The Expression Levels of SARS-CoV-2 Infection-Mediating Molecules Promoted by Interferon-γ and Tumor Necrosis Factor-α Are Downregulated by Hydrogen Sulfide.

Autoimmune thyroid diseases (AITDs), which include Hashimoto's thyroiditis (HT) and Graves' disease (GD), have a higher prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the literature. The effects of AITD-associated cytokines on SARS-CoV-2 infection-mediating molecule levels might be involved in the pathogenesis of susceptibility. We speculated that hydrogen sulfide (H2S) might attenuate this process since H2S has antiviral effects. Using immunohistochemistry, we found that angiotensin-converting enzyme-II (ACE2) expression was higher in the HT group and neuropilin 1 (NRP1) expression was higher in HT and GD groups than in the normal group, while transmembrane protease serine type 2 (TMPRSS2) expression was lower in HT and GD groups. When culturing primary thyrocytes with cytokines or sodium hydrosulfide (NaHS) plus cytokines, we found that ACE2 and NRP1 mRNA levels were upregulated while TMPRSS2 levels were downregulated by interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α). After pretreatment with NaHS in thyrocytes, ACE2 and NRP1 expression were downregulated compared to IFN-γ or TNF-α treatment, and NaHS had no effect on TMPRSS2 expression. Our findings suggested that IFN-γ and TNF-α, which are elevated in AITDs, promoted ACE2 and NRP1 expression and inhibited TMPRSS2 expression. H2S might protect against SARS-CoV-2 infection by downregulating ACE2 and NRP1 levels.

Potential health risk assessment through ingestion and dermal contact arsenic-contaminated groundwater in Jianghan Plain, China.

Groundwater contamination with high arsenic (As) levels has caused serious health problem in Jianghan Plain. This study presents a framework to evaluate the results and their probable influencing factors of non-carcinogenic risk and carcinogenic risk in Shahu Village. An appropriate health risk assessment for residents exposing to As through ingestion and dermal contact pathways is also discussed in the paper. Hazard quotient (HQ) and target cancer risk (TR) are adopted to compute the non-carcinogenic and carcinogenic effects for residents, respectively. Monte Carlo simulation technique is used to quantify the uncertainty of the risk assessment. The assessment results show that the HQs and TRs of 10-m-deep and 25-m-deep wells exhibit seasonal variations with higher values in rainy season and lower values in dry season. The HQ values exceeding 1 at the depths of 10 (from 0.09 to 23.21 m) and 25 m (from 0.29 to 130.55 m) account for 61 and 94%, respectively, which associate with the As contents distribution in the aquifer sediments. The estimated TR values at the depths of 10 (from 3.86E-05 to 1.04E-02) and 25 m (from 1.32E-04 to 5.87E-02) exceeding the highest acceptable standard (10-4) account for 95 and 100%, respectively. Comparison of the two exposure pathways, the ingestion exposure contributes much more than the dermal contact exposure for both non-carcinogenic risk and carcinogenic risk. The results of sensitivity analysis indicate that a more accurate measurement and better definition of probability distributions for As concentration in the groundwater can increase the accuracy of health risk assessment in Jianghan Plain. The findings demonstrate the importance of the drinking water safety, and the government should take measures to ensure the drinking water safety.

Using generalized additive models to investigate factors influencing cyanobacterial abundance through phycocyanin fluorescence in East Lake, China.

East Lake is a shallow lake (in Wuhan, China) where cyanobacteria blooms occurred frequently from 1970 to 1985. During the study period, all Carlson trophic state index values were > 50, indicating that East Lake is in a eutrophic state. In this study, phycocyanin concentrations were measured through phycocyanin fluorometry for rapid assessment of cyanobacterial abundance. The smoothing splines of the optimal generalized additive model (GAM) indicated that Secchi depth (SD), total phosphorus (TP) and dissolved oxygen (DO) concentrations, electrical conductivity (EC), chemical oxygen demand (COD), and ratios of total nitrogen (TN) to TP (TN:TP) were the main environmental factors in a moderate nonlinear relationship with cyanobacterial phycocyanin concentrations in East Lake. The shape of the GAM smoother can be used to quantify the relationship between a response variable and an explanatory variable in the scatterplot. Phycocyanin concentrations were sharply and negatively related to both SD and EC when the SD was 20-80 cm and EC was > 270 mg/L. Phycocyanin concentrations increased with concentrations of TP, DO, and COD. Phycocyanin concentrations increased sharply with TP concentrations when TP concentrations were > 0.10 mg/L and approached to a constant when DO concentrations were > 8.20 mg/L. Approximately, 85% of the phycocyanin concentrations were negatively correlated with TN:TP of < 26. In summary, organic compounds and TP were inferred to the key factors limiting the potential growth of cyanobacteria in East Lake. These change points/thresholds of smoothing splines of aforementioned variables may serve as a framework for managing the cyanobacterial growth.

