Reconstruction of complex tissue defects in temporal region: report of 3 cases / 中华耳鼻咽喉头颈外科杂志

Objective: To discuss the techniques and repairing methods of various degree of compound tissue defects in the auriculotemporal region. Methods: Retrospective analysis was conducted on three cases of different repairing methods for huge compound tissue defects in different degrees in the auriculotemporal region after the resection of the malignant tumor or sinus tract due to repeated infection in our hospital. Results: Following total removal of the tumors or sinus tract in all patients, we applied retroauricular lingual flap transfer repairing, latissimus dorsi flap free transfer repairing and vascular anastomosis, scalp tissue expansion in stage Ⅰ, then repairing the lesion with expanded scalp and filling the huge mastoid cavity with abdominal fat in stage Ⅱ, respectively, according to the characteristics of compound tissue defects in the auriculotemporal region. All free flaps survived well. Conclusions: The anatomy of the auricular-temporal area is complex and involves important vascular and neural structures of head and neck and lateral skull base. The huge composite tissue defect following auriculotemporal region surgery, which is composed of skin, muscle and bone tissue, needs to be repaired in one stage. Therefore, flexible repairing methods should be chosen based on different situations, for attaining the goal of completely removing tumor and lesions, and then, covering the operation cavity.

The impact of the COVID-19 pandemic on the mental health of young people: A comparison between China and the United Kingdom / 中华创伤杂志(英文版)

PURPOSE@#As COVID-19 spreads globally and affects people's health, there are concerns that the pandemic and control policies may have psychological effects on young people (age from 17 to 35 years). This psychological impact might vary in different countries, and thus we compared the prevalence of self-reported psychological distress, loneliness and posttraumatic stress symptoms (PTSS) among young people in the United Kingdom (UK) and China at the beginning of the COVID-19 pandemic.@*METHODS@#Data of this study came from two sources. One source was the first wave of COVID-19 study in Understanding Society, a special wave of the UK household longitudinal study, which provided the high-quality, national-wide representative panel data. The sample comprised 1054 young people. The other source was an online survey on the mental health of 1003 young people from Shanghai, a highly developed area in China. The questionnaire included questions on the prevalence of common mental disorders (cut-off score ≥ 4), loneliness and potential PTSS (cut-off ≥ 33). Univariable analyses were conducted to test the differences in the self-reported prevalence of psychological distress and loneliness between the two groups. Multivariable logistic regression analyses were run to explore the predictors of psychological distress and loneliness among all the young people from England and Shanghai.@*RESULTS@#Among the samples with self-reported psychological distress, the UK sample accounted for 34.4% (n=1054) and the Chinese sample accounted for 14.1% (n=1003). The difference between the two groups was statistically significant (p < 0.001). Additionally, 57.1% of people in the UK and 46.7% in China reported that they sometimes or often felt lonely, of which the difference is statistically significant (p < 0.001). Regression analysis of the entire samples showed that nationality, gender, psychotherapy and loneliness were significant predictors of 12-item General Health Questionnaire scores, while the variables of age and living alone were not. Significant predictors of self-reported loneliness were the nationality, gender, age, living alone and psychotherapy. In China, 123 (12.3%) young people, 49 men (11.3%) and 74 women (13.0%), met the criteria of PTSS symptoms (cut-off scores ≥ 33). These scores were only collected in China.@*CONCLUSION@#This evidence suggests that mental health and loneliness reported by young people were lower in China than that in the UK during the studied period. More research is needed to understand these differences. If the differential negative psychological impacts are confirmed, country-specific measures of prevention and intervention should be adopted to improve the mental health of young people under the ongoing impact of the pandemic.

