Objective    To evaluate the midterm effect of valve-sparing aortic root replacement (VSRR) on aortic root aneurysm and moderate to severe aortic regurgitation (AR). Methods    The clinical data of patients with aortic root aneurysm and moderate to severe AR undergoing VSRR and surviving from the operation from October 2013 to May 2020 were retrospectively analyzed. There were 31 males and 9 females, with an average age of 47.1±13.4 years. There were 30 patients with true aneurysm of aortic root and 10 patients with dissecting aneurysm of aortic root. There were 3 patients with bicuspid aortic valve, and 12 patients with Marfan syndrome. The AR measured by the echocardiogram was moderate in 18 patients and severe in 22 patients. The average diameter of aortic annulus was 27.0±3.9 mm, and the mean largest diameter of aortic sinus was 52.3±6.1 mm. Results    A total of 32 patients underwent David technique and 8 patients underwent Yacoub technique, and 10 patients underwent aortic cusp repair simultaneously. All 40 patients  completed the follow-up, and the follow-up period was 12-86 (45.7±18.9) months. During the period, 1 patient died of heart failure, 2 had reoperation due to new-onset Stanford B aortic dissection, and no patients had reoperation related to aortic valve. The postoperative New York Heart Association cardiac function classification (1.6±0.5 vs. 2.8±0.8), left ventricular end-diastolic dimension (52.2±7.8 mm vs. 61.4±10.6 mm) and left ventricular end-diastolic volume (136.0±58.8 mL vs. 193.3±83.9 mL) of the patients were significantly improved compared with preoperative ones (P<0.05). By echocardiography, 19 patients had no AR, 18 patients had mild AR, 3 patients had mild-moderate AR, and no patients had moderate or higher AR. Conclusion    In patients with aortic root aneurysm and moderate to severe AR, VSRR technique avoids prosthetic valves and anticoagulation-related complications, has lower rate of AR recurrence and reoperation, and improves the quality of life in the midterm period.

Objective    To evaluate the short and mid-term outcomes of valve repair in patients with insufficient bicuspid aortic valves (BAV). Methods    The clinical data of 27 consecutive patients with insufficient BAV undergoing valve repair in Shanghai Chest Hospital from September 2016 to January 2020 were retrospectively reviewed. There were 24 males and 3 females with a mean age of 38.5±14.6 years (range: 20-68 years). BAV of all patients was type 1 in Seviers' classification. There were 23 patients with left-right fusion and 4 patients with right-noncoronary fusion. There was aortic regurgitation in the patients measured by the echocardiogram, including moderate regurgitation in 3 patients, moderate-severe in 18 patients, and severe in 6 patients. The diameter of aortic annular base was 27.9±3.4 mm, and the largest diameter of aortic sinus was 39.9±7.6 mm. Left ventricular end diastolic diameter was 62.7±6.5 mm, and the volume was 197.9±53.6 mL. Results    All 27 patients completed the follow-up, and the mean time was 24.2±12.5 months (range: 12-51 months). No patient died or required aortic valve-related reoperation during the follow-up. The cardiac function of the patients significantly improved postoperatively (P<0.05). By echocardiography, 11 patients had no aortic regurgitation, 13 had mild aortic regurgitation, and 3 had moderate aortic regurgitation, and no patient had severe aortic regurgitation. Postoperative left ventricular end diastolic diameter and volume decreased, compared to preoperative ones (P<0.05). Conclusion    In patients with insufficient BAV, valve repair is safe and effective, and has excellent short and mid-term outcomes.

Objective:To observe the imaging characteristics of guinea pig cochlear structure using 9.4 Tesla magnetic resonance imaging system at different time intervals of contrast agent distribution in the inner ear.Methods:Form May 2015 to October 2015, five albino guinea pigs were injected with Gd-DTPA via the right internal jugular vein (3 ml/kg). Inner ears were scanned with 9.4T MRI. At the 10 th, 30 th, 60 th, 90 th and 120 th minutes post-Gd-DTPA, we took inner ear images to detect changes of endolymph and perilymph. Using Image J software, we acquired MRI gray value through the first, second, third and apical turn of cochlear at different time points. Analysis by one-way ANOVA was taken to analyze the resultsusing GraphPad Prism 5 software.Results:Only outlines of the cochlea and vestibule were visible before Gd-DTPA injection and there was no clear distinction between endolymph and perilymph. Cochlea vestibule on T1 weighted images was enhanced at the 10 th (the first turn of cochlear 8 203±819) after injection, and then imaging of each part of cochlea, including cochlea, vestibule, semicircular canal and even endolymph and perilymph, can be distinguished clearly, because they enhanced gradually at the 30 th(10 489±819), 60 th(13 965±591), and at 90 th(18 050±1 250) after injection. While at the 120 th(18 952±1 185) minute, imaging was not significantly enhanced than at the 90 th minute. The speed and volume of contrast agent spreaded into the various parts of the inner ear were different, and changes with distribution of contrast agent in each part of the inner ear showed a rising process in a certain period of time. The distribution of contrast agent in the inner ear had concentration gradient via basal turn higher and apical turn lower.Conclusions:Endolymph of inner ear can be distinguished from the perilymph using a 9.4T MRI system with Gd-DTPA, and the best observation timer was 90 minutes after intravenous injection of contrast agent. In summary, our study provides the clearly visualized imaging evidence of the changes of the lymphatic fluid, which may be useful for diagnosis of inner ear diseases such as Meniere′s Disease.