OpenHoldem: A Benchmark for Large-Scale Imperfect-Information Game Research.

Owing to the unremitting efforts from a few institutes, researchers have recently made significant progress in designing superhuman artificial intelligence (AI) in no-limit Texas hold'em (NLTH), the primary testbed for large-scale imperfect-information game research. However, it remains challenging for new researchers to study this problem since there are no standard benchmarks for comparing with existing methods, which hinders further developments in this research area. This work presents OpenHoldem, an integrated benchmark for large-scale imperfect-information game research using NLTH. OpenHoldem makes three main contributions to this research direction: 1) a standardized evaluation protocol for thoroughly evaluating different NLTH AIs; 2) four publicly available strong baselines for NLTH AI; and 3) an online testing platform with easy-to-use APIs for public NLTH AI evaluation. We will publicly release OpenHoldem and hope it facilitates further studies on the unsolved theoretical and computational issues in this area and cultivates crucial research problems like opponent modeling and human-computer interactive learning.

CD11c+ B Cells Participate in the Pathogenesis of Graves' Disease by Secreting Thyroid Autoantibodies and Cytokines.

Graves' disease (GD) is a common autoimmune disorder with an elevation in pathogenic autoantibodies, specifically anti-thyrotropin receptor antibodies (TRAbs), which are secreted by autoreactive B cells. To date, there has been little research on self-reactive B cells in GD. In the current study, we reported that a unique B-cell subset, CD11c+ B cells, was expanded in the peripheral blood (PB) of GD patients, as detected by flow cytometry. The frequency of CD11c+ B cells was positively correlated with serum TRAb levels. The flow cytometry data showed that CD11c expression was higher in a variety of B-cell subsets and that CD11c+ B cells presented a distinct immunophenotype compared to paired CD11c- B cells. Immunohistochemical and immunofluorescence staining indicated the presence of CD11c+CD19+ B cells in lymphocyte infiltration areas of the GD thyroid. Flow cytometric analysis of PB and fine-needle aspiration (FNA) samples showed that compared to PB CD11c+ B cells, CD11c+ B cells in the thyroid accumulated and further differentiated. We found that CD11c+ B cells from the PB of GD patients were induced to differentiate into autoreactive antibody-secreting cells (ASCs) capable of secreting TRAbs in vitro. Luminex liquid suspension chip detection data showed that CD11c+ B cells also secreted a variety of cytokines, including proinflammatory cytokines, anti-inflammatory cytokines, and chemokines, which might play roles in regulating the local inflammatory response and infiltration of lymphocytes in the thyroid. In addition, we performed a chemotaxis assay in a Transwell chamber to verify that CD11c+ B cells were recruited by thyroid follicular cells (TFCs) via the CXCR3-CXCL10 axis. In conclusion, our study determined that CD11c+ B cells were involved in the pathogenesis of GD in multiple ways and might represent a promising immunotherapeutic target in the future.

Assessment of water quality under various environmental features using a site-specific weighting water quality index.

In a multiregional river system, environmental features such as natural conditions and anthropogenic activities vary among regions, resulting in spatiotemporal variations in water quality. Therefore, a robust water quality assessment method (e.g., water quality index [WQI]) that considers various environmental features is essential for water resources management. This study developed a min/max autocorrelation factor analysis (MAFA) based WQI framework (MAFAWQI). The statistical procedure reduces the bias of expert opinions. The MAFAWQI characterizes impaired water quality variables as indicators and assesses appropriate weighting values of indicators at each sampling site to reflect site-specific environmental features. The MAFAWQI was successful for assessing water quality in the middle and down streams of Han River in central China with site-specific pollution features such as nitrogen and phosphorus pollution related to multiple-source in tributaries, impacts of tributaries on the main stream, and phosphorus pollution related to nonpoint-source in agricultural regions. The MAFAWQI exhibited a balanced rating of water quality compared to the strict assessment method using a single indicator and the lenient assessment method using stationary weighting values of indicators. The MAFAWQI scores indicated that the water quality in tributaries and during the spring were significantly worse than those in and during the other regions and seasons in the middle and down streams of Han River, respectively. The framework and application of the MAFAWQI may provide a new perspective for developing WQIs.

