Objective:To investigate the diagnosis and strategy of individualized functional rhinoplasty based on the overall evaluation of the nasal cavity as a integration.Methods:A prospective study was carried out in the patients who underwent endoscopic functional rhinoplasty at the Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University from February 2018 to August 2021. The overall evaluation of the internal and external structure and function of the nasal cavity was performed before surgery, and the individualized surgical strategies were developed. According to the surgical strategy, nasal septum correction, inferior turbinate ablation, inferior turbinate fracture displacement, inferior turbinate submucous resection, dorsal extended cartilage graft, crooked nose correction, prosthesis or autologous cartilage implantation, hump reduction and osteotomy were performed to adjust the nasal function and aesthetics. Internal nasal valve (INV) angle, INV collapse grade, INV cross-sectional area, and external nasal valve effectiveness (ENVE) index were used to evaluate the structure of nasal valve area. Nasal obstruction symptom assessment (NOSE) scale and nasal resistance [including total nasal resistance (RT), nasal resistance differential ratio (R 1r)] was used to evaluate nasal ventilation function. Facial clinimetric evaluation questionnaire rhinoplasty module (FACE-Q RM), rhinoplasty outcome evaluation (ROE) scale, external nasal subunit measurement was used to evaluate nasal appearance, and self-rating depression scale (SDS) and self-rating anxiety scale (SAS) was used to evaluate psychological status. Finally, the correlation between patient satisfaction and subjective and objective parameters were analyzed. The data before and after operation were compared by paired t-test. Correlation was tested by Pearson analysis. Results:A total of 50 patients were included, including 18 males and 32 females, ranging in age from 23 to 52 years, mean age 35.7 years. All patients had symptoms of nasal congestion, of which 28 cases with crooked nose deformity, 12 cases with nasal valve stenosis, 6 cases with saddle nose deformity, and 4 cases with hump nose. Compared with preoperative, postoperative INV angle was significantly increased, INV collapse grade was decreased, INV cross-sectional area was increased, ENVE index was increased ( P<0.05). After operation, the NOSE score decreased, and nasal resistance showed that RT and R 1r decreased, indicating that nasal congestion symptoms were relieved significantly ( P<0.05). The postoperative FACE-Q RM and ROE scores increased, indicating that patients’ nasal appearance satisfaction increased ( P<0.05), external nasal subunit measurement showed that the upper nasal alar width and lower nasal alar angle were reduced ( P<0.05), the measured value of residual structure has no significant change. Postoperative SDS and SAS scores were significantly lower than preoperative ones, and the difference was statistically significant ( P<0.05).Overall satisfaction was improved( P<0.05). Pearson correlation analysis showed that patient satisfaction was positively correlated with INV angle, INV cross-sectional area, ENVE index, and subjective nasal shape score (FACE-Q RM, ROE), and negatively correlated with INV collapse grade, NOSE score, and nasal resistance measurement, but had no correlation with external nasal subunit measurement. Conclusion:Combined with the overall evaluation of nasal structure, nasal ventilation function and external nasal aesthetics, it is beneficial to develop the diagnosis and treatment strategy of individualized functional rhinoplasty, so as to improve patient satisfaction.

