Objective:This study aims to explore the clinical effectiveness of a novel treatment method for refractory laryngeal contact granuloma, involving CO2 laser excision with local pedicled mucosal flap transfer combined with type A botulinum toxin injection. Methods:A retrospective analysis was conducted on 18 patients with refractory laryngeal contact granuloma who visited Department of Otolaryngology Head and Neck Surgery, Nanjing Tongren Hospital, School of Medicine, Southeast University from January 2021 to June 2023. These patients underwent CO2 laser excision of the granuloma with local pedicled mucosal flap transfer combined with type A botulinum toxin injection. During follow-up, electronic laryngoscopy were performed at 1, 3, 6, and 12 months postoperatively, and local laryngeal mucosa, voice quality, and pharyngeal discomfort symptoms were evaluated. Results:Postoperative electronic laryngoscopy revealed the disappearance of granulomas in all 18 patients. Symptoms such as hoarseness, foreign body sensation in the throat, and cough were significantly improved. No complications were observed systemically or locally. No recurrence was observed during one-year follow-up. Conclusion:CO2 laser excision of granuloma with local pedicled mucosal flap transfer combined with type A botulinum toxin injection could eliminate the lesion, restore the integrity of the vocal fold lining, preserve the perichondrium, and provide a time window for mucosal flap recovery. This approach adheres to the principle of preserving normal mucosa, achieves a high cure rate, and is therefore worthy of widespread promotion and application in clinical practice.
Humans ; Retrospective Studies ; Surgical Flaps ; Botulinum Toxins, Type A/administration & dosage* ; Male ; Female ; Granuloma/therapy* ; Adult ; Middle Aged ; Granuloma, Laryngeal/therapy* ; Laryngeal Diseases/therapy* ; Lasers, Gas/therapeutic use* ; Laryngoscopy ; Laser Therapy ; Treatment Outcome

Objective To investigate the clinical effect of microflap suture under self-retaining laryngoscope on benign vocal cord diseases.Methods A total of 115 patients with benign vocal cord diseases who underwent surgical treatment in the Binhai People's Hospital Affiliated to Kangda College of Nanjing Medical University and Nanjing Tongren Hospital Affiliated to School of Medicine of Southeast University were enrolled in this retrospective study.According to the surgical treatment methods,the patients were divided into observation group(58 patients were treated with microflap suture under self-retaining laryngoscope)and control group(57 patients received conventional surgery).The treatment effect,Voice Handicap Index-10(VHI-10)score,the scales of overall grade(G),roughness(R),breathiness(B),asthenian(A)and strain(S),and voice related parameters were compared between the two groups.Results The overall treatment effect of the observation group was significantly better than that of the control group(P＜0.05).There were no significant differences in the VHI-10 score functional score,physiological score,emotional score,VHI-10 score,GRBAS score,longest phonation time,recording fundamental frequency,fundamental frequency perturbation,amplitude perturbation,or voice harmonic ratio before treatment between the two groups(P＞0.05).After treatment,the VHI-10 score functional score,emotional score,total score),GRBAS score,the value of fundamental frequency perturbation and voice harmonic ratio in the observation group were significantly lower than those in the control group(P＜0.05);the longest phonation time in the observation group was significantly longer than that in the control group(P＜0.05).Conclusion Microflap suture under self-retaining laryngoscope is an effective treatment for benign vocal cord diseases,and the voice recovery is better after surgery.