A case report of concurrence of aberrant extracranial internal carotid artery and nonrecurrent laryngeal nerve in a patient of advanced thyroid carcinoma invading hypopharynx.

Aberrant extracranial internal carotid artery and nonrecurrent laryngeal nerve (NRLN) are neurovascular anomalies, which clinicians should be aware of to prevent severe complications while performing transoral or open surgery in the head and neck area. These two variants can occur simultaneously because of similar etiology of embryological maldevelopment of arch arteries. In this study, a 64-year-old woman complaining of hoarseness presented a bulge in the left hypopharynx. A contrasted computed tomography scan indicated left thyroid mass with hypopharynx invasion, accompanied by right aberrant extracranial internal carotid artery and subclavian artery. Fine needle aspiration biopsy of the mass revealed papillary thyroid carcinoma (PTC). She underwent total thyroidectomy, partial hypopharyngectomy, neck dissection, and tracheotomy. Intraoperatively, a right NRLN was found above the level of the cricothyroid junction that entered the larynx. The patient did not present severe complications postoperatively. Radioactive iodine therapy was applied after the surgery. At the 3-year follow-up, she remained cancer-free, and the hoarseness has improved. This is the first report of concurrent aberrant extracranial internal carotid artery and NRLN. NRLN of right side can be predicted in the computed tomography scan by the sign of the right subclavian artery origining from the left side of the aortic arch and running an abnormal course between the esophagus and the vertebra. Meanwhile, aberrant extracranial internal carotid artery may occur simultaneously. Recognition of aberrant neurovascular structures enables clinicians to prevent severe surgical complications.

[Diagnosis and treatment of tumors involving the root of neck: experience of 73 cases].

Objective:To summarize and analyze the clinical diagnosis and surgical treatment of patients with tumors involving the root of neck. Method:We retrospectively analyzed the clinical data of 73 patients with tumors involving the root of neck in Peking University First Hospital Otorhinolaryngology Head and Neck Surgery department. Data collected included clinical manifestations, preoperative imaging evaluation, surgical approach selection, postoperative pathological types, postoperative complications and prognosis. Result:The most frequent symptom was a painless cervical mass（36 cases） and dysphagia（16 cases）. All patients underwent preoperative enhanced CT scan or MRI, which would be helpful to evaluate the tumor size, shape, location, relationship with surrounding structures, especially important blood vessels, and secondary changes. The postoperative pathological diagnosis included 37 cases of benign and 36 cases of malignant. The most common benign tumor was retrosternal goiter in 17 cases, and the most common malignant tumor was cervical esophageal cancer in 15 cases. Nonsurgical treatment was performed in 3 cases ,while surgical treatment was performed in 70 cases, including 61 cases （87.1%）　with cervical approach , 9 cases （12.9%）　with combined cervicothoracic approach , 67 cases of complete tumor resection and 3 cases of palliative resection. Sixteen cases cooperated with thoracic surgerons, and 1 case with orthopedic surgerons. Surgical complications occurred in 16 cases （22.9%）. Seven patients were lost to follow-up, and 66 patients were followed up for 3 months to 15 years. None of the 35 patients with benign tumors had recurrence, and among the 31 patients with malignant tumors, the 3-year survival rate was 48.4% and the 5-year survival rate was 32.3%. Conclusion:Tumors involving the root of neck are challenging to diagnose and treat due to the complex regional anatomy and a variety of pathological types, with comparable proportion of benign and malignant tumors. Surgery is the first choice, but it requires careful preoperative assessment. Surgical approaches include cervical approach and combined cervicothoracic approach, which should be determined according to the pathology, size and surrounding structure of the tumor, as well as the habits of the surgeon. Most benign tumors can be excised by the cervical approach. The combined cervicothoracic approach is suitable for malignant tumors with unclear boundaries and close adhesion of important blood vessels and nerves. Proper treatment of large vessels is the key to complete resection of tumors. There are many complications in the operation of this site, so it is necessary to fully communicate with the patient before operation, and sometimes multidisciplinary cooperation is needed.