Objective:To investigate the diagnosis and strategy of individualized functional rhinoplasty based on the overall evaluation of the nasal cavity as a integration.Methods:A prospective study was carried out in the patients who underwent endoscopic functional rhinoplasty at the Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University from February 2018 to August 2021. The overall evaluation of the internal and external structure and function of the nasal cavity was performed before surgery, and the individualized surgical strategies were developed. According to the surgical strategy, nasal septum correction, inferior turbinate ablation, inferior turbinate fracture displacement, inferior turbinate submucous resection, dorsal extended cartilage graft, crooked nose correction, prosthesis or autologous cartilage implantation, hump reduction and osteotomy were performed to adjust the nasal function and aesthetics. Internal nasal valve (INV) angle, INV collapse grade, INV cross-sectional area, and external nasal valve effectiveness (ENVE) index were used to evaluate the structure of nasal valve area. Nasal obstruction symptom assessment (NOSE) scale and nasal resistance [including total nasal resistance (RT), nasal resistance differential ratio (R 1r)] was used to evaluate nasal ventilation function. Facial clinimetric evaluation questionnaire rhinoplasty module (FACE-Q RM), rhinoplasty outcome evaluation (ROE) scale, external nasal subunit measurement was used to evaluate nasal appearance, and self-rating depression scale (SDS) and self-rating anxiety scale (SAS) was used to evaluate psychological status. Finally, the correlation between patient satisfaction and subjective and objective parameters were analyzed. The data before and after operation were compared by paired t-test. Correlation was tested by Pearson analysis. Results:A total of 50 patients were included, including 18 males and 32 females, ranging in age from 23 to 52 years, mean age 35.7 years. All patients had symptoms of nasal congestion, of which 28 cases with crooked nose deformity, 12 cases with nasal valve stenosis, 6 cases with saddle nose deformity, and 4 cases with hump nose. Compared with preoperative, postoperative INV angle was significantly increased, INV collapse grade was decreased, INV cross-sectional area was increased, ENVE index was increased ( P<0.05). After operation, the NOSE score decreased, and nasal resistance showed that RT and R 1r decreased, indicating that nasal congestion symptoms were relieved significantly ( P<0.05). The postoperative FACE-Q RM and ROE scores increased, indicating that patients’ nasal appearance satisfaction increased ( P<0.05), external nasal subunit measurement showed that the upper nasal alar width and lower nasal alar angle were reduced ( P<0.05), the measured value of residual structure has no significant change. Postoperative SDS and SAS scores were significantly lower than preoperative ones, and the difference was statistically significant ( P<0.05).Overall satisfaction was improved( P<0.05). Pearson correlation analysis showed that patient satisfaction was positively correlated with INV angle, INV cross-sectional area, ENVE index, and subjective nasal shape score (FACE-Q RM, ROE), and negatively correlated with INV collapse grade, NOSE score, and nasal resistance measurement, but had no correlation with external nasal subunit measurement. Conclusion:Combined with the overall evaluation of nasal structure, nasal ventilation function and external nasal aesthetics, it is beneficial to develop the diagnosis and treatment strategy of individualized functional rhinoplasty, so as to improve patient satisfaction.

Objective:To observe the clinical efficacy, safety, compliance, and cost-effectiveness of rush immunotherapy (RIT) and conventional immunotherapy (CIT) in patients with allergic rhinitis (AR), so as to evaluate the clinical significance of CIT and preliminarily explore its economic value.Methods:A study was conducted on 72 AR patients who had received specific immunotherapy from Oct 2019 to Jun 2020 in the Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University, including 39 males and 33 females, aging 8 to 60 years. RIT or CIT was performed respectively according to the patients′ wishes. There were 35 cases in the RIT group and 37 cases in the CIT group, all subjects were followed up for 1 year. Visual analysis scale (VAS) and effectiveness were used to evaluate the clinical efficacy. Systemic adverse reactions were used to assess safety. Failure rate was calculated to evaluate the compliance. The cost and cost-effectiveness ratio (CER) were conducted to evaluate the health economics preliminarily.Results:After half a year and one year′s treatment, both RIT and CIT groups had significant clinical efficacy and RIT group had more significant clinical efficacy than CIT group at half a year (76.67% vs 46.67%, χ 2=7.37, P=0.007). During the dose accumulation phase, there was no significant difference in the incidence of systemic adverse reactions between the two groups (8.57% vs 8.10%, χ 2=0.05, P=0.943), while the drop-out rate in the RIT group was significantly lower than that in the CIT group (0 vs 13.51%, χ 2=5.08, P=0.024). After one year, the costs in RIT group were significantly higher ((8 163.08±452.67) yuan vs (7 385.87±369.92) yuan, t=-2.78, P=0.009), while there was no statistical differences in CER between the two groups ((3 298.06±1 374.09) yuan/point vs (3 154.38±1 532.51) yuan/point, t=-0.36, P=0.418). Conclusions:Both RIT and CIT are beneficial for AR, and they have similar clinical efficacy, safety, and CER. RIT is more effective in the early stage, with higher patient compliance. Thus, RIT is worth promoting and exploring in clinic.

