To explore the value of portable oto-endoscopy system in clinical teaching of otolaryngology residents.

Traumatic supraorbital fissure syndrome (TSOFS) is a symptom complex caused by nerve entrapment in the supraorbital fissure after skull base trauma. If the compressed cranial nerve in the supraorbital fissure is not decompressed surgically, ptosis, diplopia and eye movement disorder may exist for a long time and seriously affect the patients′ quality of life. Since its overall incidence is not high, it is not familiarized with the majority of neurosurgeons and some TSOFS may be complicated with skull base vascular injury. If the supraorbital fissure surgery is performed without treatment of vascular injury, it may cause massive hemorrhage, and disability and even life-threatening in severe cases. At present, there is no consensus or guideline on the diagnosis and treatment of TSOFS that can be referred to both domestically and internationally. To improve the understanding of TSOFS among clinical physicians and establish standardized diagnosis and treatment plans, the Skull Base Trauma Group of the Neurorepair Professional Committee of the Chinese Medical Doctor Association, Neurotrauma Group of the Neurosurgery Branch of the Chinese Medical Association, Neurotrauma Group of the Traumatology Branch of the Chinese Medical Association, and Editorial Committee of Chinese Journal of Trauma organized relevant experts to formulate Chinese expert consensus on the diagnosis and treatment of traumatic supraorbital fissure syndrome ( version 2024) based on evidence of evidence-based medicine and clinical experience of diagnosis and treatment. This consensus puts forward 12 recommendations on the diagnosis, classification, treatment, efficacy evaluation and follow-up of TSOFS, aiming to provide references for neurosurgeons from hospitals of all levels to standardize the diagnosis and treatment of TSOFS.

To explore the value of portable oto-endoscopy system in clinical teaching of otolaryngology residents.

Objective:This study aims to investigate the current application and the level of knowledge of intraoperative facial nerve monitoring among medical staff in China.Methods:A comprehensive online questionnaire was conducted among medical professionals across different regions in China from October 2022 to February 2023. The survey exclusively targeted departments specializing in otolaryngology, head and neck surgery, neurosurgery, and oral and maxillofacial surgery. The questionnaire covered various aspects including general information, intraoperative facial nerve monitoring practices, training history, indications for monitoring, parameters used during monitoring procedures, as well as factors influencing its implementation.Results:A total of 417 participants from 31 provincial, municipal, and autonomous regions were included. Intraoperative facial nerve monitoring was found to be implemented in 227 (54.4%,227/417) repondents of 53 institutions (24.9%, 53/213). The top three indications for implementing this technique were acoustic neuroma, parotid gland surgery, and modified middle ear surgery (mastoidectomy). Herein 81.1%(184/227) medical staff involved in intraoperative facial nerve monitoring had received relevant training, 57.3%(130/227)-92.1%(209/227) reported a lack of clear description regarding recording thresholds, stimulation currents/frequencies/wave widths.Conclusion:The majority of the institutions surveyed have not yet adopted intraoperative facial nerve monitoring. Furthermore, significant gaps concerning the procedure exist. It is imperative to establish standards or guidelines to promote its better development and application.

Mycoplasma capricolum subsp. capripneumoniae (Mccp) is the cause of contagious caprine pleuropneumonia (CCPP) in goats. Inactivated vaccines and capsular polysaccharide (CPS) indirect hemagglutination reagents are available for prevention and serological detection, but high culture costs and complex antigen quantification have been plagued by production staff. In order to solve these problems in production practice, a sugar fermentation medium with an initial pH value of 7.8, which could improve the production of two antigens simultaneously, was screened out by changing the initial pH value based on previous Mccp metabolomics analysis. Since phenol red can be identified by UV absorption spectrum and cetyltrimethylammonium bromide (CTAB) can bind to anionic capsular polysaccharide, a UV spectrum measurement method for analyzing the culture stage reached by Mccp and a CTAB precipitation test for relative quantification of capsular polysaccharide antigen content in the fermentation broth were established. The UV spectrum observation method can guide the production of Mccp according to the growth curve of Mccp, which greatly reduces the monitoring time of the traditional CCU method and improves the accuracy of the original eye-observation method. The established CTAB precipitation test can complete the monitoring of CPS content within 5 hours, which greatly reduces the time required compared with the traditional differential technique, and its accuracy was verified by the phenol-sulfuric acid method. The optimized culture medium and the two correlation comparison methods established in this study can effectively reduce the production cost of Mccp and improve the production efficiency. The two assays have been used in the research at our laboratory, which provides experimental data for further improvement of the production process of CCPP inactivated vaccine and capsular polysaccharide as well as rapid quantification.
Humans ; Animals ; Goats ; Cetrimonium ; Mycoplasma ; Polysaccharides