Galactomannan test combined with CD4+T lymphocytes for the diagnosis of invasive aspergillosis in patients with AIDS / 中国感染控制杂志

Objective To evaluate the effect of galactomannan(GM) test combined with CD4+ T lymphocyte detection on early diagnosis of invasive aspergillosis (IA) in patients with acquired immunodeficiency syndrome (AIDS).Methods 197 AIDS patients who were suspected with IA in a hospital from January 2014 to December 2016 were analyzed retrospectively,they were divided into confirmed IA group (n =35),clinically diagnosed IA group (n=96,suspected cases),and non-IA group(n =66),sensitivity and specificity of GM test and GM test combined CD4+ T lymphocyte counting for diagnosing IA were compared.Results In confirmed IA group,clinically diagnosed IA group,and non-IA group,the medium values of GM (minimum,maximum) were 1.29(0.65,1.84)pg /mL,0.91(0.36,1.23)pg /mL,and 0.11(0.28,0.72)pg /mL respectively,CD4+ T lymphocyte counting were 45 (29,69)cells/μL,79(35,99) cells/μL,and 89 (59,158) cells/μL respectively,GM value and CD4+ T lymphocyte counting among three groups were significantly different(all P＜0.05).The sensitivity and specificity of single GM test for diagnosing IA in AIDS patients were 64.9％ and 72.7％ respectively;sensitivity and specificity of two consecutive GM test within one week for diagnosing IA were 72.5 ％ and 95.5 ％ respectively;sensitivity and specificity of GM test combined CD4+ T lymphocyte counting were 86.3％ and 90.9％ respectively.Conclusion GM test has better diagnostic value for IA in AIDS patients,continuous GM test and GM test combined CD4+ T lymphocyte counting will further improve the clinical diagnostic value for IA.

Trend analysis on the mortality of cardiovascular diseases from 2004 to 2010 in China / 中华流行病学杂志

Objective To explore the trend and characteristics of cardiovascular disease mortality in China.Methods Mortality data from the National disease surveillance system from 2004 to 2010 was used.Underreporting was adjusted and trends were analyzed on the rates of crude mortality,standardized mortality and causes of death fraction among cardiovascular diseases.Results The total mortality of cardiovascular diseases increased from 240.03 to 268.92 per one hundred thousand during 2004 to 2010,with an average annual increase of 5.50 per one hundred thousand,with the annual increase of 2.17％.Data from all causes of death,ischemic heart disease,hypertensive heart disease,cerebrovascular disease,and other heart disease showed an upward trend,with the annual rise of 5.05％,2.08％,1.02％ and 2.66％ respectively while rheumatic heart disease showed a downward trend,with the declining rate of 7.02％ per annum.After eliminating the effect of aging,the trend remained the same but the slope was decreasing.The proportion of national cardiovascular mortality on total deaths increased annually by 37.46％ to 40.73％ from 2004 to 2010.The proportion of cerebrovascular disease remained unchanging but the proportion of ischemic heart disease showed a significant increase.The proportion of rheumatic heart disease declined while the proportion of other cardiovascular disease mortality showing a slight change.Conclusion In recent years,the cardiovascular mortality had significantly increased,which was mainly due to the increase of ischemic heart disease mortality.

Surgical treatment of carotid body tumor: a report of 36 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study surgical methods and techniques to reduce complications in carotid body tumors (CBT).</p><p><b>METHODS</b>A total of 36 patients with CBT treated by the same surgeon between 2004 and 2012 was reviewed. Clinical presentation, imaging, surgery techniques, postoperative complications and outcomes as well as follow-up evaluations were analyzed.</p><p><b>RESULTS</b>Of 36 patients, 13 males and 23 females, with a median age of 42 years (range 9-61 years). Nineteen patients had a CBT on the left side, 14 on the right side and 3 on both sides. All patients (36 patients with 38 tumors) received surgical treatment. Twenty nine tumors were excised completely. Kudo clamp was used in 6 cases with solid firm tumors and potentially high risks of intracranial complications, with common carotid artery compression exercise before tumor excision. Blood loss in operation were less than 80 ml(n = 17), 100-550 ml(n = 18), 800 ml (n = 1), 1000 ml(n = 1) and 1500 ml(n = 1) respectively. There were more blood loss in cases used embolization (median of 200 ml) than in those without embolization (median of 60 ml) . Post-operative local nerve impairment occurred in 10 patients (26.3%) including persistence of preexisting deficits (n = 8) and newly developed deficits (n = 2). Twenty-seven patients were followed up for 10 month to 6 years with a mean period of 24 months and 9 patients lost of follow-up. One patient with malignant CBT survived with tumor and other 26 patients were alive with no recurrence.</p><p><b>CONCLUSIONS</b>Surgery is the first choice of treatment for CBT. Soft CBT often can be excised completely with preservation of the internal carotid artery (ICA), whereas solid firm CBT encasing the ICA should be evaluated with DSA preoperatively to determine the presence of communicating branches of cerebral vessels, due to the high risk of major vessel compromise. Two-stage operation is often required, in which the ICA is gradually closed following ligation of the external carotid to establish collateral circulation, followed by excision of the tumor and IAC, so that serious intracranial complications can be avoided.</p>

