Objective: To evaluate the efficacy of neoadjuvant chemotherapy (NACT) in the treatment of locally advanced olfactory neuroblastoma (ONB), and to explore the factors related to the efficacy of NACT. Methods: A total of 25 patients with ONB who underwent NACT in Beijing TongRen Hospital from April 2017 to July 2022 were retrospectively analyzed. There were 16 males and 9 females, with an average age of 44.9 years (ranged 26-72 years). There were 22 cases of Kadish stage C and 3 cases of stage D. After multiple disciplinary team(MDT) discussion, all patients were treated sequentially with NACT-surgery-radiotherapy. Among them, 17 cases were treated with taxol, cis-platinum and etoposide (TEP), 4 cases with taxol, nedaplatin and ifosfamide (TPI), 3 cases with TP, while 1 case with EP. SPSS 25.0 software was used for statistical analysis, and survival analyses were calculated based on the Kaplan-Meier method. Results: The overall response rate of NACT was 32% (8/25). Subsequently, 21 patients underwent extended endoscopic surgery and 4 patients underwent combined cranial-nasal approach. Three patients with stage D disease underwent cervical lymph node dissection. All patients received postoperative radiotherapy. The mean follow-up time was 44.2 months (ranged 6-67 months). The 5-year overall survival rate was 100.0%, and the 5-year disease-free survival rates was 94.4%. Before NACT, Ki-67 index was 60% (50%, 90%), while Ki-67 index was 20% (3%, 30%) after chemotherapy [M (Q₁, Q₃)]. The change of Ki-67 before and after NACT was statistically significant (Z=-24.24, P<0.05). The effects of age, gender, history of surgery, Hyams grade, Ki-67 index and chemotherapy regimen to NACT were analyzed. Ki-67 index≥25% and high Hyams grade were related to the efficacy of NACT (all P<0.05). Conclusions: NACT could reduce Ki-67 index in ONBs. High Ki-67 index and Hyams grade are clinical indicators sensitive to the efficacy of NACT. NACT-surgery-radiotherapy is effective for patients with locally advanced ONB.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Neoadjuvant Therapy/methods* ; Retrospective Studies ; Esthesioneuroblastoma, Olfactory/etiology* ; Ki-67 Antigen ; Paclitaxel ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Nasal Cavity ; Nose Neoplasms/therapy* ; Neoplasm Staging

Objective: To summarize the follow-up outcomes of frontal drill out procedures (draf Ⅱb, extended draf Ⅱb and draf Ⅲ) using mucosal flaps, and discuss the surgical indications of different mucosal flaps and their potential benefits to the opening of the frontal neo-ostium. Methods: A total of 48 patients with chronic rhinosinusitis or frontal mucoceles treated by draf Ⅱb, extended draf Ⅱb and draf Ⅲ between 2013 and 2019 in Beijing TongRen Hospital were enrolled in this study. Twenty-four patients who were treated with mucosal flaps were considered as mucosal flap group (including 19 males and 5 females, aging from 19 to 71 years), and the other 24 patients who didn't have neo-ostium reconstruction were considered as control group (including 18 males and 6 females, aging from 21 to 63 years). The frontal neo-ostium crosssectional area was measured with osiriX^® 7 days and 1 year postoperatively. Lund-Kennedy score (LKS) was also completed to analyze the difference of therapeutic effect between mucosal flap group and control group. SPSS 23.0 software was used for statistical analysis. Results: The postoperative follow-up time was 18 to 102 months. The postoperative epithelialization time in the mucosal flap group and the control group was (2.5±0.9) months and (3.0±0.7) months (Mean±SD), respectively, with statistically significant (t=1.97, P=0.024). At the end of follow-up, 23 cases (95.8%) had well opened frontal neo-ostium, 1 case (4.2%) was re-stenosed, and there was no revision surgery in the mucosal flap group. In the control group, 16 cases (66.7%) had well opened frontal neo-ostium, 8 cases (33.3%) were re-stenosed, 4 cases (16.7%) had revision surgery. The mucosal flap group had much fewer stenosis cases than control group (χ²=4.92, P=0.027). The neo-ostium area in the mucosal flap group and the control group was reduced by (0.87±0.58) cm² and (1.54±1.15) cm² 1 year after operation respectively, with statistically significant (t=1.72, P=0.046). There was no case of frontal sinus atresia and no surgical complication in both groups. The two-factor repeated measurement analysis of variance after surgery showed that the average LKS of the mucosal flap group was 0.78 points lower than that of the control group. In other words, the influence of grafting technique on LKS was statistically significant (F=5.33, P=0.035). Conclusions: The application of mucosal flaps to cover the denuded bone during frontal drill out procedures can prohibit mucosal scar and new bone formation, and significantly reduce the stenosis rate of frontal neo-ostium.
Constriction, Pathologic ; Endoscopy/methods* ; Female ; Frontal Sinus/surgery* ; Humans ; Male ; Mucous Membrane/transplantation* ; Surgical Flaps