[Congenital median dermoid fistula of nasal dorsum: one case report].

Congenital median dermoid is an uncommon disease. Surgery is the main curative treatment. To review a clinical case and to summarise the characteristics and treatment experience of this disease, referring to the related literature, it is expected that we can provide more clinical thought and therapeutic method for congenital median dermoid fistula of nasal dorsum.

[Surgical treatment for cervicothoracic esophageal carcinoma with tracheal involvement].

OBJECTIVE: To evaluate the surgical treatment and outcome of cervicothoracic esophageal carcinoma with tracheal. METHODS: Ten cases of cervicothoracic esophageal carcinoma with tracheal invasion underwent surgical treatment between 2004 and 2011 was reviewed. Operative methods, complications, pathology, and prognosis were analyzed. RESULTS: The patients were divided into 2 groups, 5 patients with cervical tracheal invasion group and 5 patients with cervicothoracic tracheal invasion. Thoracotomy and anterior mediastinal tracheostomy (AMT) were required for 5 patients with cervicothoracic tracheal invasion. The median follow-up was 23 months (ranging from 6 to 76 months). Of 5 patients with cervical tracheal invasion, 3 patients survived with free of disease for more than 5 years postoperatively, 1 patient died of local recurrence at 14 months postoperatively, and 1 patient died of cardiac infarction at 26 months postoperatively. Among 5 patients with cervicothoracic tracheal invasion, 2 patients died during hospitalization, and 1 patient died of local recurrence at 16 months postoperatively, and 2 patients died of distant metastasis at 6 and 20 months after surgery respectively. CONCLUSIONS: Tracheal invasion is not a contraindication to radical operation for the cervicothoracic esophageal carcinoma. Surgical treatment has a good outcome in cervicothoracic esophageal carcinoma with only cervical tracheal invasion. If thoracic trachea is involved, especially when the length of the distal trachea is less than 5 cm, operation should be performed with caution.

[Surgical treatment for advanced carcinoma of hypopharynx and laryngeal function preservation].

OBJECTIVE: To evaluate the treatment outcome advanced hypopharyngeal carcinoma by surgery with laryngeal function preservation. METHODS: Twenty cases with squamous cell carcinoma of the hypopharynx who were treated by the function preserved surgery between January 2000 and March 2012 were reviewed. Of the patients 19 were males and 1 female, and their median age was 62.0 years. Eight cases were only applied with total or subtotal hypopharyngectomy, and others received total or subtotal hypopharyngectomy with partial-laryngectomy. Postoperative functional training was performed. Radiotherapy was used in all cases from 2 to 4 weeks after surgery. RESULTS: Speech intelligibility remained in all 20 patients and 80.0% of the patients were extracted the trachea tube in the average 60 days. CONCLUSIONS: Laryngeal functions of larynx can be preserved in advanced hypopharyngeal carcinoma by total or subtotal hypopharyngectomy alone or plus partial laryngectomy with functional reconstruction, and the patients can maintain their rational speech and swallowing functions.

[Management and classification of first branchial cleft anomalies].

OBJECTIVE: We aimed to identify the different courses of first branchial cleft anomalies and to discuss the management and classification of these anomalies. METHOD: Twenty-four patients with first branchial cleft anomalies were reviewed. The courses of first branchial cleft anomalies and their corresponding managements were analyzed. Each case was classified according to Olsen's criteria and Works criteria. RESULT: According to Olsen's criteria, 3 types of first branchial cleft anomalies are identified: cysts (n = 4), sinuses (n = 13), and fistulas (n = 7). The internal opening was in the external auditory meatus in 16 cases. Two fistulas were parallel to the external auditory canal and the Eustachian tube, with the internal openings on the Eustachian tube. Fourteen cases had close relations to the parotid gland and dissection of the facial nerve had to be done in the operation. Temporary weakness of the mandibular branch of facial nerve occurred in 2 cases. Salivary fistula of the parotid gland occurred in one patient, which was managed by pressure dressing for two weeks. Canal stenosis occurred in one patient, who underwent canalplasty after three months. The presence of squamous epithelium was reported in all cases, adnexal skin structures in 6 cases, and cartilage in 14 cases. The specimens of the fistula which extended to the nasopharynx were reported as tracts lined with squamous epithelium (the external part) and ciliated columnar epithelium (the internal part). According to Work's criteria, 9 cases were classified as Type I lesions, 13 cases were classified as Type II lesions, and two special cases could not be classified. The average follow-up was 83 months (ranging from 12 to 152 months). No recurrence was found. CONCLUSION: First branchial cleft anomalies have high variability in the courses. If a patient is suspected to have first branchial anomalies, the external auditory canal must be examined for the internal opening. CT should be done to understand the extension of the lesion. For cases without internal openings in the external auditory canal, CT fistulography should be done to demonstrate the courses, followed by corresponding treatment. Two special cases might be classified as a new type of lesions.