Diagnosis and treatment of the primary parapharyngeal space tumors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics, diagnosis and surgical managements of the parapharyngeal space tumors.</p><p><b>METHODS</b>A retrospective study of 40 patients with primary parapharyngeal space tumors treated from January 2006 to December 2008 in Chinese PLA General Hospital was performed. Among the 40 patients, there were male 22 patients, female 18 (45%), age ranged from 1 - 77, median 42 years old. CT scan combined with MRI was helpful to diagnose the parapharyngeal space tumor and make surgical plan. The surgical approaches include: trans-oral in 1 patient, trans-cervical approach in 22, transcervical-parotid approach in 8, vertical ramus osteotomy approach in 1, transcervical-partial bone resection in the angle of mandible in 4, transparotid approach in 2, and transcervical in combination with post auricle craniotomy approach in 2.</p><p><b>RESULTS</b>All 40 patients had undergone surgical treatment. Postoperative histopathology showed benign in 28 patients and malignant in 12 patients. The tumors originating from salivary glands were in 15 patients, neurogenic tumors in 12 patients and tumors originating from other tissues were in 13 patients.Among 28 patients with benign tumors, 23 had been cured with one operation, without recurrence during following-up of 13 - 47 months, with a median of 39 months. Among 12 patients with malignant tumors, 6 patients alive (with following-up of 24 - 50 months and a median of 36 months), 3 patients died in half year after operation and 3 patients lost. The post-operative complication included Cerebrospinal fluid leak in one patient, operative field infection in 2 patients, and vagus nerve injury in 3 patients.</p><p><b>CONCLUSIONS</b>Surgery is the first choice for parapharyngeal space tumors. Transcervical approach alone can apply to most tumors and a broader approach is indicated for malignant or large benign tumors. The prognosis is good for the benign lesions, but poor for the malignant tumors.</p>

Outline of the report on cardiovascular disease in China, 2010 / 生物医学与环境科学（英文）

Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens.

Relationship between SLP-2 expression and prognosis in laryngeal squamous cell carcinoma and mammary invasive carcinoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the expression of stomatin like protein-2 (SLP-2) at mRNA and protein levels in two kinds of malignant epithelial tumors, including laryngeal squamous cell carcinoma (LSCC) and invasive breast cancer, and to study the relations of SLP-2 expression and clinicopathologic parameters with the prognosis.</p><p><b>METHODS</b>RT-PCR and Western blot were used to detect the expression of SLP-2 mRNA and protein in LSCC and their normal counterparts (46 and 10 pair, respectively). Immunohistochemistry was carried on tissue array constructed from LSCC (104 cases) and breast cancer (263 cases), respectively. The association between SLP-2 expression and clinicopathologic parameters was analyzed.</p><p><b>RESULTS</b>LSCC showed a higher expression of SLP-2 than that of their normal counterparts (negative expression) at mRNA (83%, 38/46) and protein (7/10) level. Immunohistochemical analysis of LSCC showed that compared with negative expression in normal laryngeal epithelium (0/20), a higher SLP-2 expression was detected in LSCC (36/104, P=0.000) and associated with the advanced clinical stage (P<0.01) and lymph node metastasis (P=0.003). Immunohistochemical study of invasive breast cancer demonstrated that compared with negative expression in normal breast tissue (0/10), more than one half of the cases showed a high SLP-2 expression (52.5%, 138/263, P=0.000) in breast cancer, which correlated with the tumor size (P=0.020), lymph node metastasis (P<0.01), advanced clinical stage (P<0.01), distant metastasis (P=0.002) and HER2/neu protein expression (P=0.037). Survival analysis showed a shorter overall survival probability in patients with a high SLP-2 expression. It was considered that lymph node metastasis, positive HER2/neu expression, and high-level SLP-2 expression may act as the independent prognostic factors for those tumors.</p><p><b>CONCLUSIONS</b>A high expression level of SLP-2 may be associating with the development of invasion and metastasis in LSCC and breast cancer, and SLP-2 is also considered working as an independent factor indicating a poor prognosis clinically in breast cancer.</p>

