Application of rigid bronchoscopy for emergent removal of tracheobronchial foreign body in paediatric cases: a learning curve study.

OBJECTIVES: To explore the factors associated with the operative duration for paediatric tracheobronchial foreign body removal by rigid bronchoscopy, and to analyse the learning curve for mastery of the rigid bronchoscopy skill. METHODS: A retrospective study was performed of paediatric cases of tracheobronchial foreign body removal by rigid bronchoscopy in our department from January 2007 to July 2019. Multivariate Cox regression analysis was used to analyse the factors associated with the operative duration. In addition, the learning curves for two doctors were evaluated by curve-fitting regression analysis. RESULTS: A total of 410 paediatric cases of tracheobronchial foreign body removal by rigid bronchoscopy were evaluated. The operative duration was significantly influenced by the skill of the doctor. The learning curves for both doctor A and doctor B demonstrated two typical phases: an initially rapidly changing learning phase followed by a steady consolidation phase. CONCLUSION: The operative duration for paediatric tracheobronchial foreign body removal by rigid bronchoscopy was associated with the skill of the doctor. In order to fully master the rigid bronchoscopy technique, doctors should perform a minimum number of procedures to pass the learning phase and reach the consolidation phase.

[THE function and morphology study of eustachian tube based on sonotubometry and multi-slice spiral CT in normal subjects].

Objective: In order to assess ET more comprehensively, sonotubometry (STM)combined with CT images were applied to investigate the opening features of eustachian tube (ET) in normal subjects. STM was also used as a monitor training ET opening maneuver and optimizing CT scan parameters. Methods: Following ET opening training monitored by STM, STM data of ET opening duration and maximum sound pressure from 13 healthy volunteers (10 males and 3 females, 22 to 26 years old) were acquired using maneuvers of swallowing and Valsalva in standing and supine positions. Two trials of CT scan, setting A (slice thickness 6.0 mm, manually simulated to 0.6 mm, reconstruction thickness 0.6 mm) for normal and Valsalva scans and setting B(slice thickness 0.4 mm,reconstruction thickness 0.4 mm)for Valsalva scan, were conducted in each subject. The bone area and cartilage area of ET were measured respectively in reconstructed CT images. Statistical software SPSS 19.0 was employed in data analysis. Results: The duration of ET opening and maximum sound pressure by Valsalva were longer and stronger than those by swallowing in both positions. For Valsalva maneuver, standing position resulted in longer ET opening duration compared to supine position (P<0.05). Under setting A, ET cartilage area was measured larger by Valsalva scan than by normal scan (P<0.05). By Valsalva scan, setting A captured larger ET cartilage area compared to setting B (P<0.05). CT setting B resulted in longer scan time in comparison to setting A (P<0.05). Conclusions: Techniques of STM in supine position plus CT scan under setting A can be combined by Valsalva passive ET opening. Not only the invisible ET lumen through routine CT scan can be illustrated, but also relevant ET open-close process is shown, therefore, this study provides the technique for ET research of function and structure.

[Clinical application of HRCT three-dimensional reconstruction in traumatic ossicular chain interruption].

Objective:To investigate the clinical value of HRCT three-dimensional reconstruction technique in traumatic auditory chain traumatic fracture. Method:The clinical data of 14 patients with traumatic ear ossicular chain interruption were analyzed retrospectively. To evaluate the injury site and degree of the auditory chain before surgery, all the 14 patients underwent,HRCT scanning and three-dimensional reconstruction. The reconstructed auditory chain was observed from multiple angles and compared with the surgical exploration results under microscope. Result:The coincidence rate between ossicular chain injury observed by temporal bone HRCT scan before operation and ossicular chain injury observed during surgery was only 28.57%, the coincidence rate between ossicular chain injury observed during surgery and ossicular chain injury observed by three-dimensional reconstruction is 85.71%.Therefore, three-dimensional reconstruction imaging technique could give the doctor more clearly and stereoscopic images for the destruction of ossicular chain. Conclusion:Preoperative three-dimensional reconstruction can display and diagnosis of auditory ossicular chain destruction more clearly. It can be used to accurately evaluate auditory ossicular chain pathological changes, to develop individualized surgical plans and assess the risk of surgery.

[Research on the factors affecting the postoperative outcome of otosclerosis].