[Surgical management of cervical esophageal carcinoma in 16 cases].

OBJECTIVE: To investigate the method of surgical management for cervical esophageal carcinoma and the feasibility of the operation with preservation of laryngeal function. METHOD: Sixteen patients with cervical esophageal carcinoma who received surgical treatment were reviewed in our retrospective study. Removal of total hypopharynx and larynx and the inversion stripping esophagectomy were conducted in thirteen patients, of which one underwent the reconstraction with residual larynx and tracheal flap and the other twelve patients underwent the reconstraction with gastric-pharyngeal anastomosis. One patient received the cervical esophagectomy and partial hypopharyngectomy with laryngotracheal flap. The inversion stripping esophagectomy with laryngeal function preservation were conducted in two patients, who received the reconstraction with gastric-pharyngeal anastomosis and preserved total larynx. All the patients were carried out the bilateral neck dissections. RESULT: The surgical resection rate was 100% and no operative death occurred. The postoperative complications included pulmonary infection in two cases, anastomotic fistula in two cases, anastomotic stenosis in two cases and congestive heart failure in one case. The retained rate of the laryngeal function is 12.5%. The 3-year survival rate is 30.7%, and the 5-year survival rate is 23.1%. CONCLUSION: The surgical treatment of cervical esophageal carcinoma is possible. The inversion stripping esophagectomy without thoracotomy is performed to resect the tumor. The esophageal defect could be reconstructed by laryngotracheal flap or gastric-pharyngeal anastomosis. The laryngeal function should be remained as far as possible according to the location and extension of the tumor.

[Fourth branchial abnormity and management experiences].

OBJECTIVE: To investigate the fourth branchial abnormity and its managements. METHOD: Twelve cases of the fourth branchial abnormity treated between January 2005 and April 2012 were reviewed. RESULTS: Dissection of the recurrent laryngeal nerve was done in all cases. Partial thyroidectomy was performed in 10 cases, and 2 cases of them received selective neck dissection including level II, III, IV and VI. The abnormity lesions were found to pass posterior to the thyroid glands in the 10 cases and to pass through the inferior constrictor muscle into the pyriform sinus in 7 cases of them. The internal opening in the pyriform sinus demonstrated by preoperative examination couldn't be identified in the operation in one case. The abnormity tract terminated at the lateral surface of the esophagus in one case, passed into the cervical esophagus in one case, and terminated at the lateral surface of the thyroid gland in one case, and formed a cyst lateral to the thyroid gland in one case. No abnormity tract was found to loop around the hypoglossal nerve and to descend into the mediastinum. The left recurrent laryngeal nerve was cut off in one patient, although end to end anastomosis was performed immediately, the patient was still complicated with left vocal cord paralysis postoperatively. The median follow-up time of the cases was 24 months (8-88 months). One case was lost of follow up. No recurrence was found in 10 cases. Recurrence was found in one case, and no recurrence in 10 cases. CONCLUSIONS: The presentation of congenital the fourth branchial fistula is variated significantly. Most abnormity lesions had close relations to the thyroid gland and the recurrent laryngeal nerve, thus the recurrent laryngeal nerve need to protect and partial thyroidectomy might be considered. In the recurrent cases when the abnormity couldn't be identified clearly, selective neck dissection including level II, III, IV and VI should be done long term follow up should be carried out in the cases that the internal opening couldn't be found.

[Treatments of oropharyngeal anterior wall cancer by transhyoid surgery radiotherapy].

