OBJECTIVETo explore the curative effect and adverse reactions of a convenient expiratory positive airway pressure device(EPAPD) in treatment of obstructive sleep apnea/hypopnea syndrome(OSAHS). METHODS74 subjects with OSAHS were treated by EPAPD. Polysomnography(PSG) and Epworth sleepiness scores(ESS) were performed and evaluated before, within 1 week and after 3 months using the EPAPD. The index of PSG and ESS were compared at different time. The adverse reactions were also observed at the same time.RESULTS Compared to baseline, the AHI, LSaO2, ESS were significantly improved both within 1 week and after 3 months(AHI:F=73.62,P=0.00; LSaO2:F=12.65,P=0.00; ESS:F=61.49,P=0.00). The improvement of AHI between different OSAHS groups(divided by the severity of AHI in baseline) was significantly different(within 1 week:F=15.39,P=0.00; after 3 months:F=12.60,P=0.00). There was also significant difference between different hypoxia groups which were divided by the severity of LSaO2 in baseline(within 1 week:F=3.80,P=0.03; after 3 months:F=3.27,P=0.04). Meanwhile, the ESS was significantly improved in different sleepiness groups(divided by the ESS score in baseline) within 1 week(F=6.17,P=0.00). The device-related adverse events were reported by 44.59%(33/74). There were not serious adverse reaction happened. The major adverse reactions were throat and nose dry, nasal obstruction, and nose discomfort.CONCLUSION The EPAPD is an effective, convenient device in treating OSAHS. Meanwhile, the device related adverse reactions are slight. It may be more efficient for serious OSAHS patients than mild ones.

Objective To investigate the correlation between level Ⅱ cervical lymph node metastasis (CLNM) and thyroid disease background,tumor size,location,and local lymph node metastasis in patients with papillary thyroid carcinoma (PTC).Methods A thyroid cancer database was established using Access database software.62 patients with PTC undergoing neck dissection in the 1st Department of Head and Neck surgery of Sichuan Cancer Hospital from Aug.2013 to Mar.2014 were retrospectively reviewed in terms of their sex,age,thyroid disease background,number of nodules,tumor size,location,and CLNM.Results 30 out of 62 patients had level Ⅱ cervical lymph node metastasis (Ⅱa:27 cases,Ⅱb:6 cases).13 out of 23 patients without history of other thyroid disease had level Ⅱ CLNM,9 out of 17 patients with Hashimoto's thyroiditis had level Ⅱ CLNM,3 out of 18 patients concomitant with nodular goiter had level Ⅱ CLNM and 2 patients concomitant with hyperthyroidism and having received radioactive iodine 131 treatments had level Ⅱ CLNM.Among patients with level Ⅱ CLNM,2 patients had tumors ＜10 mm,17 patients had tumors between 10 mm and 40 mm,and 4 patients had tumors ＞40 mm.Most of the tumors (11/17) with level Ⅱ CLNM were located in the upper polar of the thyroid,while the rest were located in the middle (12/23) and lower (3/12) region of thyroid.Conclusions Level Ⅱ CLNM is a common feature of thyroid carcinoma.It has been well accepted that level Ⅱ cervical lymph node should be dissected when extracapsular invasion or CLNM to level Ⅲ or Ⅳ occurs.In addition to traditional risk stratification,level Ⅰ CLNM is correlated with tumor size,location,and thyroid disease background.Therefore,close attention should be paid to level Ⅱ cervical lymph node when tumors are located in the upper polar of thyroid and individualized treatment should be chosen for each patient.

Objective To discuss the surgical treatment of differentiated thyroid carcinoma ( DTC) viola-ting larynx and trachea .Methods 29 patients with DTC violating larynx and trachea received primary tumor re-section.Among them, 6 patients were with larynx violation , 3 patients with larynx and trachea violation , 16 pa-tients with trachea violation , and 4 patients with anterior strap muscles and skin violation .In addition, 5 patients were type I , 4 patients type II , 9 patients type III , and 11 patients type IV .All patients accepted the total thy-roidectomy.For patients with larynx and trachea violations , 9 received the slashing tracheal surgery ( type I and II) , 15 patients received the window resection and sternocleidomastoid muscle periosteal flap reconstruction , sleeve resection and anastomosis reconstruction , and window resection and gastrostomy .3 patients received total laryngectomy , 2 patients received partial laryngectomy and 4 patients with skin invasion received the reconstruc-tion with pectoralis major muscle flap .Results For these patients , 25 patients were with papillary adenocarcino-ma, and 4 patients with follicular carcinoma .All patients were followed up for 1 to 8 years.3 cases suffered from recurrence, 2 cases with tracheal recurrence received reoperation .3 cases with lung metastasis received the I 131 therapy, among whom 2 cases achieved the local control of lung tumor and the other one survived with tumor .1 patient died of the neck lymph nodes recurrence .25 patients survived over 3 years.13 patients survived over 5 years.Conclusions For patients with DTC with larynx and trachea violation , we should try our best to eliminate the tumor tissues.For the organs invaded by tumors , if possibly, elimination is also needed .This will eliminate or release the suffocation resulted from bleeding or obstruction .In addition , the function of larynx and trachea can be reconstructed and the life quality of these patients can be improved through the flap reconstruction and trachea anastomosis.Standard endocrine therapy and nuclear medicine therapy contribute to the prognosis improvement .

