Objective:To explore the feasibility of one-stage repair and reconstruction of glottic area wounds with the ventricular mucosal flap to prevent postoperative vocal cord adhesion in patients with T1b glottic laryngeal cancer.Methods:This case series study involved the research and analysis of clinical data of 12 patients with T1b glottic laryngeal cancer treated in the Department of Otorhinolaryngology, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to June 2023. All patients were male, aged 50-85 years (median age 64.5 years), and underwent CO 2 laser vocal cord resection under oral support laryngoscopy, followed by one-stage reconstruction of the glottic wound using a ventricular mucosal flap transfer. Postoperative observation indicators included oncological efficacy, surgical complications, degree of vocal cord adhesion, and vocal function, with routine follow-up conducted. The preoperative and postoperative Voice Handicap Index (VHI) scores were compared using a paired-sample Wilcoxon signed-rank test. Results:All 12 patients were followed up for more than 1 year, with follow-up periods ranging from 12 to 37 months and a median follow-up period of 19.5 months. During the follow-up period, no tumor recurrence was observed in any of the patients. One patient experienced suture detachment and displacement of the ventricular mucosal flap postoperatively, and no patient reported respiratory distress symptoms after surgery. 6 patients had no postoperative vocal cord adhesion, and the vocal cord length ratio in 12 patients was (0.80±0.23). The maximum glottic opening angle after surgery was (46.5±7.7) degrees. Voice function was evaluated before surgery and in six months postoperatively, when the laryngeal mucosa was on the stable phase. The median VHI-10 score for the 12 patients was 20 preoperatively and 10 postoperatively, the difference was statistically significant ( Z=-2.827, P<0.05). Conclusions:The application of ventricular mucosal flap repair and reconstruction for glottic wound following laser resection of T1b laryngeal cancer effectively prevents postoperative vocal cord adhesion. The postoperative recovery of vocal function in these patients is favorable.

Objective:To explore and summarize the morphological features of laryngeal tuberculosis under electronic laryngoscopy and image-enhanced endoscopy (i-scan).Methods:A retrospective analysis was conducted on the data of 31 patients diagnosed with laryngeal tuberculosis at the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to June 2024, encompassing the morphological features of electronic laryngoscopy and i-scan endoscopy, histopathological features, and supplementary clinical examination results. Descriptive statistical methods were employed for the analysis.Results:Thirty-one patients were diagnosed with laryngeal tuberculosis, including 25 males and 6 females, aged from 21 to 84 years old, with an average age of 57 years old, and the disease course was from 1 to 12 months with an average of 3 months. The clinical symptoms included hoarseness in 27 cases, foreign body sensation in the pharynx in 2 cases, and sore throat in 2 cases. Twenty-six cases involved a single site, including 24 cases of the vocal cords, 1 case of the ventricular bands, and 1 case of the epiglottis; 5 cases involved multiple sites, including 2 cases of the vocal cords and the interarytenoid area, 2 cases of the aryepiglottic fold and the epiglottis, and 1 case of the aryepiglottic fold, the ventricular bands and the epiglottis. Eighteen patients showed a single morphology type under electronic laryngoscopy, including 4 cases of the edematous exudative type, 5 cases of the ulcerative type, and 9 cases of the granulation hyperplasia type. Edema, ulcer, and granulation hyperplasia can coexist and transit between each other. A total of 13 cases presented with two or more morphological types, with the edematous exudative type, the ulcerative type, and the granulation hyperplasia type occurred 7, 9, and 10 times respectively. Twenty-two patients had active or chronic pulmonary tuberculosis, while 9 patients had normal lung imaging. The laryngeal tissue biopsy pathology of 21 patients was chronic granuloma, and 10 patients were chronic granuloma with caseous necrosis; among them, 19 cases completed the Ziel-Neelsen staining (7 cases were positive for acid-fast bacilli), and 3 cases completed the polymerase chain reaction (PCR) (All were positive). Twenty cases completed the T-cell assay for tuberculosis infection (19 cases were positive), 15 cases completed the sputum smear (6 cases were positive), 18 cases were tested for antinuclear antibody (6 cases were positive), and 14 cases completed the erythrocyte sedimentation rate (4 cases were positive). Six patients underwent i-scan examination. In cases of ulcerative laryngeal tuberculosis without granulation hyperplasia in the surrounding tissues, i-scan revealed an abundance of abundant slightly thickened and tortuous oblique and dendritic blood vessels around the ulcer. If the pseudomembrane in the deep ulcer was thick, the blood vessel shadow was not visible. In shallow ulcers, there were areas of deep congestion and scattered dot-shaped blood vessel shadowst with uneven distribution; in cases of laryngeal tuberculosis with coexistence of the edematous exudative type and the granuloma type, i-scan visualized laryngeal cord edema with white exudates on the surface. Beneath the laryngeal cord exudates, there were scattered dot-shaped and irregularly distorted linear blood vessel shadows with uneven distribution, and tortuous, oblique, and dendritic blood vessels were observed around the lesion. In granuloma-type laryngeal tuberculosis, i-scan demonstrated that the area of granulation hyperplasia around the ulcer focus was significantly congested, characterized by scattered thick dot-shaped blood vessel shadows and irregularly distorted linear blood vessel shadows.Conclusions:Laryngeal tuberculosis presents as the edematous exudative type, the ulcerative type, and the granulation hyperplasia type under electronic laryngoscopy, and these types can coexist and interact. i-scan endoscopy can reveal detailed microvascular morphology and other subtle morphological characteristics. The identification and summary of these morphological characteristics are beneficial for the early detection and diagnosis of laryngeal tuberculosis.

