Objective:To explore the differences in quality of life among patients with olfaction disorders (OD) due to various etiologies and to identify factors influencing olfactory-related quality of life.Methods:This cross-sectional study enrolled patients with OD who visited the Department of Otolaryngology at Fudan University Eye, Ear, Nose, and Throat Hospital between February and June 2024. Psychophysical olfactory test was performed using the Chinese Smell Identification Test (CSIT), which was based on the Chinese population, with the TDI score used as the total score for threshold (T), discrimination (D), and identification (I) tests. The quality of life related to OD was assessed using a brief version of the Questionnaire of Olfactory Disorders (bQOD), which included QOD-P, QOD-Q, and QOD-VAS. Visual analog scales (VAS) was used to rate the degree of subjective decline in olfaction. Statistical analysis was conducted to assess the impact of etiologies, age, gender, onset time, psychophysical olfactory tests, and subjective assessment on olfactory-related quality of life.Results:A total of 419 patients were enrolled, including 220 males and 199 females, with the age of (39.72±14.31) years (range: 5 to 76 years). Among the 419 patients, 380 completed the bQOD and VAS assessment. The results showed that there were intergroup differences in the QOD-P and QOD-Q scores among patients with OD caused by different etiologies ( P values were 0.001 and 0.003, respectively). The QOD-P score was negatively correlated with age ( P<0.05), and positively correlated with the TDI score ( P<0.01). The QOD-Q score was negatively correlated with disease duration ( P<0.05), and positively correlated with the patients′ subjective olfactory decline as assessed by the VAS score ( P<0.01), and had no significant correlation with psychophysical olfactory tests. Female patients had lower QOD-Q scores than male patients ( P<0.05). The QOD-VAS score was positively correlated with the patients′ subjective olfactory impairment ( P<0.01) and showed no significant correlation with psychophysical olfactory tests. Female patients had worse QOD-VAS scores than male patients ( P<0.05). Conclusion:Compared with psychophysical olfactory tests, VAS olfactory scores are more closely related to quality of life. Different etiologies, duration of the disease, and gender also affect olfactory-related quality of life.

Objective:To investigate the role of Ym2 in olfactory epithelium homeostasis and olfactory behavior.Methods:Differential expression of Ym2 in the olfactory epithelium of young and aged mice was analyzed using single-cell RNA sequencing. Ym2 and related genes in the aged olfactory epithelium were identified, and their biological function was analyzed by GO enrichment analysis. The expression of Ym2 and Ym2-related genes in the young and aged olfactory epithelium was detected by immunostaining and RNAscope in situ hybridization. Buried food pullet test was used to assess the impact of Ym2 knockout on olfactory function, while immunostaining was used to evalute the effect of Ym2 knockout of on the homeostasis of olfactory epithelium. Statistical analysis was performed using GraphPad Prism 8.0.1 software.Results:Single-cell RNA sequencing revealed that Ym2 was highly expressed in multiple cell types, including horizontal basal cells and respiratory ciliated cells of the olfactory epithelium in aged mice compared to young animals. In situ hybridization and immunostaining data showed that Ym2 mRNA level were higher in the aged olfactory epithelium than that in the young tissue ( t=4.50, P<0.001). At the protein level, Ym2 expression was higher in horizontal basal cells ( t=3.03, P<0.05) and supporting cells ( t=7.76, P<0.001) of the aged epithelium compared to the young tissue. Additionally, the mRNA levels of the two Ym2-related genes, Alox15 and Cxcl5, were also higher in the aged olfactory epithelium ( t=2.72 and 2.68, respectively, both P<0.05). Behavioral testing showed that Ym2-/- mice took significantly longer to find buried food pellets compared to wild-type (WT) mice ( t=2.35, P<0.05). Histological analysis revealed a significant reduction in the number of olfactory sensory neurons and supporting cells in the olfactory epithelium of Ym2-/- mice compared to WT mice ( t=5.86 and 3.69, respectively, both P<0.01). Conclusions:Ym2 plays a critical role in smell perception. Ym2 knockout leads to reduction in the number of olfactory epithelial cell and impairs olfactory behavior of food-searching in young mice.

