The effectiveness of various treatment approaches for laryngeal contact granulomas.

OBJECTIVES: To assess and compare the effectiveness of various treatment approaches for laryngeal contact granulomas (LCG). METHODS: A retrospective analysis was conducted on a cohort of 45 patients diagnosed with LCG at the Second Affiliated Hospital of Xi'an Jiaotong University from October 2017 to May 2023. Based on the treatment modalities administered, patients were categorized into three groups: acid suppression alone, hormone injection combined with acid suppression, and surgery combined with acid suppression. Subsequently, the study compared differences in treatment efficacy and average healing time among these three groups, using various indicators. RESULTS: The findings indicate that the granuloma size in LCG patients with hoarseness (0.126, 95% CI 0.087-0.288) was significantly greater compared to LCG patients without hoarseness (0.047, 95% CI 0.014-0.083) (P = 0.001). However, there were no significant variations in age, morphology (unlobulated/lobulated), laterality ratio (left/right), sex ratio (male/female), history of tracheal intubation (non-intubation/intubation), and RFS score (RFS > 7/RFS ≤ 7) (P > 0.05), regardless of the presence of hoarseness symptoms. At the treatment observation endpoint of 3 months, the curative ratio in the group receiving hormone injection combined with acid suppression was found to be significantly higher compared to the group receiving acid suppression alone (P = 0.018). In addition, the average healing time of patients in the hormone injection combined with acid suppression group was notably shorter than that of the acid suppression alone group (P = 0.007). CONCLUSIONS: The combination of hormonal injections and acid suppression may enhance the curative ratio and expedite the healing time of LCG.

Clinical Features and Blood Indicators for Severity and Prognosis in COVID-19 Patients.

BACKGROUND: This study aimed to analyze the clinical manifestations and blood indicators to deepen the understanding of Coronavirus disease 2019 (COVID-19). METHODS: COVID-19 patients admitted to C10 West Ward, Tongji Hospital in Wuhan City ("West Ward") between January 31 and March 28, 2020, were retrospectively analyzed. RESULTS: A total of 61 COVID-19 patients were hospitalized, wherein the non-critical Group had 30 cases, while the critical group had 31 (including 14 survivors and 17 deaths). Age, the proportion of fever cases, white blood cell (WBC), basophils, red blood cell (RBC), hemoglobin, lactate dehydrogenase (LDH), C-reactive protein (CRP), high-sensitivity troponin, pro-BNP (brain natriuretic peptide), prothrombin time (PT), and D-dimer were higher in the critical group while lymphocytes, eosinophils, albumin were lower compared with those of the non-critical group (all p < 0.05). WBC (p = 0.008), basophils (p = 0.034), and LDH (p = 0.005) of the death subgroup climbed remarkably in comparison with those of the survival subgroup. CONCLUSIONS: Advanced age, high fever, increases in indicators such as WBC, basophils, CRP, LDH, high-sensitivity troponin, pro-BNP, and D-dimer, and decreases in indicators, including lymphocytes, eosinophils, and albumin, might forebode a critical condition.

The subglottic involvement is an independent risk factor for recurrence of laryngeal amyloidosis.

OBJECTIVE: To analyze the risk factors for recurrence of laryngeal amyloidosis (LA). METHODS: The clinical data of patients with LA admitted in the Otolaryngology Head and Neck Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University from August 2009 to June 2022 were analyzed retrospectively; then, the risk factors for recurrence and their impacts on the recurrence time were also analyzed. RESULTS: Of the 44 patients with LA, the majority (38 cases, 86.4%) only involved one anatomical region and the others (6 cases, 13.6%) involved two laryngeal regions concurrently. Overall, the glottic region was the most commonly affected area (28 cases, 63.6%), followed by the supraglottic region (16 cases, 36.4%) and subglottic region (6 cases, 13.6%). In addition, all the lesions were categorized as isolated nodule (31.8%), submucosal localized deposition (52.3%), and submucosal diffuse deposition (15.9%) according to their morphologies under electronic laryngoscope. Finally, six patients (13.6%) had recurrence after operation with a median recurrence time of 24.5 months, and subglottic involvement was confirmed to be an independent risk factor for recurrence of LA by univariate and multivariate logistic regression analyses (P < 0.05). Meanwhile, the patients with subglottic involvement presented as submucosal diffuse deposition had a considerable shorter recurrence time (t = 5.759, P = 0.005). CONCLUSION: The subglottic involvement is an independent risk factor for recurrence of LA.

