Total laryngectomy is a crucial surgical intervention for patients with advanced malignant tumors of the larynx and nasopharynx. Despite its effectiveness, this procedure permanently severs the connection between the nasal cavity and the lower respiratory tract, leading to the cessation of nasal airflow. This disruption significantly impairs the patient's sense of smell and adversely affects their quality of life. Although olfactory loss is common in these patients, the assessment and rehabilitation of their olfactory function are often overlooked. This article reviews relevant literature on evaluating olfactory function and rehabilitation methods following total laryngectomy, with the aim of providing a theoretical foundation to enhance olfactory rehabilitation and overall quality of life for these patients.
Humans ; Laryngectomy/rehabilitation* ; Quality of Life ; Smell ; Laryngeal Neoplasms/surgery* ; Olfaction Disorders/etiology*

Objective:To investigate the expression of retinoic acid receptor responsive gene 2 (RARRES2), microtubule microfilament cross-linking factor 1 (MACF1), and core protein polysaccharide (DCN) in cerebrospinal fluid (CSF) of patients with neurosyphilis, and their diagnostic value for neurosyphilis.Methods:A total of 64 non neurosyphilis syphilis patients (syphilis group) and 78 neurosyphilis patients (neurosyphilis group) admitted to the Second Hospital of Nanjing between June 2020 and September 2022 were included. Among neurosyphilis patients, there were 48 early neurosyphilis patients (early group) and 30 late neurosyphilis patients (late group). Patients with neurosyphilis are treated with routine symptomatic therapy and antibiotic therapy to expel syphilis. The mRNA levels of RARRES2, MACF1, and DCN in CSF of patients with neurosyphilis before and after treatment were detected by quantitative real-time polymerase chain reaction (qRT-PCR). The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological function of patients with neurosyphilis before and after treatment. The diagnostic value of various indicators for neurosyphilis was analyzed using receiver operating characteristic (ROC) curves.Results:The mRNA levels of RARRES2, MACF1, and DCN in CSF of patients with neurosyphilis were higher than those in the syphilis group (all P<0.001). The mRNA levels of RARRES2, MACF1, and DCN in the CSF of patients with advanced neurosyphilis were higher than those in the early group (all P<0.001). Compared with before treatment, the NIHSS score and RARRES2, MACF1, and DCN mRNA levels of neurosyphilis patients decreased after treatment (all P<0.001). The area under the curve (AUC), sensitivity, and specificity of the combined diagnosis of RARRES2, MACF1, and DCN mRNA in CSF for neurosyphilis were 0.995%, 100.00%, and 93.75%, respectively. The AUC and sensitivity were higher than those of individual diagnosis. Conclusions:The expression of RARRES2, MACF1, and DCN is elevated in CSF of patients with neurosyphilis, and is associated with disease severity and treatment response. These three genes may be candidate biomarkers for diagnosing neurosyphilis.

Objective To investigate the role and mechanism of zinc finger protein 281(ZNF281)in high glucose(HG)-induced epithelial-mesenchymal transition(EMT)and extracellular matrix(ECM)synthesis in renal tubular epithelial cells(RTECs).Methods HG induced RTECs were used to construct a diabetic kidney disease cell model,and cells were divided into the control group,the HG group and the mannitol group.Cell proliferation viability was detected by CCK-8.The expression of ZNF281 was knocked down in HG-treated RTECs using small interfering RNA(siRNA).HG-induced RTECs after knockdown of ZNF281 were divided into the control group,the HG group,the HG+ZNF281 siRNA group and the HG+ZNF281 vector group.Adenosine monophosphate-activated protein kinase(AMPK)was activated using AMPK agonist,acadexin(AICAR),and then cells were divided into the control group,the HG group,the HG+AICAR group and the HG+dimethyl sulfoxide group.The expression levels of ZNF281,EMT and ECM synthesis-related indexes were detected by qPCR and Western blot assay.Results Compared with the control group,the protein and mRNA expression levels of vimentin,α-smooth muscle actin(α-SMA),fibronectin(FN)and collagen Ⅰ(Col Ⅰ)were significantly higher,and the expression of E-cadherin was significantly lower in the HG group.Compared with the HG group,the protein and mRNA expression levels of EMT and ECM synthesis-related indexes were significantly changed in the HG+ZNF281 siRNA group and the HG+AICAR group.The protein and mRNA expression levels of ZNF281 were significantly reduced in the HG+AICAR group compared with the HG group.In cells co-treated with AICAR and transfected with ZNF281 plasmid,the expression levels of vimentin,α-SMA,FN and Col Ⅰ were significantly higher in the AICAR+ZNF281 group,and E-cadherin was significantly lower compared with that of the vector group.Conclusion AMPK inhibits EMT and ECM synthesis in HG-treated RTECs by negatively regulating the expression level of ZNF281.

