OBJECTIVE: To evaluate the modified rhytidectomy incision in superficial parotidectomy. METHOD: Thirty-five patients with superficial parotid tumor were included in this study. A modified rhytidectomy incision often used in facial plastic surgery was used for superficial parotidectomy and subtotal superficial parotidectomy with preservation of facial nerve and great auricular nerve. The follow-up study included the exposed region, the cosmetic effect of this approach and the rate of complication. RESULT: All patients healed without salivary fistula, and were satisfied with this modified approach. Temporary paralysis of the marginal mandibular branch of facial nerve were found in five patients, and six patients felt insensible around earlobe after operation. They all recovered in 1 to 3 months after surgery, no recurrence was happened during follow-up in 36 to 60 months (median follow-up period was 48 months). CONCLUSION The modified rhytidectomy incision provided good exposure, had less complication and better cosmetic outcome.
Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Parotid Neoplasms ; surgery ; Rhytidoplasty ; methods ; Young Adult

Objective To observe the effect of spleen-warming and kidney-tonifying therapy on Toll-like receptor 4 (TLR4) signaling pathway of cerebral infarction sequelae patients. Methods A total of 60 cerebral infarction sequelae patients with spleen and kidney(yang) deficiency were divided into control group and treatment group, 30 cases in each group. The two groups were given function rehabilitation training following by the theory of modern rehabilitation medicine, and additionally the treatment group was treated with spleen-warming and kidney-tonifying herbs orally. The treatment period for the two groups averaged 3 months. Before and after treatment, the scores of traditional Chinese medicine (TCM) symptoms and signs, peripheral blood TLR4 mRNA expression level, and the inflammation-related factors in the two groups were observed, and the observation parameters were compared with 30 healthy volunteers. Meanwhile, the changes of modern rehabilitation evaluation indexes were also evaluated before and after treatment. Results (1) After treatment, the Fugl-Meyer scores for motor function and Modified Barthel Index(MBI) scores for activities of daily living in the treatment group were obviously increased(P < 0.05 or P < 0.01 compared with those before treatment); the MBI scores in the control group was much increased(P < 0.05 compared with those before treatment), but the Fugl -Meyer scores only showed an increasing trend(P > 0.05). (2) After treatment, the predominant symptoms and signs of hemiplegia, facial distortion and dysphasia in the two groups were much improved(P < 0.01 compared with those before treatment), and the improvement in the treatment group was superior to that in the control group(P < 0.05). The control group had no significant effect on relieving the symptoms and signs of dizziness and blurred vision, numbness of limbs, spontaneous sweating, shortness of breath and weakness, and darkish tongue(P > 0.05 compared with those before treatment); the treatment group had obvious effect on the above symptoms and signs, and the effect was superior to that in the control group(P < 0.05 or P < 0.01).(3) For the inflammation-related factors, tumor necrosis factor alpha(TNF-α) level in the treatment group was much decreased and even arrived to the normal level(P > 0.05), and TNF-α level in the control group was decreased but did not arrive to the normal level(P < 0.05); levels of interleukin(IL)-1β, IL-6 and TLR4 mRNA in the two groups were decreased but did not arrive to the normal(P < 0.01), and the decrease in the treatment group was superior to that in the control group(P < 0.05 or P < 0.01). (4) During the treatment period, no obvious adverse effect was found in the two groups. Conclusion Oral use of spleen -warming and kidney –tonifying Chinese medicine combined with modern rehabilitation therapy is effective for the treatment of the sequelae of cerebral infarction patients by relieving the clinical TCM symptoms, and one of the therapeutic mechanisms is probably related with the TLR4 signaling pathway through regulating the expression of inflammatory factors.

OBJECTIVE: To provide anantomical basis for the endoscope-assisted partial superficial parotidectomy via retroauricular hairline approach (EASPRHA) and assess its feasibility and safety. METHOD: The surgical anatomy of retroauricular hairline region and parotid gland region were observed in 15 fresh human cadavers (30 halves). The EASPRHA was performed on 5 human cadavers (10 halves). After the procedure, the related vascular and neural structures were evaluated. RESULT: The retroauricular hairline region extends between superficial musculoaponeurotic system and superficial cervical fascia. On the superficial surface of the upper sternocleidomastoid lie the lesser occipital nerve, the great auricular nerve and the external jugular vein. The bifurcation of great auricular nerve is(22.85 ± 2.01) mm from the bottom of earlobe. The parotid gland region extends between parotidomassteric fascia and parotid gland parenchyma. The facial nerve emerging from the stylomastoid foramen runs across the superficial surface of base of styloid process, passes through the interspace between cartilage of external acoustic meatus and posterior belly of digastric muscle, and enters the parotid gland. The bifurcation of facial nerve trunk is (19.10 ± 3.10)mm from the mastoidale and (39.49 ± 5.78) mm from the mandibular angle. Above the posterior belly of digastric muscle, the posterior auricular artery arises from the posterior wall of the external carotid artery with its main stem running over the superficial surface of facial nerve trunk. In all endoscope-assisted operations, the partial superficial parotidectomy was successful without the need for an additional incision. No major neurovascular damage wasobserved. CONCLUSION A thorough knowledge of the surgical anatomy of retroauricular hairline region and parotid gland region is an essential requirement in performing the safe and feasible EASPRHA.
Cranial Nerves ; anatomy & histology ; Endoscopes ; Endoscopy ; methods ; Facial Nerve ; anatomy & histology ; Fascia ; Feasibility Studies ; Humans ; Male ; Neck Muscles ; anatomy & histology ; Parotid Gland ; anatomy & histology ; surgery