OBJECTIVE: To evaluate the transhyoid resection of oropharyngeal anterior wall cancer and oncological outcomes of the surgery combined with radiotherapy. METHODS: A total of 24 cases with carcinoma located in the anterior wall of oropharynx was reviewed. The TNM stages were as follows: T2 in 7 cases, T3 in 2 cases, T4 in 15 cases; NO in 7 cases, N1 in 4 cases, N2 in 12 cases and N3 in 1 case. Tumor resection was performed via transhyoid approach, including 9 cases with partial glossectomy + partial laryngectomy, 7 cases with partial glossectomy + total laryngectomy, 7 cases with total glossectomy + partial laryngectomy and 1 case with partial glossectomy alone pectoralis major myocutaneous flaps were applied to repair synchronously the defects of tongue and lateral pharyngeal wall in 16 cases and the defect of cervical skin in 1 case. Radial forearm free flap and sternohyoid myocutaneous flap were used to repair the defect of tongue and lateral and posterior pharyngeal wall in 1 case. Sternohyoid myocutaneous flap was applied to reconstruct the tongue base in 2 cases. Bilateral and unilateral neck dissections were performed in 20 cases and 4 cases respectively. Five cases received preoperative radiotherapy and 16 cases received postoperative radiotherapy. RESULTS: All cases had negative surgical margin. Pathological examination showed neck lymph metastasis in 17 cases (70.8%). Three patients had postoperative pharyngocutaneous fistula. Two of them who underwent partial glossectomy + total laryngectomy and pectoralis major myocutaneous flaps synchronously reconstruction suffered from pharyngocutaneous fistula 4 days after operation. The fistula was closed by re-suturation following debridement and 2 weeks dressing change. The other one who underwent partial glossectomy + partial laryngectomy suffered from pharyngocutaneous fistula during postoperation radiotherapy and healed by the pectoralis major myocutaneous repair. Tracheostomy tubes were removed within 1-6 months, with good voice and swallowing functions, in 16 of 17 cases who underwent partial laryngectomy. Another one failed to pull out tracheotomy tube because of dyspnea. Twenty one cases were followed up over 3 years and Kaplan-Meier survival analysis showed the 3-year overall survival rate was 72.6%. CONCLUSIONS: The transhyoid tumor resection is an effective surgical approach for oropharyngeal anterior wall cancer. The defect following tumor resection is commonly need repair synchronously with various flaps. Acceptable outcome could be received by surgery combined with radiotherapy.

First branchial cleft fistula presenting with internal opening on the Eustachian tube: Illustrated cases and literature review.

OBJECTIVE: Two cases of first branchial cleft fistula with internal opening on the Eustachian tube are reported and the diagnosis, management and embryological hypothesis are discussed. DESIGN: Retrospective study and review of the literature. RESULTS: Both patients were young boys with first branchial cleft anomaly clearly identified by computed tomography fistulography scan and direct Methylene Blue dye injection. In both cases, surgical removal revealed a fistula with internal opening located on the Eustachian tube near the nasopharynx. DISCUSSION: The main embryological theories and classification are reviewed. A connection between the theories of first branchial apparatus development and the classification by Work might explain the reported clinical association.

[Tortuosity and kinking of cervical segment of internal carotid artery: an analysis of 7 cases].

OBJECTIVE: To outline the clinical manifestations and compare the different radiological methods of detecting malformation of cervical segment of internal carotid artery. METHODS: A retrospective analysis of 7 cases with malformation of cervical segment of internal carotid artery between May, 2004 and April, 2011. CT angiography (CTA) and magnetic resonance angiography (MRA) were used to detect the morphology of cervical segment of internal carotid artery. RESULTS: This disease entity provided no obvious symptoms in five cases, and such complains as pharyngeal foreign body sensation in one and odynophagia in another. Physical examination showed a bulge with pulsation on pharyngeal wall in four cases, and apparent normal pharynges in other three patients, all of which were covered with intact pharyngeal mucosa. Twelve carotid arteries were observed in seven cases, five of which were showed tortuosity and seven kinking. All of the five patients with recorded radiological materials had identified malformations of internal carotid artery, two of which were tortuosity bilaterally and two kinking bilaterally and one tortuosity and kinking respectively. CTA and MRA revealed tortuosity of cervical segment of internal carotid arteries. CONCLUSIONS: No typical clinical symptoms were shown in the malformation of cervical segment of internal carotid artery. Pharyngeal bulge with pulsation could be encountered. CTA and MRA showed excellent ability to depict the malformation of cervical segment of internal carotid artery and its relationship with surrounding structures, which could protect carotid artery from unintended damage.

[Selective neck dissection and the management of the hypopharyngeal cancer].

