A Comparison Between W Score and RYAN Score in Diagnosing Laryngopharyngeal Reflux Disease.

OBJECTIVE: To assess the diagnostic value of the W score in differentiating laryngopharyngeal reflux disease (LPRD) patients from the normal population by pharyngeal pH (Dx-pH) monitoring, compared with the RYAN score. METHODS: One hundred and eight patients with suspected LPRD and complete follow-up results after more than 8 weeks of anti-reflux therapy were enrolled from the Department of Otolaryngology-Head and Neck Surgery, Gastroenterology and Respiratory Medicine of seven hospitals. Their Dx-pH monitoring data before treatment were reanalyzed to obtain the W score in addition to the RYAN score and then the diagnostic sensitivity and specificity were compared and evaluated with reference to the result of anti-reflux therapy. RESULTS: In eighty-seven (80.6%) cases, anti-reflux therapy was effective, and in 21 patients (19.4%), therapy was ineffective. Twenty-seven patients (25.0%) had a positive RYAN score. The W score was positive in 79 (73.1%) patients. There were 52 patients who had a negative RYAN score, but a positive W score. The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of the RYAN score were 28.7%, 90.5%, 92.6%, and 23.5%, respectively (kappa = 0.092, P = 0.068), whereas those of the W score for LPRD was 83.9%, 71.4%, 92.4%, and 51.7%, respectively (kappa = 0.484, P < 0.001). CONCLUSIONS: W score is much more sensitive for the diagnosis of LPRD. Prospective studies with larger patient populations are necessary to validate and improve diagnostic efficacy. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1800014931.

A Novel Strategy for the Treatment of Allergic Rhinitis: Regulating Treg/Th17 and Th1/Th2 Balance In Vivo by Vitamin D.

Objective: This prospective study is aimed at observing the number of nasal itching and sneezing in rats from the macroscopic level and examine the pathological changes of nasal mucosa, Th1 and Th2-related cytokines, and Treg/Th17 by vitamin D3 administration from the microscopic level, in order to explore the role of vitamin D in allergic rhinitis and to provide theoretical guidance for prevention and treatment. Results: There were significant differences in nasal itching and sneezing between the administration groups and the positive groups. Meanwhile, the level of Th1 and Treg in the administration groups increased, while the level of Th2 and Th17 decreased, indicating that the balance of Th1/Th2 was corrected. Our study revealed that vitamin D3 has preventive and therapeutic effects on allergic rhinitis, which provides theoretical guidance for practical application.

[Analysis of the effect of noninvasive positive-pressure ventilation with simultaneous detection of Dx-pH monitoring in oropharynx and esophagus for 48 hours in patients with moderate and severe OSA].

Objective:To investigate the effect of noninvasive positive-pressure ventilation（NPPV） on the related indexes of gastroesophageal reflux（GER） and laryngopharyngeal reflux（LPR） in patients with moderate and severe obstructive sleep apnea（OSA）. Method:This was a retrospective study of 23 cases with moderate or severe OSA and suspected laryngopharyngeal reflux disease （LPRD）. The results of 48h-pH monitoring of oropharynx and esophagus, polysomnography（PSG） and NPPV were analyzed to explore the relationship between reflux related parameters and sleep disordered respiratory. To analyze the impact of NPPV on reflux, the data related to nocturnal reflux with or without NPPV treatment was compared. Result:On the first day of Dx-pH, 5 cases of LPRD were diagnosed with a positive Ryan score rate of 21.7%. There were 19 cases（82.6%） with more than one nocturnal reflux event with pH6.0 as the threshold. Ten cases of GERD were diagnosed with a positive DeMeester score rate of 43.5%. The lowest pH value of oropharynx and esophagus was negatively correlated with the obstructive apnea index（OAI）. The total number of reflux episodes falling below pH thresholds of 6.0 and the duration of the longest episode of gastroesophageal reflux were positively correlated with AHI and OAI（P<0.05）. On the night of NPPV treatment, the lowest pH value in the oropharynx increased, while the total number of reflux episodes below pH6.0 and the percentage time below pH5.0 decreased（P<0.05）. Similar significant difference was found in the GER parameters（P<0.05）. Conclusion:OSA patients were associated with a higher incidence of GER at night and a certain degree of LPR. NPPV treatment can not only effectively improve GER, but also reduce LPR to a certain extent.

Relationship between reflux diseases and obstructive sleep apnea together with continuous positive airway pressure treatment efficiency analysis.