The effects of Helicobacter pylori eradication therapy on salivary pepsin concentration in patients with laryngopharyngeal reflux.

OBJECTIVE: To investigate the effect of Helicobacter pylori (HP) eradication therapy on salivary pepsin concentration in laryngopharyngeal reflux (LPR) patients with HP infection. MATERIALS AND METHODS: A total of 477 patients with suspected LPR were enrolled from June 2020 to September 2021. Reflux symptom index, reflux finding score, the positive rates and disintegrations per minute values of HP infection detected by 14C urea breath test and salivary pepsin concentrations analyzed using enzyme-linked immunosorbent assay were compared in LPR patients and non-LPR patients with or without HP infection. HP-positive patients were treated with HP eradication therapy while HP-negative patients with PPI therapy. RESULTS: The scores of nagging cough (0.88 vs. 0.50, P = 0.035), erythema or hyperemia (1.93 vs. 1.78, P = 0.035) and vocal fold edema (1.04 vs. 0.85, P = 0.025) were higher in the LPR (+) Hp (+) subgroup than in LPR (+) Hp (-) subgroup. The concentrations of salivary pepsin in the Hp (+) subgroup were higher than in the Hp (-) subgroup either in LPR patients (75.24 ng/ml vs. 61.39 ng/ml, P = 0.005) or the non-LPR patients (78.42 ng/ml vs. 48.96 ng/ml, P = 0.024). Compared to baseline (before treatment), scores of nagging cough (0.35 vs. 0.84, P = 0.019) and erythema or hyperemia (1.50 vs. 1.83, P = 0.039) and the concentrations of salivary pepsin (44.35 ng/ml vs. 74.15 ng/ml, P = 0.017) in LPR patients with HP infection decreased after HP treatment; yet, this was not observed for the LPR patients without HP infection treated with PPI only (P > 0.05). CONCLUSION: HP infection may aggravate the symptoms and signs of LPR patients, partly by increasing their salivary pepsin concentration.

Investigation of swallowing function and swallowing-related quality of life after partial laryngectomy in Chinese patients with laryngeal carcinoma.

BACKGROUND: Swallowing function and swallowing-related quality of life (QoL) can be adversely affected in patients after partial laryngectomy, but are often neglected by patients and clinical workers. This study aimed to investigate the degree of swallowing function and swallowing-related QoL after partial laryngectomy in patients with laryngeal carcinoma. METHODS: Sixty-eight hospitalized patients undergoing partial laryngectomy due to laryngeal carcinoma at the Second Affiliated Hospital of Xi'an Jiao Tong University were included in this prospective study. A general information questionnaire was used to collect baseline characteristics. The water swallow test and swallowing quality of life questionnaire (SWAL-QOL) were carried out the day before surgery and at 2, 4, 12, 24 and 48 weeks after surgery. RESULTS: Swallowing dysfunction occurred in 1 case (1.5%) the day before surgery and in 49 (72.1%), 44 (64.7%), 33 (49.3%), 19 (28.4%) and 8 (11.9%) cases at 2, 4, 12, 24 and 48 weeks after surgery, respectively. Mean SWAL-QOL total scores were 4266.3 ± 232.0 the day before surgery, and 1992.9 ± 1062.4, 2473.9 ± 962.9, 3169.2 ± 753.6, 3696.7 ± 718.3 and 3910.8 ± 1510.4 at 2, 4, 12, 24 and 48 weeks, respectively. SWAL-QOL total scores increased gradually after operation, and the differences were statistically significant (P < 0.05). There was no statistical difference between postoperative 24 and 48 weeks (P = 0.379). CONCLUSIONS: Partial laryngectomy affects swallowing function and swallowing-related QoL in patients with laryngeal carcinoma. While swallowing function and swallowing-related QoL increase gradually over time, in some patients, nearly a year after surgery they are not fully restored. Therefore, attention should be paid during postoperative nursing to improve swallowing function.

EZH2 promotes invasion and metastasis of laryngeal squamous cells carcinoma via epithelial-mesenchymal transition through H3K27me3.

