Objective:To explore the surgical intervention strategy for metastatic cervical lymph nodes surrounding the carotid artery in head and neck squamous cell carcinoma.Methods:A total of 62 patients with advanced head and neck tumors and carotid wrap by disease treated in Department of Otorhinolaryngology and Head and Neck Surgery, the Affiliated BenQ Hospital of Nanjing Medical University between June 2019 and December 2023 were reviewed, of whom 9 patients presented with metastatic squamous cell carcinoma in cervical lymph nodes of unknown primary or with no recurrence of primary lesion and all the 9 patients were males, aged from 48 to 79 years old, with≤level 2 of Eastern Cooperative Oncology Group-Performance Status (ECOG-PS). Radiographically common carotid artery (CCA) and/or internal carotid artery (ICA) were surrounded by≥270° with tumor. All the 9 patients received implantation of covered stent in carotid artery and radical resection of metastatic cervical lymph nodes. The success rate, complications, surgery-related complications, local recurrence rate, quality of life (QOL) and overall survival (OS) were analyzed. The QOL of patients was compared by paired rank sum test, and P<0.05 indicated statistically significant difference. The OS was analyzed by Kaplan-Meier. Results:The success rate of stent implantation was 100%, with no implantation-related complications. R0 resection was performed in 8 cases and R1 resection in 1 case. The QOL of patients after surgery was improved, and the improvements in "pain", "mood" and "anxiety" were statistically significant( Z values were -2.236, -2.460 and -2.200, respectively, and all P values were<0.05). Follow-up was 1-18 months, with a median of 7 months, and 1 case was lost to follow-up. Local recurrence occurred in 3 patients with an incidence of 37.5% (3/8). OS was 59.9% at 12 months after surgery. Conclusion:Implantation of covered stent in carotid artery combined with radical resection is an effective method for the treatment of cervical lymph node metastasis.

Objective To investigate the expression and clinical significance of serum homocysteine (Hcy),galectin-3 (GAL3) and monocyte chemotactic protein-1 (MCP-1) in patients with acute ischemic stroke (ACIS).Methods 100 patients with ACIS in our hospital from January 2016 to February 2018 were selected as the observation group,and 64 healthy persons in our hospital were selected as the control group during the same period.The levels of serum Hcy,GAL3 and MCP-1 were detected and compared between the two groups.The levels of serum Hcy,GAL3 and MCP-1 in patients with different pathological changes,different cerebral infarction areas and different prognosis in the observation group were compared.The correlation between serum Hcy,GAL3 and MCP-1 levels and ACIS cerebral infarction area and neurological deficit scale (NIHSS) was analyzed.The sensitivity,specificity and accuracy of MCP-1 in diagnosing ACIS alone and in combination.Results The levels of serum Hcy,GAL3 and MCP-1 in the observation group were higher than those in the control group (P ＜ 0.05).There were significant differences in serum Hcy,GAL3 and MCP-1 levels between the patients with different pathological degrees of disease (P ＜ 0.05).The level of the above-mentioned indicators in patients with severe injury was higher than that in patients with moderate injury.The patients with moderate injury were higher than those with mild injury (P ＜ 0.05).There were significant differences in serum Hcy,GAL3 and MCP-1 levels in patients with different cerebral infarction areas (P ＜ 0.05),and the above-mentioned index leve1 of patients with large-area infarction was higher than that of patients with moderate-area infarction.The patients with moderate-area infarction were higher than those with small-area infarction (P ＜ 0.05).The levels of serum Hcy,GAL3 and MCP-1 in the dead patients in the observation group were higher than those in the survivors (P ＜ 0.05);correlation analysis showed that serum Hcy,GAL3,MCP-1 levels were positively correlated with ACIS cerebral infract size and NIHSS score (P ＜0.05);the sensitivity (91.00％) and accuracy (83.54％) of combined diagnosis of ACIS were higher than the single-index diagnosis (P ＜ 0.05).Conclusions The levels of serum Hcy,GAL3 and MCP-1 in patients with acute ischemic stroke are highly expressed,and their levels are closely related to the degree of disease,cerebral infarction area and prognosis.The combined detection of Hcy,GAL3 and MCP-1 could improve the accuracy and sensitivity of diagnosis,and could be used as an effective index for clinical diagnosis,condition and prognosis evaluation of acute ischemic stroke.

Objective: To investigate the significance of circulating tumor cells (CTC) in squamous cell carcinoma of the head and neck (HNSCC). Methods: Twenty-four patients with HNSCC treated between October 2016 and July 2017 in our department were selected (experimental group), including 23 males and 1 females, aged 47-81 years. There were 14 cases of squamous cell carcinoma of larynx and 10 cases of hypopharynx, including I-Ⅱ stage (5 cases) and Ⅲ- Ⅳ stage (19 cases). All patients were primary and/or relapsed after treatment. Nine healthy volunteers were selected as control group. A novel in vivo capture technique (CellCellector system) was used to detect CTC. SPSS23.0 was used for statistical analysis. Results: The total capture rate of CTC in patients with HNSCC before treatment was 70.8% (17/24), with 40% (2/5) for patients at I-Ⅱ stage, and 78.9% (15/19) for patients at Ⅲ- Ⅳ stage, and was 0 in patients of control group. The total capture rate of CTC in patients with HNSCC after treatment was 50% (8/16). There was no significant correlation between CTC and age, sex, location of tumor or lymph node metastasis (P>0.05). CTC was related to tumor staging and tumor differentiation (P<0.05). The positive rate of EGFRVⅢ in CTC was 26.3% (5/19). Conclusions The CellCollector system is a very efficient way of detecting CTC, and CTC plays an important role in the occurrence, progression and metastasis of HNSCC.