Objective:In combination with 3D printing technology and degradable composite materials, to discuss the preparation method of tissue engineering ossicles for middle ear hearing reconstruction.Methods:Domestic polymer (polylactic acid-glycolic acid copolymer, PLGA) and degradable ceramic material (β-tricalcium phosphate, β-TCP) were selected and prepared by low temperature deposition method according to the design ratio to Program according to the outline design code of the required scaffold to generate appropriate print files, and then the self-developed low-temperature deposition printing device was used to prepare tissue-engineered osseous scaffolds in accordance with the print files in a low-temperature environment. The scaffolds was freeze-dried and sterilized for later use after printing. Light microscopy and scanning electron microscopy were used to observe the apparent characteristics and internal structure of the scaffolds and to check its pore size, porosity and mechanical properties.Results:After printing, a degradable scaffold was obtained. Under the optical microscope, it was a small cylindrical shape with a diameter of 1.5 mm and a length of 6.0 mm, and its surface had micropores. The degradable scaffold had a horizontal and vertical interlaced warp and weft structure, the wire spacing was 1.2 mm, and the pores were connected to each other. The surface could see circular or quadrangular pores with a pore size of about 100-400 μm. The diameter of the inter-pore cross-linked channels was about 50 μm and the diameter of the surrounding circular micropores was about 10-40 μm. β-TCP particles with a size of about 700 nm were attached to the surface of the PLGA material. The average porosity of the whole scaffolds was (83.43±0.01)%, and the content of BMP-2 loaded was about 0.7 μg/mm 3. After freeze-drying, the mechanical strength of the scaffold was moderate, and there was no obvious deformation during stretching and compression, which met the mechanical requirements of tissue engineering ossicles. Conclusions:Using the low-temperature deposition printing method and strictly controlled processes and conditions, a polymer-degradable ceramic ossicle tissue engineering scaffold can be prepared for implantation experiments. The scaffold has suitable porosity and mechanical properties, and can be loaded with osteoinductive factors.

Objective To research the diagnostic value of the wide band acoustic absorbance rate in children otitis media with effusion. Methods The wide band acoustic absorbance rate was tested in 114 children (a control group of 30 healthy children;50 patients shown middle ear effusion during tympanotomy;and 34 patients with chronic effusion shown no middle ear effusion during tympanotomy).The data of each group were analyzed, and the diagnostic value of wide band absorbance was analyzed with the receiver operating characteristic curve.Results The wide band acoustic absorbance rate of otitis media with effusion group was notably lower than that of non-effusion group and control group at the 0.5～4 kHz averaged absorbance (P＜0.05).After analyzing the receiver operating characteristic curve, it showed that the diagnosis value was highest in the range of 0.5～2 kHz (area under the curve0.984), followed by 1 kHz and 1.5 k Hz (area under the curve:0.973 and 0.967). Conclusion Compared with the conventional 226 Hz tympanometry, the wide band tympanometry is more accurate for the diagnosis of children otitis media with effusion.It can be used as a better method for the diagnosis of otitis media exudative lesions.