Background In recent years, the incidence of metabolic syndrome (MS) is increasing significantly in China. Some studies have found that temperature is related to single metabolic index, but there is a lack of research on associated mechanism and identifying path of the influence of temperature on MS. Objective Based on the data of Guangdong Province, to investigate the effect of temperature on MS and its pathway. Methods A total of 8524 residents were enrolled by multi-stage random sampling from October 2015 to January 2016 in Guangdong. Basic characteristics, behavioral characteristics, health status, and physical activity level were obtained through questionnaires and physical examinations, and meteorological data were obtained from meteorological monitoring sites. We matched individual data both with the temperature data of the physical examination day and of a lag of 14 d. A generalized additive model was used to explore the exposure-effect relationship between temperature and MS and its indexes, calculate effect values, and explore the effects of single-day lag temperature. Based on the literature and the results of generalized additive model analysis, a path analysis was conducted to explore the pathways of temperature influencing MS. Results The association between daily average temperature on the current day or lag 14 day and MS risk was not statistically significant. When daily average temperature increased by 1 ℃, the change values of fasting blood-glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and high density lipoprotein cholesterol (HDL-C) were −0.033 (95%CI: −0.040-−0.026) mmol·L⁻¹, −0.662 (95%CI: −0.741-−0.583) mmHg, −0.277 (95%CI: −0.323-−0.230) mmHg, and −0.005 (95%CI: −0.007-−0.004) mmol·L⁻¹ respectively. The effects of average daily temperature on FBG, blood pressure, HDL-C, and waist circumference lasted until lag 14 day. The effects of daily average temperature on SBP and DBP were the largest on the current day. Daily average temperature of current day had direct and indirect effects on FBG and SBP. Temperature had an indirect effect on TG, and the intermediate variables were waist circumference and FBG, with an indirect effect value of −0.011 (95%CI: −0.020-−0.002). The indirect effects of daily average temperature on SBP, FBG, and TG were weak. Conclusion There is no significant correlation between temperature and risk of MS, and daily average temperature of current day could significantly affected blood pressure and FBG with a lag effect. Daily average temperature of current day has indirect effects on FBG and TG.

Objective:To examine the value of serum protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) detection in the early diagnosis and surveillance of hepatocellular carcinoma (HCC).Methods:The clinical data of 215 patients with HCC admitted to Department of Hepatobiliary-Pancreatic Surgery of China-Japan Union Hospital of Jilin University from October 2017 to May 2018 were analyzed retrospectively. There were 172 males and 43 females, aged of (59.0±9.3) years old (range 34 to 86 years old). In addition, there were 85 non HCC patients were enrolled in the control group, 42 males and 43 females, aged (54.2±11.3) years old (range 22 to 80 years old). The blood sample of 3 ml was drawn from the elbow vein at 6∶00 am on the next day of admission, and then was kept in low temperature away from light, and sent for PIVKA-Ⅱ detection on the same day. The positive value of AFP was ≥20 μg/L and PIVKA-Ⅱ was ≥32 AU/L. The data were analyzed statistically by χ 2 test, t test or rank sum test. The correlation between AFP, PIVKA-Ⅱ and tumor maximum diameter was analyzed by linear regression. Results:The sensitivity of PIVKA-Ⅱ detection only for the diagnosis of HCC in all stages was significantly higher than AFP or equivalent to AFP, the overall sensitivity of PIVKA-Ⅱ and AFP was 85.1% and 52.1%, respectively. But the specificity of PIVKA-Ⅱ was lower than that of AFP, they were 78.8% and 96.5%, respectively. In particularly, in the earlier stage of HCC (Ⅰa) , the sensitivity of PIVAK-Ⅱ to HCC was 64.5%, while the AFP was only 26.3%. Combined detection of PIVKA-Ⅱ and AFP significantly improved the diagnostic rate of HCC to 88.4%, and the specificity to 76.5%. Moreover, there was a positive correlation between PIVKA-Ⅱ level and the maximum tumor diameter ( r2=0.587, P<0.05), but there was no correlation between the AFP level and the maximum tumor diameter ( r2=0.296, P>0.05). The positive rate of PIVKA-Ⅱ in the diagnosis of HCC with vascular invasion was also significantly higher than that of AFP ( P<0.01) . Conclusions:PIVKA-Ⅱ can be used as a serological marker for HCC screening and diagnosis. In particular, PIVKA-Ⅱ detection was significantly sensitive than AFP in the earlier stage of HCC. Combined detection of PIVKA-Ⅱ and AFP can effectively improve the diagnostic rate of HCC in all stages. The significant elevation of PIVKA-Ⅱ is also helpful to determine the tumor aggressiveness, vascular invasion and prognosis of HCC patients.