OBJECTIVE: To determine the most appropriate form of selective neck dissection(SND) in the hypopharyngeal cancer with cervical lymph node metastasis. METHOD: We have retrospectively analyzed the distribution and prevalence of cervical metastasis in 26 patients with hypopharyngeal squamous cell carcinoma from January 1998 to December 2008. All the patients underwent SND as part of the primary treatment. There were 34 elective SNDs and 17 therapeutic SNDs from 11 node-negative hypopharyngeal cancers and others node-positive. RESULT: Occult metastasis was found in 6 patients (55%) with cervical metastasis confined to level II and III. Clinical node-positive necks were all pathologically identified with 6.7%, 66.7%, 86.7%, 46.7%, and 20.0% of the prevalence of metastasis to level I, II, III, IV and V respectively. The regional recurrences were found in 4 patients during the follow-up, which were all from cN+ patients. No patient experienced level I recurrence. CONCLUSION: The results of this study suggest that SND (I-III) may be feasible for the treatment of cN0 hypopharyngeal cancer, which needs a larger sample to verify. Meanwhile, from our data, it has a satisfactory result to perform SND (II-V) with adjuvant radiotherapy for the cN+ patients.

[A comparative study of complications in transoral CO2 and Nd:YAG laser surgery for glottic carcinoma].

OBJECTIVE: To compare the complications in transoral CO2 and Nd:YAG laser surgery for the treatment of laryngeal carcinoma. METHODS: Retrospective analysis of 83 cases of glottic laryngeal carcinoma treated with laser surgery from January 1, 1999 to December 31, 2008 was carried out. Thirty-two cases were treated with the CO2 laser, including Tis (2 cases), T1N0M0 (21 cases), T2N0M0 (8 cases), and T3N0M0 (1 case). Fifty-one cases were treated with the Nd:YAG laser, including Tis (3 cases), T1N0M0 (36 cases), T1N2M0 (3 cases), and T2N0M0 (9 cases). RESULTS: Four complications (12.5%) occurred in the CO2 laser group. There was 1 local infection (3.1%), 1 numbness of the tongue (3.1%), 1 odontoseisis (3.1%), and 1 subcutaneous emphysema (3.1%). Twenty-seven complications (52.9%) occurred in 19 patients in the Nd:YAG laser group. There were postoperative bleeding 2 (3.9%), dyspnea 5 (9.8%), local infection 7 (13.7%), aspiration pneumonia 4 (7.8%), numbness of the tongue 2(3.9%), pharyngeal cutaneous fistula 1 (2.0%), vocal cord fixation 4 (7.8%), and laryngostenosis 2 (3.9%). CONCLUSION: More complications were observed in the patients with Nd:YAG laser surgery when compared to the patients with CO2 laser surgery.

[Study on hemorrhage following coblation assisted uvulopalatopharyngoplasty].

OBJECTIVE: To compare the postoperative hemorrhage between standard uvulopalatopharyngoplasty (UPPP) and coblation assisted UPPP, and to evaluate the related risk factors and preventive measures. METHODS: Five hundreds and ninety seven patients with obstructive sleep apnea hypopnea syndrome (OSAHS) underwent UPPP and coblation assisted UPPP between January 1, 1999, and September 30, 2009 were reviewed retrospectively. Two hundred and sixty three patients with coblation assisted UPPP and 334 patients with standard UPPP were treated respectively. Single factor statistic analysis, multiple factors Logistic regress statistic analysis and Wilcoxon test method for related risk factors were applied. RESULTS: A total of 42 patients (7.0%) experienced postoperative bleeding. Among them, 24 patients with coblation assisted UPPP (9.1%) and 18 patients with UPPP (5.4%) had postoperative hemorrhage. Significant difference was not found in the degree of hemorrhage (z = 0.784, P > 0.05), hemorrhage site(χ(2) = 1.387, P > 0.05) and postoperative hemorrhage rates (χ(2) = 3.14, P > 0.05) between the two surgical techniques. Significant difference was found in the interval of hemorrhage after surgery between the two surgical techniques (χ(2) = 9.25, P < 0.01). History of hypertension, smoking, hepatic dysfunction was found to be correlated with the postoperative hemorrhage (Odd-ratio were respectively 7.326, 3.674, 2.707). CONCLUSION: Coblation technique did not significantly increase UPPP postoperative hemorrhage.