Enhancer of Zeste Homolog 2(EZH2), which can change chromatin structure by tri-methylation of the 27th lysine of H3 in nucleosome histone (H3K27me3), is involved in different types of cancers. However, the role and mechanism underlying aberrant EZH2 expression in laryngeal squamous cells carcinoma (LSCC) remain unclear. In the present study, we found that down-regulation of EZH2 and H3K27me3 in LSCC cells (Hep-2 and SCC10A) resulted in an mesenchymal-epithelial transition(MET) like cell morphology and lower invasion in vitro, weakened tumor growth, intrahepatic and pulmonary metastasis in vivo. Furthermore, EZH2 promoted the epithelial-mesenchymal transition(EMT) process through down-regulation of Ca2+ dependent cell adhesion molecule E (E-cadherin) and up-regulation of H3K27me3 in vitro and in vivo. Moreover, E-cadherin was transcriptionally induced upon stable knockdown of EZH2, and quantitative chromatin immunoprecipitation(qChIP) analysis confirmed the depletion of H3K27me3 enrichment on E-cadherin promoter upon EZH2 knockdown in Hep-2 and SCC10A cells. In addition, the expression of EZH2 was positively correlated with that of H3K27me3 and both of them were inversely correlated with E-cadherin expression in human LSCC tissues. In summary, this study indicated that EZH2 promoted invasion and metastasis of LSCC via EMT through H3K27me3.

miR-9 targets CXCR4 and functions as a potential tumor suppressor in nasopharyngeal carcinoma.

MicroRNA deregulation and pathway alterations have been implicated in nasopharyngeal carcinoma (NPC), a highly invasive and metastatic cancer widely prevalent in Southern China. In this study, we report that miR-9 is commonly downregulated in NPC specimens and NPC cell lines with important functional consequences. The reduced expression of miR-9 was inversely correlated with clinical stages and marked the progression from locoregional to metastatic tumors. The CpG island hypermethylation contributed to miR-9 silencing in NPC cell lines and tissues. Ectopic expression of miR-9 dramatically inhibited the proliferative, migratory and invasive capacities of NPC cells in vitro and in vivo. We found that miR-9 strongly reduced the expression of CXCR4 in NPC cells. Luciferase assay demonstrated that miR-9 could directly bind to the 3' untranslated region of CXCR4. Similar to the restoring miR-9 expression, CXCR4 downregulation inhibited cell growth, migration and invasion, whereas CXCR4 overexpression rescued the suppressive effect of miR-9. Mechanistic investigations revealed that CXCR4 functionally mediated the SDF-1-stimulated activation of p38 mitogen-activated protein kinase pathway in NPC cells with miR-9 downregulation or CXCR4 overexpression. In clinical specimens, CXCR4 and phospho-p38 were widely overexpressed, and the levels increased with the progression from locoregional to metastatic tumors in NPC tissues. The levels of CXCR4 were inversely correlated with miR-9 or phospho-p38 expression. Taken together, our results indicate that miR-9 functions as a tumor-suppressive microRNA in NPC, and that its suppressive effects are mediated chiefly by repressing CXCR4 expression.

The effect of OSA on the negative pressure and acoustic compliance of middle ear cavity in children.

OBJECTIVE: To explore the effect of obstructive sleep apnea (OSA) on the negative pressure and acoustic compliance of middle ear cavity in children. METHODS: The clinical data of 258 children with suspected OSA, who complained of mouth breathing or snoring at night in the Department of Otolaryngology Head and neck surgery of the Second Affiliated Hospital of Xi'an Jiao Tong University from August 2020 to March 2022, were enrolled and analyzed retrospectively. The OSA and otitis media with effusion (OME) were determined by polysomnography (PSG) and acoustic immittance examination, respectively. Then, the parameters of tympanometry were compared between OSA and non-OSA children or among the children with various severity of OSA. RESULTS: There was no significant difference in the incidence of OME between children with OSA and those with non-OSA (15.80% vs 11.80%, P = 0.422). Compared with non-OSA children, OSA children had lower negative pressure (-56.42 vs -12.38, P < 0.001) and higher acoustic compliance (0.45 vs 0.38, P = 0.030) in middle ear cavity. There were also significant differences in negative pressure and acoustic compliance among children with mild, moderate and severe OSA (P < 0.001; P = 0.001). However, only the absolute value of negative pressure was markedly decreased after surgical therapy accompanied with transformation from OSA to non-OSA (-156.67 vs -45.67, P < 0.05), while this was not observed for acoustic compliance (0.48 vs 0.40, P > 0.05). CONCLUSION: OSA may have an adverse influence on the negative pressure and acoustic compliance of middle ear cavity in children.