Objective:To explore the feasibility of one-stage repair and reconstruction of glottic area wounds with the ventricular mucosal flap to prevent postoperative vocal cord adhesion in patients with T1b glottic laryngeal cancer.Methods:This case series study involved the research and analysis of clinical data of 12 patients with T1b glottic laryngeal cancer treated in the Department of Otorhinolaryngology, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to June 2023. All patients were male, aged 50-85 years (median age 64.5 years), and underwent CO 2 laser vocal cord resection under oral support laryngoscopy, followed by one-stage reconstruction of the glottic wound using a ventricular mucosal flap transfer. Postoperative observation indicators included oncological efficacy, surgical complications, degree of vocal cord adhesion, and vocal function, with routine follow-up conducted. The preoperative and postoperative Voice Handicap Index (VHI) scores were compared using a paired-sample Wilcoxon signed-rank test. Results:All 12 patients were followed up for more than 1 year, with follow-up periods ranging from 12 to 37 months and a median follow-up period of 19.5 months. During the follow-up period, no tumor recurrence was observed in any of the patients. One patient experienced suture detachment and displacement of the ventricular mucosal flap postoperatively, and no patient reported respiratory distress symptoms after surgery. 6 patients had no postoperative vocal cord adhesion, and the vocal cord length ratio in 12 patients was (0.80±0.23). The maximum glottic opening angle after surgery was (46.5±7.7) degrees. Voice function was evaluated before surgery and in six months postoperatively, when the laryngeal mucosa was on the stable phase. The median VHI-10 score for the 12 patients was 20 preoperatively and 10 postoperatively, the difference was statistically significant ( Z=-2.827, P<0.05). Conclusions:The application of ventricular mucosal flap repair and reconstruction for glottic wound following laser resection of T1b laryngeal cancer effectively prevents postoperative vocal cord adhesion. The postoperative recovery of vocal function in these patients is favorable.

Objective:To explore and summarize the morphological features of laryngeal tuberculosis under electronic laryngoscopy and image-enhanced endoscopy (i-scan).Methods:A retrospective analysis was conducted on the data of 31 patients diagnosed with laryngeal tuberculosis at the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2014 to June 2024, encompassing the morphological features of electronic laryngoscopy and i-scan endoscopy, histopathological features, and supplementary clinical examination results. Descriptive statistical methods were employed for the analysis.Results:Thirty-one patients were diagnosed with laryngeal tuberculosis, including 25 males and 6 females, aged from 21 to 84 years old, with an average age of 57 years old, and the disease course was from 1 to 12 months with an average of 3 months. The clinical symptoms included hoarseness in 27 cases, foreign body sensation in the pharynx in 2 cases, and sore throat in 2 cases. Twenty-six cases involved a single site, including 24 cases of the vocal cords, 1 case of the ventricular bands, and 1 case of the epiglottis; 5 cases involved multiple sites, including 2 cases of the vocal cords and the interarytenoid area, 2 cases of the aryepiglottic fold and the epiglottis, and 1 case of the aryepiglottic fold, the ventricular bands and the epiglottis. Eighteen patients showed a single morphology type under electronic laryngoscopy, including 4 cases of the edematous exudative type, 5 cases of the ulcerative type, and 9 cases of the granulation hyperplasia type. Edema, ulcer, and granulation hyperplasia can coexist and transit between each other. A total of 13 cases presented with two or more morphological types, with the edematous exudative type, the ulcerative type, and the granulation hyperplasia type occurred 7, 9, and 10 times respectively. Twenty-two patients had active or chronic pulmonary tuberculosis, while 9 patients had normal lung imaging. The laryngeal tissue biopsy pathology of 21 patients was chronic granuloma, and 10 patients were chronic granuloma with caseous necrosis; among them, 19 cases completed the Ziel-Neelsen staining (7 cases were positive for acid-fast bacilli), and 3 cases completed the polymerase chain reaction (PCR) (All were positive). Twenty cases completed the T-cell assay for tuberculosis infection (19 cases were positive), 15 cases completed the sputum smear (6 cases were positive), 18 cases were tested for antinuclear antibody (6 cases were positive), and 14 cases completed the erythrocyte sedimentation rate (4 cases were positive). Six patients underwent i-scan examination. In cases of ulcerative laryngeal tuberculosis without granulation hyperplasia in the surrounding tissues, i-scan revealed an abundance of abundant slightly thickened and tortuous oblique and dendritic blood vessels around the ulcer. If the pseudomembrane in the deep ulcer was thick, the blood vessel shadow was not visible. In shallow ulcers, there were areas of deep congestion and scattered dot-shaped blood vessel shadowst with uneven distribution; in cases of laryngeal tuberculosis with coexistence of the edematous exudative type and the granuloma type, i-scan visualized laryngeal cord edema with white exudates on the surface. Beneath the laryngeal cord exudates, there were scattered dot-shaped and irregularly distorted linear blood vessel shadows with uneven distribution, and tortuous, oblique, and dendritic blood vessels were observed around the lesion. In granuloma-type laryngeal tuberculosis, i-scan demonstrated that the area of granulation hyperplasia around the ulcer focus was significantly congested, characterized by scattered thick dot-shaped blood vessel shadows and irregularly distorted linear blood vessel shadows.Conclusions:Laryngeal tuberculosis presents as the edematous exudative type, the ulcerative type, and the granulation hyperplasia type under electronic laryngoscopy, and these types can coexist and interact. i-scan endoscopy can reveal detailed microvascular morphology and other subtle morphological characteristics. The identification and summary of these morphological characteristics are beneficial for the early detection and diagnosis of laryngeal tuberculosis.