BACKGROUND: Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China. METHODS: The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD. RESULTS: A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082-4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606-3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044-1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061-2.424), DRI (OR, 2.094; 95% CI, 1.328-3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679-4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777-6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996-0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379-0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160-0.467) were preventive factors for BPD (all P < 0.05). CONCLUSION Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.
Birth Weight ; Bronchopulmonary Dysplasia ; China/epidemiology* ; Delivery Rooms ; Female ; Gestational Age ; Humans ; Infant ; Infant, Extremely Low Birth Weight ; Infant, Extremely Premature ; Infant, Newborn ; Male ; Pregnancy

BACKGROUNDAdenoid hypertrophy (AH) is associated with pediatric chronic rhinosinusitis (pCRS), but its role in the inflammatory process of pCRS is unclear. It is thought that innate immunity gene expression is disrupted in the epithelium of patients with chronic rhinosinusitis (CRS), including antimicrobial peptides and pattern recognition receptors (PRRs). The aim of this preliminary study was to detect the expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pCRS to better understand their role in pCRS.

METHODSNine pCRS patients and nine simple AH patients undergoing adenoidectomy were recruited for the study. Adenoidal epithelium was isolated, and real-time quantitative polymerase chain reaction (RT-qPCR) was employed to measure relative expression levels of the following messenger RNAs in hypertrophic adenoid epithelial cells of pediatric patients with and without CRS: Human β-defensin (HBD) 2 and 3, surfactant protein (SP)-A and D, toll-like receptors 1-10, nucleotide-binding oligomerization domain (NOD)-like receptors NOD 1, NOD 2, and NACHT, LRR and PYD domains-containing protein 3, retinoic acid-induced gene 1, melanoma differentiation-associated gene 5, and nuclear factor-κB (NF-κB). RT-qPCR data from two groups were analyzed by independent sample t-tests and Mann-Whitney U-tests.

RESULTSThe relative expression of SP-D in adenoidal epithelium of pCRS group was significantly lower than that in AH group (pCRS 0.73 ± 0.10 vs. AH 1.21 ± 0.15; P = 0.0173, t = 2.654). The relative expression levels of all tested PRRs and NF-κB, as well as HBD-2, HBD-3, and SP-A, showed no statistically significant differences in isolated adenoidal epithelium between pCRS group and AH group.

CONCLUSIONSDown-regulated SP-D levels in adenoidal epithelium may contribute to the development of pCRS. PRRs, however, are unlikely to play a significant role in the inflammatory process of pCRS.

Adenoids ; cytology ; Antimicrobial Cationic Peptides ; metabolism ; Child ; Epithelial Cells ; metabolism ; Female ; Humans ; Immunity, Innate ; genetics ; physiology ; Male ; Receptors, Pattern Recognition ; metabolism ; Sinusitis ; metabolism ; Toll-Like Receptors ; metabolism

BACKGROUNDThe inferior turbinate (IT) and nasolacrimal duct (NLD) are often sacrificed while managing the diffuse lesion of maxillary sinus (MS). We report a new approach to MS without ablation of NLD and IT.

METHODSThis retrospective study enrolled 19 hospitalized patients (aged from 42 to 68 years) who underwent endoscopic sinus surgery between 2003 and 2008. Twelve patients had inverted papilloma (IP), two had nasal polyps, two had Kubo's postoperative cyst of MS, one had recurrent bone cyst of maxilla, one had dentigerous cyst and one had bleeding of internal maxillary artery secondary to Caldwell-Luc operation respectively. Two IP patients were excluded from this group since the follow-up time was less than 12 months. The NLD was dissected after removing the anterior bony portion of nasal lateral wall. The prelacrimal recess approach (PLRA) to MS was established when IT-NLD flap was raised medially. The flap was repositioned when MS lesion was removed.