Objective:To explore the differences in quality of life among patients with olfaction disorders (OD) due to various etiologies and to identify factors influencing olfactory-related quality of life.Methods:This cross-sectional study enrolled patients with OD who visited the Department of Otolaryngology at Fudan University Eye, Ear, Nose, and Throat Hospital between February and June 2024. Psychophysical olfactory test was performed using the Chinese Smell Identification Test (CSIT), which was based on the Chinese population, with the TDI score used as the total score for threshold (T), discrimination (D), and identification (I) tests. The quality of life related to OD was assessed using a brief version of the Questionnaire of Olfactory Disorders (bQOD), which included QOD-P, QOD-Q, and QOD-VAS. Visual analog scales (VAS) was used to rate the degree of subjective decline in olfaction. Statistical analysis was conducted to assess the impact of etiologies, age, gender, onset time, psychophysical olfactory tests, and subjective assessment on olfactory-related quality of life.Results:A total of 419 patients were enrolled, including 220 males and 199 females, with the age of (39.72±14.31) years (range: 5 to 76 years). Among the 419 patients, 380 completed the bQOD and VAS assessment. The results showed that there were intergroup differences in the QOD-P and QOD-Q scores among patients with OD caused by different etiologies ( P values were 0.001 and 0.003, respectively). The QOD-P score was negatively correlated with age ( P<0.05), and positively correlated with the TDI score ( P<0.01). The QOD-Q score was negatively correlated with disease duration ( P<0.05), and positively correlated with the patients′ subjective olfactory decline as assessed by the VAS score ( P<0.01), and had no significant correlation with psychophysical olfactory tests. Female patients had lower QOD-Q scores than male patients ( P<0.05). The QOD-VAS score was positively correlated with the patients′ subjective olfactory impairment ( P<0.01) and showed no significant correlation with psychophysical olfactory tests. Female patients had worse QOD-VAS scores than male patients ( P<0.05). Conclusion:Compared with psychophysical olfactory tests, VAS olfactory scores are more closely related to quality of life. Different etiologies, duration of the disease, and gender also affect olfactory-related quality of life.

Objective:To investigate the role of Ym2 in olfactory epithelium homeostasis and olfactory behavior.Methods:Differential expression of Ym2 in the olfactory epithelium of young and aged mice was analyzed using single-cell RNA sequencing. Ym2 and related genes in the aged olfactory epithelium were identified, and their biological function was analyzed by GO enrichment analysis. The expression of Ym2 and Ym2-related genes in the young and aged olfactory epithelium was detected by immunostaining and RNAscope in situ hybridization. Buried food pullet test was used to assess the impact of Ym2 knockout on olfactory function, while immunostaining was used to evalute the effect of Ym2 knockout of on the homeostasis of olfactory epithelium. Statistical analysis was performed using GraphPad Prism 8.0.1 software.Results:Single-cell RNA sequencing revealed that Ym2 was highly expressed in multiple cell types, including horizontal basal cells and respiratory ciliated cells of the olfactory epithelium in aged mice compared to young animals. In situ hybridization and immunostaining data showed that Ym2 mRNA level were higher in the aged olfactory epithelium than that in the young tissue ( t=4.50, P<0.001). At the protein level, Ym2 expression was higher in horizontal basal cells ( t=3.03, P<0.05) and supporting cells ( t=7.76, P<0.001) of the aged epithelium compared to the young tissue. Additionally, the mRNA levels of the two Ym2-related genes, Alox15 and Cxcl5, were also higher in the aged olfactory epithelium ( t=2.72 and 2.68, respectively, both P<0.05). Behavioral testing showed that Ym2-/- mice took significantly longer to find buried food pellets compared to wild-type (WT) mice ( t=2.35, P<0.05). Histological analysis revealed a significant reduction in the number of olfactory sensory neurons and supporting cells in the olfactory epithelium of Ym2-/- mice compared to WT mice ( t=5.86 and 3.69, respectively, both P<0.01). Conclusions:Ym2 plays a critical role in smell perception. Ym2 knockout leads to reduction in the number of olfactory epithelial cell and impairs olfactory behavior of food-searching in young mice.