Objective:To evaluate the clinical value of high-definition intelligent endoscopy (iSCAN) combined with stroboscopy in identifying vocal cord leukoplakia.Methods:Seventy-nine patients with vocal cord leukoplakia who underwent CO 2 laser laryngeal microsurgery and diagnosed by histopathology were recruited between October 2020 to August 2021. The morphological features, microvascular morphology and mucosal waves were observed by stroboscope; SPSS 20.0 software was used for statistical analysis. Results:There were 79 patients with a total of 119 lesions (56 on left and 63 on right).Pathological examination showed that 51 sides of the vocal cords were malignant lesions (severe dysplasia, carcinoma in situ and invasive carcinoma), and 68 sides were benign lesions.Under stroboscopy, 69 sides of mucosal wave were normal or slightly decreased, and 50 sides were severely decreased or disappeared.The decrease degree of mucosal wave was positively correlated with malignant lesions ( ρ=0.687, P<0.001).Under iSCAN endoscopy, there was a positive correlation between the morphological changes of microvessels at the lesion site (vertical) and the malignant lesion ( ρ=0.687, P<0.001).Univariate analysis showed that lesion size, thickness, uneven color, granular elevation, peripheral erythema and asymmetry were positively correlated with malignant lesions ( ρ=0.530, 0.401, 0.538, 0.315, 0.497, 0.281, P<0.05).Logistic regression analysis showed that the risk of pathological malignancy with large lesions was 5.437 times higher than those of small lesions, the vertical vascular changes under iSCAN were 8.711 times higher than that of normal vascular morphology, and the severe reduction or disappearance of mucosal waves was 9.12 times higher than that of normal or mild reduction of mucosal waves. Conclusion:ISCAN can be combined with staphyloscopy to comprehensively observe and evaluate the changes of vocal cord morphology, submucosal microvessels and mucosal wave of vocal cord in patients with vocal cord leukoplosis, thus improving the ability to distinguish benign and malignant lesions.

AIM:To investigate the effect of phosphodiesterase 4 (PDE4) inhibitor rolipram on the levels of cyclic adenosine monophosphate (cAMP), protein kinase A (PKA), cAMP response element-binding protein (CREB), phosphorylated CREB (p-CREB) and brain-derived neurotrophic factor (BDNF) in the hippocampus and the prefrontal cortex (PFC) of alcoholism model mice.METHODS:The mice (n=60) were randomly divided into control group , con-trol+rolipram group, alcoholism model group, and alcohol +rolipram (0.1, 0.5 and 1 mg/kg) groups.The mice were given alcohol preference test on days 6, 13, 20 and 27.After the test, the mice received withdrawal of alcohol for 1 d.On day 28, the mice were given behavior test of depression , and after the test, the mice were sacrificed.The cAMP levels in the hippocampus and PFC were detected by ELISA , and the protein levels of PKA , CREB, p-CREB and BDNF were detec-ted by Western blot.RESULTS:The mice showed an obvious drinking phenomenon (P<0.01), and the immobility time of forced swimming test and tail suspension test was significantly increased (P<0.01), with increasing drinking days and withdrawal times .However , chronic treatment with rolipram for 28 d reversed this phenomenon .Moreover , the cAMP lev-els in the hippocampus and PFC were significantly decreased after 28 d alcohol treatment ( P<0.01 ) , and pretreatment with rolipram (1 mg/kg) obviously reversed this decrease (P<0.01).Parallel to these changes of cAMP , the protein lev-els of PKA, p-CREB and BDNF were also decreased in the hippocampus and PFC (P<0.01), and 28 d rolipram adminis-tration inhibited the decreased cAMP , PKA, p-CREB and BDNF levels in the hippocampus .Moreover, 28 d rolipram ad-ministration also reversed decreased cAMP , PKA and p-CREB in the PFC.CONCLUSION:Rolipram treatment protects against alcohol-induced depression-like behaviors , and also reduces alcohol drinking .These effects may be related to PDE4-cAMP-PKA-CREB-BDNF pathway .