Objective:To evaluate the role of natural killer T cells in renal fibrosis in mice with acute kidney injury (AKI).Methods:Twenty-four clean-grade healthy male C57BL/6 mice, aged 8-10 weeks, weighing 20-30 g, were divided into 4 groups ( n=6 each) using a random number table method: control group (group C), AKI group (group A), control plus CD1d antibody group (group C-MA), and AKI plus CD1d antibody group (group A-MA). The model of renal fibrosis in mice with AKI was established by intraperitoneal injection of folic acid 250 mg/kg.In group C, homotypic control antibody 20 mg/kg was injected via the tail vein.In group AKI, homotypic control antibody 20 mg/kg was injected via the tail vein at 24 h before establishing the model. In group C-MA, anti-CD1d monoclonal antibody 20 mg/kg was injected via the tail vein.In group A-MA, anti-CD1d monoclonal antibody 20 mg/kg was injected via the tail vein at 24 h before establishing the model.On the 14th day after folic acid injection, blood samples were taken from eyeballs to determine the concentrations of blood urea nitrogen (BUN) and creatinine (Cr) in serum.Then the mice were sacrificed, and the renal tissues were taken for Sirius red staining and HE staining to determine the area of renal fibrosis, and renal injury was scored.The expression of fibronectin (FN), type I collagen (Col-Ⅰ) and alpha-smooth muscle actin (α-SMA) in renal tissues was detected by immunofluorescence method.The expression of interleukin (IL)-4, IL-13, arginase-1 (Arg-1) and found in inflammatory zone 1 (FIZZ1) mRNA in renal tissues was detected by real-time polymerase chain reaction. Results:Compared with group C, the concentrations of BUN and Cr in serum, renal injury score, and area of renal fibrosis were significantly increased, the expression of FN, Col-Ⅰ and α-SMA and IL-4, IL-13, Arg-1 and FIZZ1 mRNA was up-regulated in A and A-MA groups ( P<0.05), and no significant change was found in the above indexes in group C-MA ( P>0.05). Compared with group A, the concentrations of BUN and Cr in serum, renal injury score, and area of renal fibrosis were significantly decreased, the expression of FN, Col-Ⅰ and α-SMA and IL-4, IL-13, Arg-1 and FIZZ1 mRNA was down-regulated in group A-MA ( P<0.05). Conclusion:Activation of natural killer T cells is involved in the process of renal fibrosis in mice with AKI, and the mechanism may be related to promoting the release of Th2 cytokines and M2 polarization of macrophages.

Objective:To evaluate the role of interleukin-4 (IL-4) in renal fibrosis induced by acute kidney injury (AKI) in mice.Methods:Twenty-four male C57BL/6 mice, aged 8-10 weeks, weighing 20-30 g, were divided into 4 groups ( n =6 each) using a random number table method: control group (group CON), AKI group, control plus anti-IL-4 antibody group (group CON-A), and AKI plus anti-IL-4 antibody group (group AKI-A). In AKI-A and AKI groups, folic acid was intraperitoneally injected to induce AKI in anesthetized mice, and the anti-IL-4 antibody 40 mg/kg and the equal volume of PBS were intraperitoneally injected, respectively, at 3, 6, 9 and 12 days after injection. The equal volume of PBS and anti-IL-4 antibody was given at the corresponding time point in CON and CON-A groups, respectively.The orbital blood samples were taken on day 14 after injecting folic acid for determination of the serum blood urea nitrogen (BUN) and creatinine (Cr) concentrations.The animals were then sacrificed, and renal tissues were obtained for examination of the pathological changes (using Sirius red staining and Masson staining) and for determination of the expression of fibronectin(FN), collagen-Ⅰ(Col-Ⅰ) and α-smooth muscle actin (α-SMA) (by Western blot) and expression of CD206, Arg-1 and FIZZ1 mRNA (by real-time polymerase chain reaction). The area of renal fibrosis was measured. Results:Compared with group CON, the serum BUN and Cr concentrations were significantly increased, the area of renal fibrosis was increased, and the expression of FN, Col-Ⅰ, α-SMA and CD206, Arg-1 and FIZZ1 mRNA in renal tissues was up-regulated in group AKI ( P<0.05), and no significant change was found in the parameters mentioned above in group CON-A( P>0.05). Compared with group AKI, the serum BUN and Cr concentrations were significantly decreased, the area of renal fibrosis was reduced, and the expression of FN, Col-Ⅰ, α-SMA and CD206, Arg-1 and FIZZ1 mRNA in renal tissues was down-regulated in group AKI-A ( P<0.05). Conclusion:IL-4 is involved in the process of renal fibrosis following AKI, and the mechanism may be associated with the regulation of macrophage M2 polarization in mice.

