Surgical treatment of nasopharyngeal cancer - a consensus recommendation from two Chinese associations.

BACKGROUND: Surgical treatment is playing an increasingly important role in the management of nasopharyngeal carcinoma (NPC). This consensus focuses on the indications for optimal surgery, and surgical methods in the whole process of treatment for NPC to provide a useful reference to assist these difficult clinical decisions. METHODOLOGY: A thorough review of available literature on NPC and surgery was conducted by the Association for the prevention and treatment of nasopharyngeal carcinoma in China, international exchange and promotion Association for medicine and healthcare, and the Committee on nasopharyngeal cancer of Guangdong provincial anticancer association. A set of questions and a preliminary draft guideline was circulated to a panel of 1096 experienced specialists on this disease for voting on controversial areas and comments. A refined second proposal, based on a summary of the initial voting and different opinions expressed, was recirculated to the experts in two authoritative medical science and technology academic groups in the prevention and treatment of NPC in China for review and reconsideration. RESULTS: The initial round of questions showed variations in clinical practice even among similar specialists, reflecting the lack of high-quality supporting data and resulting difficulties in formulating clinical decisions. Through exchange of comments and iterative revisions, recommendations with high-to-moderate agreement were formulated on general treatment strategies and details of surgery, including indications and surgical approaches. CONCLUSION: By standardizing the surgical indications and practice, we hope not only to improve the surgical outcomes, but also to highlight the key directions of future clinical research in the surgical management of NPC.

[The accuracy and influencing factors of sleep staging based on single-channel EEG via a deep neural network].

Objective: To investigate theaccuracy of artificial intelligence sleep staging model in patients with habitual snoring and obstructive sleep apnea hypopnea syndrome (OSAHS) based on single-channel EEG collected from different locations of the head. Methods: The clinical data of 114 adults with habitual snoring and OSAHS who visited to the Sleep Medicine Center of Beijing Tongren Hospital from September 2020 to March of 2021 were analyzed retrospectively, including 93 males and 21 females, aging from 20 to 64 years old. Eighty-five adults with OSAHS and 29 subjects with habitual snoring were included. Sleep staging analysis was performed on the single lead EEG signals of different locations (FP2-M1, C4-M1, F3-M2, ROG-M1, O1-M2) using the deep learning segmentation model trained by previous data. Manual scoring results were used as the gold standard to analyze the consistency rate of results and the influence of different categories of disease. Results: EEG data in 124 747 30-second epochs were taken as the testing dataset. The model accuracy of distinguishing wake/sleep was 92.3%,92.6%,93.5%,89.2% and 83.0% respectively,based on EEG channel Fp2-M1, C4-M1, F3-M2, REOG-M1 or O1-M2. The mode accuracy of distinguishing wake/REM/NREM and wake/REM/N1-2/SWS , was 84.7% and 80.1% respectively based on channel Fp2-M1, which located in forehead skin. The AHI calculated based on total sleep time derived from the model and gold standard were 13.6[4.30,42.5] and 14.2[4.8,42.7], respectively (Z=-2.477, P=0.013), and the kappa coefficient was 0.977. Conclusions: The autonomic sleep staging via a deep neural network model based on forehead single-channel EEG (Fp2-M1) has a good consistency in the identification sleep stage in a population with habitual snoring and OSAHS with different categories. The AHI calculated based on this model has high consistency with manual scoring.

Upper airway morphological changes in obstructive sleep apnoea: effect of age on pharyngeal anatomy.