Objective:To examine the value of serum protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) detection in the early diagnosis and surveillance of hepatocellular carcinoma (HCC).Methods:The clinical data of 215 patients with HCC admitted to Department of Hepatobiliary-Pancreatic Surgery of China-Japan Union Hospital of Jilin University from October 2017 to May 2018 were analyzed retrospectively. There were 172 males and 43 females, aged of (59.0±9.3) years old (range 34 to 86 years old). In addition, there were 85 non HCC patients were enrolled in the control group, 42 males and 43 females, aged (54.2±11.3) years old (range 22 to 80 years old). The blood sample of 3 ml was drawn from the elbow vein at 6∶00 am on the next day of admission, and then was kept in low temperature away from light, and sent for PIVKA-Ⅱ detection on the same day. The positive value of AFP was ≥20 μg/L and PIVKA-Ⅱ was ≥32 AU/L. The data were analyzed statistically by χ 2 test, t test or rank sum test. The correlation between AFP, PIVKA-Ⅱ and tumor maximum diameter was analyzed by linear regression. Results:The sensitivity of PIVKA-Ⅱ detection only for the diagnosis of HCC in all stages was significantly higher than AFP or equivalent to AFP, the overall sensitivity of PIVKA-Ⅱ and AFP was 85.1% and 52.1%, respectively. But the specificity of PIVKA-Ⅱ was lower than that of AFP, they were 78.8% and 96.5%, respectively. In particularly, in the earlier stage of HCC (Ⅰa) , the sensitivity of PIVAK-Ⅱ to HCC was 64.5%, while the AFP was only 26.3%. Combined detection of PIVKA-Ⅱ and AFP significantly improved the diagnostic rate of HCC to 88.4%, and the specificity to 76.5%. Moreover, there was a positive correlation between PIVKA-Ⅱ level and the maximum tumor diameter ( r2=0.587, P<0.05), but there was no correlation between the AFP level and the maximum tumor diameter ( r2=0.296, P>0.05). The positive rate of PIVKA-Ⅱ in the diagnosis of HCC with vascular invasion was also significantly higher than that of AFP ( P<0.01) . Conclusions:PIVKA-Ⅱ can be used as a serological marker for HCC screening and diagnosis. In particular, PIVKA-Ⅱ detection was significantly sensitive than AFP in the earlier stage of HCC. Combined detection of PIVKA-Ⅱ and AFP can effectively improve the diagnostic rate of HCC in all stages. The significant elevation of PIVKA-Ⅱ is also helpful to determine the tumor aggressiveness, vascular invasion and prognosis of HCC patients.

COVID-19 has spread globally, infecting and killing millions of people worldwide. The use of operating rooms (ORs) and the post-anaesthesia care unit (PACU) for intensive care is part of surge response planning. We aim to describe and discuss some of the practical considerations involved in a large tertiary hospital in Singapore. Firstly, considerations for setting up a level III intensive care unit (ICU) include that of space, staff, supplies and standards. Secondly, oxygen supply of the entire hospital is a major determinant of the number of ventilators it can support, including those on non-invasive forms of oxygen therapy. Thirdly, air flows due to positive pressure systems within the OR complex need to be addressed. In addition, due to the worldwide shortage of ICU ventilators, the US Food and Drug Administration has granted temporary approval for the use of anaesthesia gas machines for patients requiring mechanical ventilation. Lastly, planning of logistics and staff deployment needs to be carefully considered during a crisis. Although OR and PACU are not designed for long-term care of critically ill patients, they may be adapted for ICU use with careful planning in the current pandemic.
COVID-19/therapy* ; Critical Care/organization & administration* ; Critical Illness ; Health Care Rationing/organization & administration* ; Health Resources/organization & administration* ; Health Services Accessibility/organization & administration* ; Humans ; Intensive Care Units/organization & administration* ; Operating Rooms/organization & administration* ; Pandemics ; Respiration, Artificial ; Singapore/epidemiology* ; Tertiary Care Centers/organization & administration*

Objective To analyze the clinical data of patients with hilar cholangiocarcinoma (HCCA),and to compare the therapeutic effects of different methods on treating these patients.Methods The clinical data of 101 patients with HCCA in China-Japan Union Hospital of Jilin University were analyzed.Results The overall 1-year and 2-year survival rates in the radical operation group were 95.5％ and 40.9％,respectively.There was a significant difference between the radical operation group and the palliative resection group (P ＜ 0.05).The overall 1-year and 2-year survival rates in the palliative resection group were 75.0％ and 16.7％,respectively,which were much better than those in patients treated with PTCD,biliary stent on open abdominal biliary drainage (P ＜ 0.05).There were no significant differences among the PTCD,biliary stent and open abdominal biliary drainage groups (P ＞ 0.05).Conclusions Radical HCCA resection is still the best and the first choice treatment for patients with HCCA.The therapeutic effects of radical operation were much better than those of palliative resection,biliary stent,PTCD and open abdominal biliary drainage.