Objective: To investigate the clinical efficacy of preoperative-, postoperative-radiotherapy and surgery for preserving laryngeal function in patient over 70 years of age with medial wall pyriform sinus cancer. Methods: Clinical data of 48 patients over 70 years of age with medial wall pyriform sinus cancer who received surgical treatment from January 2001 to December 2010 were retrospectively analyzed. Among them, 21 cases were given preoperative radiotherapy and surgery (R+ S). The radiation therapy dose was 45 Gy. And 14 cases′ larynx is preserved. In addition, 27 cases were given postoperative radiotherapy and surgery (S+ R). The radiation therapy dose was 65 Gy. And 10 cases had preserved laryngeal function. Survival rates were analyzed by the Kaplan-Meier method. Chi-square test was used to compare complications between two groups. Results: The larynx preservation rate in R+ S group [66.7% (14/21)] was significantly higher than that in S+ R group [37.0% (10/27), P<0.05]. The complication rate and decannulation rate in R+ S group were 42.9% (9/21) and 64.3% (9/14), respectively, showing no difference compared with those in S+ R group [37.0% (10/27) and 50.0% (5/10), respectively] (all P>0.05). The complication rates of patients with and without larynx preservation were 41.7% (10/24) and 37.5% (9/24), respectively, showing no difference between two groups (P>0.05). The overall 3-years and 5-years survival rates for all patients were 54.2% (26/48) and 35.4% (17/48), respectively. There was no significant difference in survival rates between R+ S [38.1% (8/21)] group and S+ R group [33.3% (9/27), P>0.05)]. In the R+ S group, the survival rates in patients with and without larynx preservation were 40.0% (4/10) and 29.4% (5/17), respectively, showing no significant difference between two groups (P>0.05). Conclusions It is secure and effective to choose the operation with laryngeal preservation for patient over 70 years of age with medial wall pyriform sinus cancer based on their physical conditions and the tumor extension. The preoperative- and postoperative-radiotherapy have the similar effect. Preoperative radiotherapy and surgery increases the laryngeal preservation rate.

Objective To investigate the safe and effective method for laryngeal microsurgery in difficult la‐ryngeal exposure cases .Methods We selected 62 patients’ clinical data who had received laryngeal microsurgery with difficult laryngeal exposure and could not exposure by normal self -retaining laryngoscope between July 2012 and June 2015 .There were 42 cases of vocal cord polyp ,9 cases of the vocal cyst ,5 cases of the vocal amyloidosis , 4 cases of severe atypical hyperplasia of vocal cords and 2 cases of vocal cord high differentiated squamous carcino‐ma .We completed all kinds of laryngeal microsurgery to expose the glottis by adjusting the postures of patients ,in‐creasing the anesthesia depth ,using self -retaining laryngoscope with endoscopy which can be adjusted and pressing the throat .Results In 62 patients ,58 patients were successfully operated with adjustable self -retaining laryngo‐scope with endoscopy ,the success rate was 93 .55% .And 25 cases was exposed the glottis completely by increasing the anesthesia depth ,however ,when we increased the anesthesia depth ,there were 10 cases needed to combined with pressing the throat to expose .Five patients had retropharyngeal injure with different levels .One case with small jaw deformity of the vocal cord polyp surgery was not successful ,the success of electronic endoscopic under surface anesthesia surgery .The other one case with teeth unkempt and porcelain teeth and two cases of intraoperative frozen tip vocal cord cancer completed the operation of the open throat under the non trachea incision .Conclusion Most of difficult exposed laryngeal can be safely and effectively exposed through using the adjustable self -retaining laryngo‐scope with endoscopy while normal self -retaining laryngoscope can not .When necessary ,we can put 30°endoscope into the side channel of self -retaining laryngoscope to complete all kinds of laryngeal microsurgery .

Adult ; Bronchi ; pathology ; Diagnostic Errors ; Foreign Bodies ; Humans ; Trachea ; pathology

OBJECTIVE: To investigate the clinical features, imaging characteristics, pathological types, the misdiagnosis causes and the early diagnosis method of malignant lymphoma in nasal cavity and paranasal sinuses. METHOD: Clinicopathological data of 34 patients with malignant lymphoma in nasal cavity and paranasal sinuses were retrospectively analyzed. RESULT: Most of patients were middle aged man, the incidence of malignant lymphoma of nasal cavity and paranasal sinuses accounted for 21.7% of nasal malignant tumor over the same period, nasal malignant lymphoma incidence rate was higher than the sinus malignant lymphoma (76.5% VS. 17.6%). The main symptoms were presented as snuffle, epistaxis, purulent nasal discharge, fever and so on. Nasal neoplasm, nasal mucosa hyperemia, erosion, necrosis are the main signs of the disease. CT features were summarized as the lesions located in the anterior-middle area in nasal cavity, homogeneous in density, soft tissue swelling in some cases and less bone destruction. The majority pathological type of nasal malignant lymphoma was NK/T cell lymphoma, but the common pathological type of paranasal sinus malignant lymphoma was B-cell lymphoma. The misdiagnosis rate of malignant lymphoma in nasal cavity and paranasal sinus was 21.2%. CONCLUSION Malignant lymphoma in nasal cavity and paranasal sinuses without specific clinical characteristics, but has some certain CT characteristics. Combined with the clinical, imaging and pathological features, can improve the cognition and diagnosis of the disease.
Diagnostic Errors ; Epistaxis ; Humans ; Lymphoma ; diagnosis ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Male ; Middle Aged ; Nasal Cavity ; pathology ; Necrosis ; Paranasal Sinus Neoplasms ; diagnosis ; Paranasal Sinuses ; pathology ; Retrospective Studies ; Tomography, X-Ray Computed