Rescue of postoperative carotid blowout in head and neck neoplasms / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the prevention and rescuing measures of postoperative fatal bleeding induced by carotid blowout in head and neck tumors.</p><p><b>METHODS</b>Seven cases with postoperative carotid bleeding treated from October 2003 to August 2009 were reviewed retrospectively. Of the patients, 6 were with common carotid blowout and one with internal carotid artery blowout. All patients underwent pre- or post-operative radiotherapy for primary head and neck tumours and 3 patients had neck defect repair with deltopectoral skin flap, frontal flap or free radial arm flap respectively. After carotid blowout bleeding, the patients were treated in time with X ray transcatheter intervention including transcatheter arterial embolization (TAE) and self-expanding covered stent implantation, followed by repairing the carotid region with appropriate myocutaneous flaps.</p><p><b>RESULTS</b>Of 7 patients with carotid blowout, 5 patients were successfully rescued with X ray transcatheter intervention, of them 2 with self-expanding covered stent implantation and 2 with TAE respectively, and other 2 patients died due to rapid bleeding. Of the successfully rescued patients, 2 patients were with the repair of carotid area by pectoralis major myocutaneous flap, one by submental flap and one by local flap, but another one not with flap repair. Follow-up showed the 3 patients rescued with self-expanding covered stent implantation were survival for 6, 12, and 20 months, respectively, and the 2 patients rescued with TAE died of repeated carotid blowout in 2 and 13 months later, respectively.</p><p><b>CONCLUSIONS</b>The planned and timely X ray transcatheter intervention is an effective method to treat carotid blowout bleeding in the patients underwent head and neck tumour surgeries. Compared with TAE, self-expanding covered stent implantation may be more reliable for restoring the blood supply of head and neck region, with less complications. One-stage repair of carotid region with myocutaneous flap is of great importance to protect the carotid and to promote the wound healing.</p>

Effects of amlodipine plus telmisartan or amlodipine plus amiloride regimen on blood pressure control in hypertensive patients: preliminary report of Chinese Hypertension Intervention Efficacy (CHIEF) trial / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effects of amlodipine-based antihypertensive combination regimen on blood pressure control and impact on cardiovascular events.</p><p><b>METHODS</b>From Oct. 2007 to Oct. 2008, a total of 13 542 hypertensive patients from 180 centers in China were included in this multi-centre randomized, controlled, blind-endpoint assessment clinical trial. Inclusion criteria were: essential hypertension, 50 - 79 years of age with at least one cardiovascular risk factor and signed consent forms. Patients were randomly assigned to receive low-dose amlodipine + diuretics (group A) or low-dose amlodipine + telmisartan (group T). The primary endpoints are composite of non-fatal stroke/myocardial infarction and cardiovascular death. All patients will be followed-up for 4 years.</p><p><b>RESULTS</b>The characteristics of patients between the two groups were similar: mean age (61.5 +/- 7.7) Yrs with 19% history of cerebrovascular diseases, 12% coronary diseases, 18% diabetes, 42% dyslipidemia, mean initial blood pressure 157/93 mm Hg. After 8-week treatment, mean blood pressure in group A and B were reduced to (133.0 +/- 11.0)/(81.0 +/- 7.6) mm Hg, (132.9 +/- 11.6)/(80.6 +/- 7.9) mm Hg respectively. Blood pressure control rates reached 72.1% and 72.6% in group A and T, respectively.</p><p><b>CONCLUSION</b>Amlodipine-based antihypertensive combination regimens achieved satisfactory blood pressure control rate in patients with essential hypertension in this patient cohort.</p>