Objective: To observe the effect of mild-warm moxa stick moxibustion on fatigue, immune state and quality of life (QOL) in sub-health population. Methods: A total of 120 cases were randomly allocated into a moxibustion group (n=60) and a Chinese patent medicine (CPM) group (n=60). People in the moxibustion group were intervened with mild-warm moxa stick moxibustion, once a day; while people in the control group took oral Bu Zhong Yi Qi Wan (Spleen/stomach-supplementing and Qi-boosting Pill), 3 doses a day. Two months made up a course of treatment. The fatigue, immune state and QOL were then observed after one treatment course, followed by a 12-month follow-up. Results: A total of 115 cases completed the clinical trial. After intervention, the fatigue scores, immune parameters and QOL scores were significantly increased in both groups, showing statistical significances (P<0.05). There were between-group significant differences in fatigue score, levels of immunoglobulin M (IgM) and IgG, natural killer (NK) cell activity and QOL score (P<0.05). After the 12-month follow-up, there were still significant between-group differences in fatigue score, physical health, psychological, social relationships and overall perception of QOL and overall perception of health (P<0.05). Conclusion: Mild-warm moxibustion can markedly improve the fatigue, immune state and QOL in sub-health population.

An online solid phase extraction ( SPE ) coupled with high performance liquid chromatography (HPLC)-mass spectrometry (MS) method was developed for the separation of 1,3,5,7-tetraacetyl-1,3,5,7-tetraazacyclooctane ( TAT ) and 1 , 3 , 5-triacetyl-1 , 3 , 5-triazacyclohexane ( TRAT ) which are the synthetic intermediates of cyclotetramethylenetetranitramine ( HMX) . In this experiment, molecularly imprinted polymers with TAT as the template were used as SPE sorbents. PC HILIC column was employed in liquid chromatographic separation. The parameters of SPE-HPLC were optimized. Acetonitrile was selected as the loading solution with flow rate of 0. 1 mL/min. After flushed by ethyl acetate, the TAT adsorbed on SPE was eluted by methanol, which was also used as the mobile phase in HPLC separation. The mass spectrometry was coupled with HPLC to identify the corresponding peaks. Under the optimized conditions, the linear detection range of this method was 6. 0 mg/L to 500. 0 mg/L, with the detection limit of 1. 8 mg/L (3σ). The enriching factor was 400 times and TAT recovery was 79%–93% in the standard addition experiment.

Objective To improve the knowledge of the diagnosis and treatment of functional insulinoma. Methods The clinical data of 12 cases of functional insulinoma in China-Japan Union Hospital of Jilin University from 2000 to 2009 were analyzed retrospectively. Results For the 12 cases of functional insulinoma, preoperative fasting blood glucose and the positive rate of insulin were 92% and 89% respectively. The positive rate of IRI/G and C-Peptide reached 100%. The accuracy of the niveau diagnosis of preoperative abdomen ultrasound, CT and of MRI were 75%, 36% and 0% respectively; whereas the accuracy of localization of intraoperative palpation combined with ultrasonography reached 100%. The result of glucose increased by one time within one hour after excision and the rest excision. In the 7 follow-up cases, the symptom of hypoglycemia was not found. There were 3 cases of pancreatic fistula after operation. Conclusions For the suspected cases of functional insulinoma, the measurement of IRI/G and C-Peptide are needed besides measuring blood glucose and insulin. Intraoperative palpation and ultrasonography are effective methods of the localization of functional insulinoma. The complete resection of the insulinoma can be assessed by monitoring the change of the blood glucose after excision as well as the rapid intraoperative pathological examination.