BACKGROUND: Obstructive sleep apnea (OSA) is known to be highly associated with reflux diseases. There is evidence that continuous positive airway pressure (CPAP) can decrease the clinical symptoms of gastroesophageal reflux (GER) in OSA patients, but whether CPAP can decrease nocturnal laryngopharyngeal reflux (LPR) episodes is still lack of strong evidence. OBJECTIVE: To investigate the efficiency of CPAP on LPR and the relationship between LPR, GER and OSA. STUDY DESIGN: retrospective study. METHODS: Forty adult patients who had confirmed OSA by polysomnography and suspected LPR were enrolled. Their results of synchronous polysomnography and 24 h esophageal and oropharyngeal Dx-pH monitoring were analyzed. Twenty-seven OSA patients were treated with CPAP on the second night. The nocturnal reflux parameters with and without CPAP treatment were compared. RESULTS: 15.0% and 42.5% of OSA patients were associated with LPR and GER through Dx-pH monitoring respectively. Nevertheless, more than one reflux attack falling below pH6.0 of oropharynx during sleep time was detected in 80.0% patients. There was a significant inverse correlation between the lowest/mean pH values of oropharynx and obstructive apnea index (OAI), so was the lowest pH values of esophagus. Significant positive correlation was calculated between the total number of reflux episodes below pH6.0 of oropharynx and apnea-hypopnea index (AHI)/OAI/hypopnea index (HI). A similar positive correlation was also significant between AHI/OAI and GER parameters. The assessment of the efficacy of CPAP treatment showed significant difference both in GER and LPR related parameter. CONCLUSIONS: OSA patients have a higher incidence of nocturnal LPR and GER. CPAP treatment can effectively reduce both GER and LPR attacks while disordered sleep events reduced in OSA patients.

Relationship between laryngopharyngeal reflux disease and gastroesophageal reflux disease based on synchronous esophageal and oropharyngeal Dx-pH monitoring.

PURPOSE: To use the synchronous esophageal and oropharyngeal Dx-pH monitoring analysis to investigate the relationship between LPRD and GERD. MATERIALS AND METHODS: Synchronous esophageal and oropharyngeal Dx-pH monitoring, electronic gastroscopy, reflux symptom index (RSI) and gastroesophageal reflux questionnaire (Gerd-Q) were collected from 514 consecutive patients and comparative analysis was done. RESULTS: A total of 85 patients had positive Ryan score and 251 cases had positive DeMeester or acid exposure time percent (AET) ≥4.2%. Moreover, 61.2% (52/85) of all LPRD cases were pure LPRD without GERD. There was no statistical difference in the acid exposure to oropharynx between pure LPRD group and LPRD+GERD group (U test, P > 0.05). Furthermore, there were no statistical differences in the other esophageal reflux data between pure GERD without LPRD group and LPRD+GERD group (U test, P > 0.05) apart from the number of episodes, which was higher in the pure GERD group than in LPRD+GERD group (U test, P = 0.027). Additionally, 149 patients were diagnosed with reflux esophagitis by electronic gastroscopy. No significant difference in the acid exposure to oropharynx was seen between different grades of reflux esophagitis (U test, P > 0.05). Among the LPRD patients, 32 cases (37.6%) were negative for Gerd-Q, Dx-pH esophageal probe and gastroscopy. CONCLUSION: The results of synchronous esophageal and oropharyngeal Dx-pH monitoring demonstrated that LPRD and GERD could co-exist as separate medical conditions. Our data suggest that some LPRD are not accompanied by GERD, and that LPRD is not secondary to severe GERD.

Reflux finding score is associated with gastroesophageal flap valve status in patients with laryngopharyngeal reflux disease: a retrospective study.

Endoscopic grading of gastroesophageal flap valve (GEFV) is simple and reproducible and offers useful information for reflux activity. To investigate the potential correlation between GEFV grading and reflux finding score (RFS) in patients with laryngopharyngeal reflux disease (LPRD), 225 consecutive Patients with suspected LPRD who underwent both routine upper gastrointestinal endoscopy and laryngoscope were enrolled in our study. Patients with a RFS of more than 7 were diagnosed with LPRD. The GEFV was graded as I through IV according to Hill's classification and was classified into two groups: normal GEFV group (grades I and II) and the abnormal GEFV group (grades III and IV). The percent of GEFV grades I to IV was 39.1%, 39.1%, 12.4%, and 9.3%, respectively. Age was significantly related to an abnormal GEFV (p = 0.002). Gender, BMI, smoke and alcohol were not related to GEFV grade. Fifty-one patients (22.67%) had positive RFS. Reflux finding scores were higher in GEFV grades III and IV than I and II (p < 0.05). Endoscopic grading of GEFV is well correlated with reflux finding score in patients with LPRD. This is a simple and useful technique that provides valuable diagnostic information of LPRD.