OBJECTIVE: To analyze the long-term efficacy of nasal endoscopic opticnerve decompression for traumatic optic neuropathy(TON) and to explore its possible influencing factors. METHOD: To summarize the clinical data of 39 cases underwent transnasal decompression, which were followed-up for more than 1 year. The data, including optic canal CT scanning, flashed-elicited visual-evoked potential (FVEP), preoperational vision and visual field examination were reviewed. Nasal endoscopic optic nerve decompression was preformed. Whether or not optic nerve sheath incision decided to perform was according to preoperative CT and situations in operation. Postoperative follow-up including vision, visual field, funduscopy, nasal endoscopy were performed. RESULT: Total efficacy rate was 30. 77% (12/39), inefficacy rate was 69. 23%(27/39). The efficacy rate was 85. 71% with better than nolight perception, and the efficacy rate was 18. 75% with nolight perception, the clinical effect in the group of preoperative better than nolight perception was better than that of nolight perception, the difference was statistically significant (P<0. 05). The efficacy rate was 34. 38% with duration of less than 7 days from the traumatic point to the operation point, and the efficacy rate was 14. 29% for more than 7 days, but the difference was not statistically significant (P> 0. 05). The efficacy rate was 26. 32% with optic nerve sheathincision, while the efficacy rate was 35. 00% without optic nerve sheath incision, and there was no statistically significant difference (P>0. 05); Postoperative vision tended to stabilize until about 6 months post-operation, without complications. CONCLUSION The long-term efficacy of nasal endoscopic opticnerve decompression for TON was certain; The efficacy with preoperative residual vision was better than that of nolight perception, the factor of long or short duration from the trauma point to the operation point and the factor of optic nerve sheath incision didn't influence long curative effect. To avoid the secondary damage to the optic nerve after trauma was the key to increase long curative effect in TON.
Decompression, Surgical ; Endoscopy ; Humans ; Neurosurgical Procedures ; Nose ; surgery ; Optic Nerve ; surgery ; Optic Nerve Injuries ; surgery ; Postoperative Period ; Tomography, X-Ray Computed ; Treatment Outcome ; Visual Acuity

Objective Thyroid lobectomy can be programmed to operate as "step by step".Each step must be performed meticulously with quality control,so as to minimize the complications of surgery.Methods From May 2013 to Auguest 2014,the meticulous thyroid operation was conducted in 72 cases (144 lobectomies).Pre-and post-operative evaluations by strobe laryngoscopy,parathyroid hormone (PTH),and blood calcium examinations were conducted in all cases.Results Four cases (5.6％) had transient recurrent laryngeal nerve paralysis after surgery,but no permanent recurrent laryngeal nerve paralysis.There was no transient or permanent superior laryngeal nerve paralysis.Transient hypoparathyroidism occurred in 10 cases,with no permanent hypoparathyroidism.No case presented with postoperative bleeding or infection.Conclusions " Meticulous operation of thyroid lobectomy" may minimize effectively the complication of surgery.

Objective To understand the clinical distribution of Acinetobacter baumannii and its resistance to antibacterial drugs in order to provide reference for clinical rational drug use in the treatment of Acinetobacter baumannii infection.Methods 162 strains of Acinetobacter baumannii isolated from clinical specimens were collected and performed the statistical analysis on the dis-tribution and the sensitivity to 16 kinds of antibacterial drugs.Results The specimen distribution was dominated by sputum speci-mens(75.3%).The ICU ward had the highest detection rate(49.3%),in which,multidrug resistant strains accounted for 81.2%(65/80);the strains from ICU had the serious multidrug resistance,their resistance rates to 16 kinds of commonly used antibacterial drugs were significantly higher than those the strains isolated from other wards,the difference had statistical significance(P <0.01).The resistance rates of Acinetobacter baumannii to tobramycin,amikacin and cefperazone/sulbactam were relatively lower. Conclusion Strengthening the monitoring of multidrug resistant Acinetobacter baumannii strains and the sterilization and isolation of ICU ward has the important significance to prevent and control nosocomial infection.

Adenocarcinoma ; Humans ; Practice Guidelines as Topic ; Thyroid Neoplasms ; diagnosis ; therapy

Objective To investigate the protection of the parathyroid in the total thyroidectomy to avoid the postoperative permanent hypoparathyroidism.Methods Forty-three consecutive cases underwent total thyroidectomy from June 2013 to June 2014 in Nanjing Tongren Hospital were reviewed.Of them 26 cases with malignant and 17 cases with benign thyroid diseases.Results Intraoperatively,all 4 parathyroid glands were identified in 27 cases,3 parathyroids in 10 cases and 2 parathyroids in 6 cases.Intraoperative parathyroid transplantation was performed in 6 cases,including 5 cases with 1 parathyroid transplantation and 1 case with 2 parathyroid transplantation.With the follow-up of 1-3 months after surgery,10 cases presented with transient hypocalcemia,8 cases with temporary hypoparathyroidism and no case with permanent hypoparathyroidism.Conclusion Accurate identification and conservation in situ or auto-transplantation in total thyroidectomy could be effective for prevention of postoperative permanent hypoparathyroidism.