RESULTSAll the 17 patients had unilateral lesions. Ten MS IP patients were at the T3 Krouse stage. The follow-up ranged from 7 to 60 months. No recurrence was seen in 16 patients. Only one IP patient had a local recurrence in MS. All of them had no any complications.

CONCLUSIONThe diffuse or severe diseases of MS may be the potential indications for PLRA.

Adult ; Aged ; Endoscopy ; methods ; Female ; Humans ; Male ; Maxillary Sinus ; surgery ; Middle Aged ; Papilloma, Inverted ; surgery ; Retrospective Studies

Background The inferior turbinate (IT) and nasolacrimal duct (NLD) are often sacrificed while managing the diffuse lesion of maxillary sinus (MS).We report a new approach to MS without ablation of NLD and IT.Methods This retrospective study enrolled 19 hospitalized patients (aged from 42 to 68 years) who underwent endoscopic sinus surgery between 2003 and 2008.Twelve patients had inverted papilloma (IP),two had nasal polyps,two had Kubo's postoperative cyst of MS,one had recurrent bone cyst of maxilla,one had dentigerous cyst and one had bleeding of internal maxillary artery secondary to Caldwell-Luc operation respectively.Two IP patients were excluded from this group since the follow-up time was less than 12 months.The NLD was dissected after removing the anterior bony portion of nasal lateral wall.The prelacrimal recess approach (PLRA) to MS was established when IT-NLD flap was raised medially.The flap was repositioned when MS lesion was removed.Results All the 17 patients had unilateral lesions.Ten MS IP patients were at the T3 Krouse stage.The follow-up ranged from 7 to 60 months.No recurrence was seen in 16 patients.Only one IP patient had a local recurrence in MS.All of them had no any complications.Conclusion The diffuse or severe diseases of MS may be the potential indications for PLRA.

Objective To investigate the clinical application of global osteitis score system(GOSS)in patients with chronic rhinosinusitis(CRS).Methods Three hundreds and thirty-four patients with CRS were enrolled prospectively in a large tertiary referral center.The paranasal sinus bone Hounsfield unit (Hu),thickness,scope were measured by PHILIPS MxLiteView software.Nasal endoscopy Lund-Kennedy score was analyzed in all patients.Sinus CT scans of all patients were analyzed for Lund-Mackay score and for osteitis using the GOSS.Association between GOSS and Lund-Mackay,Lund-Kennedy was analyzed by SPSS 16.0 software.Results The incidence of osteitis in patients with CRS was 53.9％(180/334).The incidence of osteitis(more than grade 2)in patients with CRS was 33.8％(113/334).Average GOSS score of osteitis was 7.51 ± 7.27.The highest incidences of osteitis were in the maxillary and anterior ethmoid sinuses.The left anterior ethmoid sinuses was 37.2％.The right anterior ethmoid sinuses was 32.8％.The left maxillary sinuses was 46.1％.The right maxillary sinuses was 42.2％.GOSS score were significantly correlated with Lund-Mackay and Lund-Kennedy scores(r value were 0.497 and 0.409 respectively,all P ＜ 0.001).Conclusion GOSS can define and evaluate the extent and the severity of osteitis in patients with CRS by using CT,and can also reflect the extent and the severity of CRS.

Objective To study the CT and MRI findings of lesions in unilateral maxillary sinus,and to compare the effect of CT and MRI in the differential diagnosis of lesions in unilateral maxillary sinus.Methods Retrospective analysis of CT and contract-enhanced MRI imaging data from 34 patients with lesions in unilateral maxillary sinus which were diagnosed by endoscopic sinus surgery and postoperative pathology.The CT and contract-enhanced MRI's value in the differential diagnosis in lesions in unilateral maxillary sinus was analysed.Results All 34 patients had unilateral maxillary sinus lesions.On CT:soft tissue density shadow in the unilateral maxillary sinus was found in all 34 cases.Five cases showed spot high density with thickening bone in the maxillary sinus wall.Eleven cases showed expansion of the opening of maxillary sinuses.Two cases showed broken lateral wall of nasal cavity.One case showed soft tissue density shadow in the maxillary sinus with curve edge with high density shadow which had a tooth shadow in it.Other 14 cases showed only soft density shadow in the maxillary sinuses.On MRI:all 34 cases revealed lower signals on T1WI compared to gray matter.Little loss signal were found in the inner of the maxillary sinus fungal balls on T1WI.Enhanced MR imaging showed no enhanced in nasal sinusitis,sinus cysts and polyp of posterior naris.Inhomogenous enhancing and "the cerebral convolution sign" were found in the hemorrhagic and necrotic nasal polyp,the nasal inverted papilloma and the malignant tumor cases.Higher signals were seen in the nasal sinusitis,fungal balls and the polyp of posterior naris cases on T2WI.Inhomogenous signal with different levels were found in the hemorrhagic and necrotic nasal polyp,the nasal inverted papilloma and the malignant tumor cases on T2WI.Conclusions CT and MRI examination are important in the diagnosis of the unilateral maxillary sinus lesions.Both CT and MRI had more differential diagnostic value in the unilateral maxillary sinus lesions than only CT used.