OBJECTIVE: To evaluate the upper airway morphology changes associated with ageing in adult Chinese patients with obstructive sleep apnoea. METHODS: A total of 124 male patients diagnosed with obstructive sleep apnoea by overnight polysomnography, who underwent upper airway computed tomography, were enrolled. The linear dimensions, cross-sectional area and volume of the upper airway region and the surrounding bony frame were measured. The association between ageing and upper airway morphology was analysed. RESULTS: Soft palate length, minimum cross-sectional area of the retroglossal region, lateral dimensions at the minimum cross-sectional area of the retropalatal and retroglossal regions, nasopharyngeal volume, and average cross-sectional area of the nasopharyngeal region were found to significantly increase with ageing in all patients, while the upper airway shape flattened with ageing. The volume of the retropalatal region increased with ageing among the patients with a body mass index of less than 24 kg/m2. The volume of parapharyngeal fat pad increased with ageing among patients with a body mass index greater than 28 kg/m2. CONCLUSION: A number of dimensional, cross-sectional and volumetric parameters of the pharynx increased with age, indicating that non-anatomical factors may play a more important role in the pathogenesis of obstructive sleep apnoea in aged patients.

[The effect of the nasal packing material on nasal epithelial cells].

Objective:The aim of this study is to investigate the effect of polyethylene glycol acrylate hybrid hydrogel degradation substance on nasal mucociliary transport system. Method:In our experiment, the complex hydrogel were formed by the combination of different ratios of polyethyleneglycol diacrylate, chitosan and polyvinyl alcohol. The experiment was divided into four groups according to the international standard of medical devices. DMEM/F12∶BEGM culture medium was used for each packing material extraction, DMEM/F12∶BEGM culture medium was used as control. Human nasal uncinate tissue, gas liquid interface culture of human nasal mucociliary epithelium cells. The high frequency digital microscope video imaging system was used to detect the ciliary wiggle frequency. The baseline state (0 min) and 1 h,1 d, 2 d, 3 d of CBF were measured after dosing. Result:①In the experimental group and the control group, with the increase of the number of days, the ciliary beat frequency increased first and then slowed down. ②Compared with the other groups, Polyethylene glycol acrylate hybrid hydrogel group increase on CBF (P<0.05). There was no significant difference between the maximum increase and the maximum decrease in B, C and D groups (P>0.05). Therefore, it can be concluded that absorbable gelatin sponge material and absorbable chitosan material had no effect on nasal mucociliary activity. Conclusion:Polyethylene glycol diacrylate composite hydrogel material can increase the frequency of ciliary wounded nasal mucosa epithelial cells cultured in air-liquid interface in vitro, and enhanced the activity of nasal mucosa cilia. Therefore, it can meet the safety requirements of clinical application of the new material.

[The impact of arousal on sleep-related deglutition in patients with obstructive sleep apnea hypopnea syndrome].

Objective: To investigate the sleep-related deglutition in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its correlation with sleep stage and cortical arousals. Methods: From December 2015 to September 2017, simultaneous polysomnography and pharyngeal pressure monitoring were performed in 23 adult patients with OSAHS, Mann-Whitney U test were employed to analyze the following parameters: (1) the relationship between arousal and deglutition; (2) the effect of sleep stage on deglutition; (3) The relationship between the frequency of deglutition and the severity of OSAHS. Results: The subjects in this study aged (43±12) years, and the mean apnea-hypopnea index (AHI) was (49.2±27.7) times/hour. A total of 1 382 deglutition were recorded during sleep, with a median of 9.2[5.8, 13.8]times/person. There was a positive correlation between deglutition frequency and AHI(r=0.570, P=0.005) and negatively correlated with oxygen saturation (r=-0.639, P=0.001). The majority of the deglutition (73.7%) occurred after the respiratory event and in association with respiratory arousal. Deglutition occurred more in Non-rapid eye movement sleep stage 1 (N1) than N2, N3 and REM sleep (Z=-3.680, P<0.001; Z=-2.746, P=0.006; Z=- 3.490, P<0.001). Conclusions: The occurrence of deglutition in patients with OSAHS is associated with cortical arousals. Deglutition frequency increased with the severity of apnea and affected by sleep staging.

[Differential evaluation of diagnostic criteria for pediatric obstructive sleep apnea hypopnea syndrome].