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Objective:To compare the short- and long-term efficacy and safety of endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) in the treatment of rectal neuroendocrine tumor (NET) with maximum diameter ≤20 mm.Methods:From January 1, 2014 to June 30, 2022, the clinical data of 111 patients with rectal NET with maximum diameter ≤20 mm treated by ESD or TEM at Peking University People′s Hospital were retrospectively analyzed. According to the treatment of ESD or TEM, 111 patients with rectal NET were divided into ESD group (76 cases) and TEM group (35 cases). The clinicopathological characteristics (age, distance from anal margin, depth of invasion, etc.) were compared between patients with tumor maximum diameter<10 mm and 10 to 20 mm, and between ESD group patients and TEM group patients. The clinical efficacy and prognosis were also compared between ESD group and TEM group. The follow-up time was 41 months (16 months, 76 months). The propensity score matching (PSM) method was used to balance the differences of clinical characteristics between ESD and TEM groups. Independent sample t test, Wilcoxon rank-sum and chi-square test were used for statistical analysis. The risk factors of lymph node or distant metastasis were analyzed by univariate and multivariate binary logistic regression. Results:The maximum tumor diameter of 111 patients with rectal NET was (6.6±0.3) mm (ranged from 2 to 20 mm). The maximum tumor diameter of 85 cases (76.6%) was <10 mm and that of 26 cases (23.4%) was between 10 mm and 20 mm. There were statistically significant differences in age, distance from the anal margin and incidence of submucosal infiltration between patients with tumor maximum diameter<10 mm and patients with tumor maximum diameter 10 to 20 mm ((49.8±11.6 ) years old vs. (56.8±13.8) years old; 5.0 cm (4.0 cm, 8.0 cm) vs. 8.0 cm (5.0 cm, 8.0 cm); 69.4%, 59/85 vs. 96.2%, 25/26; t=2.58, Z=-2.23, χ2=6.35, P=0.011, 0.026 and 0.012). The en block resection rate of rectal NET treated with ESD or TEM was 100.0%(111/111), the complete resection rate was 93.7% (104/111), and the postoperative bleeding rate was 2.7% (3/111). There were no postoperative perforation or other major complications. During the follow-up period, there was no local recurrence. The metachronous recurrent rate was 0.9% (1/111), 3.6% (4/111) patients had lymph node or distant metastasis, and there was no death. Compared with patients with tumor maximum diameter<10 mm, more patients with tumor maximum diameter of 10 to 20 mm selected TEM (57.7%, 15/26 vs. 23.5%, 20/85), and the difference was statistically significant ( χ2=10.76, P=0.001). Before PSM, a total of 7 patients in the ESD group had positive vertical margins, and during the follow-up of 21 months (15 months, 48 months), 2 patients had lymph node or distant metastasis and received surgery. The proportion of patients with tumor maximum diameter of 10 to 20 mm and submucosal invasion in TEM group were both higher than those in ESD group (42.9%, 15/35 vs. 14.5%, 11/76; 88.6%, 31/35 vs. 69.7%, 53/76), and the differences were statistically significant( χ2=10.76 and 3.65, P=0.001 and 0.032). After PSM, there were no statistically significant differences in the complete resection rate, postoperative bleeding rate, metachronous recurrence rate, lymph node or distant metastasis rate between ESD group and TEM group (89.3%, 25/28 vs.100.0%, 28/28; 3.6%, 1/28 vs. 0, 0/28; 3.6%, 1/28 vs. 0, 0/28; 0, 0/28 vs.3.6%, 1/28; all P>0.05). However, the operation time and hospital stay of the ESD group were both shorter than those of the TEM group (27.0 min (25.0 min, 30.0 min) vs. 39.0 min (32.0 min, 45.0 min); 5.0 d (4.0 d, 5.0 d) vs. 6.0 d (3.0 d, 9.0 d)), and the differences were statistically significant ( Z=-3.38 and -2.23, P=0.001 and 0.021). Conclusion:The efficacy of ESD and TEM in rectal NET with maximum diameter ≤ 20 mm is equal, however, ESD has the advantage of shorter procedure time and hospital stay.