Objective:To explore the subjective and objective evaluation methods in functional rhinoplasty.Methods:Sixty-four patients who underwent rhinoplasty in the Department of Otorhinolaryngology, the First Affiliated Hospital of Chongqing Medical University were included in this study from January 2017 to October 2018. There were 32 males and 32 females, with the age ranging from 18 to 45 years old. Before and 6 months after operation, nasal ventilation function was evaluated by Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), nasal acoustic reflex and nasal resistance. Satisfaction with nasal appearance was evaluated by VAS, Rhinoplasty Outcome Evaluation (ROE) and facial proportions evaluation. Psychological state was assessed by Emotional Balance Scale and Rosenberg Self-esteem Scale. Finally, the Pearson correlation analysis of patient satisfaction was performed. SPSS 23.0 software was used for statistical analysis. Results:Compared with pre-operation, nasal obstruction VAS, NOSE scores, total nasal resistance and difference ratio of nasal resistance showed significantly decline after surgery (1.62±0.85 vs 7.56±1.44, 22.62±3.54 vs 69.75±7.85, (0.16±0.08) Pa·s/ml vs (0.31±0.43) Pa·s/ml, 0.33±0.28 vs 0.71±0.32, all P<0.05). VAS of appearance and ROE scores showed an increase after surgery (11.20±3.66 vs 2.70±0.97, 17.80±2.71 vs 7.50±1.12, all P<0.05). The measurement of the external nasal subunits showed that the length of the dorsum of the nose, the angle of the face to the nose, the angle of the frontal and the angle of the alar of the nose were obviously reduced ((29.33±4.26) mm vs (33.61±5.24) mm, (135.11±3.81)° vs (139.91±6.30)°, (130.63±2.88)° vs (136.74±5.72)°, (99.71±4.02)° vs (106.27±5.60)°, all P<0.05). The scores of postoperative Emotional Balance Scale and Rosenberg Self-esteem Scale increased significantly (5.88±1.54 vs 4.31±1.85, 28.31±2.64 vs 22.13±2.77, all P<0.05). The Pearson correlation analysis showed that patients′ satisfaction was positively correlated with subjective score of nasal ventilation (VAS, NOSE), subjective score of nasal appearance (VAS, ROE) and emotional balance scale, while negatively correlated with nasal resistance, and not correlated with the measurement of external nasal subunit. There was a significant positive correlation between the subjective score of nasal ventilation and the measurement of nasal resistance, but there was no significant correlation between the subjective score of nasal appearance and the measurement of external nasal subunit. Conclusion:The subjective and objective evaluation of nasal ventilation function, aesthetics of nasal appearance and psychological state can evaluate the effect of functional rhinoplasty effectively.

Objective:To explore whether the improvement of subjective symptoms and objective grades after endoscopic sinus surgery in patients with chronic sinusitis (CRS) are related to the degree of preoperative anxiety or depression and to provide reference for improving the effects of clinical treatment.Methods:The clinical data of one hundred and sixty patients with CRS treated by endoscopic sinus surgery in the First Affiliated Hospital of Chongqing Medical University from April 2018 to August 2019 were collected prospectively. The visual analogue scale (VAS) scores, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, Lund-Kennedy scores of nasal endoscopy and the Lund-Mackay scores of CT before and 6 months after surgery were used to analyse the correlation between the scores of anxiety or depression and the subjective and objective scores of patients before and after operation by grouping and layering. One hundred and one males (63.1%) and 59 females (36.9%) with an average age of 47.3 years (18-75 years) were included. Single-sample, independent or paired t-test, one-way ANOVA and rank-sum test were used for comparison and Pearson correlation analysis was used for the correlation between groups. Results:There was no statistical difference of anxiety or depression between different groups in terms of age, gender and course in the 160 effective patients ( t values were -0.151, -0.487, -0.846, all P values>0.05; t values were -0.473, -1.302, -1.069, all P values>0.05). And the degree of preoperative anxiety or depression was positively correlated with the subjective scores, including overall discomfort, nasal obstruction, runny nose and olfactory decline ( r values were 0.515, 0.606, 0.424, 0.306, all P values<0.01; r values were: 0.518, 0.584, 0.448, 0.308, all P values<0.01), but not significantly correlated with objective scores of Lund-Mackay and Lund-Kennedy (all P value >0.05). Moreover, as far as the symptoms of overall discomfort, nasal obstruction, headache and runny nose, the results of one-way ANOVA showed that the improvement of symptoms in patients with serious anxiety or depression was worse than that of the normal, mild and moderate patients (all P values<0.05). However, there was no significant difference in the scores of Lund-Kennedy 6 months after surgery between them (both P values>0.05). Conclusion:The state of anxiety or depression affects the improvement of symptoms after endoscopic sinus surgery for CRS patients. Compared with the patients with normal and mild to moderate anxiety or depression, the improvement of symptoms in patients with severe anxiety and depression is worse. It is necessary to evaluate the anxiety or depression of the patients with CRS who are going to undergo endoscopic sinus surgery.

