mass index. Males aged 20-30 years and females aged 35-40 years had peak BMD values. Peak BMD values of the lumbar spine, femoral neck, and total femur were 1.09 g/cm2, 0.97 g/cm2, and 0.97 g/cm2 in males, and 1.11 g/cm2, 0.84 g/cm2, and 0.88 g/cm2 in females, respectively. Among all scanned sites, the prevalence of osteoporosis was highest in the femoral neck in males (4.58％) and in the lumbar spine in females (23.38％). The age-standardized prevalence of osteoporosis at any site was 6.46％ in males and 29.13％ in females aged 50 years and older. Based on the 2010 national census data, 10879115 males and 49286542 females currently have osteoporosis. Conclusion Mean BMD values varied according to geographic region, body mass index, age group, and sex in Chinese adults. The age-standardized prevalence of osteoporosis was 6.46％ in males and 29.13％ in females aged 50 years and older.

OBJECTIVE: To investigate the feasibility and safety of lingual tonsil excision by endoscopic assisted coblation. METHOD: Twenty seven cases with lingual tonsil hypertrophy were recruited in this study. Preoperative fibrolaryngoscope and CT and (or) MRI examination of the base of the tongue, lingual tonsil was removed by 70 degrees nasal endoscopy-assisted plasma radiofrequency after nasotracheal intubation. The tongue wound healing and post-operative bleeding were observed after operation, the advantages of the endoscopic-assisted plasma radiofrequency on lingual tonsil removal were analyzed, and its feasibility and safety were summarized. RESULT: During the surgery the base of the tongue and epiglottis had satisfaction exposure in the same operative field. No complications happened in the surgery and endotracheal tube was plucked safely after operation. There was no primary bleeding, and the number of secondary bleeding were 4 cases, accounting for 14.81% (4/27), respectively occurred on the sixth, seventh, tenth and twelfth day with the amount of bleeding of 30-70 ml. The bleeding were cured after conservative treatment or re-application applicating of radiofrequency; 27 patients had no taste disturbance, and they were followed up for 6-30 months without recurrence. CONCLUSION Lingual tonsil excision by nasal endoscopic-assisted coblation has enough exposure, complete resection and low recurrence rate. Stopping bleeding should be attentioned to prevent postoperative bleeding.
Adult ; Catheter Ablation ; methods ; Endoscopy ; Female ; Humans ; Hypertrophy ; surgery ; Male ; Middle Aged ; Palatine Tonsil ; pathology ; Pharyngeal Diseases ; Tongue ; pathology

Objective:To investigate the clinical outcome of arthroscopic suture-button Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability.Methods:A retrospective case series study was conducted to analyze 28 patients with recurrent anterior shoulder instability admitted to Shanghai Sixth People’s Hospital from March 2015 to September 2018，including 26 males and 2 females，aged 18-36 years ［（24.1 ± 3.2）years］. Preoperative MRI showed Bankart injury and three-dimensional CT showed glenoid bone defect > 15%. The Hill-Sachs injury was found in 27 patients. Arthroscopic Bristow procedure was used to fix coracoid process graft with the suture-button plate and glenoid labial complex was repaired with the suture anchor to treat anterior instability of the shoulder joint. The visual analogue scale （VAS），American shoulder and elbow surgeon （ASES） scale，Constant score and Rowe score were used to evaluate the shoulder joint function preoperatively，at postoperative 3，6，12 months and at the last follow-up. The postoperative infection，neurovascular injury，redislocation and other complications were recorded，and the incidence rate was calculated. The bone resorption and bone healing of coracoid process graft were analyzed by CT.Results:All patients were followed up for 22 - 36 months ［（24.5 ± 6.3） months］. Three months after operation，the VAS，ASES scale and Constant score were not significantly different from those before operation （ P > 0.05）. In comparison，the Rowe score was significantly higher than that before operation （ P < 0.05）. Six and twelve months after operation，the VAS，ASES scale，Constant score and Rowe score were significantly improved from those before operation （ P < 0.05）. At the last follow-up，the VAS decreased from （2.7 ± 1.5）points preoperatively to （0.8 ± 0.3）points，the ASES scale increased from （78.6 ± 12.7）points preoperatively to （92.4 ± 8.4）points，the Constant score increased from （43.4 ± 5.2） points preoperatively to （81.6 ± 6.7） points，the Rowe score increased from （52.3 ± 7.1）preoperatively to （92.7 ± 5.4） points （ P < 0.05）. During the follow-up，there was no infection，neurovascular injury，re-dislocation and other complications. In addition，24 （86%） out of the 28 patient showed healing of coracoid process grafts，and the overall bone resorption rate was （18.4 ± 6.1）%. No patients had glenohumeral joint osteoarthritis. Conclusion:Arthroscopic Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability has advantages of a low rate of postoperative complications and a high union rate，indicating an effective and safe surgical procedure.

Objective:To evaluate the performance of aldosterone testing in China through the External Quality Assessment (EQA) and improve the testing quality of aldosterone.Methods:Two kinds of EQA program for aldosterone were carried out in China, one of which is Routine EQA and the other is Trueness verification scheme. Lyophilized sera with 5 concentration levels were used as quality control of Routine EQA. The results were grouped according to the instrument. Target values and the coefficient of variation ( CV) were calculated in each group. Trueness verification scheme was verified by using frozen human sera of 3 concentration levels determined by the reference method, and the bias of each instrument group from the target value was calculated. Results:272 laboratories submitted the testing results, and 91.6% of laboratories used chemiluminescence method. The maximum CV was obtained by radioimmunoassay and liquid chromatography mass spectrometry, and the robust CVs were 14.6%-33.4% and 43.5%-53.9%, respectively. For chemiluminescence methods, the robust group CV was less than 10%. The results of the Trueness verification scheme showed that liquid chromatography mass spectrometry method was the most accurate method, with biases of -7.9%, 8.9% and -0.7% for the three quality controls. Diasorin system had the more accurate results deviated from the target by 58.7%, 7.9% and -2.1%, respectively. The results of other chemiluminescence methods were negatively correlated with the sample concentration, and one of them with a bias of 479%. Conclusions:The accuracy and comparability of aldosterone among laboratories in China are not satisfactory. Reagent manufacturers and laboratories should pay more attention to EQA, with the aldosterone results traceable to SI unit, and improve the test quality of aldosterone.