Objective:To investigate the distribution and primary drainage sites of the venous drainage system in the pedicled nasal septal mucosal flap, as well as to examine protective measures for the venous system of the nasal septal mucosal flap and its application in repairing the nasal skull base through the anatomical study of the nasal septum mucosal venous system in cadavers.Methods:Gross anatomy dissections were performed on 13 sides perfused fresh frozen cadaveric head specimens. The nasal septum mucosal flap was separated along the perichondrium and subperiosteum, then passed across the vomer, anterior wall of sphenoid sinus, clivus, and towards the anterior edge of vertical plate of palatine bone. Detailed documentation, including photographs, was made to record the morphology, distribution and drainage location of veins of the nasal septum mucosal flap and its pedicle, along with number of sphenopalatine veins. Furthermore, venous injuries resulting from obtaining a pedicled nasal septal mucosa flap were observed. From March 2023 to March 2024, a retrospective analysis was conducted on patients with nasopharyngeal lesions who underwent surgical repair using a modified pedicled nasal septum mucosal flap for venous system protection in the ENT institute and Department of Otorhinolaryngology at the Eye & ENT Hospital of Fudan University. The postoperative endoscopy was employed to assess the viability of the mucosal flap.Results:The veins of the nasal septum mucosa were primarily located in the posterior region, including the vomerine region, anterior wall of the sphenoid sinus, clivus region, and posterolateral wall of the nasal cavity, in a reticular pattern. Perforating veins draining into these bony structures could be observed, although their quantity and morphology varied. Notably, no prominent sphenopalatine veins were identified in 10 specimens examined, while 3 specimens exhibited sphenopalatine veins: one with a small single branch and two with venous bundles. Preservation of the nasal septal vein was possible when dissection was limited to the anterior edge of the wing of vomer. A wider range of dissection increased the risk of veinous injury. In cases where only vascular pedicles at the sphenopalatine foramen were preserved, three cadaveric head specimens retained intact sphenopalatine veins, while drainage veins were completely destroyed in ten other specimens. Fifteen patients with unilateral lesions (8 with recurrent nasopharyngeal carcinoma and 7 with nasopharyngeal radionecrosis) were included in this study. The postoperative reconstructions were carried out using contralateral pedicled nasal septal mucosal flaps. The average follow-up time was 7 months (ranging from 3 to 12 months), and all the nasal septal mucosal flaps survived.Conclusions:The primary location of the drainage vein within the nasal septum mucosa is situated in its posterior region, where it penetrates into adjacent bone structures. Very few sphenopalatine veins pass through the sphenopalatine foramen. Extensive dissection of the pedicled nasal septal mucosal flap may potentially impair the venous system and adversely affect flap survival rates, necessitating further clinical exploration.

Objective To evaluate the application of immediate resection after interventional embolization in treating hypervascular nasal skull base tumors.Methods The clinical data of 25 patients with hypervascular nasal skull base tumors,who were treated at the Affiliated Eye ENT Hospital of Fudan University of China from December 2020 to June 2022,were retrospectively analyzed.All patients underwent tumor surgical resection immediately after interventional embolization on the same day of admission.The success rate of embolization,incidence of complications,amount of blood loss during resection,tumor resection condition and prognosis were analyzed.Results Successful immediate surgical resection after interventional embolization was accomplished in all the 25 patients.Arterial approach was used for the interventional embolization,which was successfully performed under general anesthesia(n=19)or local anesthesia(n=6).No embolization-related complications occurred.The tumor resection was successfully accomplished under nasal endoscopy,endoscopy-guided translabial-gingival crevicular incision,or under oral endoscopy.No resection-related complications occurred.The median amount of blood loss during resection was 844 mL(range of 100-2 000 mL).Conclusion For the treatment of hypervascular nasal skull base tumors,immediate surgical resection after interventional embolization is clinically safe and feasible,and this therapeutic method is worthy of clinical promotion.