Utility of 24-hour pharyngeal pH monitoring and clinical feature in laryngopharyngeal reflux disease.

BACKGROUND: pH monitoring can reflect the changes in H+ in the airway. OBJECTIVES: To explore the utility of pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux disease (LPRD). MATERIAL AND METHODS: Clinical data from 956 suspected LPRD patients from February 2016 to March 2018 were analyzed retrospectively. RESULTS: One hundred forty-one patients had positive Ryan score. The positive rates of reflux symptom index (RSI), reflux finding score (RFS), RSI and RFS and RSI or RFS were 14.7%, 32.5%, 21.9%, 7.8% and 46.5%, respectively. The RFS in the positive Ryan score group was higher than that in the negative Ryan score group [(6 ± 3.5) vs. (4.8 ± 2.9)], while the RSI was not significantly different from that in the negative Ryan score group [(10.9 ± 8) vs. (11.3 ± 7.1)]. Regarding Ryan score as the gold standard in the diagnosis of LPRD, the sensitivity, specificity, positive and negative predictive value of identifying LPRD by RSI/RFS were 15.9%, 86.3%, 50.4% and 54%, respectively. CONCLUSIONS: Ryan score, RSI and RFS have poor correlation in detecting LPRD. Some patients may be missed with the Ryan score as a diagnostic criterion. SIGNIFICANCE: Pharyngeal pH monitoring is useful and more appropriate index is expected.

Estrogen inhibits the overgrowth of Escherichia coli in the rat intestine under simulated microgravity.

Microgravity can affect many aspects of intestinal homeostasis, leading to an increased risk of colitis. Estrogen, the most frequently affected hormone when under simulated microgravity, regulates the permeability of the colonic mucosa barrier. The associations between alterations in intestinal microbiota and increased susceptibility under microgravity have not been thoroughly elucidated. The aim of the present study was to evaluate the changes in intestinal microbiota under simulated microgravity and to investigate the protective effect of estrogen against those changes. The hindlimb unweighting (HU) model was used to simulate microgravity in rats. Estrogen was administered via intramuscular injection. Amplicons of the V3 variable regions of bacterial 16S rDNA were analyzed using denaturing gradient gel electrophoresis (DGGE), cloning and sequencing. Several specific bacterial groups were assayed using quantitative­polymerase chain reaction. Bacterial translocation was evaluated by detecting serum lipopolysaccharide (LPS) and LPS binding protein (LBP) levels. DGGE profiles generated by universal primers revealed minor, though specific, changes in bacterial communities under simulated microgravity, particularly the band matching the sequence of Escherichia coli (E. coli). The quantification of 16S RNA revealed increased numbers of Bacteroides fragilis, E. coli and Fusobacterium nucleatum; however, Bifidobacteria longum significantly decreased under microgravity. Estrogen inhibited the overgrowth of E. coli, and decreased the levels of LBS and LBP under simulated microgravity. These results demonstrated that simulated microgravity alters the intestinal microflora and may contribute to bacterial translocation in the gut mucosa. The data also suggested that further investigations evaluating the administration of estrogen to protect against microgravity­associated diseases may be required.

[Combined simulated weightlessness and noise affect cell cycles and composition in rat thymocytes].

OBJECTIVE: To observe the combined effects of simulated weightlessness and noise on the cell cycles of thymocytes and cell compositions of thymus in rats and to explore the possible mechanism of immune function depression in space flight. METHODS: SD rats were stimulated by simulated weightlessness and/or noise. On the 3rd, 7th and 14th day, the rats were weighed and then killed. The thymuses were taken, weighed and cell suspensions were made. Cell cycles and compositions in thymocytes were analyzed by flow cytometry. RESULTS: Compared with control group, the weights of rats were reduced in combined group and simulated weightlessness group, but the weights of rats increased or did not change in noise group. Rats in the three groups showed thymus atrophy. The ratio of cells increased in G0/G1 phase and decreased in S and G2/M phases. The ratios of CD4(-) CD8(-), CD4(+) CD8(-) and CD4(-) CD8(+) T lymphocytes increased and CD4(+) CD8(+) T lymphocytes decreased. However, these changes occurred at different time points in different groups. CONCLUSION: Simulated weightlessness and noise have significant effects on thymus, but the severity are different. The combined factors have superimposed effects. Maybe this is one of the reasons for depressed functions of T lymphocytes in space flight.