Objective:To evaluate the difference of accessing pediatric sleep symptoms and living qualities between 3 diagnostic criteria: American Thoracic Society (ATS), International Classification of Sleep Disorder (ICSD-3), domestic Urumqi criterion (Draft); To investigate the relationship of PSG parameters and quality of life scale OSA-18. Method:Children with snoring who received PSG in Capital Medical University Beijing Tongren Hospital were recruited from Jan 2016 to Apr 2017. Subjects were diagnosed and grouped to SS, ICSD, ATS&ICSD (ATS&ICSD1, ATS&ICSD2) according to 3 criteria: ATS (AHI>5 or OAI>1), ICSD-3 (OAHI≥1) and Urumqi (AHI>5 or OAI>1, with LSaO2<92%). Subjects' height, weight as well as quality of life scale OSA-18 were recorded. Result:Five hundred and fifteen children were finally included (Male: 350 cases, Female: 165 cases). There were 315, 70 and 130 children in group SS, ICSD, ATS&ICSD respectively. Weights and BMI of ICSD and ATS&ICSD were significantly higher than those of SS (P<0.05), and dysplasia scale of ATS&ICSD was higher than SS (P<0.05); after adjusting height, weight and BMI, sub-scores of sleep disorder were statistically different between 3 groups (P<0.05). Numbers and indexes of respiratory events other than central apneas and hypopneas in group SS, ICSD and ATS&ICSD were increased sequentially and statistically different (P<0.05); numbers and indexes of respiratory events other than mixed apneas in ATS&ICSD2 were significantly higher than that of ATS&ICSD1 (P<0.05). Conclusion:OAHI≥1/h combined with LSaO2<92% should be used as pediatric OSAHS diagnostic criterion.

Independent prognostic Factor of low-expressed LncRNA ZNF667-AS1 for cervical cancer and inhibitory function on the proliferation of cervical cancer.

OBJECTIVE: To investigate the expression of long non-coding RNA ZNF667-AS1 in cervical cancer and its effect on the proliferation of cervical cancer cell line, SiHa cells. MATERIALS AND METHODS: The expression level of ZNF667-AS1 from two microarray datasets (GSE63514 and GSE6791) and TCGA (The Cancer Genome Atlas) were selected to analyze the difference between cervical cancer tissues and normal cervical tissues with bioinformatics methods. Then, the prognosis of ZNF667-AS1 was calculated in TCGA. The expression of LncRNA ZNF667-AS1 in 30 normal cervical tissues and 60 cervical cancer tissue samples was explored using qRT-PCR. In addition, analysis of the clinical data found that the expression of LncRNA ZNF667-AS1 was correlated with the total survival, tumor size and International Federation of Gynecology and Obstetrics (FIGO) stage. At last, the proliferative ability was detected by CCK8 and colon formation assay. RESULTS: Search the relevant microarray datasets using the keywords "cervical cancer" and "GPL570" from the Gene Expression Omnibus (GEO) database. Afterwards, two microarray datasets (GSE63514 and GSE6791) were selected to analyze the differentially expressed genes in cervical cancer tissues and normal cervical tissues using bioinformatics methods. The results showed that the expression of LncRNA ZNF667-AS1 in cervical cancer was significantly lower than that in normal cervical tissues. 30 normal cervical tissues and 60 cervical cancer tissue samples were selected to extract total RNA for qRT-PCR experiment, and found that the expression of LncRNA ZNF667-AS1 in cervical cancer tissues was lower than that in normal cervical tissues, which was consistent with that of TCGA. Analysis of the clinical data found that the expression of LncRNA ZNF667-AS1 was correlated with the total survival, tumor size and FIGO stage. Compared with the negative control group, the proliferation ability and cell cloning ability of cells with over-expressed LncRNA ZNF667-AS1 were significantly decreased (p<0.001), indicating that overexpression of ZNF667-AS1 inhibited the proliferation of SiHa cells. CONCLUSIONS: Expression of LncRNA ZNF667-AS1 was significantly lower in cervical cancer tissues, and its expression was negatively correlated with the overall survival, tumor size and FIGO stage. ZNF667-AS1 inhibited the proliferation of cervical cancer cells and was expected to be the biomarker and potential therapeutic target for predicting cervical cancer and determining its prognosis.