Coronavirus disease 2019 (COVID-19) has spread to many countries in the world, and some patients show liver injury during the epidemic of COVID-19. In order to improve the awareness of COVID-19 among patients with viral hepatitis cirrhosis and strengthen patients’ self-protection and disease management, this article discusses the pathogenic mechanism of liver injury caused by COVID-19 and reasonable epidemic prevention, standardized medical treatment, and scientific medication for such patients and gives related recommendations, so as to ensure the routine management of viral hepatitis and reduce the risk of infection in such population.

Objective To investigate the image features of congenital pyriform sinus fistula (CPSF). Methods We retrospectively analyzed the clinical features and preoperative images of 80 patients with confirmed diagnosis of CPSF by surgical and pathological outcome in Guangdong general hospital from January 2007 to December 2014. At least one of the following imaging examinations were performed for all the patients, including Barium swallow X-ray (BSX), CT and MRI. Among them, 63 patients were examined with BSX, while 42 patients underwent plain and enhanced CT scans, wherein 40 of them were exanimated shortly after BSX. Thirty-two patients underwent plain and enhanced MRI scans. Patients were divided into two groups according to their age, young age group (≤14 years old) and older age group (>14 years old). Furthermore, they were also grouped based on inflammatory or quiescent stage clinically. The images of BSX, CT, and MRI from the patients were analyzed and the positive diagnostic rates (PDR) between groups were compared by using χ2 tests. Results For the patients examined with BSX, sinuses in 35 of 63 were depicted from pyriform and fistulas in 9 of 63 were depicted from the pyriform. The overall PDR of BSX was 74.6%(47/63),wherein 46.2%(12/26)in young age group , 94.6%(35/37)in older age group, 52.9%(9/17) in inflammatory stage group ,and 82.6%(38/46)in quiescent stage group. The inter-group differences were statistically significant (χ2 were 18.911 and 5.766,both P<0.05). The PDR of CPSF with CT was 85.7%(36/42), MRI was 84.4%(27/32), BSX+CT was 87.5%(35/40). The courses of fistula or sinus were showed on CT and MRI. The presence of air bubbles at the inferomedial edge of cricothyroid joints or around the upper lobe of the thyroid gland, the changes of the morphology of thyroid grand as well as the inflammatory change along the fistula region were detected much clearly on CT and MRI. There was no statistical difference between CT and MRI groups(P>0.05).Conclusions BSX could be a screening method for suspected cases of CPSF in quiescent stage. However, the PDR could be affected by many factors (age and inflammation). CT and MRI could provide valuable information for diagnosis. An examination combined BSX and CT is preferred to improve the positive detective rate of CPSF.

Objective To investigate if there were connections between sporadic Parkinson's disease (PD) and three single nucleotide polymorphisms (SNPs) in transmembrane protein 175 (TMEM175 rs34311866), methylcrotonoyl-coenzyme A carboxylase 1 ( MCCC1 rs12637471 ) and alpha-synuclein (SNCA rs356182) in Northern Chinese Han population , and provide basic data for PD genetic research. Methods The research recruited 310 sporadic PD patients in northern Chinese Han population from the Department of Neurology, the First Hospital of China Medical University between 2008 and 2012, and 339 controls without nervous system manifestations from other departments of the First Hospital of China Medical University during the same period.We applied cleaved amplification polymorphism sequence-tagged sites polymerase chain reaction-restriction fragment length polymorphism method to detect the genotype distributions of the SNPs in the northern Chinese Han population , and calculated relevance with PD of the SNPs by chi-square test.Results According to the data, the allele A of SNCA rs356182 had positive effects on the onset of PD in northern Chinese Han population compared with controls (patient group A%＝20.97%(130/620), control group A% ＝29.20%(198/678), χ2＝11.632, P＝0.001); allele G of MCCC1 rs12637471 (χ2＝0.009, P＝0.926) and allele C of TMEM175 rs34311866 (χ2＝1.369, P＝0.242) showed no significant differences between PD and control groups.Conclusion SNCA rs356182 was related with PD, and TMEM175 rs34311866 (M311Y) as well as MCCC1 rs12637471 showed no correlation with PD in the northern Chinese Han population.