Cartilage engineering using chondrocyte cell sheets and its application in reconstruction of microtia.

The imperfections of scaffold materials have hindered the clinical application of cartilage tissue engineering. The recently developed cell-sheet technique is adopted to engineer tissues without scaffold materials, thus is considered being potentially able to overcome the problems concerning the scaffold imperfections. This study constructed monolayer and bilayer chondrocyte cell sheets and harvested the sheets with cell scraper instead of temperature-responsive culture dishes. The properties of the cultured chondrocyte cell sheets and the feasibility of cartilage engineering using the chondrocyte cell sheets was further investigated via in vitro and in vivo study. Primary extracellular matrix (ECM) formation and type II collagen expression was detected in the cell sheets during in vitro culture. After implanted into nude mice for 8 weeks, mature cartilage discs were harvested. The morphology of newly formed cartilage was similar in the constructs originated from monolayer and bilayer chondrocyte cell sheet. The chondrocytes were located within evenly distributed ovoid lacunae. Robust ECM formation and intense expression of type II collagen was observed surrounding the evenly distributed chondrocytes in the neocartilages. Biochemical analysis showed that the DNA contents of the neocartilages were higher than native human costal cartilage; while the contents of the main component of ECM, glycosaminoglycan and hydroxyproline, were similar to native human costal cartilage. In conclusion, the chondrocyte cell sheet constructed using the simple and low-cost technique is basically the same with the cell sheet cultured and harvested in temperature-responsive culture dishes, and can be used for cartilage tissue engineering.

Prototyped grafting plate for reconstruction of mandibular defects.

To esthetically and functionally restore a 40-mm canine mandibular discontinuity defect using a custom-made titanium bone-grafting plate in combination with autologous iliac bone grafts. Individualized titanium bone-grafting plates were manufactured using a series of techniques, including reverse engineering, computer aided design, rapid prototyping and titanium casting. A 40-mm discontinuous defect in the right mandibular body was created in 9 hybrid dogs. The defect was restored immediately using the customized plate in combination with autologous cancellous iliac blocks. Sequential radionuclide bone imaging was performed to evaluate the bone metabolism and reconstitution of the grafts. The specimens were evaluated by biomechanical testing, 3-dimensional microcomputed tomographic scanning, and histological examination. The results revealed that the symmetry of the mandibles was reconstructed using the customized grafting plate, and the bony continuity of the mandibles was restored. By 12 weeks after the operation, the cancellous iliac grafts became a hard bone block, which was of comparable strength to native mandibles. A fibrous tissue intermediate was found between the remodelled bone graft and the titanium plate. The results indicate that the prototyped grafting plate can be used to restore mandibular discontinuous defects, and satisfactory aesthetical and functional reconstruction can be achieved.

One-stage reconstruction of two atypical small concha-type microtic ears.

This report presents 2 cases of atypical small concha-type microtia, which were reconstructed with full utilization of the remnant cartilage. To repair the deformity, we harvested the 8th and 9th costal cartilage to form the helix and anthelix structure. The remnant auricular cartilage mass was retained and utilized as the base block of the framework, onto which sculptured helical rim and anthelix were added. Thus an ear of symmetrical shape, projection and visible convolutions was reconstructed. We suggest making use of the remnant cartilage to minimize the donor site morbidity, especially for mild to moderate microtia reconstruction.

[The ear angioplasty and hearing reconstruction of microtia].

OBJECTIVE: To Study the clinical features of congenital microtia and atresia . To evaluate the methods and results of the same microtia surgery, ear canal and middle ear reconstruction. METHOD: Statistically analysis of the data of the hospitalization microtia 62 ears of 58 cases of patient in our department from January 2005 to October 2010 waw conducted. These patients with congenital ear malformations are associated with aural atresia, ossicular chain abnormalities, severe conduction Deafness. All patients received preoperative temporal bone CT examination and reconstruction, hearing examination. Operation was given in two phases, first operation aim to form a line of ear, ear canal reconstruction, ear reconstruction, the second one aim to line of ear skin graft, cranial angle of the ear reconstruction. The preoperative and postoperative data were retrospectively analyzed. RESULT: The auricle plus external auditory canal, middle ear reconstruction came out with a good shape of the ear and the ear canal in close proximity to the normal population. Most patients' hearing were improved after surgery. CONCLUSION: Surgeries of patients with congenital ear malformations and aural atresia should be carefully designed according to the three-dimensional reconstruction of multislice spiral CT reconstruction, which can provide information about surgery approach and middle ear abnormality. The whole ear shape and hearing ear after reconstruction are improved after the surgery.