[Clinical characteristics and efficacy of vocal fold epidermoid cysts coexisting with sulcus vocalis].

Objective: To investigate the clinical characteristics and voice outcomes after laryngeal microsurgery for vocal fold epidermoid cysts coexisting with sulcus vocalis. Methods: The clinical data of 115 vocal fold epidermoid cysts coexisting with sulcus vocalis patients in Shandong provincial ENT hospital, were retrospectively analyzed, including 49 males and 66 females, aged 17-70 years old, and the duration of hoarseness ranged from 6 months to 30 years. All patients underwent surgery through suspension laryngoscope and microscope under general anestgesia. Ninety-four patients were treated with microflap excision of sulcus vocalis, cyst wall, and contents.And 21 patients that occulted with mucosal bridges were applied mucosal bridges resection (2 cases) and mucosal bridges reconstruction (19 cases) respectively. Videolaryngoscopy, subjective voice evaluation (GRBAS), objective voice evaluation, and Voice Handicap Index(VHI) were performed before and after surgery. All patients underwent histopathologic examination and follow-up after the procedure. The preoperative acoustic parameters of patients with vocal fold epidermoid cysts coexisting with sulcus vocalis were compared with those of vocal fold mucus retention cysts and simple vocal fold epidermoid cysts by independent samples t-test. The patients were compared by paired t-test for preoperative and postoperative parameters. Results: Significant reduction or lack of mucosal waves were shown via videolaryngostroboscopy in all 115 cases.In addition, vascular changes including dilation, tortuousness, increased branches, and abrupt direction change were shown on the cystic area. Eighty-one patients were detected cysts and/or sulcus vocalis by preoperative laryngoscopy, and intraoperative microscopic findings in the remaining 34 patients. The intraoperative microscopic examination revealed a focal pouch-like deficit plunging into the vocal ligament or muscle. The deep surface of the mucosal bridges was sulcus vocalis, and that in 89 cysts was lined with caseous content. Histopathology demonstrated a cystic cavity structure lined with squamous epithelium and caseous keratin desquamation inside the cystic cavity. Four of 115 patients were lost at follow-up and excluded from the analysis of voice outcomes after surgery. There was no significant mucosal wave and the voice quality in all but 14 patients 1month after surgery. Except for the fundamental frequency and noise harmonic ratio, all other voice parameters[ G, R, B, A, VHI-10, jitter, shimmer, maximum phonatory time (MPT) ]showed a significant improvement 3 months after surgery(t=15.82, 20.82, 17.61, 7.30, 38.88, 7.84, 5.88, -6.26, respectively, P<0.05). Then mucosal waves and the voice quality were gradually improved and became steady in 6 months after surgery. The subjective and objective voice parameters[G, R, B, A, VHI-10, jitter, shimmer, noise to harmonic ratio(NHR), MPT], except for the fundamental frequency, were all significantly improved(t=23.47, 25.79, 18.37, 9.84, 54.45, 10.68, 8.07, 3.24, -9.08, respectively, P<0.05). In addition, there were 2 patients with no significant improvement after the operation. Steady function with no complications was observed during the 12 months (up to 3 years in 34 patients) follow-up period in 111 patients. Conclusion: Ruptured vocal fold epidermoid cysts can result in sulcus vocalis and mucosal bridges. Characteristics changes in preoperative videolaryngoscopy are effective diagnostic tools. The complete excision of the cyst wall and repair of the lamina propria can lead to satisfactory long-term effects.

[Distribution of airway inflammation phenotype in patients with bronchial asthma and its correlation with control level].