There exists unbalanced development of medical technology and uneven quality of medi-cal staff in our current medical status,so it is urgent to reform the training mode of talents. Through the analysis of the shortcomings of traditional talents training and based on the thought of training applied talents, we explore the best training model of application-oriented professionals of otolaryngology head and neck surgery which is suitable for our country's national conditions by reforming clinical teaching methods, theo-retical teaching curriculum revision and clinical skills training, in order to strengthen the quality of person-nel training.

Objective: To analyze the clinical effect of the endoscopic holistic rhinoplasty in order to improve its clinical application and safety. Methods: The patients with external nasal deformities and complained nasal congestion were assessed before operation and undergoing endoscopic holistic rhinoplasty from January 2015 to June 2017. Therefore, the internal nasal plasty and external nasal plasty were performed simultaneously, so as to correct the abnormalities of internal and external nasal structures, restore nasal ventilation function, and achieve the purpose of external nose cosmetology. The nasal congestion, visual analog scale, rhinomanometry and acoustic rhinometry and patient satisfaction were used to assess the efficacy. SPSS 21.0 was used for statistical analysis. Paired sample t test was used for preoperative and postoperative comparison, and P<0.05 was taken as statistically significant difference. Results: All the patients were followed up from one month to one year without complications. Postoperative nasal obstruction VAS score (1.63±0.76) was significantly lower than preoperative(6.35±0.65) (t=6.315, P<0.001). The minimum nasal cross-sectional area was (0.38±0.29) cm² preoperatively and (0.52±0.14) cm² postoperatively, which was significantly higher than that before the operation (t=9.732, P<0.001). Postoperative nasal volume (9.21±3.23) cm³ was significantly higher than preoperative (6.44 ± 1.04) cm³ (t=9.559, P<0.001), and postoperative nasal resistance (0.26 ± 0.07) kPa·s/L was lower than preoperative (0.65±0.21) kPa·s/L(t=7.524, P<0.001). The postoperative satisfaction survey result were very satisfactory in 41 cases (78.85%), accounted satisfaction in 11 cases (21.15%). Conclusions The application of the endoscopic holistic rhinoplasty has a good clinical effect and a high degree of satisfaction.

Objective To explore the imaging characteristics of common malignant sinonasal tumors for improving the diagnostic accuracy of the disease. Methods Radiological and clinical data of 78 patients with sino-nasal malignant tumors confirmed by pathological examination were retrospectively analyzed. Results Sinonasal malignant tumors lacked imaging specificity. Most of CT showed uneven soft tissue densities with unclear boundary and destruction of bone which invaded the soft tissue outside of the cavity including orbit or intra-cranium. There was moderate to remarkable enhancement of the lesion. T1WI in MR demonstrated homo-and hypo-intense signal , while T2WI revealed homo- and hyper-intense signal ,and post contrast MR imaging displayed heterogeneous con-trast enhancement. There was no significant statistical difference between CT and MRI in the detection rate of ma-lignant tumors(P > 0.05),but CT in combination with MRI improved the positive rate of detection(P < 0.05). Conclusions The imaging of sinonasal malignant tumors is complicated and lacks specificity. For complicated si-nonasal malignant tumors,enhanced CT in combination with MRI should be used to determine the nature and limi-tation of the tumor,and its relationship with the surrounding structures,resulting in improvement of the diagnostic accuracy of the disease.