Objective:By analyzing the expression of pepsin in nasopharyngeal carcinoma (NPC) tissues, to investigate the correlation between laryngeal reflux (LPR) and NPC, as well as the effect of LPR on the quality of life of patients with NPC after radiotherapy.Methods:A total of 133 patients with NPC who underwent radiotherapy at the Department of Otorhinolaryngology of the Affiliated Hospital of Guizhou Medical University and the Affiliated Cancer Hospital of Guizhou Medical University from 2005 to 2019 were enrolled consecutively, including 90 males and 43 females, aged (44.32±7.47) years old. At the same period, 58 patients with chronic nasopharyngitis who underwent nasopharyngeal biopsy were selected as the control group. Immunohistochemical method was used to detect the expression of pepsin in nasopharyngeal specimens of the two groups. In addition, 188 normal individuals were selected as the normal group in the same period. NPC patients before and within 6 months after radiotherapy were inverstigated by the General Information Questionnaire and the Quality of Life Scale, and the pepsin levels in saliva of NPC patients before and after radiotherapy and the individuals in normal group were measured. SPSS 21.0 software was used for statistical analysis.Results:Pepsin expression in 133 specimens of NPC patients was strongly positive in 24 cases (18.05%), positive in 21 cases (15.79%), weakly positive in 69 cases (51.88%), and negative in 19 cases (14.29%). The specimens of control group had 10 cases of weakly positive (17.24%), 48 cases of negative (82.76%), but no strong positive or positive pepsin expression. The rate of positive pepsin expression in the NPC group was higher than that in the control group, with a statistically significant (χ 2=83.15, P<0.001). The pepsin content in the saliva of NPC patients after radiotherapy ((30.31±7.82) ng/ml) was higher than that before radiotherapy ((20.47±8.21) ng/ml) and the normal group (5.11±2.13) ng/ml), and the pepsin content in saliva before radiotherapy was higher than that in the normal group, and all differences were statistically significant (all P<0.05). After radiotherapy, the five functional domains of quality of life and overall quality of life of NPC patients decreased, while the related symptom scores increased (all P<0.05). Multiple linear regression analysis showed that pepsin content in saliva was the influential factor of five functional domains of quality of life, related symptoms and overall quality of life in NPC patients after radiotherapy (all P<0.05). Conclusion:The positive rate of pepsin expression in NPC tissues is high, and the pepsin in saliva before and after radiotherapy of NPC patients is significantly higher than that in normal, suggesting that LPR may be involved in the process of NPC and affect the quality of life after radiotherapy in NPC patients.

Objective:To introduce our experience on dealing with the internal carotid artery (ICA) during the resection of lateral skull base tumors, and to explore the reference values for using radiological findings to make a rational surgical plan.Methods:A retrospective study of patients who underwent resection of lateral skull base tumors involving ICA at Peking Union Medical College Hospital from May 2015 to May 2021 was conducted. The demographic information, preoperative examinations, diagnosis, surgical details and follow-ups were collected. A total of 41 patients were enrolled [24 (58.5%] females, 17 (41.5%) males], with an average age of 47.9 years. According to the preoperative imaging findings, the relationships between the tumors and ICA were divided into four types: adjacency, compression, invasion and ICA aneurysm.Results:The ICA was preserved in 32 (78.0%, 32/41) cases and was reconstructed in nine (22.0%, 9/41) cases. All the 27 (65.9%, 27/41) tumors adjacent to ICA were successfully separated from the artery. Among the 11 tumors compressing the ICA, six were resected with the involved ICA segment and vascular reconstruction was conducted. One (2.4%, 1/41) tumor invading ICA and two (4.9%, 2/41) ICA aneurysms required revascularization. The mean follow-up time was (26.1±2.9) months. There was no recurrence, except one case of adenoid cystic carcinoma which had brain metastases one year after surgery.Conclusions:According to the preoperative imaging, lateral skull base tumors adjacent to ICA can be detached from the vascular surface. Separation should be attempted first for tumors compressing ICA, and revascularization should be followed if separation failed. Vascular reconstruction is usually needed in the removal of tumors invading ICA and ICA aneurysms. Preoperative radiology can provide good references for planning a surgery for lateral skull base tumors.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.