Analysis of cases with emergency thyroid surgery / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the clinical features of cases with emergency thyroid surgery. Methods: Nineteen cases treated with emergency thyroid surgery from May 2014 to May 2019 were analysed retrospectively, including 9 males and 10 females, aged from 24-79 years old. Among them, 6 cases had nodular goitres and 13 cases had thyroid malignancies. One case underwent tracheal stenting before operation. Emergency thyroid surgery was due to severe dyspnea in all cases. Treatment outcomes and prognoses of patients were evaluated. Results: All the 19 patients underwent general anesthesia with endotracheal intubation. One patient underwent extracorporeal membrane oxygenation(ECMO) and two patients underwent cardiopulmonary bypass. Six cases of nodular goitres underwent proximal thyroidectomy. Eight cases of malignant tumors underwent total thyroidectomy, six cases with invading the trachea underwent tracheal end-end anastomosis after partial tracheal resection, one case underwent tumor resection with sternal sternum approach, cervical and mediastinal lymph node dissection, total laryngectomy and tracheal low ostomy. Two cases with extensive involvement of malignant tumors were given a definite diagnosis and tracheostomy. Of three cases with malignant lymphoma, one underwent total thyroidectomy, and two were only given a definite diagnosis and tracheostomy. No complications such as hemorrhage, recurrent laryngeal nerve or parathyroid injury occurred after operation in all patients. With followed up for 6-50 months, except 2 cases died due to tumor progression, the rest were alive. Conclusions: Patients with obvious dyspnea caused by thyroid tumors have a high mortality rate and should be treated actively. Emergency surgery not only relieves respiratory obstruction and saves the lives of patients, but some patients can get a radical cure as well.

Advances in atrial fibrillation and cardiac autonomic nerve and its remodeling area / 医学研究生学报

Atrial fibrillation (AF) is the most common arrhythmia in clinical work, accounting for about 1/3 of patients in hospital due to arrhythmia. Recently, more and more studies have shown that cardiac autonomic nerve and its remodeling are involved in the occurrence and maintenance of AF, which is one of the important mechanisms of AF. At present, the treatment methods of AF include drug therapy and radiofrequency ablation. As we all know, drug therapy has many limitations. In this paper, the mechanism of sympathetic, parasympathetic nerve and AF and the changes of cardiac autonomic nerve and its remodeling area before and after the occurrence of AF were studied, so as to explore a better treatment method of AF, and then simplify the tedious steps of radiofrequency ablation, reduce the scope of ablation, more accurately locate ectopic trigger point and vulnerable matrix, reduce the intensity of ablation, improve the success rate of operation and obtain good economic benefits.

Primary mechanism of the role of dual oxidase-1 causing airway allergic diseases in human bronchial epithelium / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the role of dual oxidase-1 (DUOX-1) inducing airway hyperresponsiveness in human bronchial epithelium.</p><p><b>METHODS</b>The human bronchial epithelial cells were divided into several groups: control group, tumor necrosis factor-α (TNF-α) group, methyl-β-cyclodextrin (M-β-CD)+TNF-α group, desipramine (DES)+ TNF-α group, diphenylene iodonium (DPI) + TNF-α group and apocynin (APO)+TNF-α group. Fractionation was performed by sucrose gradient centrifugation and the protein DUOX-1 was measured by western blotting. The lipid raft clusters and its colocalization with DUOX-1 were confocal analysed. The intracellular reactive oxygen species (ROS) accumulation was measured by fluorescence of reactive oxygen probe of intracellular measurement. Sigmastat 3.02 software was used to analyze the data.</p><p><b>RESULTS</b>(1) Detection of ROS, control group: 1.00 ± 0.00; TNF-α group: 1.95 ± 0.16; M-β-CD+TNF-α group: 0.91 ± 0.16; DES+TNF-α group: 1.49 ± 0.20; DPI+TNF-α group: 1.03 ± 0.16; APO+TNF-α group: 1.47 ± 0.26. The difference was statistically significant (F = 3.83, P < 0.05). (2) Extracts in rafts to lipid rafts region represents the ratio of total protein, protein content DUOX-1 each group, control group: 0.21 ± 0.02; TNF-α group: 0.49 ± 0.04; M-β-CD+TNF-α group: 0.08 ± 0.02; DES+TNF-α group: 0.09 ± 0.03; the difference was statistically significant (F = 3.96, P < 0.05). (3) DUOX-1 protein fluorescence values, control group: 1.72 ± 0.21; TNF-α group: 8.11 ± 1.23; M-β-CD+TNF-α group: 1.51 ± 0.32; DES+TNF-α group: 1.43 ± 0.11; the difference was statistically significant (F = 4.87, P < 0.05). (4) DUOX-1 gene detection, control group: 1.00 ± 0.00 ScrRNA+TNF-α group: 1.75 ± 0.04; DUOX-1siRNA+TNF-αgroup: 1.15 ± 0.02; the difference was statistically significant (F = 4.19, P < 0.05).</p><p><b>CONCLUSION</b>TNF-α can induce DUOX-1 expression increasing in lipid raft, then the DUOX-1 can be activated to increase reactive oxygen species level; acidic sphingomyelinase inhibitor desipramine can inhibit this process, the results disclose that the process will depend on the ceramide of lipid raft.</p>