OBJECTIVE: To investigate specific immunologic therapy (SIT) intervention in patients with nasal polyps accompanied with perennial rhinitis after functional endoscopic sinus surgery (FESS). METHOD: To divide patients with nasal polyps into two groups randomly: group I: FESS + SIT after operation; group II: FESS only. To compare the symptom and physical sign of the 2 groups before the operation and 1 and 2 years after the operation, with SNOT-20 and Lund-Kennedy and Lund-Mackay Standard. RESULT: Both of the 2 groups' final scores of the total 20 items and the most important 5 items of SNOT-20 and Lund-Kennedy and Lund-Mackay were greatly improved, however there is an obvious difference between them: the therapeutic effect of groups I is better than group II. CONCLUSION SIT can reduce the recurrence of nasal polyps after operation, and improve the state after treatment.
Adolescent ; Adult ; Aged ; Endoscopy ; Female ; Humans ; Immunotherapy ; methods ; Male ; Middle Aged ; Nasal Polyps ; diagnosis ; surgery ; therapy ; Postoperative Period ; Prognosis ; Recurrence ; Treatment Outcome ; Young Adult

OBJECTIVE: To summarize the clinical repairment experience of postoperative skin defects in head and neck cutaneous tumor. METHOD: From July 2002 to September 2006, 24 patients with head and neck cutaneous tumor were treated in our department. Every specimen and resection margin of all cases were monitored by intraoperative frozen section. Extents of operative skin defects were from 1.0 cm x 1.5 cm to 3.0 cm x 3.5 cm, all of which were repaired by rhomboid flap. RESULT: All the cases were primarily repaired, and followed up 6 month to 3 years. The repaired skins had the normal colour, without obviously scars or secondary deformations. CONCLUSION The rhomboid flap is reasonably designed, conveniently procured and manipulated. It is a better method to immediately repair the head and neck skin defects after radical excision of tumor.
Adult ; Aged ; Female ; Head and Neck Neoplasms ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Period ; Reconstructive Surgical Procedures ; methods ; Skin Neoplasms ; surgery ; Skin Transplantation ; methods ; Surgical Flaps

OBJECTIVE: To investigate the clinical treatment effect of refractory hypertension accompanied with OSAHS by surgery on upper airway. METHOD: Thirty-two patients were enrolled in our research. PSG and blood pressure were examined on preoperation and 6th month, 1 year, 2 year of postoperation. RESULT: The AHI and the time of SaO2 < 90% were lower significantly, and LSaO2 was improved (P < 0.01). The blood pressures of 32 patients were decreased. CONCLUSION The operation on upper airway could improve the hypertension of patient with OSAHS effectively.
Adult ; Blood Pressure ; Female ; Humans ; Hypertension ; surgery ; Male ; Respiratory System ; surgery ; Sleep Apnea, Obstructive ; surgery

OBJECTIVE: To evaluate the role of selective neck dissection in the treatment of recurrent branchial anomalies. METHOD: The clinical data of 18 patients with recurrent branchial anomalies were retrospectively analyzed. In accordance with the embryologic and anatomic features of branchial anomalies, different types of selective neck dissection were applied. With dissection and protection of important vessels, nerves and other structures, enbloc resection principles were applied to extirpate branchial lesions, scarrings and inflammatory granuloma during the operation. RESULT: Of all 18 patients, 16 cases were healed with primary healing, 2 cases with local incision infection were healed after dressing changes. A temporary facial nerve paralysis occurred in 1 case with recurrent first branchial cleft fistula postoperatively, and completely recovered 2 months after operation. A postoperative temporary vocal cord paralysis occurred in 1 case with recurrent fourth branchial cleft fistula, and totally recuperated 1 month after operation. No recurrences were found in all 18 cases with a follow-up period of 12-78 months (average 35 months). CONCLUSION Selective neck dissection is a safe and effective surgical procedure for the radical treatment of recurrent branchial anomalies.
Adolescent ; Branchial Region ; abnormalities ; surgery ; Child ; Child, Preschool ; Female ; Humans ; Male ; Neck Dissection ; methods ; Retrospective Studies ; Treatment Outcome ; Young Adult