Summary Otosclerosis is not often seen in the clinic, but it can seriously affect the quality of life due to the hearing loss of patients. Currently, the treatment of otosclerosis is mainly surgery. With the development of microsurgical techniques, the treatment of surgery for otosclerosis has been highly praised and widely carried out. However, different surgical methods, assistive techniques and instruments used during surgery, selected placement of prostheses, and varying levels of experience of the surgeon can all affect postoperative outcomes. In order to provide reference for the surgical treatment of otosclerosis in the future，this paper will summarize the factors related to postoperative efficacy of stapes surgery for otosclerosis.

[Current diagnosis and treatment of pseudoaneurysms of the internal carotid artery in postirradiated nasopharyngeal carcinoma].

Nasopharyngeal carcinoma is one of the most common of head and neck malignant tumors in southern region of China. Till date radiotherapy is considered as the first choice of treatment this disease.Although the rate of occurrence of pseudoaneurysms of the internal carotid artery in post radiation treatment of nasopharyngeal carcinoma is low, it is also a hot topic in department of otolaryngology and doctors because of its dangerous and lifethreatening emergencies.In order to improve the level of diagnosis and treatment of the disease, diagnosis, risk, treatment, prognosis and prevention are current summarized in this report.

Inhibitory effect of microRNA-24 on fatty acid-binding protein expression on 3T3-L1 adipocyte differentiation.

We examined the effect of microRNAs on 3T3-L1 adipocyte differentiation and expression of adipocyte-specific gene fatty acid-binding protein 4 (FABP4). We screened and identified adipo-related microRNAs during 3T3-L1 adipocyte differentiation with a microRNA microarray. High expression plasmids of miR-24 and miR-21 were constructed and transfected into 3T3-L1 preadipocytes by lipofectamine. The effects of miR-24 and miR-21 on 3T3-L1 adipocyte differentiation were observed, and the protein and mRNA expression levels of FABP4 and AP-1 were determined. The expression profiles of microRNAs significantly changed during 3T3-L1 adipocyte differentiation. The expression of 33 microRNAs was downregulated, among which downregulation of miR-24 was the most extensive. There were 17 microRNAs with upregulated expression; the highest levels were found for miR-21. miR-24 significantly inhibited 3T3-L1 adipocyte differentiation and maturity, while miR-21 had no significant effect. In addition, miR-24 significantly inhibited the expression of FABP4, while it upregulated AP-1 expression, but had no effect on the level of FABP4 mRNA. miR-21 had no effect on FABP4 protein and mRNA expression. AP-1 silencing could, at least partially, reverse the inhibitory effect of miR-24 on FABP4 expression. We conclude that microRNA expression profiles change significantly during 3T3- L1 adipocyte differentiation and that miR-24 plays an important role in regulating adipocyte differentiation and FABP4 expression. The mechanism involved may be the upregulation of AP-1.

[Usefulness of CT scan in secretory otitis media in patient with nasopharyngeal carcinoma].

OBJECTIVE: To explore the usefulness of CT scan in nasopharyngeal carcinoma (NPC) with secretory otitis media (SOM). METHOD: CT of the nasopharynx and mastoid in 127 cases with NPC pro- and post-irradiation were analyzed. RESULT: Total incidence rate of SOM was 59% before irradiation. The incidence corresponded to T stage and tumor location of NPC. In the patients without SOM before irradiation, 70 percent of the ears developed SOM, and the peak stage of the formation of SOM was in three to six month after irradiation. CONCLUSION: CT scan for the patient with NPC is useful for the diagnosis and prognosis of SOM induced by NPC.

[The treatment of nasal adhesion after radiotherapy in the patients with nasopharyngeal carcinoma].

OBJECTIVE: In order to find a best way for treating the nasal adhesion after radiotherapy in the patients with nasopharyngeal carcinoma (NPC). METHOD: 4 cases of nasal adhesion after radiotherapy in the patients with NPC were operated by the way through palate. 32 cases were operated under endoscope, in them, 26 cases were set a tube in nasal cavity after operation, and the other 6 cases were not. And the postoperative consequences were analyzed. RESULT: The curative effect of the reconstruction of nasal cavity with a tube through palate are favorable, but the processes are too complex and the trauma are too large for patients. Whereas the way which only sever the nasal adhesion under endoscope is simple, but the disease recur easily. The reconstruction of nasal cavity with a tube under endoscope not only predigest the operation, but also obtain the well effect. CONCLUSION: The reconstruction of nasal cavity with a tube under endoscope is a good way to treat nasal adhesion.