Comparison between harmonic scalpel as major instrument and conventional operation for tonsillectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility of applying harmonic scalpel in tonsillectomy by comparing it with the conventional tonsillectomy.</p><p><b>METHODS</b>Thirty-five patients were treated by harmonic scalpel assisted tonsillectomy (harmonic scalpel group) and 35 patients were treated by conventional tonsillectomy (control group). The operating time and blood loss during operation and the degree of pain and post-tonsillectomy hemorrhage as well as the time of defining were observed.</p><p><b>RESULTS</b>The data of the operating time and blood loss during operation and the degree of pain in harmonic scalpel group were lower than that in the conventional group, the harmonic scalpel group had less perioperative bleeding (median 1 ml), short operation time (median 20 min), postoperative pain during 5 days with visual analogue scale was lighter (median from 5 scores down to 1 score), there was statistical difference (P < 0.01). Neither primary hemorrhage nor secondary hemorrhage occurred in harmonic scalpel group, while one primary hemorrhage and one secondary hemorrhage occurred in conventional group. No difference was found in the beginning time of defining (P > 0.05).</p><p><b>CONCLUSION</b>The application of harmonic scalpel in tonsillectomy was safe, efficient and feasible, which had a nice application prospect in the field of otolaryngology.</p>

Partial laryngectomy for ninety-eight patients with glottic carcinoma of the larynx / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic results after various kinds of partial laryngectomy for patients with glottic carcinoma of the larynx.</p><p><b>METHODS</b>From January 1980 to Mar 2004, 98 patients with glottic carcinoma of the larynx were treated by various kinds of partial laryngectomy. The types of operation varied according to stage of the lesion: vertical or frontovertical partial laryngectomy for T1b, T2 and T1a with invasion of anterior commissura, Tuker's operation or supracricoid partial laryngectomy for T1b, T2 or those with invasion of over half of contralateral cord, and extended vertical partial laryngectomy with resection of arytenoids for T3, or with invasion of ipsilateral arytenoids cartilage without involving postcricoid mucosa or posterior commissura. Totally, vertical partial laryngectomy was carried out for 76 patients, extended vertical partial laryngectomy for 7, supracricoid partial laryngectomy for 3 and Tucker's operation for 12. One stage unilateral neck dissection was performed in 5 patients and postoperative radio-therapy was supplemented to 5 (dose 60 Gy). For laryngeal function restoration, pectoro-hyomyo-flap and cricohyoidoepi glotopexy procedures were also performed for some patients. The clinical data of these patients were retrospectively analyzed.</p><p><b>RESULTS</b>The 3- and 5-year survival rate was 86.5% (64/74) and 81.7% (49/60), respectively. The total decannulation rate was 94.9% (93/98), though fifteen patients had had symptoms of aspiration. Swallowing function of all patients recovered to the normal level. The phonation of all patients was restored to various degrees and they were able to communicate socially.</p><p><b>CONCLUSION</b>The 3- and 5-year survival rates of partial laryngectomy for patients with glottic carcinoma of the larynx are comparable to the results achieved by total laryngectomy, but the quality of life of the patents much better. Complete resection of the tumor and simultaneous preservation of respiratory and vocal function whenever possible by partial laryngectomy is very important for improving patients' life quality. With a suitable size and good blood supply, the sternohyoid muscle flap of unipedical and half-thickness instead of whole thickness is ideal in the reconstruction of laryngeal defect after vertical partial laryngectomy.</p>