Submucosal Clustered Brownish Microvessels Based on NBI Endoscopy: A Characteristic of LPR.

OBJECTIVE: This study aimed to analyze the characteristics of laryngopharyngeal reflux (LPR) by using narrow band imaging (NBI) endoscopy. STUDY DESIGN: A prospective study. SETTING: A large-volume practice with tertiary care providers. METHODS: A total of 67 patients with suspected LPR who underwent 24-hour multichannel intraluminal impedance-pH monitoring were included from June 2020 to March 2022. Manifestations of NBI endoscopy included submucosal clustered brownish microvessels (CBMs), spotted brownish microvessels, and no special microvessels; the latter 2 formed the non-CBM group. The manifestations of all patients and their changes were observed after 8 weeks of proton pump inhibitor and symptomatic treatment for patients with LPR, and symptomatic treatment for patients without LPR. RESULTS: According to the results of 24-hour multichannel intraluminal impedance-pH monitoring, the incidence of submucosal CBMs was significantly higher in patients with LPR (30 cases) than in those without LPR (37 cases, P < .001), particularly in the posterior cricoid area (P < .001). Besides Reflux Finding Score, the incidence of signs such as subglottic edema and vocal fold edema was significantly higher in the CBM group than the non-CBM group (P < .05). Finally, 22 patients with LPR (91.7%) and only 2 patients without LPR (28.6%) underwent a transformation from CBMs to spotted brownish microvessels after continuous medication for 8 weeks in the CBM group (χ2 = 15.916, P < .001), while no significant change was observed in patients with or without LPR in the non-CBM group (P > .05). CONCLUSION: Submucosal CBMs in the posterior cricoid area under NBI endoscopy may be a characteristic of LPR.

Hypoxia in non-rapid eye movement sleep in children with otitis media with effusion.

OBJECTIVE: This study aimed to analyze the status of hypoxia in non-rapid eye movement (NREM) sleep in children with otitis media with effusion (OME). METHODS: A total of 232 children with OME and/or adenotonsillar hypertrophy were enrolled in this retrospective study between August 2020 and November 2021. Polysomnographic monitoring was carried out, and the differences in polysomnographic results between the experimental group (children with OME and adenotonsillar hypertrophy) and control group (children with adenotonsillar hypertrophy only) were compared. RESULTS: The lowest oxygen saturation level during sleep was significantly lower in the experimental group (n = 36) than in the control group (n = 196). However, the apnea-hypopnea index, respiratory disorder index, apnea index, obstructive apnea index, obstructive apnea-hypopnea index, and mixed apnea-hypopnea index were significantly higher in the experimental group than in the control group. More importantly, the apnea-hypopnea index, the oxygen desaturation index, oxygen desaturation events, the average heart rate during NREM sleep, and the NREM stage in total sleep time were also significantly higher in the experimental group than in the control group. CONCLUSIONS: Hypoxia during NREM sleep may affect the severity of OME in children.

[Clinical features of diffuse large B-cell lymphoma in head and neck].