Objective: To investigate the distribution of airway inflammation phenotypes in patients with bronchial asthma and its correlation with asthma control level. Methods: Patients who met GINA 2017 asthma diagnostic criteria from October 2017 to April 2018 in respiratory outpatient department of China-Japan Friendship Hospital were included. The clinical data of non-acute asthma patients were prospectively collected, including general data, asthma control level, pulmonary function, induced sputum cell classification, serum total IgE, exhaled nitric oxide (FeNO), blood cell classification. The correlation between phenotype distribution of airway inflammation and airway inflammation markers (eosinophils in sputum, FeNO, blood eosinophil, serum IgE) and asthma control was analyzed by correlation analysis. The correlation between sputum eosinophil level and FeNO, blood eosinophil count, serum total IgE, forced expiratory volume in one-second (FEV(1)) predicted (FEV(1)%pred) was analyzed by correlation analysis too. Results: A total of 97 asthmatic patients were enrolled. There were 38 males (39.2%) and 59 females (60.8%), aged (48±14) (range 22 to 80). Control level of asthma:13 cases (13.4%) were controlled, 39 cases(40.2%) were partially controlled and 45 cases (46.4%) were uncontrolled. The phenotypes of airway inflammation were eosinophilic 51 cases (52.6%), neutrophilic 9 cases (9.3%), mixed 35 cases (36.1%) and paucigranulocytic 2 cases (2.1%). There was no significant correlation between airway inflammation phenotype distribution, airway inflammation markers and asthma control level (P>0.05). Sputum eosinophil level was positively correlated with FeNO level in controlled and uncontrolled patients (r=0.420, P=0.008 and r=0.325, P=0.031); sputum eosinophil level was positively correlated with blood eosinophil level in uncontrolled asthma patients (r=0.328, P=0.037). There was no significant correlation between sputum eosinophil level and FEV(1)%pred (P>0.05). Conclusions: Eosinophil type is the dominant type of airway inflammation in asthmatic patients, and there is no significant correlation between airway inflammation and asthma control level. At present, airway inflammation cannot be used to assess asthma control level.

The relationship between serum lipid levels and nutrient intake in healthy inhabitants of urban and rural Shanghai.

The serum lipid levels (mean +/- SD) of 3312 healthy urban and rural inhabitants over 40 years of age in Shanghai were studied. The results were: cholesterol 166.7 +/- 30.9 mg/ml, triglyceride 81.1 +/- 42.3 mg/dl, HDL-cholesterol (HDLc) 57.4 +/- 11.6 mg/dl, HDL2c 20.6 +/- 9.8 mg/dl and HDL3c 37.1 +/- 7.8 mg/dl. Dietary surveys were carried out in 512 of these subjects and their average daily nutrient intake was estimated to be: total calories 2,577 Kcal, proteins 656 g (50.7 g of vegetable proteins), fat 69.1 g (P/S ratio 0.70), carbohydrates 423 g, cholesterol 282 mg, dietary fibres 23.5 g, sodium 4993 mg, potassium 2,618 mg and magnesium 575 mg. The serum lipid levels of urban and rural inhabitants were compared. Total cholesterol levels were significantly higher in urban inhabitants of all age groups and of both sexes, while triglyceride levels were significantly higher in urban inhabitants of certain age groups. However, HDLc levels, particularly HDL2c levels were significantly higher in rural inhabitants of most age groups and of both sexes. The above differences were probably the result of differences in dietary patterns and nutrient intake between urban and rural inhabitants.

L-652,469--a dual receptor antagonist of platelet activating factor and dihydropyridines from Tussilago farfara L.

L-652,469, 14-acetoxy-7 beta-(3'-ethylcrotonoyloxy)-notonipetranone, isolated from the methylene chloride extracts of the buds of Tussilago farfara L, was found to inhibit both platelet activating factor (PAF) and Ca2+ entry blocker binding to membrane vesicles. It inhibits the [3H]PAF specific binding to rabbit platelet membranes with equilibrium inhibition constants (Ki) of 3.2 and 4.0 microM in the presence of 150 mM NaCl and 10 mM MgCl2 respectively. It is a competitive PAF receptor antagonist with an equilibrium dissociation constant (KB) of 5.16 microM. It also competitively inhibits the specific binding of Ca2+ channel blockers (e.g. [3H]nitrendipine; Ki = 1.2 microM) in cardiac sarcolemmal vesicles. At 10(-5) M, L-652,469 causes a 60% relaxation of Ca2+-induced contraction of rat thoracic aorta strips. Due to its dual antagonistic activities, L-652,469 potently inhibits the gel-filtered rabbit platelet aggregation with a pA2 of 5.79. It was also found to be orally active with a beneficial effect to inhibit the PAF-induced rat foot edema and the first phase of carrageenan-induced rat hindpaw edema.