[Application of optical coherence tomography angiography in evaluation of retinal microvascular changes in patients with obstructive sleep apnea syndrome].

Objective: To assess the changes of retinal microvasculature in patients with obstructive sleep apnea syndrome (OSAS) evaluated by optical coherence tomography (OCTA). Methods: Adult OSAS patients who visited Beijing Tongren Hospital from Jan 2016 to Apr 2016 and complained of snoring were included in this study. The patients' general information, results of polysomnography, and OCTA parameters were collected. Patients were divided into three groups according to their apnea hypopnea index (AHI) results: Mild-moderate group, AHI≤30/h; Severe group, 30/h60/h, and clinical characteristics, polysomnography and OCTA parameters among the three groups were compared. Results: A total of 27 patients were included in this study with 21 males (77.8%) and 6 females (22.2%). Mean age was (41.7±10.0) years, and the mean body mass index was (27.9±4.5) kg/m(2;) Neck circumference was 31-48 cm, mean (39.8±4.3) cm; 8 patients (29.6%) suffered from hypertension that could be controlled; Epworth sleepiness scale scored 1-18 points and mean (8.5±4.4) scores; AHI ranged between 5.5 and 92.1/h with a mean of (46.4±28.6)/h. There were 9 (33.3%), 7 (25.9%), and 11 (40.7%) patients in mild-moderate group, severe group, and extremely severe group, respectively. Compared with severe group, the optic nerve head and radial peripapillary capillaries (RPC) peripapillary vascular density in extremely severe group were significantly decreased (62.4%±1.9% vs 60.3%±1.9%, P=0.041; 64.7%±1.7% vs 62.2%±2.3%, P=0.036). Conclusions: OCTA has rapid, safe, and objective characteristics in assessing the retinal microvascular changes in OSAS patients. Retinal microvascular damage in patients with OSAS is associated with the disease severity. Reduction of retinal microvascular density in patients with OSAS may be associated with intermittent hypoxia.

[The implantation of Bonebridge in bilateral congenital malformation of external and middle ear].

Objective: To evaluate the auditory efficacy of Bonebridge implantation in patients with bilateral congenital malformation of external and middle ear. Methods: Eleven cases (6 males and 5 females) had unilateral Bonebridge implantation. The age ranged from 8 to 26 and the average age was 16.9. Seven to ten days after operation, the first fitting was undergone. In acoustic sound field, the average auditory thresholds were respectively measured for unaided ears and Bonebridge implanted ears by pure tone auditory (PTA, 0.25, 0.5, 1, 2 and 4 kHz). For the group over 12-year-old, MSTM was applied to evaluate speech discrimination score (SDS). For the other cases, MLNT was used as the test material. The auditory efficacy post Bonebridge implantation would be analyzed and evaluated by comparing the differences between unaided ears and Bonebridge implanted ears. Results: The bone conduction audibility threshold after Bonebridge implantation was as well as the preoperative. The auditory threshold with Bonebridge aided was improved to 25-35 dB HL, when compared to that of the unaided ears in the sound field. The SDS in the group over 12-year-old was improved about 50%; the efficacy was slightly limited for the other two cases (both less than 12 years old). Statistical analysis showed that there were significant differences between unaided ears and Bonebridge implanted ears in the sound field and SDS(P<0.05). Conclusions: The auditory efficacy of Bonebridge is significant and noticeable in patients with bilateral congenital malformation of external and middle ear. Bonebridge provides a new and effective way for patient with congenital malformation of external and middle ear to reconstruct hearing.

[Efficacy and safety of Xiaoaiping combined with chemotherapy in the treatment of advanced esophageal cancer].