OBJECTIVE To investigate the effect of ferulic acid(FA)on motor function of rats with a spinal cord injury model(SCI)and its possible effects on expression of microtubule-associated protein light chain 3(LC3),Beclin1,Bcl-2 and Bax. METHODS SD rats were randomly divided into 3 groups:sham group,SCI group,FA(100 mg·kg-1,po)group. Rats were subjected to moderate contusion inju?ries using a vascular clip for 2 min to establish an SCI animal model beforfe they were given BBB scores and inclined plate scoring function test on 6 h,1,3,7 and 14 d after SCI. After the test,rats were sacrificed. Spinal cords were observed by hematoxylin eosin(HE)staining. Furthermore,the expressions of LC3,Beclin1,Bcl-2 and Bax were detected by Western blotting. RESULTS Compared with the sham group,BBB scores and inclined plate function scores significantly decreased in model group. The BBB scores decreased from 21 in sham group to(0.5±0.5)in SCI group,and inclined plate function scores decreased from 70° in sham group to(5.8±2.0)° in SCI group. However,this was reversed by FA treatment. BBB scores and inclined plate function scores increased from 3.0 ± 1.7 to 6.2 ± 3.6(P<0.05)and from (13.3 ± 4.1)° to(26.7 ± 8.7)°(P<0.05)after FA was po given for 7 d,respectively. HE staining showed the gradual emergence of internal spinal cord edema,while the structural changes associated with spinal cord injury could be significantly reversed by administration of FA. Moreover,the expression of LC3-Ⅱ/LC3-Ⅰand Beclin1 was significantly increased in SCI 1 d group(P<0.01),but was decreased in 14 d group when compared with SCI 1 d group(P<0.05). The expression of Bcl-2 was increased in SCI 14 d group,and the ratio of Bcl-2/Bax was increased on 14 d after SCI(P<0.05). Compared with the SCI group,LC3-Ⅱ/LC3-Ⅰand Beclin1 expression was increased in FA-treated 1 d group(P<0.05),Bcl-2 expression was increased in FA-treated 14 d group and the ratio of Bcl-2/Bax was significantly increased on 14 d after SCI(P<0.05). CONCLUSION FA has a therapeutic effect on SCI,which may be related to the impact of neuronal autophagy and apoptosis. Meanwhile,autophagy of SCI may be a process of gradual enhancement followed by weakening,and the anti-apoptosis effect may gradually increase with autophagy.

Objective To explore the effect of the gargled astragalus water decoction as the adjuvant therapy on serum CD14, TNF-αand IL-8 levels in patients with acute suppurative pulpitis.Methods 42 patients who were diagnosed with acute suppurative pulpitis in our hospital were collected. All patients were randomly divided into experimental group and control group, 21 cases in each group.Patients in the control group received conventional therapy, while patients in the experimental group were given the additional adjuvant therapy that gargled with astragalus water decoction.After the treatment, the serum levels of CD14,TNF-αand IL-8 were detected in all patients.Results After treatment, the serum levels of CD14, TNF-αand IL-8 in the experimental group were statistically lower than control group ( P<0.05 ) .Conclusion The gargled with astragalus water decoction as the adjuvant therapy could significantly reduce the serum CD14,TNF-αand IL-8 levels in patients with acute suppurative pulpitis,and it could obviously relieve inflammation.

T1 glottic carcinoma is part of early laryngeal carcinoma which involves the vocal cords, including anterior commissure or posterior commissure. We analyzed the treatment options of T1 glottic carcinoma by reviewing the related literatures about T1 glottic carcinoma treated by conservative surgery (open surgery and laser microsurgery), radiotherapy, robot surgery, photodynamic treatment.
Glottis ; pathology ; Humans ; Laryngeal Neoplasms ; surgery ; therapy ; Laser Therapy ; Microsurgery ; Vocal Cords