Objective:To investigate the clinical features of diffuse large B-cell lymphoma （DLBCL） of head and neck. Methods:A retrospective study was conducted among patients with DLBCL in the Department of otolaryngology and head and neck surgery of the Second Affiliated Hospital of Xi'an Jiaotong University from July 2011 to September 2021. The disease location, clinical manifestations, diagnosis, treatment and prognosis of DLBCL patients in head and neck were analyzed retrospectively. Results:Oropharynx（27 cases, including 25 cases in tonsil）, neck（29 cases）, nasopharynx and nasal cavity （7 cases）were included in 63 cases of DLBCL in head and neck. Pharyngalgia, pharyngeal foreign body sensation and dysphagia were the most common manifestations of oropharyngeal DLBCL, while nasal obstruction, runny nose and hyposmia were the initial manifestations of nasal and nasopharyngeal DLBCL.Under the NBI endoscopy, locally uplifted neoplasm with rough surface mucosa was observed in 34 cases DLBCL patients of oropharynx, nasopharynx and nasal cavity. Among them, 16 cases were covered with yellow-white and patchy pseudomembrane on the surface of the neoplasm, and 5 cases were detected with abnormal new vessels, including 3 cases of tonsils, 1 case of root of tongue, and 1 case of nasopharynx. Painless progressive lymphadenectasis was the common manifestation of DLBCL in head and neck, and the maximum diameter（[21.3±6.7]mm） of neck lymph nodes in the same side of DLBCL was significantly larger than that in the opposite side（[16.0±7.2]mm, P=0.009）. Sixty-three cases of DLBCL in head and neck, including 27 cases of germinal center type（GCB）, 33 cases of nongerminal center type（non-GCB）, and 3 cases of non-specific DLBCL, were confirmed the diagnosis by needle biopsy（33 cases, 52.4%） and surgical resection（30 cases, 47.6%）. The imaging features of DLBCL in head and neck were mostly showed as local soft tissue masses with uniform density and uneven enhancement, and the surrounding structures were often compressed and displaced. All the patients were treated with standard R-CHOP chemotherapy regimens, and overall survival was longer in normal LDH, and overall survival of the patients at low risk of IPI was longer than those at medium-high or high risk of IPI（PLDH=0.011, PIPI=0.022, P<0.05）. Conclusion:DLBCL mainly occurs in oropharynx, especially the unilateral tonsil. When flake yellow-white pseudomembrane adhesion and abnormal neovessels on the surface of the mass are detected under endoscopy, and the ultrasound suggested multiple enlarged lymph nodes in the neck with large iplateral lymph nodes, the possibility of DLBCL should be considered. Surgical resection could be performed for diagnosis if necessary, and early diagnosis would have a better prognosis.

[The application of NBI endoscopy in finding concealed primary lesions of misdiagnosis of oropharyngeal cancer].

Objective:The aim of this study is to analyze the application value of NBI endoscopy in finding the concealed primary lesions of misdiagnosis of oropharyngeal cancer. Methods:The clinical data of patients with missed oropharyngeal cancer treated in the Department of Otolaryngology Head and neck surgery, the Second Affiliated Hospital of Xi'an Jiaotong University from May 2018 to June 2021, were retrospectively studied, and the missed diagnosis was also analyzed combined with results of NBI endoscopy. Results:In 31 cases of misdiagnosis of oropharyngeal cancer patients, including 25 males and 6 females, there was no significant difference in age, BMI index, course of disease and TNM stage （P> 0.05）, and the pharyngeal or cervical symptoms were the first clinical manifestations of them, containing pharyngeal pain in 17 cases（54.8%） , pharyngeal foreign body sensation in 4 cases（12.9%） and unilateral cervical mass in 10 cases （32.3%）. No laryngoscopy was performed （21 cases） or no primary lesion was found by laryngoscopy （10 cases） at initial diagnosis. Among them, "inflammatory lesions" were given anti-inflammatory treatment with ineffective results or surgical resection was explored for suspicious lesions （17 cases）, or imaging examination （9 cases, including 6 cases with CT and MRI, 3 cases with PET-CT） and cervical lymph node biopsy （5 cases） were carried out for further diagnosis. According to these results, they were given ordinary laryngoscope （2 cases） or NBI endoscopy （29 cases） subsequently, finally they were confirmed as oropharyngeal squamous cellcarcinoma after localized biopsy at the suspicious lesions, indicating that the accuracy of NBI endoscopy in finding the concealed primary lesions of oropharyngeal cancer （93.55%） is significantly higher than that of ordinary electronic laryngoscope （6.45%）（χ²=43.613, P<0.01）. Conclusion:NBI endoscopy has unique advantages in finding oropharyngeal cancer in concealed parts such as tonsil, root of tongue, soft palate and lateral wall of oropharynx, which could reduce misdiagnosis of oropharyngeal cancer.

[Effect of proton pump inhibitort on salivary pepsin concentration in patients with laryngopharyngeal reflux].