From the perspective of medical institutions, this paper sorted out the contents of Article 32 of the Measures for Ethical Review of Life Sciences and Medical Research Involving Human regarding "exemption from ethical review". At the same time, combined with domestic and foreign regulations, this paper deeply considered and analyzed the applicable premise and special circumstances of the provisions from the implementation level, and then put forward suggestions from the perspective of practical operation of medical institutions, with a view to providing some practical guidance and reference for ethical practitioners of medical institutions.

Objective:To develop a novel, flexible, dual-arm, master-slave digestive endoscopic minimally invasive surgical robot system named dual-arm robotic endoscopic assistant for minimally invasive surgery (DREAMS) and to evaluate its feasibility for endoscopic submucosal dissection (ESD) by using ex vivo porcine stomachs.Methods:A novel endoscopic robot (DREAMS) system was developed which was composed of a flexible two-channel endoscope, two flexible robotic manipulators, a master controller, a robotic arm, and a control system. A total of 10 artificial round-like lesions with diameters ranging from 15 to 25 mm were created (5 in gastric antrum and 5 in gastric body) by using fresh peeled stomach of healthy pigs as the model. Submucosal dissection was performed with the assistance of the DREAMS system by two operators. The main outcome was submucosal dissection speed, and the secondary outcomes included muscular injury rate, perforation rate, and grasping efficiency of the robot.Results:All 10 lesions were successfully dissected en bloc by using the DREAMS system. The diameter of the artificial lesions was 22.34±2.39 mm, dissection time was 15.00±8.90 min, submucosal dissection speed was 141.79±79.12 mm 2/min, and the number of tractions required by each ESD was 4.2 times. Muscular injury occurred in 4/10 cases of ESD. No perforation occurred. Conclusion:The initial animal experiment shows the DREAMS system is safe and effective.

Platelet-rich plasma (PRP) is a kind of autologous blood product. It is a platelet concentrate extracted from autologous blood through centrifugation or apheresis process. It is generally believed that the platelet concentration in PRP should be 4-8 times of the platelet count in the whole blood. Platelets with high concentration can release a variety of growth factors and media after activation, which is conducive to tissue repair and regeneration. PRP has been used in regenerative medicine for more than 30 years, and has achieved good results. In recent years, it has also been widely used in facial aesthetics, involving acne, skin aging, hair loss, chloasma and other fields. In this review, we are not only emphasized the preparation and use of PRP, but also outlined the application progress of PRP in facial aesthetics.