Result analysis of perioperative radiotherapy and laryngeal preservation in hypopharyngeal and pyriform sinus squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate perioperative radiotherapy and laryngeal preservation clinical result of hypopharyngeal pyriform sinus squamous cell carcinoma.</p><p><b>METHODS</b>A retrospective review was undertaken of 134 pyriform sinus squamous cell carcinoma cases who were treated at this institute in Department of Head and Neck Surgery from September 1985 to July 2001. One hundred patients received preoperative radiotherapy and surgery (R + S). Thirty-four patients received surgery and postoperative radiotherapy (S + R). The median follow-up interval was 38.1 months.</p><p><b>RESULTS</b>(R + S) and (S + R) group 3-year and 5-year survival according to Kaplan-Meier were 54.8%, 50.1%; 51.1%, 45.9% respectively, and had no significant differences (all P > .05). The laryngeal function preservation of T1, T2, T3, T4 in (R +S) and (S + R) were 4/5, 3/3; 66.7% (32/48), 6/6; 32.4% (12/37), 0 (0/16); 0 (0/10), 0/9 respectively. T3 stage in (R + S) was good and significant different than in (S + R) (P < 0.05) and laryngeal preservation didn't increase hazard of survival and local recurrence. The two group Pathology( + ,P + ) in specimen margin were 7.0% (7/100); 20.6% (7/34) and had significant difference (P <0. 05). P + in specimen margin and clinical N stage are obvious interrelated in prognosis(P < 0. 05).</p><p><b>CONCLUSIONS</b>Combined therapy (R + S) and (S + R) are equal in treat result. T3 (only paraglottic space is invaded) stage of (R + S) could increase preserved laryngeal ratio if condition is permitted and didn't add hazard. P + in specimen margin could be receded in (R + S) and profit to prognosis and function. Clinical N stage is obvious hazard and is an emphasis in combined therapy.</p>

Surgical therapy of subglottic carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical characteristics, surgical procedures and correlated prognostic factors of the cases with subglottic carcinoma; to seek for the optimal surgical treatment for the patients suffering from subglottic carcinoma.</p><p><b>METHODS</b>Twenty-four cases with subglottic carcinoma were retrospectively reviewed, the disease-free survival rates of the patients at 3 years were analyzed according to the different T N phases and the surgical modalities.</p><p><b>RESULTS</b>The free-disease survival rate at 3 years was 50.0% (12/24) for 24 cases with subglottic carcinoma. The survival rates of 19 cases with total laryngectomy was 47.4% (9/19), and the survival rates in T2, T3, T4 phases were respectively 1/1, 6/11, 2/7. The survival rates of 5 cases with partial laryngectomy was 3/5, the survival rates in T2, T3 phases were respectively 3/4, 0/1, and the surgical margins were verified to be positive in 2 of 5 cases being performed partial laryngectomy. The metastasis rate of lymph nodes was 33.3% (8/24). The survival rates of patients with N0, N1, N2 disease were respectively 10/16, 1/4, 1/4. The positive lymph nodes were verified in the neck regions of II-VI and superior mediastinum.</p><p><b>CONCLUSIONS</b>Prognoses of the cases with subglottic carcinoma were poor, early treatment could result in good effect. Until now total laryngectomy still the mainly treatment of subglottic carcinoma. Only the patients with earlier subglottic carcinoma are amenable to partial laryngectomy and should be given postoperative irradiation. Lymph node metastasis was a very important prognostic factor. Paratracheal lymph nodes are the sentinel nodes for subglottic carcinoma, and it is reasonable to probe the nodes. Once verifying positive lymph node, the typical neck dissection involving I-VI regions and superior mediastinum should be performed.</p>