OBJECTIVE To accurately identify the rare adverse drug reactions （ADR） of vancomycin-pancytopenia in order to promote its safe use. METHODS Through a case report of a child with suppurative hip arthritis who developed pancytopenia combined with delayed drug fever caused by intravenous infusion of vancomycin，Naranjo score method and related literature were used to summarize the association between the ADR and vancomycin and its possible mechanism， and suggestions for rational use of vancomycin in pediatric patients were put forward. RESULTS & CONCLUSIONS The association of pancytopenia combined with delayed drug fever and vancomycin in this child is “very likely”. In clinical practice， it is difficult to distinguish between pancytopenia combined with delayed drug fever from fever and hematopenia caused by aggravation of infection. Medical staff should increase their awareness of vancomycin rare ADR such as pancytopenia， and pharmacists should assist medical staff in timely screening for ADR. The initial dose of vancomycin infusion for children should start from 60 mg/（kg·d），and the blood concentration should be monitored 48 h after the first infusion and the dose should be adjusted in time to maintain the valley concentration of vancomycin at 5-15 mg/L to prevent the occurrence of ADR caused by excessive blood concentration. For children who have been using vancomycin for more than one week，the blood routine should be rechecked regularly. Once pancytopenia occurs，the drug should be stopped immediately，and symptomatic treatment should be given according to the situation.

Objective:To assess the prognosis of sinonasal adenoid cystic carcinoma with hard palatine invasion treated by transnasal endoscopic total maxillectomy. Methods:Clinical data of twenty-six patients with sinonasal adenoid cystic carcinoma invading hard palatine treated by transnasal endoscopic total maxillectomy between May 2014 and December 2020 was analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Cox regression was used to investigate the prognosis factors. Masticatory function after maxillectomy has also been assessed using the questionnaire of patients' satisfaction about masticatory function. Results:Margins in 8 patients（30%） were positive. The median time of follow-up was 38 months（6 to 85 months）. Twenty-five patients recurred. Four patients died of distant metastasis. The 5-year overall survival rate and relapse-free survival rate was 79.5% and 89.1%, respectively. Independent predictors of outcome on multivariate analysis were positive margin（P=0.018）, recurrence（P=0.006） and distant metastasis（P=0.04）. Conclusion:Transnasal endoscopic total maxillectomy could be performed for the treatment of the sinonasal adenoid cystic carcinoma with hard palatine invasion. Positive margin, local recurrence and distant metastasis were important predictors for patients' prognosis.
Humans ; Carcinoma, Adenoid Cystic/pathology* ; Paranasal Sinus Neoplasms/pathology* ; Retrospective Studies ; Neoplasm Recurrence, Local/pathology* ; Prognosis

OBJECTIVE To learn from the self-medication tax system in Japan and improve over-the-counter drug cost sharing mechanism in China. METHODS By searching relevant policies and literature ，the evolution ，specific contents ，current situation and effects of Japanese self-medication tax system were summarized. Recommendations were put forward in the light of the actual situation of over-the-counter drug guarantee in China. RESULTS & CONCLUSIONS Japan has implemented the self-medication tax system since 2017. The Ministry of Health ， Labour and Welfare has made clear provisions on the preconditions for applying for the tax system and the deduction standards of the tax system ，and established a list of drugs to be responsible for the regular inclusion and discharge of the drugs under the tax system. The self- medication tax system has a remarkable effect in promoting the self-health management ，disease prevention and reducing medical expenses of Japanese residents. Our country can learn from the self-medication tax system in Japan and the experience of implementing the special deduction system for major medical conditions in China. To promote rational self-medication ，it is advisable to add a special deduction system for over-the-counter drugs into deductions in personal income tax and formulate the criteria and scope of application ，and establish a special list of over-the-counter drugs，thereby reducing the heavy burden of medical expenses of residents ，and exploring a new way to share the costs of over-the-counter drugs which is applicable to our national conditions.

Nasopharyngeal carcinoma (NPC) is a common malignant tumor in China. Radiotherapy is the first-line treatment. After appropriate radiotherapy, about 5%-15% patients experience recurrence. In view of the poor efficacy and high incidence of severe late toxicities associated with re-irradiation, salvage surgery by the transnasal endoscopic approach is recommended for recurrent NPC (rNPC). Compared with re-irradiation, endoscopic surgery can better prolong survival, improve the quality of life, and reduce complications and medical expenses of patients with rNPC. However, the complexity of the nasopharyngeal skull base enhances the difficulty and risk of surgery. Expanding the boundary of surgical resection remains a clinical challenge for otolaryngologists. In this regard, to help more advanced patients with rNPC, the surgical innovative system of NPC needs to be established by multi-disciplinary cooperation, involving skull base anatomy-based investigation, appropriate administration of the internal carotid artery (ICA), repair of skull base defect, and establishment of various types of endoscopic endonasal nasopharyngectomy.