Objective:To study the clinical, endoscopic and histological characteristics of heterotopic gastric mucosa in upper esophagus (HGMUE).Methods:A Total of 177 patients who underwent gastroscopy and were diagnosed as having HGMUE at the Endoscopy Center of Wuhan Union Hospital from January 2017 to December 2017 were included in the study. According to the gastroesophageal reflux disease symptom questionnaire (GERD-Q) scores, patients were divided into the HGMUE group (GERD-Q<8, n=101) and GERD+HGMUE group (GERD-Q≥8, n=76). The data of clinical, endoscopic and histological characteristics were analyzed. Results:Among the 177 HGMUE cases, there were 111 males (62.71%) and 66 females (37.29%), 76 (42.94%) with GERD, and 101 (57.06%) without GERD. The most common symptom was continuous clearing throat [54.24% (96/177)], followed by foreign body sensations of throat [48.59% (86/177)], and gastroesophageal reflux symptoms such as heartburn, chest pain, indigestion, acid reflux [48.59% (86/177)]. In the HGMUE group, the occurrence rate of clearing throat was the highest [42.57% (43/101)], then foreign body sensations of throat accounted for 33.66% (34/101), and gastroesophageal reflux symptoms was 27.72% (28/101). In the HGUME+GERD group, the most common symptom was gastroesophageal reflux symptoms [76.32% (58/76)], then clearing throat [69.74% (53/76)] and foreign body sensations of throat [68.42% (52/76)]. Under gastroscopy, 177 heterotopic gastric lesions were found under gastroscopy with orange-red round, oval or elongated island like ones, most of which were flat and a few slightly protruded from the peripheral plane. There were 132 (74.58%) single-lesion cases, 38 (21.47%) 2-lesion, and 7 (3.95%) 3- or more-lesion cases; there were 37 (20.90%) small lesions (maximum diameter <0.5 cm), and 74 (41.81%) median-size lesions (maximum diameter of 0.5-1.0 cm), and 66 (37.3%) larger lesions (maximum diameter >1.0 cm). Among the 30 [16.95% (30/177)] samples of mucosal tissue, 15 [50.00% (15/30)] were mainly cardia gland, 8 [26.67% (8/30)] were mainly pyloric gland, 6 [20.00% (6/30)] were mixed type, and 1 [3.33% (1/30)] was squamous epithelium. In the immunohistochemical test, 20 cases [66.67% (20/30)] showed positive of H +/K +-ATPase, and 10 cases [33.33% (10/30)] were negative. Conclusion:HGMUE is more common in male patients, and may be combined with GERD. Among them, patients with combined GERD are more likely to develop laryngopharyngeal reflux. The heterotopic gastric mucosas lesions are orange-red round, oval or elongated island-like under gastroscopy, and most of them are flat, single and median- or large-sized. Histological types are mostly fundic glands, and H +/K +-ATPase positive is more common. It is speculated that acid secretion may be an important factor leading to throat symptoms.

Objective:To analyze the accuracy of digital orthognathic surgery by evaluating the effects of brackets, dentition status and registration method on the accuracy of registration of cone beam computed tomography(CBCT) dentition and laser scanning dental casts.Methods:A retrospective analysis of the data of patients who underwent digitally designed maxillary and mandibular surgeries from December 2017 to December 2019 in the Department of Orthognathic Surgery, Tianjin Stomatological Hospital. The CBCT and laser scanning dental mold data of the patients were imported into Mimics 20.0 software to build three-dimensional reconstructed dentition. Global registration and local registration of STL registration were used to register non-occlusal, occlusal CBCT dentition and laser scanning dental molds, which could be divided into four groups. Group 1: non-occlusal dentition using local registration, group 2: non-occlusal dentition using global registration, group 3: occlusal dentition using local registration, group 4: occlusal dentition using global registration. Each group included three subgroups, subgroup A used 3.0 mm distance parameters for registration once, subgroup B used 3.0 and 1.5 mm distance parameters for registration twice, and subgroup C used 3.0, 1.5 and 0.3 mm distance parameters for registration three times. With the assistance of the distance analysis function of Geomagic Studio software, the root mean square of the distance between the two images was obtained. The comparison of normal power data between subgroups was performed by analysis of variance, and the multiple comparisons among subgroups were performed by LSD- t test. After testing the normality and homogeneity of variance of the data, a general linear model was established to test the influence of bracket, dentition state and registration method on the accuracy of registration by multi-factor analysis of variance. Results:A total of 24 patients were enrolled, 7 males and 17 females, aged 19-30 years, 12 of which had orthodontic metal brackets and 12 had no brackets. (1) The local registration of each group is the best in subgroup A, and the global registration is the best in subgroup C. (2) The effects of bracket, dentition status and registration method on the registration result were statistically significant( P<0.05). The interaction among them was not significant ( P>0.05), but the interaction between bracket and dentition state, bracket and registration method, dentition status and registration method was significant ( P<0.05). Through simple effect analysis, it was found that in occlusal dentition registration/bracket registration, the simple single effect of registration method on registration accuracy did not exist ( P>0.05), while that of non-occlusal dentition registration/non-bracket registration had a simple single effect on registration accuracy ( P<0.05). Conclusions:If you use local registration, you only need to match the parameters of 3.0 mm once; if you use global registration, you need to register three times according to the parameters of 3.0, 1.5 and 0.3 mm. Bracket, dentition status, registration methods can all affect the accuracy of registration of CBCT dentition and laser scanning dental mold.