Objective To evaluate the benefits of CT angiography (CTA) in preoperative mapping of anterolateral thigh perforator flap (ALTPF) for reconstruction of defect after head and neck cancer resection.Methods Twenty-four patients underwent reconstruction of postoperative defect with ALTPF from March 2011 to March 2014 were retrospectively reviewed.According to the imaging methods used for examining perforating artery,these patients were divided into two groups:color Doppler flow imaging (CDFI)-group and CTA-group,12 patients in each group.The surgical results of all patients were evaluated for consistency in number of perforating artery,operation time and flap-related complications.Results Only one of all patients had complete flap necrosis,with an overall flap survival rate of 95.83％.All perforating branches showed with preoperative CTA were found in operation (12/12),significantly higher than CDFI-group (8/12).The mean operation time of CTA-group was significantly shorter than that of CDFI-group (Unilateral neck dissection:(6.80 ± 0.53) vs (8.39 ± 0.75) h,bilateral neck dissection:(8.79 ± 0.97) vs (10.96 ± 0.26)h,both P ＜0.05).Flap-related complication occurred in one case in CTA-group,but in 5 cases in CDFI-group.Conclusions CTA can accurately provide anatomical information of perforator vessels and guide preoperative design of ALTPF to improve operative outcomes,including the decrease in operation time and surgical injury.

Objective To explore the value of free latissimus dorsimyocutaneous flap in repairing severe defect of head and neck after resection of tumor.Methods Free latissimus dorsimyocutaneous flap was used to repair defect after resection of tumor in 12 patients (13 sides) with head and neck tumors.Of them 2 cases underwent radical radiotherapy before operation.and 3 cases received adjuvant radiotherapy postoperatively.Results Aside from one flap with necrosis, other 12 flaps survived after operation including 5 cases with radiotherapy.Conclusion Free latissimus dorsimvocutaneous flap can afford large tissue, has reliable blood supply, is easy to survive, and resist to radiotherapy, which is fit for repairing severe defect of head and neck.

Hepatocellular carcinoma (HCC) is one of the major malignant tumors that lead to death, and chronic hepatitis B virus (HBV) infection is an important risk factor for HCC. This article introduces the detailed mechanisms of HBV-related HCC, including HBV X protein, immune imbalance, and integration of HBV DNA into the host genome, with a focus on the pathological role and related mechanisms of HBV X protein in HCC. HBV X protein enhances carcinogenesis by promoting tumor cell proliferation, invasion, and metastasis, affecting angiogenesis, promoting cell apoptosis, and interfering with cell metabolism. In-depth studies on the biological functions of HBV X protein, immune imbalance, and HBV DNA integration will help to clarify the pathogenesis of liver cancer and promote the development of novel therapeutic targets for HBV-related HCC.

Thyroid cancer is a common head and neck malignant tumor,it has become a malignant tumor of the highest incidence in young women in China.The treatment of thyroid cancer is a surgery-based comprehensive therapy,and the protection of the parathyroid gland during surgery has always been a major problem for clinicians.The methods for protection of parathyroid glands are in situ preservation or immediate parathyroid autotransplantation according to whether or not the blood supply can be maintained.To identify the parathyroid gland is the key issue of the protection during thryoidectomy.This article reviews the recent progress of the identification and protection of parathyroid glands at home and abroad.

The TNM staging system is an essential standard for cancer treatment and evaluation, and is used to assess a patient''s prog-nosis. Therefore, every update made to the system is of great significance. According to the recently released edition of the American Joint Committee on Cancer (AJCC) Staging Manual, several major changes to head and neck cancer staging have been made. In this pa-per, we analyze the advantages and disadvantages of these amendments and offer a direction for making future amendments. Our goal is to provide a brief introduction of recent research on head and neck cancers, which can be used as a reference by clinicians.

Objective:This study evaluates the performance of chemiluminescence assay, which is designed to detect Hepatitis D Virus (HDV) Immunoglobulin G (IgG) antibodies.Methods:A comparative analysis was conducted among chemiluminescence anti-HDV IgG reagent, the magnetic particle-based domestic reagent A and domestic reagent B, and the Robo Gene HDV RNA kit, using 1909 HBsAg-positive plasma samples. This comparison aimed to delineate clinical specificity and detection accuracy. The anti-HDV IgG reagent precision was assessed at three different concentration levels following the Clinical Laboratory Standards Institute EP5-A2 guidelines. The specificity of the assay was validated using 200 HAV IgM positive, 545 HBsAg-positive but anti-HDV IgG-negative, 350 anti HCV positive plasma samples and 200 healthy human blood samples. Additionally, a concordance study was conducted with 545 HBsAg-positive and 37 anti-HDV IgG-positive plasma samples, comparing the anti-HDV IgG reagent against reagent A.Results:1 909 HBsAg-positive plasma samples were tested using 3 anti HDV IgG reagent and 1 HDV RNA reagent, 19 samples were identified as anti-HDV IgG-positive. The anti-HDV IgG demonstrated superior accuracy and specificity. The assay exhibited excellent precision, with intra-assay coefficient of variation (CV) values ranging from 1.57% to 4.30%, and inter-assay CV values between 1.71% and 4.67% for detecting samples at high, medium, and low concentration levels. Concordance with Reagent A showed consistent results in both positive and negative detections.Conclusion:In this study, the anti-HDV IgG reagent (chemiluminescence method) displayed outstanding specificity in detecting clinical samples and exhibited a high conformity rate with commercialized reagents, making it potentially suitable for screening anti-HDV IgG in HBsAg-positive samples.