Objective To summarize the follow-up outcomes of Draf Ⅱ b frontal sinusotomy and it's modified procedures,and to discuss the surgical indications and prognostic factors.Methods Thirty-two patients treated between 2004 and 2010 were enrolled in this study.There were 15 patients for recurrent frontal inverted papilloma ( IP),6 for mucocele,4 for recurrent frontal sinusitis,3 for osteoma,2 for meningoeneephalocele with cerebrospinal fluid rhinorrhea,1 for meningoencephalocele alone and 1 for acute frontal sinusitis.All patients underwent preoperative paranasal sinus computed tomography (CT) scans.Patients with tumor accepted magnetic resonance imaging (MRI).The patients with meningoencephalocele and cerebrospinal fluid rhinorrhea recieved magnetic resonance cistemography (MRC).The Draf Ⅱ b frontal sinusotomy and it's modified Draf Ⅱ b-1 -3 procedures were applied endoscopically under general anesthesia mainly by high speed bur and power system.The postoperative CT scan was obtained as a base line for follow-up 1 week after the operation.Postoperative follow-up was performed under endoscope.Results Among 19 cases of Draf Ⅱ b,12 were recurrent IP of frontal sinus,4 were mucocele,2 were recurrent frontal sinusitis and 1 were osteoma.Five cases received Draf Ⅱ b-1,2 for each recurrent IP of frontal sinus and recurrent frontal sinusitis and 1 for osteoma. Six cases received Draf Ⅱ b-2, 3 for meningoencephalocele,1 for each IP,acute frontal sinusitis and osteoma.Two cases received Draf Ⅱ b-3 were mucocele.The follow-up ranged from 8 to 73 months.Twenty-two cases of the frontal neoostium were widely opened,7 were stenosis and 3 were closed.Revision surgery was seen in 2 cases with IP.All of them had no complications.Conclusions The Draf Ⅱ b frontal sinusotomy and it's modified procedures are suitable for complex frontal sinus disease,which can be selected according to pathological and anatomical features,and have a good prospect for clinical application.

Objective To sum up the follow-up outcomes of endoscopic modified Lothrop procedure (EMLP) and retrospectively analyze the indications,methods and prognostic factors of EMLP.Methods The collected data of 73 cases who received EMLP with frontal sinus diseases were analyzed in this paper.The mean age was 45.6 (ranging from 14 to 72 years).There were 52 males and 21 females.Only patients with follow-up time greater or equal to 6 months were included.Paranasal sinus CT scan was adopted for all cases and MRI for tumor patients.All patients were followed under endoscope.Results There were 21 inverted papilloma in the frontal sinus,16 chronic sinusitis with asthma,12 frontal sinusitis,9 chronic sinusitis with or without polyps,7 osteoma of the frontal sinus,4 frontal mucocele,3 allergic fungal sinusitis and 1 congenital encephalocele.Sixty-one cases had prior surgical history ( 1.8 times on the average).Their mean follow-up was 25.0 months,(ranging from 6 to 122 months).At the end of follow-up,44 cases (60.3％ ) had well opened frontal drainage pathway.Twenty-five (34.2％ ) was re-stenosed and 4 (5.5％)closed.Seven cases (9.6％ ) underwent revision surgeries.There were no surgical complications.Conclusions EMLP is an effective and salvage procedure in dealing with tumor of frontal sinus and recurrent frontal sinusitis.Combined with medical treatment,EMLP will have a better results for chronic sinusitis with or without polyps and asthma.The degree of diseases,mucosal loss,anatomic variability and prior surgeries are important prognostic factors.