Objective: To evaluate the efficacy and safety of Xiaoaiping combined with chemotherapy in the treatment of advanced esophageal cancer. Methods: This is a multi-center, randomized, open label and parallel controlled study. A total of 124 advanced esophageal cancer patients with Karnofsky Performance Status (KPS) score ≥60 and expected survival time≥3 months were enrolled. We adopted design and divided the patients into study and control group. The patients in study group received Xiaoaiping combined with S-1 and cisplatin. The control group received S-1 and cisplatin. Each group included 62 patients and 21 days as a treatment cycle. The efficacy and adverse events in patients of the two groups were observed and compared. Results: 57 patients in the study group and 55 in the control group were included in efficacy assessment. The response rate was 54.4% and 34.5% in the study group and control group, respectively(P<0.05). Disease control rates were 86.0% and 69.1%, respectively(P<0.05). The median progression-free survival (PFS) was 7.97 in the study group and 6.43 months in the control group(P<0.05). The median overall survival(OS) was 12.93 in the study group and 10.93 months in the control group(P<0.05). The most common adverse events in the two groups were nausea and vomiting, thrombocytopenia, anemia, neutropenia, liver damage, pigmentation, oral mucositis, renal impairment and diarrhea. The incidences of nausea, vomiting, thrombocytopenia, leukopenia, neutropenia and diarrhea in the study group were significantly higher than those in the control group(P<0.05). Conclusion: Xiaoaiping combined with S-1 and cisplatin significantly increased response rate, and prolongedpatients' survival in patients with advanced esophageal cancer.

Evaluation of the subjective efficacy of nasal surgery.

OBJECTIVES: This study aimed to evaluate subjective symptom changes in obstructive sleep apnoea hypopnea syndrome patients following nasal surgery, and to explore treatment efficacy in improving patient quality of life. METHODS: Patients with nasal blockage accompanied by habitual snoring were stratified into four groups. Their subjective symptoms were evaluated before and after nasal surgery. RESULTS: There was a significant decrease in the nasal blockage symptom visual analogue scale, Epworth Sleepiness Scale, Snore Outcomes Survey, Spouse/Bed Partners Survey and Sino-Nasal Outcome Test 20 scores for all patients at six months after surgery. The visual analogue scale score for subjective olfactory function was significantly improved in the severe obstructive sleep apnoea hypopnea syndrome patient group. CONCLUSION: Nasal surgery can effectively improve the subjective symptoms of patients with simple snoring accompanied by nasal blockage and of patients with obstructive sleep apnoea hypopnea syndrome, thus improving their quality of life.

[Efficacy and security of matched unrelated donor hematopoietic stem cell transplant with transfusion of multipotent mesenchymal cells in pediatric severe aplastic anemia].

OBJECTIVE: To observe the efficacy of matched unrelated donor hematopoietic stem cell transplant (HSCT) with transfusion of multipotent mesenchymal cells (MSC) in pediatric severe aplastic anemia (SAA). METHODS: 19 children with SAA received matched unrelated donor HSCT with MSC, and the hematopoietic recovery and transplant-associated complications of these children were monitored. RESULTS: All patients achieved rapid hematopoietic reconstruction after HSCT, and the median durations to neutrophil and platelet recovery were 12 (9-21) days and 14 (8-24) days respectively, but delayed rejection occurred in one case four months after HSCT. 9 cases developed grade Ⅰ acute graft-versus-host (aGVHD), and one case grade Ⅲ aGVHD and diffuse chronic graft-versus-host. Cytomegalovirus viremias were observed in 15 patients. 2 cases developed hemorrhagic cystitis, 10 children experienced infections. All the children were alive during a median following-up time of 27(8-70) months, one of them developed LPD and received rituximab and chemotherapy, delayed rejection occurred in this patient four months after HSCT, Haplo-identical HSCT from his father as the donor was performed and achieved successful engraftment. CONCLUSION: The matched unrelated donor HSCT with MSC in pediatric SAA was safe and effective.