Objective:To investigate the effect of proton pump inhibitor（PPI） treatment on salivary pepsin concentration in laryngopharyngeal reflux（LPR）. Methods:152 patients with suspected LPR complaining non-specific symptoms such as foreign body sensation, dry throat, phlegm and other non-specific symptoms were enrolled， in the Second Affiliated Hospital of Xi'an Jiaotong University from August 2019 to December 2020. According to the scores of reflux symptom index（RSI） and reflux finding score（RFS）, all the patients were divided into LPR （+） group and LPR （-） group, RSI （+） group and RSI （-） group, RFS （+） group and RFS （-） group . Patients in the LPR （+） group were reassessed after 1 month of PPI treatment. Saliva samples were collected from all the patients at initial diagnosis and follow-up diagnosis after treatment. The salivary pepsin concentration was determined by enzyme linked immunosorbent assay （ELISA）. The differences of RSI, RFS scores and salivary pepsin concentrations before and after treatment were compared. Results:The median concentration of salivary pepsin in LPR （+） group was significantly higher than that in LPR （-） group, and （73.01 ng/mL vs 25.66 ng/mL, P<0.01）, the median concentration of salivary pepsin in RFS （+） group were significantly higher than that in RFS （-） group（78.00 ng/mL vs 35.79 ng/mL, P<0.01） Furthermore, the median scores of RSI （11.00 vs 7.00, P<0.05） and RFS （9.00 vs 7.00, P<0.01） of LPR （+） patients notably decreased after PPI treatment for 1 month, and the salivary pepsin median concentration was memorably lower than that before treatment（53.60 ng/mL vs 46.49 ng/mL, P<0.05）. Meanwhile, the scores of symptoms such as pharyngeal paraesthesia, heartburn, chest pain, stomachache, and the scores of signs such as false vocal fold, erythema or congestion, vocal fold edema, posterior commissure hypertrophy and thick endolaryngeal mucus were conspicuously lower after treatment than those before treatment（P<0.05）. Conclusion:After 1 month of PPI treatment, the scores of partial symptoms and signs, and the salivary pepsin concentrations of LPR patients decreased significantly, suggesting that pepsin plays an important role in the pathogenesis of LPR, and pepsin may be closely related to the symptoms and signs such as pharyngeal paraesthesia and vocal fold edema.

Assessment of event-related evoked potentials and China-Wechsler intelligence scale for cognitive dysfunction in children with obstructive sleep apnea.

OBJECTIVE: To explore the relationship between obstructive sleep apnea (OSA) and cognitive impairment by combining event-related evoked potentials (ERPs) and China-Wechsler Younger Children Scale (C-WISC) in children with sleep-disordered breathing (SDB) with vs. without OSA. METHODS: This was a retrospective case-control study of all consecutive children (n = 148) with adenoid tonsil hypertrophy between July 2017 and March 2019 at the Hospital. RESULTS: The children were divided into the OSA (n = 102) and non-OSA (n = 46) groups. The apnea-hypopnea index (AHI), obstructive apnea index (OAI), and obstructive apnea-hypopnea index (OAHI) in the OSA group were elevated compared with those of the non-OSA group (all P < 0.001). The mean oxygen saturation (SaO2) and SaO2 nadir were lower in the OSA group compared with the non-OSA group (both P < 0.001). The respiratory arousal index (RAI) values in the OSA group were larger than those of the non-OSA group (P < 0.001). The P300 and N100 latencies in the OSA group were longer than those of the non-OSA group (both P < 0.001). Pearson's correlation analysis revealed correlations of the P300 peak latency with full-scale intelligence quotient (FIQ) (P < 0.001 and r = -0.527), verbal intelligence quotient (VIQ) (P < 0.001 and r = -0.448), and performance intelligence quotient (PIQ) (P < 0.001 and r = -0.515). There was a correlation between the N100 peak latency and PIQ (P = 0.026 and r = -0.183). CONCLUSION: ERPs, as an objective measurement, might help assess cognitive impairment in children with OSA.

[Analysis of influencing factors of excessive daytime sleepiness in adults with different degrees of sleep-disordered breathing].