Objective:To analyze the accuracy of digital orthognathic surgery by evaluating the effects of brackets, dentition status and registration method on the accuracy of registration of cone beam computed tomography(CBCT) dentition and laser scanning dental casts.Methods:A retrospective analysis of the data of patients who underwent digitally designed maxillary and mandibular surgeries from December 2017 to December 2019 in the Department of Orthognathic Surgery, Tianjin Stomatological Hospital. The CBCT and laser scanning dental mold data of the patients were imported into Mimics 20.0 software to build three-dimensional reconstructed dentition. Global registration and local registration of STL registration were used to register non-occlusal, occlusal CBCT dentition and laser scanning dental molds, which could be divided into four groups. Group 1: non-occlusal dentition using local registration, group 2: non-occlusal dentition using global registration, group 3: occlusal dentition using local registration, group 4: occlusal dentition using global registration. Each group included three subgroups, subgroup A used 3.0 mm distance parameters for registration once, subgroup B used 3.0 and 1.5 mm distance parameters for registration twice, and subgroup C used 3.0, 1.5 and 0.3 mm distance parameters for registration three times. With the assistance of the distance analysis function of Geomagic Studio software, the root mean square of the distance between the two images was obtained. The comparison of normal power data between subgroups was performed by analysis of variance, and the multiple comparisons among subgroups were performed by LSD- t test. After testing the normality and homogeneity of variance of the data, a general linear model was established to test the influence of bracket, dentition state and registration method on the accuracy of registration by multi-factor analysis of variance. Results:A total of 24 patients were enrolled, 7 males and 17 females, aged 19-30 years, 12 of which had orthodontic metal brackets and 12 had no brackets. (1) The local registration of each group is the best in subgroup A, and the global registration is the best in subgroup C. (2) The effects of bracket, dentition status and registration method on the registration result were statistically significant( P<0.05). The interaction among them was not significant ( P>0.05), but the interaction between bracket and dentition state, bracket and registration method, dentition status and registration method was significant ( P<0.05). Through simple effect analysis, it was found that in occlusal dentition registration/bracket registration, the simple single effect of registration method on registration accuracy did not exist ( P>0.05), while that of non-occlusal dentition registration/non-bracket registration had a simple single effect on registration accuracy ( P<0.05). Conclusions:If you use local registration, you only need to match the parameters of 3.0 mm once; if you use global registration, you need to register three times according to the parameters of 3.0, 1.5 and 0.3 mm. Bracket, dentition status, registration methods can all affect the accuracy of registration of CBCT dentition and laser scanning dental mold.

Objective:To analyze the clinical efficacy and safety of camrelizumab combined with apatinib as a second-line therapy for unresectable hepatocellular carcinoma (HCC).Methods:Ninety-four cases with mid-and advanced-stage HCC who received camrelizumab combined with apatinib as second-line treatment were enrolled. Routine blood test, blood biochemical indexes, tumor stage, tumor imaging characteristics, previous treatment strategies and other clinical data before treatment were documented. Imaging examination follow-up results and adverse reactions during treatment were followed up until the end of follow-up or loss of follow-up or death. Kaplan-Meier method was used to analyze the clinical efficacy.Results:As of the last follow-up, 94 cases with mid-and advanced-stage HCC had received camrelizumab combined with apatinib as second-line treatment. Among them, 15 cases were lost to follow-up, 31 cases died, and 48 cases survived. The overall remission rate was 31.9%. The overall disease control rate was 71.3%. The median time to disease-free progression was 6.6 months. The median time to disease progression was not yet available. The 1-year cumulative survival rate was 62.3%. Grade 3 and above adverse reactions mainly included were thrombocytopenia (7.4%), abdominal pain (4.3%), active hepatitis (4.3%), leukopenia (4.3%), diarrhea (3.2%), hand-foot syndrome (3.2%). All adverse reactions were effectively controlled.Conclusion:Camrelizumab combined with apatinib can effectively prolong the survival period of patients with mid-and advanced-stage HCC, and it is well tolerated.