Objective:To explore the main influencing factors of excessive daytime sleepiness（EDS） in adults with different degrees of sleep-disordered breathing（SDB）, which will provide the scientific evidences for the individualized diagnosis and treatment. Method:Retrospective analysis was performed on the clinical data of 361 young and middle-aged snoring patients monitored by polysomnography. According to the presence or absence of obstructive sleep apnea（OSA） and apnea hypopnea index（AHI） levels, they were divided into primary snoring（AHI<5）, mild OSA（AHI 5-<15）, moderate OSA（AHI 15-<30） and severe OSA（AHI≥30）. From sleep efficiency（ES）, different sleep stages（REM, NREM1, NREM2, NREM3） ratio of total sleep, oxygen reduction index（ODI）, blood oxygen saturation<90% of total sleep time（TS90%）, the average saturation of blood oxygen（MSaO2） and the lowest blood oxygen saturation（LSaO2） of all-night sleep, and AHI in different sleep stages（REM-AHI, NREM-AHI）, MSaO2 in different sleep stages（REM-MSaO2, NREM-MSaO2） and LSaO2 in different sleep stages（REM-LSaO2, NREM-LSaO2）, the main influencing factors of EDS were discussed. Result:Among the 361 patients, 23 patients suffered from the primary snoring, 47 patients with mild OSA, 56 patients with moderate OSA, and 235 patients with severe OSA. REM-AHI, ODI and TS90% in EDS group were 10.9, 9.6 and 0.2 respectively in patients with primary snoring, which were significantly higher than those without EDS（P<0.01）. The main influencing factors of EDS were REM-AHI, ODI, and TS90%. However, among patients with mild OSA, REM-AHI was the main influencing factor of EDS, REM-AHI of the EDS group was 29.6, which was significantly higher than that of the non-EDS（P<0.05）. In patients with moderate OSA, LSaO2 of the EDS group was 76.2, significantly lower than the group without EDS（P<0.05）, the main influencing factor of EDS is LSaO2. In patients with severe OSA, BMI, ODI and TS90% in EDS group were significantly higher than those without EDS（P<0.05 or P<0.01）, while NREM-MSaO2, MSaO2 and LSaO2 were significantly lower than those without EDS（P<0.05 or P<0.01）. The main influencing factors of EDS were BMI, NREM-MSaO2, MSaO2, LSaO2, ODI and TS90%. Conclusion:Frequent apnea during REM stage may be one of the important factors causing EDS in patients with primary snoring and mild OSA. For patients with moderate and severe OSA, intermittent hypoxia at night may be the main factor leading to EDS, and obesity may promote the development of the disease and the occurrence of sleepiness.

RP11­156L14.1 regulates SSR1 expression by competitively binding to miR­548ao­3p in hypopharyngeal squamous cell carcinoma.

Emerging studies have demonstrated that long non­coding RNAs (lncRNAs) play essential roles in tumorigenesis. However, the role and function of lncRNAs in hypopharyngeal squamous cell carcinoma (HSCC) have not been completely elucidated. The present study explored the function of a novel lncRNA, RP11­156L14.1, in HSCC. RP11­156L14.1 was revealed to be highly expressed in HSCC tissues and cell lines. Knockdown of RP11­156L14.1 inhibited proliferation, migration, and invasion in HSCC cells. Furthermore, RP11­156L14.1 regulated epithelial­mesenchymal transition (EMT) by controlling EMT­related protein expression. Mechanistically, RP11­156L14.1 exerted its function as a competing endogenous RNA (ceRNA) and directly interacted with miR­548ao­3p. The present study also demonstrated that miR­548ao­3p regulated signal sequence receptor subunit 1 (SSR1) expression by targeting SSR1 3'­UTR. Moreover, the xenograft HSCC tumor model revealed that knockdown of RP11­156L14.1 markedly suppressed HSCC tumor growth in vivo. In summary, these findings indicated that the lncRNA RP11­156L14.1 functions as an oncogene in HSCC by competing with miR­548ao­3p in regulating SSR1 expression. The RP11­156L14.1/miR­548ao­3p/SSR1 axis could be utilized as a potential novel biomarker and therapeutic target for HSCC.

Aberrant methylation­mediated decrease of lncRNA HNF1A­AS1 contributes to malignant progression of laryngeal squamous cell carcinoma via EMT.

Aberrant methylation is one of the most frequent epigenetic alterations that regulate the expression levels of genes, including long non­coding RNAs (lncRNAs), in tumors. However, to the best of our knowledge, the expression and function of hepatic nuclear factor 1α antisense RNA 1 (HNF1A­AS1) and its methylation condition have not yet been reported in the development and progression of laryngeal squamous cell carcinoma (LSCC). In the present study, the expression and methylation of HNF1A­AS1 were first examined by reverse transcription­quantitative PCR, bisulfite genomic sequencing and methylation­specific polymerase chain reaction in samples from patients with LSCC, which were based on the in silico analysis using The Cancer Genome Atlas data, and were then further verified in LSCC cell lines with and without 5­Aza­2'­deoxycytidine (5­Aza­dC) treatment. Subsequently, proliferation, cell cycle distribution, migration and invasion of LSCC cells following either knockdown or overexpression of HNF1A­AS1 were determined in vitro. Furthermore, the characteristic of HNF1A­AS1 on epithelial­mesenchymal transition (EMT) changes was investigated in vitro and in vivo. The associations between the expression levels of HNF1A­AS1 and tumorigenicity and cervical lymph node metastasis were assessed in a xenograft model in nude mice. In the present study, downregulation and hypermethylation in CpG sites of HNF1A­AS1 were detected in LSCC tissues as well as metastatic cervical lymph nodes samples when compared with those in the adjacent non­tumor tissues. Additionally, HNF1A­AS1 inhibited proliferation, migration and invasion of LSCC cells in vitro by regulating the process of EMT. Furthermore, HNF1A­AS1 inhibited tumor growth and metastasis by regulating EMT in vivo. Additionally, the migration and invasion abilities, and the expression levels of HNF1A­AS1 and EMT markers in LSCC cells were significantly reversed by treatment with 5­Aza­dC. In summary, HNF1A­AS1 was downregulated by hypermethylation in LSCC and laryngeal cancer cells. These findings suggested that HNF1A­AS1 could serve as a tumor suppressor lncRNA in LSCC by regulating the EMT process, leading to the discovery of novel therapeutic targets and strategies for the treatment of patients with LSCC.

[Association of CXCR4 and SDF-1alpha with organ-specific metastasis of nasopharyngeal carcinoma].

OBJECTIVE: To explore the role of CXCR4/SDF-1alpha axis in organ-specific metastasis of nasopharyngeal carcinoma (NPC) by assessment of CXCR4 expression in NPC cells and SDF-1alpha expression in distant target organs of NPC. METHODS: Thirty patients with NPC and fifteen normal subjects were recruited in this study. The expressions of CXCR4 in NPC and normal cases were identified by RT-PCR and immunohistochemistry (IHC), then the relationship between CXCR4 expression and clinicopathological factors was analyzed. IHC was also used to analyze the SDF-1alpha protein expression in normal cervical lymph nodes (including normal superior and inferior deep cervical lymph nodes), bone marrow, lung, liver, kidney and colon tissues of NPC patients (5 cases/each group). RESULTS: The relative expression level of CXCR4 mRNA in NPC (0.71 +/- 0.22) was significantly higher than that of normal nasopharynx tissues (0.14 +/- 0.07, F = 27.94, P < 0.05). The relative expression level of CXCR4 protein in NPC (1.58 +/- 0.59) was significantly higher than that of normal nasopharynx tissues (0.51 +/- 0.22, F = 17.75, P < 0.05). The high expression levels of CXCR4 mRNA and protein in NPC were closely related to clinical stage, cervical lymph node metastasis and cancer cell differentiation (P < 0.05). SDF-1alpha protein was strongly expressed in normal superior deep cervical lymph nodes, bone marrow, lung and liver (2.35 +/- 0.67), but absent or very poor expression in inferior deep cervical lymph nodes, kidney and colon tissues (0.68 +/- 0.23), and the differences between them were statistically significant (t = 10.13, P < 0.01). CONCLUSION: CXCR4 is closely correlated to metastasis of nasopharyngeal carcinoma. CXCR4/SDF-1alpha axis may play an important role in organ-specific metastasis of NPC.

Related biomarkers of neurocognitive impairment in children with obstructive sleep apnea.

OBJECTIVES: Different experiment approaches have demonstrated that children with obstructive sleep apnea (OSA) exhibit neurocognitive and behavioral deficits. This review summarized the potential biomarkers of OSA-associated neurocognitive impairment in children. METHODS: A scoping review of studies on children with OSA that evaluated the potential value of different markers in identifying neurocognitive impairment was undertaken. Additionally, the biomarkers were categorized according to the different research methods, including brain imaging studies, serological indicators and urine markers. RESULTS: Majority of the studies that evaluated blood biomarkers, plasma insulin growth factor-1 (IGF-1) and Alzheimer's disease (AD)-related biomarkers appeared to exhibit a favorable profile, and could discriminate between OSA children with or without neurocognitive impairments. Brain imaging studies and urinary neurotransmitters could also be helpful for screening OSA cognitive morbidity in children. CONCLUSION: Due to limited research methods available in children, the cognitive susceptibility of children with OSA has been rarely studied. The main reason for this may be the limited research methods in children. Numerous study populations of children and complex psychological tests are required, which involve major labor and costs.Multi-center prospective studies are needed to identify suitable biomarkers for the timely prediction and effective intervention to prevent neurocognitive impairment in children with OSA and to explore further opportunities in this arena.